A survey published by the Royal College of Nursing in early November (1) suggested that the large majority of nurses felt unable to give the right level of care consistently to dying patients. This frustration was laid at the door of poor staffing levels, inadequate resources and lack of training. (2)
Over a year after the Neuberger Review (3) scrapped the Liverpool Care Pathway (LCP), it seems that we are still not addressing end of life care in hospital or community. Shortly after the LCP was scrapped, a leading palliative care nurse expressed concerns that this would set back care of the dying in this country by years. (4) Since then, a new set of inter-professional guidelines has been developed (The Priorities of Care for the Dying Person), (5) emphasising the involvement of the dying person and their family in individualised care planning, sensitive ongoing communication with the patient and within the care team. (6) This is all very positive, but it is still early days for these guidelines, and this RCN survey suggests that nurses at least are still struggling – not for a lack of guidelines per se, but lack of resources or real training.
A 2010 review by The Economist ranked the UK as the global leader in end of life care. (7) If we want to continue in that position, and enable and encourage other countries to improve their end of life care, it is vital that we go beyond guidelines on good practice to training and resourcing good quality end of life care throughout the NHS. Half a million people die every year in the UK; end of life care is not a minority concern!
The RCN survey also highlighted that nurses felt giving good quality end of life care was a huge privilege and responsibility, and one that they wanted to discharge to the best of their ability. As a society, we should be doing all we can to enable them to do this.