Scrapping end of life care pathway was 'too extreme'
Axing the controversial Liverpool Care Pathway (LCP) was “too extreme” a measure, a medical ethics expert has argued in a leading journal.
The decision to scrap the end of life care pathway, following a wave of bad publicity last year, has been dubbed “peculiar” by ethicist Dr Anthony Wrigley from the Centre for Professional Ethics at Keele University.
Writing in the Journal of Medical Ethics, Dr Wrigley said Britain was ranked as having the best end of life care in the world before the LCP was axed.
“The Neuberger Review has taken us both one step closer and one step further away from the goal of achieving the highest quality end of life care”
He said that the recent review into the LCP highlighted some cases of inadequate implementation of the care regime. But he said scrapping the measure on the basis of some poor use was like prohibiting the use of morphine because some do not know how to implement it properly.
In July last year the government announced that the measure would no longer be used, after an independent review concluded doctors had used the LCP “as an excuse for poor-quality care”.
The review panel, chaired by crossbench peer Baroness Neuberger, said they were “shocked” and “upset” at some of the “distressing” cases of appalling care.
Patients were left on the pathway for weeks without any review and some patients’ families were even shouted at by nurses for giving them water.
In response, care and support minister Norman Lamb ordered all NHS hospitals to undertake reviews of care given to dying patients.
He also ordered hospital bosses to ensure that in the future every patient has a named senior clinician responsible for their care in their final hours and days of life. Financial incentives to put people on the regime would also be scrapped, Mr Lamb added.
But Dr Wrigley said the conclusion of the Neuberger Review were “questionable”.
“What seems to be far too extreme, however, is the recommendation by the Neuberger Review that on these grounds the LCP should be phased out,” he wrote.
“One reason why this seems too extreme is that end of life care in the UK is of a quality that is world-leading, recently being ranked as having the best overall palliative care in the world.
“Moreover, one of Neuberger Review’s conclusions was that: ‘In the right hands, the Liverpool Care Pathway can provide a model of good practice for the last days or hours of life for many patients… But it is clear that, in the wrong hands, the LCP has been used as an excuse for poor quality care.’
“However, to recommend from this position that the LCP be phased out is to make a seemingly invalid inference.
“By analogy, one might construct a similar argument for many different treatments by claiming that, for example, the use of morphine should be phased out as a painkiller in medicine because its correct use is beneficial but some people incorrectly use it.”
He added: “The Neuberger Review has taken us both one step closer and one step further away from the goal of achieving the highest quality end of life care.
“It has taken us closer by helping to break a long-standing taboo that end of life issues are not widely and openly discussed, by highlighting reasons why there are failings in providing high quality care that are very entrenched and go beyond the failure to properly implement a particular approach, and by calling for more emphasis to be placed on this area in terms of training, support and development.
“It has also taken us a step further away by calling for the phasing out of a care pathway that is widely held to be an example of the very best approach to palliative care.”