End of life care must be tailored to the individual according to new NICE guidelines released today. The guidelines aim to put the dying person at the heart of decisions about their care, so that they can be supported in their final days in accordance with their wishes.

Around 500,000 people die each year in the UK. Of these deaths 75% are not sudden, but expected.

While a recent report has ranked end of life care in the UK as the best in the world, there are areas where care can be improved and made more consistent.Until recently, the Liverpool Care Pathway (LCP) was used to provide good end of life care.  It was withdrawn however, following widespread criticism.

NICE was asked to develop evidence-based guidelines on care of the dying adult.  The new guidelines provide recommendations for the care of a person who is nearing death no matter where they are.

The guidelines for health professionals include the following core areas:

• -       Recognising when a person might be entering the last days of life
• -       Appreciating that improvements in a person’s condition can suggest they are stabilising
• -       Monitoring for further changes every 24 hours, updating care plans
• -       Ensuring good communication and shared decision-making with family members and carers
• -       Giving accurate information to the dying person and those important to them, allowing the time to discuss fears and anxieties
• -       A named healthcare professional should be made responsible for a person’s end of life care
• -       Supporting people to have fluids if they want to, not allowing them to become dehydrated, whilst being aware of any problems that fluids may cause
• -       An individual rather than ‘blanket’ approach to care.

Professor Sam Ahmedzai, Emeritus Professor of palliative medicine and chair of the guideline development group, said “Until now we have never had guidelines in this country on how to look after people at the end of life. This evidence-based guideline provides a good overview of how to give good end of life care in any setting in the NHS. “

He added: “The main way this guideline differs to the LCP is that it stresses an individualised approach rather than a ‘blanket’ method of using the LCP in an unthinking way. The guideline also stresses that the patient should be reviewed daily, and the person should always be taken as an individual.”

Professor Gillian Leng, deputy chief executive of NICE, said: “Death is something that happens to us all and how we are cared for can make a big difference to our final days.

Lord Howard, chairman of Hospice UK, welcomed the guidelines but said there would be real challenges putting them into practice.

"There can never be 'a tick-list approach' towards caring for the dying and this guidance must be underpinned by greater investment in training and education for all staff involved in end-of-life care.