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Nursing groups back chair of Liverpool Care Pathway review

A review of the Liverpool Care Pathway will be chaired by crossbench peer Baroness Julia Neuberger, care and support minister Norman Lamb has announced.

The independent panel, led by Baroness Neuberger, was announced in November.

It will examine the use of the end-of-life regime, which has faced criticism in the national media regarding the withholding of food and drink from terminally ill patients in hospitals and care homes.

Before reporting to ministers and the NHS Commissioning Board this summer, the panel will hear evidence from patients, families and healthcare professionals.

Discussing the appointment, Mr Lamb said that Baroness Neuberger would bring “unique knowledge and experience” to the job.

Baroness Neuberger, a senior rabbi at the West London Synagogue and former chief executive of the King’s Fund, said: “How we care for people at the end of their lives is a reflection of our society’s values and civilisation.

“At its best, Britain leads the world in end-of-life care, but it is not always perfect, and we need to work hard to get it right for everyone, providing the personal care individuals and their families both want and need.”

Amid reports suggesting that doctors are establishing “death lists” of patients and hospitals could be misusing the pathway to cut costs and save on bed space, the Liverpool Care Pathway has recently come under intense scrutiny.

However, healthcare professionals say that the pathway – which recommends in some circumstances that treatment, food and water be withdraw from sedated patients in their final days – has “transformed” end-of-life care.

They argue that when used correctly it can offer peaceful, pain-free deaths.

Imelda Redmond, director of policy and public affairs at Marie Curie, welcomed the appointment of Baroness Neuberger.

“The Liverpool Care Pathway has enabled thousands of people to experience dignified care in the last hours and days of life. It was developed to spread the hospice model of end of life care into hospitals and other healthcare settings.

But she added: “We know from the stories in the media, that not everyone is getting the high quality end of life care they need and many are being badly let down.

“We look forward to working closely with Baroness Neuberger and the review panel.”

Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “Baroness Julia Nueberger is a welcome appointment as independent chair who will bring a wealth of experience – gained from many areas of care – to the role.

“We feel that under her guidance, this inquiry is well placed to make important and impartial recommendations.”

He added: “We will work closely with Baroness Neuberger and the other organisations involved in supporting the inquiry and what it may find.”

Claire Henry, director of the National End of Life Care Programme, said: “This important step forward will help ensure that we thoroughly learn from people’s experiences, make informed recommendations and implement any improvements as quickly as possible.

“It is vital that the review is both robust and impartial. Baroness Neuberger, with her extensive experience and influential position, is well placed ensure that it is both of these things. 

Eve Richardson, chief executive of the National Council for Palliative Care and the Dying Matters Coalition, said also welcomed the announcement.

She said: “There is a real need to ensure everyone receives excellent care at the end of life and to take people’s fear away from dying and from the care they may receive in their final days, including through far more open communication about end-of-life issues.

“This requires meaningful dialogue between bereaved people and health professionals to better understand people’s fears and concerns.”

The review will look at:

  • the experience and opinions of patients and families
  • the experience and opinions of health professionals
  • hospital complaints
  • local payments made to hospitals in respect of the LCP
  • the literature about benefits and limitations of the Liverpool Care Pathway

Readers' comments (7)

  • "However, healthcare professionals say that the pathway – which recommends in some circumstances that treatment, food and water be withdraw from sedated patients in their final days – has “transformed” end-of-life care." That is an unreasonable assertion, where is the evidence to support this claim. I think the LCP needs a review and massive overhaul, I do not support the LCP. I took my brother off the LCP, he revived.. Many relatives are haunted by the fact that their loved ones were deprived of drinks and dehydrated to death. You might think this is a wonderful end of life care pathway but it isn't. No-one in my family will have their death hastened by the LCP. There is no scientific way to predict when someone will die, and I've been a nurse for 40 years so I know this to be true. this is like the story of the Emperor's New Clothes, people believe it's good because everyone says it's good, well it very often isn't.

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  • michael stone

    kathleen flanagan | 15-Jan-2013 6:01 pm

    It isn't about the accuracy of predicted prognosis, it is about who makes decisions - I'm fine with the LCP provided the patient makes the decision to use it, or if the correct legal requirements re 'proxy consent' are obtained if the patient is mentally incapable (at the moment, those requirements are often not followed, because many clinicians simply do not properly interpret the Mental Capacity Act).

    This isn't about inevitable uncertainties, it is about the fact that the person who experiences his or her own life is the patient, and patients are legally allowed to make their own decisions - it is about who makes what decisions, and who talks to whom about what !

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  • I have seen a patient today, who had a stroke, delay (initially refused admission to hospital) treatment due to reading articles on the LCP in the Daily Mail. Fortunately, her stroke is not too severe and they should be discharged in a couple of days. I am sure there are issues to be resolved regarding the LCP, but all this scare-mungering is unacceptable.

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  • If the pathway is so wonderful, how is it in the 12th addition, within 10yrs of commencement? I agree with Kathleen, patients ARE dehydrated to death. Perhaps to speed the end, but as Kathleen found, they are not ALLl necessarily dying. No one, even if fit and well can survive lfor long without fluid and it is a very unpleasant end, symptoms being masked by sedation. Why, oh why do we need a pathway! Nurses have cared for the dying for hundreds of years and now have more symptom-controlling drugs than ever! Are nurses not taught how to care for dying people any more? The Professor, who opened the nations eyes to what is going on behind hospital doors, emphasised the difficulty in diganosing an accurate life expectancy, even using "Tools". I know, I was in the meeting, in June and it is a real concern to me that we are using dehydration and starvation as a means to save money and, indeed, BEING PAID to put people on this controversial pathway

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  • surely this should be a decision for the general public to make and not some old chair! After all they are the ones most affected by it and we should follow their wishes, wants and expressed needs in this.

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  • michael stone

    Is anyone else going to submit something to this Review ?

    Details of the review can be found at:

    http://mediacentre.dh.gov.uk/2013/01/15/independent-review-of-liverpool-care-pathway-to-be-chaired-by-baroness-neuberger/

    My own submission can be found on the Dignity in Care website:

    www.dignityincare.org.uk > Discuss and debate > 'A Submission to the Independent Review of Liverpool Care'

    and I hope my submission will be downloadable (currently it is 'waiting approval').

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  • Firstly, we need to have an honest discussion about euthanasia.At present, we have the absurd situation in which on the one hand, people are obliged to go to Switzerland for the certainty of a swift & (presumably) painless death, & their partners are threatened with prosecution: on the other, patients are afraid that doctors may choose to sentence them to a protracted death by dehydration for which no one has given informed consent.

    In cases where patients are unconscious,can't drink & intravenous fluids would postpone an imminent death, & that is not in the patient's best interests in terms of prolonged suffering, the denial of water seems justifiable, though even then, surely someone can moisten patients' mouths. Otherwise, it seems cruel to starve and dehydrate those who have come to hospital looking for care and compassion. I find it astonishing that this is even an issue in the 21st century. It seems our laws protect animals better than people (which is not an argument for reducing animal protection, just in case anyone thought it was).

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