1. The Liverpool Care Pathway Dr Kate Tredgett, Consultant in Palliative Medicine

2. Place of Death *Data from End of Life Intelligence network * Place of deathSwindon Cancer Patients (%) Swindon All Patients (%) National All patients 2008-2010 (%) Home282120 Hospice2785 Hospital345254 Care Home101718 Total2279

3. Quality of End of Life Care First National Voices Survey of the Bereaved ONS / Dept. Of Health July 2012 Location of CareNumber of Respondents% Rating Care Outstanding / Excellent / Good Home371282 Hospital949268 Care Home435783 Hospice128087

4. Research Evidence of LCP Outcomes Improves confidence of nurses. Demonstrates reduced symptom burden. Improves multi-disciplinary team working. Improves documentation of care delivery. Improves anticipatory prescribing of medications for the 5 key symptoms that may develop.

5. Local Support and Governance of the LCP Educational Support Mandatory e.learning module Biannual study days Preceptorship training Link nurse training Foundation Dr training Ward based training Clinical Governance LCP death numbers monitored National Biannual Audit – Dissemination of findings – Participation is a Quality Marker

6. The LCP document Diagnosis of dying – Audit Decision to commence LCP endorsed by most senior clinician 96% – For 3% of patients the pathway ceases to be appropriate Communication – A full explanation of the current plan of care (LCP) is given to the patient – Audit 61% – A full explanation of the current plan of care (LCP) is given to the relative or carer – Audit 94%

7. The LCP document Withdrawal of treatment. – Requirement is for interventions to be reviewed – Requirement if for artificial hydration and nutrition to be reviewed

8. Local Picture LCP use – Median age 83 yrs – Median 27hrs supported by LCP Impact of recent publicity YearNumber of deaths supported by LCP 2010377 2011427 2012 (up to July)201

9. Moving Forward Information Development Continue Education and Support Participate in next National Audit Await outcome of Independent Review in summer

10. THANK YOU