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One Chance to Get it Right: Improving people’s experience of care in the last few days and hours of life

This document sets out the approach to caring for dying people that health and care organisations and staff caring for dying people in England should adopt in future. The approach should be applied irrespective of the place in which someone is dying: hospital, hospice, own or other home and during transfers between different settings.

The approach has been developed by the Leadership alliance for the care of Dying People (LacDP), a coalition of 21 national organisations concerned to ensure high quality, consistent care for people in the last few days and hours of life.1 the alliance was established following an independent review of the Liverpool care Pathway for the Dying Patient (LcP), which reported in July 2013.2 the LcP was an approach to care developed during the 1990s, based on the care of the dying within the hospice setting, with the aim of transferring best practice to other settings. the review panel found evidence of both good and poor care delivered through use of the LcP and concluded that in some cases, the LcP had come to be regarded as a generic protocol and used as a tick box exercise. generic protocols are not the right approach to caring for dying people: care should be individualised and reflect the needs and preferences of the dying person and those who are important to them.

The review panel recommended that use of the LcP should be phased out by July 2014; the Minister for care and Support agreed this recommendation.3 this document sets out the approach that should be taken in future in caring for all dying people in england, irrespective of whether organisations were previously using the LcP.

The approach focuses on achieving five Priorities for care. these make the dying person themselves the focus of care in the last few days and hours of life and exemplify the high-level outcomes that must be delivered for every dying person. the way in which the Priorities for care are achieved will vary, to reflect the needs and preferences of the dying person and the setting in which they are being cared for. this approach is not, in itself, new. Where good care for dying people has been and continues to be given, it is typified by looking at what that care is like from the perspective of the dying person and the people who are important to them and developing and delivering an individualised plan of care to achieve the essentials of good care. Many health and care organisations and staff are already doing this and in some cases, as the review panel found, used the LcP to help them do so. however in other places, the LcP was associated with standardised treatment and care, carried out irrespective of whether that was right for the particular person in the particular circumstances. in some cases, the delivery of standardised treatment and care caused unnecessary distress and harm to dying people and those who were important to them. the risk of this continuing to happen is not tenable. hence, the new approach set out in this document will replace the LcP.