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Review likely to call for withdrawl of end-of-life care pathway

An independent review of a controversial end-of-life regime is likely to recommend that it is phased out, it has emerged.

The review of the the Liverpool Care Pathway (LCP), chaired by crossbench peer Baroness Julia Neuberger, has been hearing evidence from patients, families and health professionals.

The LCP - which recommends that in some circumstances doctors withdraw treatment, food and water from sedated patients in their final days - has come under intense scrutiny.

Reports have suggested that doctors have been establishing ”death lists” of patients to be put on the pathway. Articles have also claimed hospitals might be employing the method to cut costs and save bed spaces.

But medics have argued that the pathway has ”transformed” end-of-life care, saying it can offer peaceful, pain-free deaths when used properly.

A Department of Health spokeswoman said last night: “The independent review into end of life care system the Liverpool Care Pathway, commissioned last year by care and support minister Norman Lamb and backed by health secretary Jeremy Hunt, is likely to recommend that the LCP is phased out over the next 6 to 12 months.

“The review panel, set up by ministers following reports from families concerned about the care of their loved ones, is due to report back on Monday.

“It is expected to say that when used properly the LCP can give people a dignified and peaceful death, but that they found numerous examples of poor implementation and worrying standards in care which mean it needs to be replaced.”

Mr Lamb told the Daily Telegraph: “I took the decision to launch this review because concerns were raised with me about how patients were being cared for and how families were being treated during this difficult and sensitive time.

“We took those concerns very seriously and decided that we needed to establish the facts of what was happening so we could act where needed.”

He added: “We need a new system of better end-of-life care tailored to the needs of individual patients and involving their families.”

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Readers' comments (7)

  • michael stone

    I'm awaiting this report with interest, but there has been an 'anti-LCP alliance' rather like the 'Allies' during WW2.

    The issue isn't whether or not dying patients are sedated, but whether some clinicians are not obtaining the necessary consent (which gets tricky once patients have lost mental capacity); I'm all for decent palliative care, even 'deep permanent sedation', IF it is at the patient's request.

    But the anti-LCP isn't based on any consensus about 'what is right'.

    It is fascinating that 12 months ago, the LCP would be described by most clinicians as 'the gold-standard for care of the dying' and yet now it is so flawed as to need scrapping entirely !

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  • The LCP per se is not flawed - it is the inappropriate use of it which has lead us to the current situation. In addition attaching financial rewards to it's use was very wrong and sent the wrong message to people.

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  • I also dont think it is flawed, but I do think that (from my experience in Australia), it has been implemented with little regard for prior education for clinicians on how and when to use it.
    Also, we need to focus on helping clinicians have the difficult conversations about impending death with the patient/family BEFORE an end of life pathway is started

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  • there seem to be very clear indicatons that adequate training in its use by all clinicians was needed
    as well as explanation of its rationale for each patient to all concerned with their agreement before its implementation.

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  • There is no part of the pathway that witholds either food or water. Please stop reporting that it does.

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  • michael stone

    Anonymous | 15-Jul-2013 3:14 pm

    Anonymous | 16-Jul-2013 0:04 am

    Ignoring my basic objection that it isn't logical to describe decent EoL care 'as a thing' (as a pathway, for example), I agree with both of you.

    But the LCP was intended to 'create' expert EoL care where the staff involved were not experts in EoL - 'hospice-like' care, but outside of hospice enviroments.

    There are three main issues, which have screwed things up:

    1) Inadequate training about the LCP

    2) Inadequate attempts to deal with 'we need to focus on helping clinicians have the difficult conversations about impending death with the patient/family BEFORE an end of life pathway is started'

    3) Inadequate, and often incorrect in legal terms, training of clinicians and other professionals about the law for who 'makes' what decisions, and similar issues.

    Used properly, the LCP was a significant improvement on what happened before (although it never seemed to have been able to cope properly with 'complex deaths from old age' and the like, compared to the deaths from cancer where it originated).

    Saul Richardson | 16-Jul-2013 10:42 am

    The reporting (in the review) was that some nurses were withholding drinks in particular, and stating that the LCP was the reason for that behaviour.

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  • What will it be replaced with, we used to have the Ropers ADLs death and dying section which never got filled out, that failed so we introduced the LCP which some think has also 'failed'.
    Like someone else reported, the LCP does not withold fluids and foods so please don't deliberately misinterpret what it actually says.

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