Palliative care & end of life care

 Key personnel

  • Clinical Pathway Chair - Dr Sarah Cox, consultant in palliative medicine, Chelsea and Westminster NHS Foundation Trust 
  • Project manager - Maureen McGinn, LCA

The London Cancer Alliance palliative care pathway group was formed to improve the access, experience and outcomes for patients requiring palliative care, irrespective of diagnosis, across the LCA populations.

The membership of the group brings together specialist NHS and voluntary sector expertise from primary, secondary and tertiary care, as well as service users, to enable development of high quality patient centred care.

Find more information in the group's Terms of Reference.

The palliative care pathway group supports the aims and objectives of the LCA, in providing world class cancer services across south and west London.

The group is comprised of a wide multi-disciplinary group of clinical and carer representatives from primary, secondary and tertiary LCA providers, including NHS and voluntary sector hospices.

In London, approximately 48,000 people die from cancer each year - 0.62% of the total population (Office for National Statistics). Not all would need palliative care, for instance if their cause of death is sudden, either through unpredictable onset of disease or an external cause.

However, in 2011, the Palliative Care Funding Review (PCFR) reported the findings of a King's College London/South West Public Health Observatory/Whole Systems Partnership study, which estimated total palliative care needs of the population in England, for both adults and children, providing a minimum, maximum and a set of intermediate estimates.

Based on the intermediate estimates, the PCFR suggests that the size of the population having palliative care needs is somewhere between 69-82% of total deaths.

For London, in 2010, this equates to 33,325 people with palliative care needs.

What is palliative care?

In 2004, the National Institute for Health and Clinical Excellence (NICE) defined palliative care as:

"…the active holistic care of patients with advanced progressive illness. Management of pain and other symptoms and provision of psychological, social and spiritual support is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of the illness in conjunction with other treatments."

In 2011, NICE published its quality standard for end of life care, following the Department of Health's national End of Life Care Strategy in 2008.

In the quality standard, NICE states:

"The quality standard for end of life care for adults requires that services are commissioned from, and coordinated across, all relevant agencies, including specialist palliative care and encompass the whole end-of-life care pathway."

An integrated approach to provision of services is fundamental to the delivery of high-quality care to people approaching the end of life and their families and carers.

This quality standard uses the following General Medical Council definition of people approaching the end of life from Treatment and care towards the end of life: good practice in decision making:

"People are 'approaching the end of life' when they are likely to die within the next 12 months. This includes people whose death is imminent (expected within a few hours or days) and those with:

  • advanced, progressive, incurable conditions
  • general frailty and coexisting conditions that mean they are expected to die within 12 months
  • existing conditions if they are at risk of dying from a sudden acute crisis in their condition
  • life-threatening acute conditions caused by sudden catastrophic events"

Providing end of life care should be an integral part of every health and social care worker's role.

However, for many, such care is likely to form only a small part of their workload. Many of these professionals are "generalists" (GPs, community nurses and hospital medical and surgical staff, for example), while recognising that some generalists will have a greater role in providing end of life care than others (such as care home workers).

Palliative medicine is a recognised medical specialty, requiring the equivalent of four years' specialist training. Other specialists will have received specific training and qualifications relating to end of life care, or acquired substantial practical experience.

These specialists, who frequently dedicate all or most of their time to the care of people approaching the end of life, include:

  • palliative medicine physicians
  • palliative care specialist nurses
  • specialist allied health professionals
  • specialist social workers
  • counsellors and therapists

End of Life Care event June 18 2014

Presentations and the final agenda for the event are available below. Posters from the event are available on the right.

LCA EOLC event final agenda 

LCA EOLC event part 1

LCA EOLC event part 2

LCA EOLC event part 3

LCA EOLC event part 4

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