END OF LIFE POLICY IN UK

End Of Life Policy In UK



End Of Life Policy In UK

Introduction

The Department of Health will shortly publish a comprehensive strategy on end of life care for adults in England7, acknowledging that whilst some patients receive excellent care, others do not. The End of Life Care Strategy is being led by the Department of Health's National Cancer Director, Professor Mike Richards. It will provide guidance to commissioners and providers on how to improve end of life care at a local level.

The key aim of the United Kingdom (UK) End of Life Care Strategy is to ensure that people's individual needs, priorities and preferences for end of life care are identified, documented, reviewed, respected and acted upon wherever possible; integral to this is the process of Advance Care Planning (ACP) (NHS end of Life strategy ie ref 1). ACP involves eliciting “the person's preferences regarding both the type of care they would wish to receive and the setting or location in which they wish to be cared for”. Potential outcomes may include: an “advance statement” - patient preferences for future care and where it is delivered; an “advance decision” - patient refusal of certain treatment in specific circumstances and granting another individual a Lasting Power of Attorney, that is the ability to make treatment decisions on their behalf should they loose the capacity to make their own decisions. (Davison 2006:886-9)

In practice, ACP usually involves a series of discussions between a patient and their professional carers, and sometimes family carers. It is a dynamic process of recoding people's preferences and choices, and should be reviewed as an individual's condition changes. In particular it is necessary to ensure that there are systems in place which enable everyone who may come into contact with an individual is aware of the existence of their ACP and the wishes documented in it. One way to achieve this might be to hold the document electronically so that all those with a legitimate reasons i.e. health and social care professionals, can access it readily. Although ACP is integral to the NHS End of Life Care Programme , it is not yet fully integrated into everyday practice, and factors which facilitate the successful introduction of ACP within routine care need to be defined . Although ACP in the UK is policy driven, there is a dearth of empirical, UK-based research on ACP particularly in dementia care, although findings from international research may be helpful .

ACP is not only important in palliative care but can also be seen as a key component of person-centred care in dementia. In the UK, national guidance on dementia care stipulates that ACP should be discussed with the person with dementia whilst he/she still has mental capacity. This is particularly relevant with the full implementation of the Mental Capacity Act where Lasting Powers of Attorney now include health and welfare in addition to financial issues. However, the incidence of advance care directives in dementia is low , this may be ...