Friday, 27 January 2012

Gold Standards Framework

Had an update on the end of life management policies in Cornwall through the Gold Standards Framework (GSF).
"[GSF] was first piloted in Yorkshire in 2001 in Phase 1, followed by a national phased programme supported by the NHS, Macmillan and more recently the DH End of Life Care Programme. An intrinsic element of the work has been the internal and external evaluations, originally using questionnaires and more recently the on-line After Death Analysis audit tool, plus several independent University based evaluations, which contributed to the further development of the work. National spread was enabled through a strategic national cascade plan with the GSF Central Team supporting local facilitators, enabling best implementation of the work, overseeing training and audit plus developing further adaptations and resources."
Recent progress in Cornwall includes the adoption of the same version 12 of the Liverpool integrated care pathway for the dying patient (LCP) in primary care, secondary care and care homes. There is ongoing negotiation about the implementation of the GSF in Cornwall.

These approaches both originated from examples of best practice in the NHS. The LCP from the NHS Beacon Programme in 2001/2 [1] and the GSF at a similar time being taken up by the National Council for Palliative Care from 2003. They are both widely adopted. I'm looking forward to reading more about the evaluations they have undergone [2,3] and the particular challenges of evaluating this type of quality improvement [4]. Do they make a difference?[5]

1. Ellershaw J, Ward C. Care of the dying patient: the last hours or days of life. BMJ 2003 Jan;326(7379):30-34. Available from:

2. Costantini M, Ottonelli S, Canavacci L, Pellegrini F, Beccaro M. The effectiveness of the Liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial. BMC Health Serv Res 2011;11:13. Available from:

3. Duffy A, Payne S, Timmins F. The Liverpool Care Pathway: does it improve quality of dying? [corrected]. Br J Nurs 2011 Sep;20(15):942-946. Available from:

4. Pugh EJ, McEvoy M, Blenkinsopp J. Use of the proportion of patients dying on an End of Life Pathway as a quality marker: considerations for interpretation. Palliat Med 2010 Jul;24(5):544-547. Available from:

5. Kinley J, Froggatt K, Bennett MI. The effect of policy on end-of-life care practice within nursing care homes: A systematic review. Palliative Medicine 2012 Jan; Available from:

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