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NICE urges doctors to treat dying patients as individuals NICE urges doctors to treat dying patients as individuals
(35 minutes later)
End of life care in England must be tailored to the needs of each patient, rather than a "tick-box approach", new guidelines from NICE say. End-of-life care in England must be tailored to the needs of dying patients rather than a "tick-box approach", the health watchdog NICE says.
The health watchdog says doctors and nurses must focus on individuals rather than offering one-size-fits-all care. Patients must be treated with respect and compassion, it said, and doctors should avoid making "snap decisions" about whether someone was dying.
The guidance is designed to address misuse of the previous system - the Liverpool Care Pathway - which left some patients without food and water. The guidance is designed to address misuse of the previous system, the Liverpool Care Pathway.
Charities welcomed the new guidelines - but warned more investment was needed.Charities welcomed the new guidelines - but warned more investment was needed.
The Liverpool Care Pathway (LCP) was introduced in the late 1990s, in an attempt to ensure people had a dignified and comfortable death.The Liverpool Care Pathway (LCP) was introduced in the late 1990s, in an attempt to ensure people had a dignified and comfortable death.
Among other things, it involved checklists prompting staff to consider whether invasive procedures, drips and drugs should be withdrawn from people in the last stages of life.Among other things, it involved checklists prompting staff to consider whether invasive procedures, drips and drugs should be withdrawn from people in the last stages of life.
'Individualised approach'
But it was phased out last year after a government-commissioned review revealed serious concerns that it was being used in the wrong way, leading to a "tick-box" culture.But it was phased out last year after a government-commissioned review revealed serious concerns that it was being used in the wrong way, leading to a "tick-box" culture.
The new wide-ranging guidelines, produced by the National Institute of Health and Care Excellence (NICE), cover many of the same key principles as the LCP, but call for a stronger focus on individual plans for each patient. Reports suggested that incorrect use of the LCP left some patients without food and water.
NICE says the wishes of the patients and those close to them must be central. 'Individualised approach'
The new wide-ranging guidelines - the first national guidelines to be introduced in England - cover many of the same key principles as the LCP.
However, NICE called for a stronger focus on individual plans for each patient, saying their wishes and those of their family must be central.
Palliative carePalliative care
A good death: Can guidelines really help?A good death: Can guidelines really help?
UK end-of-life care 'best in world'UK end-of-life care 'best in world'
Liverpool Care Pathway: Your experiencesLiverpool Care Pathway: Your experiences
Prof Sam Ahmedzai said this needed to be underpinned by a change in attitude to ensure staff had more respect for care of the dying.Prof Sam Ahmedzai said this needed to be underpinned by a change in attitude to ensure staff had more respect for care of the dying.
"The main thing that is different is that we are saying we would want to have an individualised approach rather than applying a blanket approach," he said. "You have to look at each individual person and respect them as an individual person, ask them about their wishes," he told BBC Radio 4's Today programme.
"Some people may want interventions, may want tests to carry on. Others may want to stop all those things. Some people may want fluids, others may not want fluids. So respecting the individual and not having a one-size-fits-all approach."
The expert panel acknowledged that recognising whether someone is in the last few days of life can be difficult.The expert panel acknowledged that recognising whether someone is in the last few days of life can be difficult.
Staff should seek guidance from senior colleagues if there are uncertainties and avoid snap decisions, the panel said. Staff should seek guidance from senior colleagues if there were uncertainties and avoid snap decisions, the panel said.
The guidelines emphasise that patients must be monitored for improvements on a daily basis. Staff are offered information on how to spot signs that death is imminent.The guidelines emphasise that patients must be monitored for improvements on a daily basis. Staff are offered information on how to spot signs that death is imminent.
HydrationHydration
The document also looked closely at hydration for people in their last few days of life.The document also looked closely at hydration for people in their last few days of life.
Previous reports suggested that when the LCP was used incorrectly some patients were left so thirsty they tried to suck water from sponges used to moisten their mouths.Previous reports suggested that when the LCP was used incorrectly some patients were left so thirsty they tried to suck water from sponges used to moisten their mouths.
The new guidance says anyone who is capable of drinking should be encouraged to do so if it is safe and family and friends should be able to help.The new guidance says anyone who is capable of drinking should be encouraged to do so if it is safe and family and friends should be able to help.
But despite these recommendations, experts say there is a lack of evidence about whether giving or withholding fluids can prolong or shorten life in these circumstances.But despite these recommendations, experts say there is a lack of evidence about whether giving or withholding fluids can prolong or shorten life in these circumstances.
Lord Howard, chairman of Hospice UK, welcomed the guidelines but said there would be real challenges putting them into practice.Lord Howard, chairman of Hospice UK, welcomed the guidelines but said there would be real challenges putting them into practice.
"There can never be 'a tick-list approach' towards caring for the dying and this guidance must be underpinned by greater investment in training and education for all staff involved in end-of-life care."There can never be 'a tick-list approach' towards caring for the dying and this guidance must be underpinned by greater investment in training and education for all staff involved in end-of-life care.
"This is crucial if we are to avoid the failings of how the Liverpool Care Pathway was implemented," he added."This is crucial if we are to avoid the failings of how the Liverpool Care Pathway was implemented," he added.
Are you affected by the issues in this story? Share your experiences. You can email haveyoursay@bbc.co.uk.Are you affected by the issues in this story? Share your experiences. You can email haveyoursay@bbc.co.uk.
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