Wednesday, 16 July 2008

bedtime reading: End of Life Care strategy

Today the government published the first national End of Life Care (EoL) Strategy for adults in England. This is very important for people with kidney disease and the kidney care community.
One of the key achievements of the Renal NSF was the inclusion of a chapter and quality requirements for supportive and end of life kidney care. Earlier NSFs were weak on this topic and yet a peaceful death in the patient’s preferred place of care with family support is an integral part of good medical practice. The fact that dialysis is often a palliative treatment – it doesn’t cure renal failure, and that when given the space and time to consider the options many frail individuals choose the “no dialysis” option is a unique feature of the supportive and end of life care kidney care pathway. My sense is that it has a much more defined start point than in many other organ failure situations.
The Renal NSF therefore laid some of the foundations for the EoL Care Strategy which aims to deliver increased choice to all adult patients, regardless of their condition, about where they are cared for and die and to improve care given in all settings to patients, carers and families.
The overarching strategy has been developed over a 2 year period by Professor Mike Richards and the End of Life Team and a wide range of stakeholders and experts. I am particularly grateful to many people in the kidney community including Dr Aine Burns (Consultant Nephrologist, Royal Free), Liz Cropper (Consultant Nurse, North Staffs Royal Infirmary), Dr Ken Farrington (Consultant Nephrologist, Lister Hospital) who were members of the working groups and to many others who contributed to the work programme. It has been further shaped and strengthened by the work of the SHAs as they developed a vision for end of life care for the NHS Next Stage Review and again, many of these contain scenarios and examples of kidney supportive or end of life care, contributed by kidney care professionals or palliative care colleagues with whom we are now, I am pleased to say, working more closely.
This is the first time the country will have a long term, comprehensive strategy for the care of adults at the end of their life. The strategy sets a clear direction for the development of EoL care services over the coming year. It sets out a range of recommendations for improvements in care, covering an array of services and staff groups in both health and social care. Key recommendations in the strategy focus on providing improved community services, workforce development and the increased provision of specialist palliative care outreach services. It sets out the responsibilities of all involved in the delivery of EoL care and gives information on increasing government funding to support the development of services.
Check it out. Most of it is generic but you won’t be disappointed if you do a word search. I think it is well worth reading in entirety. It will form one of the cornerstones for developing our supportive and EoL kidney care programmes on which I have asked Stephanie Gomm (Consultant in Palliative Medicine, Salford Royal) and Ken Farrington (Consultant Nephrologist, Lister Hosptial) to lead. Mike Richards’ slideshow, available at the same link, will give you the headlines including “research and audit”, "outcome and patient experience measures”, “workforce development” and the levers to be used – finance, local strategic planning, provider organisation responsibilities and national support.