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Never before has there been such a focus on end of life care with Government initiatives, the Dignity in Care agenda and extensive media coverage, making it the most appropraite time to launch the National Council for Palliative Care’s updated Guidelines for End of Life Care.

These guidelines will help to provide good quality End of Life Care and help people to experience a ‘good death’.

The type of care required in the last days of life is different to the palliative care provided earlier in a patient’s condition and so we refer to this as a ‘change of gear’. Changing Gear is a practical manual of guidelines designed for use by all health and social care staff. This will help the last days of life of people dying from both cancer and other conditions, as part of NCPC’s commitment to promote good palliative care for all who need it.

The main principles of care management are outlined in chronological order, from recognising that death is approaching, to facilitating this change in gear, and includes bereavement follow-up, and may also be used in clinical and quality audit. As such, it provides invaluable assistance to service providers in all settings. It will support the training of all health and social care staff and also help them to be aware of their own feelings towards death. It outlines the importance of listening to the wishes of the dying person and balancing this with the views of relatives, which may be different. It covers practical guidance on medication for pain and symptom relief; understanding diversity around people’s beliefs and spiritual needs; their need for social and psychological support, and highlights the importance of sensitive communication. The guidelines have been designed for use by all who are caring for dying people in acute and community hospitals, in care homes as well as in hospices. There are around 20,000 care homes in England and Wales, in which 1 in 5 deaths occur, making Changing Gear an essential guide for all care homes staff.

Changing Gear was originally developed by the NCPC’s Working Party on Clinical Guidelines, chaired by Dr Derek Doyle in 1997; the guidelines were the first of their kind to offer practical assistance to all involved in end of life care. They were then reviewed in 2004 by a working party led by Prof Irene Higginson.

In 2006, the National Council for Palliative Care convened a further multi-disciplinary working party to update the guidelines in line with recent evidence. Prof John Ellershaw, Director of the Marie Curie Palliative Care Institute at the University of Liverpool led this working party.

The National Council for Palliative Care (NCPC) is the umbrella organisation for all those who are involved in providing, commissioning and using palliative care and hospice services in England, Wales & Northern Ireland. NCPC promotes the extension and improvement of palliative care services for all people with life-threatening and life-limiting conditions. The NCPC promotes palliative care in health and social care settings across all sectors to government, national and local policy makers.

Changing Gear: Guidelines for Managing the Last Days of Life in Adults is available at £20 with discounts for multiple copies. To order a copy please contact Nick Hayes, or telephone on on 020 7697 1520.

Nick Hayes
Communications Co-ordinator
NCPC