Minister Lynch launches two Palliative Care National Clinical Effectiveness Guidelines

Minister of State at the Department of Health, Kathleen Lynch, has launched two new National Clinical Effectiveness Guidelines. They will help health professionals with managing the symptoms of pain in cancer patients and constipation in patients receiving palliative care.

The new guidelines were drafted by the National Clinical Programme for Palliative Care (NCPPC)  and quality assured by the Department of Health’s National Clinical Effectiveness Committee (NCEC). They now have Ministerial endorsement as high quality guidelines to be implemented in full across the health service. They are the first NCEC clinical guidelines for palliative care. They will help to improve the quality, safety and cost-effectiveness across the many settings where palliative care is delivered in Ireland.

“The primary goal of palliative care is to allow patients to live as comfortably and as pain free as possible.  Cancer pain and constipation are two of the most common symptoms experienced by patients with advanced, progressive illness.  Unnecessary suffering can be reduced by promoting prevention and early effective treatment of these burdensome symptoms and this is what the guidelines intend to achieve” Minister Lynch said.

“These guidelines will help care givers to identify and alleviate cancer pain and constipation which, if not properly managed can negatively impact a patient’s quality of life” said Dr Áine Carroll, National Director for Clinical Strategy and Programmes Division of the HSE.

The guidelines are based on the best research evidence and on clinical expertise. They aim to prevent variation in practice and assist both health professionals and their patients in making decisions about treatments. Dr Karen Ryan, Clinical Lead of the NCPPC acknowledged the commitment and expertise of the multi-disciplinary teams in developing the guidelines. She also commended the input and assistance of the programme management of the NCPPC and the Royal College of Physicians of Ireland.

“The completion of the two guidelines is a shining example of the collaboration with partners that has been the key to the successes of the National Clinical Programme to date. The hard work of colleagues from the Department of Health, the NCEC, the HSE, the All Ireland Institute of Hospice and Palliative Care and the Irish Hospice Foundation will ensure that real improvements are realised in the care that patients and their families receive.”

The National Clinical Effectiveness Committee (NCEC) was established as an essential component of the Patient Safety First initiative. It provides leadership for national clinical effectiveness through prioritisation and quality assurance of National Clinical Guidelines and audit. These palliative care guidelines bring to ten, the number of NCEC National Clinical Guidelines published and available for use in the health service.

Minister Lynch acknowledged the work of NCEC in advancing patient safety and quality, and the Irish clinical effectiveness agenda, under the chairmanship of Professor Hilary Humphreys. She congratulated the National Clinical Programme for Palliative Care on this important contribution to evidence-based care.  Extending and implementing the suite of National Clinical Effectiveness Guidelines is a Department of Health priority for 2015. Find further information on Guidelines here.


Further information

NCEC Terms of Reference 2015:

- Apply criteria for the prioritisation of clinical guidelines and audit for the health service
- Apply criteria for quality assurance of clinical guidelines and audit for the health service
- Disseminate a template on how a clinical guideline and audit should be structured, how audit will be linked to the clinical guideline and how and with what methodology it should 
  be pursued
- Recommend clinical guidelines and national audit, which have been quality assured against these criteria, for Ministerial endorsement within the Irish health service
- Facilitate with other agencies the dissemination of endorsed clinical guidelines and audit outcomes to front-line staff and to the public in an appropriate format
- Report periodically on the implementation of endorsed clinical guidelines.

Information on the NCEC, NCEC documentation and endorsed National Clinical Guidelines is available here.


National Clinical Programme for Palliative Care

The goal of palliative care is to enhance quality of life and, wherever possible to positively influence the course of illness. 

The National Clinical Programme for Palliative Care is one of the HSE’s National Clinical Programmes, under the auspice of the Clinical Strategy and Programmes Division, and aims to ensure that people with life-limiting conditions and their families can easily access a level of palliative care service that is appropriate to their needs regardless of care setting or diagnosis. 

The NCPPC has a number of work-streams that focus on service delivery improvements, development and implementation of quality initiatives and the establishment of children’s palliative care services.  Outputs to date include increased bed capacity, increased access to specialist palliative care in the community and the development of access policy and referral criteria to specialist palliative care services and a Palliative Care Role Delineation Framework.  These 2 guidelines sit alongside and amongst other quality initiatives, such as the Palliative Care Competence Framework and Palliative Care Needs Assessment Guidance.


National policy on Palliative Care

National policy on Palliative Care is contained in the Report of the National Advisory Committee on Palliative Care (2001),the HSE 5 year / Medium Term Framework for Palliative Care Services 2009 – 2013 and, in relation to children, Palliative Care for Children with Life-limiting Conditions in Ireland - A National Policy. Palliative Care is now moving beyond the traditional life limiting area of cancer to address other non-malignant or chronic conditions (primary diagnosis: 77% cancer, 23% non-cancer).  

The HSE has set up a steering group to review the existing national strategic and policy documents and develop a new framework which will provide a direction for adult palliative care services into the future. Separately, the Taoiseach has asked Senator Marie Louise O’Donnell and the IHF to look at the non-health aspects of state services and supports around end of life, palliative care and bereavement and to identify good practice and where improvements are needed.

On 17 April 2015 officials from the Department of Health and the HSE met in private session with the Joint Committee on Health and Children to discuss the Minister’s reasoned opinion on the JCHC’s recommendations on end of life, palliative care and bereavement.  The meeting formed part of a wider follow-up on the Committee’s report recommendations, which included recent engagement with the Irish Hospice Foundation and the Forum for the End of Life Care.

For more information, please contact Yvonne McCahill, Royal College of Physicians of Ireland