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08th April 2016

Improvements in End of Life Care

The RCP Audit of Practice

The Royal College of Physicians has carried out an audit of care for people who are at the end of their life in hospital trusts across England. The Marie Curie Trust and NHS England commissioned the audit, and it covered the changes in practice since 2013. In particular, it took account of the results of the official withdrawal of the Liverpool Care Pathway (LCP) in 2014.

The LCP had been previously reviewed by a group under Baroness Julia Neuberger, after concerns that it was associated with poor training, financial targets and possible bed clearing. The Neuberger report found some ‘distressing’ problems associated with the implementation of the pathway, and its use was officially discontinued in 2014.

Results of the Audit

Overall, while some local improvements were still needed, the audit found there had been steady progress in practice and policies across trusts in England. The report of the audit found improvements in:

  • Recognition that patients are dying and that they have received holistic assessments of their care;
  • The amount and quality of communication with patients who are able to communicate, and with those identified as important to them;
  • Symptom control for the dying person;
  • Commitment to education, training, reporting and continuous improvement in caring for dying people.

The chair of the steering group for the audit stated:

‘The period 2013 to 2015 saw momentous changes in how we look after dying people in England. These include the phasing out of the ‘one-size-fits-all’ Liverpool Care Pathway and the introduction of individualised care, with an emphasis on assessing holistic needs, respecting the wishes of dying people and those important to them, including maintaining hydration where desirable.'

‘It is heartening that the results of the latest Royal College of Physicians audit largely reflect these changes positively in terms of improved statistics of care for people in the last days of life who were dying in the month of May 2015 in English hospitals. There is still room for improvement, notably in providing 24/7 access to specialist palliative care for those with difficult problems…’

Previous Research

A previous study by the BMA had noted the need, in end of life care, for:

  • Engagement, choice and participation by patients in their treatment;
  • Being enabled to live as 'normally ' as possible;
  • Access to information, and good communication about their condition;
  • Timely access to medical services;
  • Personalised planning and co-ordination of services;
  • Emotional support, for patients and their family;
  • Access to legal and financial advice;
  • Choice of where to live and choice of how to be cared for.


It is good to see that previous practice in end of life care has been thoroughly reviewed, problems identified, and good progress in the quality of care is being made. This brings confidence and it is to be hoped some comfort to people who are terminally ill and to those who care for, and are important to them.

Tony Clarke – QCS Expert Scottish Care Contributor

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