Wednesday, January 11, 2012

NICE confirms death-bed place for chaplains

DYING patients must be offered spiritual or religious support at any time of the day or night, new NHS guidelines state. 

The National Institute for Health and Clinical Excellence (NICE) last month drew up new “quality standards” to improve treatment for the half-a-million people who die each year in England. 

The standards promise that patients, families, and carers should be offered information in a “sen­s­itive” manner, and that people approaching the end of life should have access to an NHS chaplain, or a religious or spiritual leader, as ap­propriate, at any time of the day or night. 

The standards have been wel­comed by the Church of England, as explicitly recognising the im­portance of chaplaincy in the NHS. 

The health-policy adviser for the Church, Brendan McCarthy, said that the commission document that accompanied the quality stan­dards made explicit, for the first time, that those who commission spir­itual and religious support should use chaplains.

“Of particular significance is the fact that it talks about not only spiritual, but religious care. This is good news for patients, who ought to get their spiritual and religious needs addressed, and good news for those involved in delivery.” 

The quality standards say that the physical and psychological needs of patients should also be met, even if they occur in the middle of the night. Patients should have their own individualised “death plans” to ensure that they die with dignity, and that their own wishes are taken into account. 

This may include the Liverpool Care Pathway (LCP), the guidelines say. 

The LCP seeks to give patients a peaceful death without un­necessary medical interference. A recent audit of palliative-care ser­vices found that relatives were not always told when their loved ones were placed on the LCP. 

The NICE guidelines also say that spiritual support should be offered after death to relatives, and that doctors must handle bereaved rela­tives in a “sensitive way”. 

The director of policy at the National Council for Palliative Care, Simon Chapman, said that the em­phasis on 24/7 care for dying patients was an important change: “We only get one chance to get it right for people at the end of their lives, which is why it is so important to ensure high-quality end-of-life care is uni­versal. We welcome NICE’s emphasis that people should get the care they need at any time of day or night. This is a powerful but necessary challenge to the NHS to ensure that people approaching the end of life receive the support and care they need, when and where they need it.”

The NICE quality standards are de­scribed as “aspirational, but achievable” statements, which have been developed in collaboration with the NHS and social care services. 

Dr Fergus Macbeth of NICE said that the standards put “compassion, kindness, and consideration” at the heart of end-of-life care.