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Liverpool Care Pathway to face independent scrutiny, says Lamb

A series of reviews into the Liverpool Care Pathway for end of life care patients will be overseen by an independent chair, the government has announced.

Three separate reviews of end of life care are currently being carried out by the Association of Palliative Medicine, the Dying Matters group and the National End of Life Care Programme.

Health minister Norman Lamb yesterday announced that an independent chair would be appointed to oversee the three reviews.

Mr Lamb’s intervention follows ongoing negative press coverage surrounding the Liverpool Care Pathway, which has persisted despite efforts by clinicians and palliative care organisations to defend the pathway when implemented correctly. 

In particular, there have been stories regarding patients being put on the pathway without the knowledge of their relatives and, more recently, claims that trusts are putting too many patients on the pathway in order to meet targets linked to payments.

Mr Lamb said: “It is clear that everyone wants their loved ones’ final hours of life to be as pain free and dignified as possible, and the Liverpool Care Pathway is an important part of achieving this aim.

“However, as we have seen, there have been too many cases where patients were put on the pathway without a proper explanation or their families being involved. This is simply unacceptable.

“I have committed to appoint an independent chair to review how end of life care is working and oversee the reviews into the LCP. This will report back to me in the New Year.”

He added that work would also be undertaken to “consider the value of locally set incentives and whether they are leading to bad decisions or practice”.

“It is vitally important that everyone can be confident in the findings of this work – and that we learn lessons where they are needed, so we can ensure that end of life care is as good as it can be,” he said.

Mr Lamb made the announcement after attending a roundtable meeting yesterday with stakeholder groups.

He added: “Care for the dying is an emotive issue and is never an easy subject to discuss. I am grateful to those who attended the roundtable and shared their views and experiences with me this afternoon.”

Groups attending the meeting included the Marie Cure Palliative Care Institute Liverpool, which brings together the academic and NHS organisations that originally developed the pathway.

Professor John Ellershaw, the institute’s director and national clinical lead for the LCP, told the meeting: “The Liverpool Care Pathway and its use have been misrepresented in some sections of the media in a way that is unhelpful to improving care for people at the very end of their lives. It has fed on the fear of death in society.

“The LCP provides focus for care in the last hours or days of life but the vital communication, care and compassion required in those days and hours come from those caring for the patient and their family.”

The National End of Life Care Programme also attended the meeting. Its director Claire Henry said: “We were pleased to contribute to an informed debate on how improvements can continue to be made.”

She added: “We strongly welcome the minister’s announcement of an independent chair to help deliver these reviews. This is crucial if the findings are to be viewed credible by all.

“A main priority is to ensure that this work is undertaken transparently. We look forward to working with the appointed chair to publish findings in the New Year.”

The government announced earlier this month that rules in the NHS Constitution on involving individuals and families in treatment decisions would be strengthened.

 

 

Readers' comments (12)

  • michael stone

    '“However, as we have seen, there have been too many cases where patients were put on the pathway without a proper explanation or their families being involved. This is simply unacceptable.'

    It is clinicians making decisions alone, when patients should be making the decisionf or themselves, or when the patient has becoem emntally incapabable and relatives should be consulted (and are not being consulted) that needs addressing - the issue isn't about the pathway, it is about consent/communication.

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  • michael stone

    when patients should be making the decision for themselves, or when the patient has become mentally incapable

    my typing does not improve !

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  • tinkerbell

    i watched newsnight last night and this was discussed amongst relatives,clinicians et al and this was the main problem, the lack of communication with relatives being informed what was happening and why. One trust apologised to the relative for their lack of communication.

    I recently met a family who said their parent was put on LCP and it wasn't explained to them at all.

    Hopefully this matter will now be addressed.

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  • good, will there be members of the media there too, the Mail and the Telegraph don't seem to understand anything health related.

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  • I watched newsnight too and have to say I was surprised by the invited array of guests. They did as a whole seem to highlight the basic lack of communication issues at different stages of the prognosis path as well as the various entry points onto the LCP for different reasons. However what was missed, I tthink, was the opportunity to discuss and acknowledge the overwhelming medicalisation of dying. Terry Pratchett tried to highlight this issue but was overwhelmed by the medical fraternity and the politician,..... familiar?
    Mary Warnock was making an interesting point near the end around the philosophical issues and was promptly interrupted and cut off.
    I think this reflects the process and undercurrents of the decision makers whereby discussion of the ideas and issues are restricted by what 'must be done' by the doers.
    Glad the discussions are atually happening though, long overdue.

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  • ps. apologies re spelling!

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  • This is what happens when nurses are not left alone to do what they do best - nurse! In a previous job in the community our team provided excellent palliative care without the LCP thank you very much. We attended palliative care courses, we had close links with the MacMillan nurse service, GPs, etc, in order to ensure that our patients needs were met. We always involved family members. I once drove with controlled drugs in my car, which was against PCT policy, in order to ensure that my patient received them when they needed them. One patient could no longer get upstairs. We didn't have access to equipment stores back then so I borrowed a bedpan from from a local nursing home. I know this is against the rules now. The patient was very happy and relieved not to have to go downstairs to the loo that night.

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  • policies are there for your protection too, whilst it was obviously in the patients best interests to have cds to hand it could cause a major red-tape headache. you do have to do things by the book and cover your own backside, unfortunately common sense and being honest are not always enough - someone somewhere will make a mountain out of a molehill (usually about the size of an ant-hole if we are honest).

    sadly in todays climate 'rules is rules' - although we all know that rules are often broken according to who you are and who you know.

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  • michael stone

    Anonymous | 30-Nov-2012 4:57 pm

    Anonymous | 30-Nov-2012 5:24 pm

    This is the obvious problem with 'tick-box rules' versus 'use your expertise and sense'.

    But IF YOU WERE THE PATIENT, wouldn't you prefer 4:57 pm to 5:24 pm ?

    I know that I would !

    The problem, is that the tick-box rules always fail horribly, in very unusual situations - but 'use your expertise and sense' is useless in 'typical situations' if staff are not adequately expert/trained.

    This crops up in my EoL discussions with people, and it must crop up almost everywhere in the NHS - the problem si much easier to see, than the solution !

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  • tinkerbell

    Anonymous | 30-Nov-2012 4:57 pm

    Well done you i say. You are taking initiative in the best interests of your patients and stupid rules are meant to be broken. Should you get taken to court i think you could justify your actions to a group of peers.

    It's more of an injustice that people are left in pain unnecessarily.

    This covering our backside malarkey is leaving us unable sometimes to take any action and the bats have well and truly got into the belfry when we can't act in a timely manner.

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  • This debate on the se of the LCP has left us with staff not willing to initiate it.

    It's a very sad state of affairs.

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  • I would like to testify that i have lost a father to this dreadful and lame pathway. i can only describe it as legalised killing!
    my father went in to hospital with a heart attack, a mild on at that, he was not reliant on machines to keep his heart beating and was to an extent needing oxygen. however he was alert, able to understand and communicate, and had mental capacity. and had mobility. his organs other than a slightly weaker heart were all fine.
    his appetite and outlook positive.
    however the consultant had written my father of and then came the so called pathway to death!
    nil by mouth, no drip feed, tablets to drain the body of its water, constant blood tests, high dosage of painrelief to keep him quite, resulting in a rapid dehydration and body and soul smoothered to death.
    no consultation to explain the pathway prior or later.
    And as a worker in the care sector i am now more aware of this and the same hospital is routinely exercises it population control. as a matter of fact a current person i know is having the same fate as my father as i write this. It may be our hospital that is notoriouse for high number on the pathway.

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