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Government to beef up rules on Liverpool Care Pathway


New commitments on end-of-life care and single-sex wards are set to be included in the NHS Constitution, under proposals unveiled today.

Ministers said the wide-ranging package of reforms would empower patients and ensure their wishes come first.

Rules on involving individuals and families in treatment decisions are being strengthened following negative press coverage surrounding the use of the Liverpool Care Pathway for end of life care patients.

Under the measures being put out for consultation, trusts that fail to discuss issues properly could be sued. Doctors who ignore the wishes of patients and relatives face being struck off.

For the first time, the coalition coalition’s policy on single sex wards would be included in the constitution.

The document would pledge that those admitted to hospital “will not have to share sleeping accommodation with patients of the opposite sex”.

Other planned changes include:

  • A new right for patients to receive acknowledgement, an explanation and apology where mistakes have been made
  • A commitment that complaints will be acknowledged within three working days, and tougher rules on handling them
  • A warning that abusive and violent patients could be denied access to NHS services, if it is “safe” to do so.

Health minister Norman Lamb said the government was determined to protect the founding principles of the health service.

“The NHS is one of this country’s greatest achievements. This government will always make sure it is free to all, no matter your age or the size of your bank balance,” he said.

“That’s why at the same time as we are protecting its budget, we are strengthening this constitution, which enshrines the right of everyone to have first class care, now and in the future.”

Royal College of Nursing chief executive and general secretary Peter Carter said: “At a time when the NHS is facing huge challenges and increasing demand it’s important that the constitution has greater traction.

“We’re pleased to see the suggestions of a stronger constitution, which in particular calls for the NHS to aspire to the highest standards of excellence, but we’re concerned about just how big a constitution this will be,” he said. “How will a huge, complex document make the necessary improvements to staff on the ground and improve the care of patients?”

He added: “While a greater emphasis on the relationship between staff and patients is welcome, more steps will have to be taken to make everyone aware of the Constitution’s existence and its benefits, as the questions we’re still hearing are ‘how does it affect me?’.  This is especially important when it comes to clearly explaining the sanctions in place to protect staff from violent attacks.”


Readers' comments (6)

  • Florence

    I know it will increase workload but acknowledging and dealing with complaints more quickly will stop these escalating and in the long run save us alot of problems.
    In my experience most people settle down alot when they at least feel listened to.

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  • Can someone tell me - is the NHS Constitution 'the law' or is it 'just strong guidance' ?

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  • I am glad the LCP is under scrutiny. It is a requirenet of the critieria for patients being put on the pathway, that relatives and patients are fully informed, and in agreement. Why has this not been adhered to? The whole pathway should be investigated . Actual time of death is very difficult to assess, even using "Tools" for the purpose and mistakes can and are made. It is an assumption at best, unless ofcourse the person is in the 'process of dying', which means there is no need for a pathway. Any Health professional that cannot look after the dying, should seek another profession! It is not palliative care to have everyone on the same care, same drugs and certainly not ethical to remove fluid and nutrition, if it is required. What ever happened to sub-cut fluids? Set up is not a big deal and not invassive, yet relatives ,as well as patients, would feel happier if the minimun of hydration where given. Get rid of this pathway and save the tax payer a lot of money ie (End of life Funding) and lets have more training in palliative care and end of life care.

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  • what is going to happen when relatives disagree amongst themselves or a patient wishes to withdraw treatment and the family disagree?

    I am going to write an advanced directive because I don't want anyone arguing about my best interests.

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  • Tinkerbell

    Anonymous | 5-Nov-2012 4:20 pm

    well said. If nothing else it is just common decency to let relatives know what is happening with their loved ones and i have never agreed with dying patients on LCP not being given fluids in one way or another.

    When i first saw this happen and questioned fluids not being given it i was told it was all part of the protocol but i thought it was unethical.

    I am not against necessary pain relieving drugs hastening death as I think it is unethical to allow someone to die in pain if they can die pain free but to allow someone to die of thirst and parched to the bone is wrong.

    Having attended a study day today in which advance directives were discussed we were told that in an advanced directive you can only state what you don't want done not what you do want. You can of course change your advance directive at anytime whilst in hospital verbally. Therefore you can say i don't want to be resuscitated, i don't want fluids if i'm dying, I don't want ECT if i become mentally ill etc., etc.,

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  • I am sorry, but research has shown that with the dying patient it is in fact MORE painful for S.C. Fluids to be administered and of course it also lengthens quite significantly the distressful (for both patient & relatives) and painful dying process. What nurse whether palliative trained or otherwise would wish this. I worked for a number of years in palliative care, using the LCP a number of times and we always consulted the family prior to the use of it. Fluids should be maintained orally until the patient is not conscious enough to take them and then it is at that stage that it is recognised that the pt is terminal so all fluids and other meds can be stopped. The family is consulted and advised in this. The idea of the LCP is that there is more time for real patient care and less paperwork to be completed. Surely this is a good thing? It is obvious that there has been some bad experience through misuse of this, but I feel from the comments above that unless you have worked for a period of time in a terminal setting that a misconception can be made.The LCP should be brought into use only when the patient is in a terminal stage, not before, then there would be less chance of misunderstanding surrounding these issues.

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