One Chance to Get it Right: understanding the new guidance for care of the dying person

Background: Following criticism of the Liverpool Care of the Dying Pathway (LCP), widely used to guide care of dying people in British health-care settings, the UK Government set up an independent review which in 2013 recommended that use of the LCP be discontinued. In response, the Leadership Alliance for the Care of Dying People, a coalition of a wide range of stakeholders, recently published guidance entitled One Chance to Get it Right. This guidance contains five Priorities of Care for the dying person that are intended to guide clinical staff and will inform Care Quality Commission inspections of health-care providers. This article summarizes the background to One Chance to Get it Right and the guidance it contains.

Sources of data: One Chance to Get it Right, More Care, Less Pathway and related guidance documents.

Areas of agreement: The need to improve the standard of end-of-life care in every clinical setting.

Areas of controversy: The value of a pathway-based approach to end-of-life care in a context where well-implemented programmes of staff education in the subject are lacking.

Growing points: Public concern with, and scrutiny of, the quality of dying in the UK health-care system, particularly in hospitals but also the ability of patients to die well at home where that is their place of choice.

Areas timely for developing research: Effective methods of teaching end of life care to all clinical staff; the effect upon families of caring for a dying relative at home; the optimum type, quantity and source of external support to informal carers that is perceived by them as adequate and enables the ill person to die well in in their own home; fuller understanding of the physiology of dying.