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Axing of Liverpool Care Pathway branded 'illogical'


The decision to axe the controversial Liverpool Care Pathway (LCP) is “illogical”, a senior end-of-life doctor has said.

Scrapping the care pathway is a “tragedy”, palliative care consultant Claud Regnard said. He suggested the LCP was a “scapegoat” and compared the decision to replace it with banning the Highway Code because of bad drivers.

In July it was 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, he added.

Writing in Age and Ageing, the journal of the British Geriatrics Society, Mr Regnard said: “The death of the Liverpool Care Pathway was preventable, an irony that was lost in the rush to pronounce its demise and promote the message of a listening government.

“It is as logical to discredit guidance because of errant clinicians as it is to ban the Highway Code because of bad drivers.”

He added: “The Neuberger report failed to show that the Liverpool Care Pathway was the cause of poor end-of-life care and made it the scapegoat for poor communication and faulty decision-making.

“The report’s discrediting of a quality assurance mechanism that had the potential for improvement is a disservice to dying patients.”


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Readers' comments (19)

  • Care Homes performing Pathway need even more oversight!

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  • Ellen Watters

    I totally agree, and shame on the Nursing Times for quoting the same sensationalist, negative, inaccurate text as the tabloids about food and drink withdrawn in the last hours or days of life.

    A few who lacked proper training or who didn't use the pathway properly were culpable for its demise.

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  • What a travesty. I helped to implement the LCP into the hospital where I work. Used correctly it was an amazing tool that took the guess work out of the last few days of a patients life. Admittedly, human nature and its indominatable fight for life sometimes confounded us and those patients were taken off it. It was never set in stone and relatives and patients (if able) were always told this. Once again, a knee jerk reaction to bad care given by a few health professionals.
    I will not say that it was perfect, but it gave us a chance to care differently, to be gentle instead of intrusive and give some genuine TLC instead of trying to put a cannulla into some poor old ducks, dry, collapsed veins. We never had a rule to say that if they wanted a drink they couldn't have it, mouth care and hygiene needs still counted for everything. Nicer for the relatives as well, they had a chance to see their loved ones at peace and not poked around so much. In all honesty we haven't used it for a little while here as I think people were a bit alarmed by all the alarmist media attention it got. We now seem to be in limbo trying to do the best for our dying patients, but not sure how to go about it without the documentation to back us up.

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  • michael stone

    Now I'm puzzled - I thought Claud had retired by now, based on an e-mail he sent to me in January.

    The LCP, for one reason or another, all too frequently led to confusion between the efficiency of a treatment and whether it had been consented to, and it very clearly did not properly address (or explain) some issues about decision-making during periods when patients have lost mental capacity. Something not peculiar to the LCP, amongst clinically-authored guidance.

    melanie campbell | 17-Dec-2013 1:51 pm

    You write:

    'Used correctly it was an amazing tool that took the guess work out of the last few days of a patients life.'

    That was the problem - seeing the LCP 'as a plan' instead of seeing it as a set of available options, with the chosen options sometimes differing from patient to patient even in identical CLINICAL situations.

    Claud has written widely about the MCA and other EoL issues - we are not in complete agreement, about what the law means. In particular, we disagree about verbal refusals of possible future treatments, expressed by mentally-capable patients during an ongoing clinical situation, but not written down as an Advance Decision: Claud claims they (verbal refusals) are not 'legally binding' and I say Claud is misunderstanding the Mental Capacity Act and the purpose of written ADRTs.

    Going back to Melanie, this reminds me of something I commented on to Tessa Ing, when we were discussing the LCP:

    'Nicer for the relatives as well, they had a chance to see their loved ones at peace and not poked around so much.'

    Tessa said 'one advantage of the LCP, is it tells clinicians to stop taking unnecessary blood samples, etc' I told Tessa, that if I were dying and still mentally capable, then I would forbid clinicians from using me as a human pin cushion and taking blood samples, unless I could see some advantage to me - which seems unlikely, if I was 'dying' (and even less likely if I were on the LCP, which claimed to not shorten or lengthen life - if those blood samples were not to extend my life, why would I allow them to be taken ? If clinicians were trying to extend my life, I couldn't be on the LCP by definition.).

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  • I was initially so pleased to read that headline.....what a disappointment that youve written such incorrect information. Where in the LCP does it recommend withdrawing treatment, food & water from sedated patients? Good end of life care needs good education & training, not well respected sources such as the Nursing Times publishing such incorrect information.

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  • Totally agree. LCP was improving care in my setting and it's loss has undone a lot of hard work in changing doctors attitudes to EOL care. The irony is the trusts replacement guidelines are virtually identical to the LCP framework.

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  • Well it was trial by media for the LCP and we all know we must do what the media decide don't we?!

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  • grumpy

    Michael stone - who and what are you exactly?
    Read many of your comments and you surely cannot be a practising nurse

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  • michael stone

    grumpy | 17-Dec-2013 11:25 pm

    I'm an annoyed ex family-carer, who isn't at all happy with what many clinical authors are writing about the 'meaning' of the MCA, and neither am I happy with contemporary guidance for EoL (as in 'final yea rof life') patients who are at home and arrest at home (especially those patients who arrest 'unexpectedly' [to be more technical, before 'expected death'} directly from mental capacity, and who would not want attempted CPR irrespective of why they arrested).

    I'll put a few links up later, then if you care to you will be able to work out 'who I am'.

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  • michael stone

    Hi Grumpy, the following would let you understand 'where I'm coming from', I think.

    You can download my submission to the Neuberger Review of the LCP from the first post at this link (anyone can download files from that website, although to post a comment you need to join it), and I started my submission with a quick explanation of how I'm involved:

    The following are links to two pieces of mine in BMJ online - again, they should make it clearer 'where I am coming from':

    The second of those two pieces, is the one I regard as 'the more fundamental', although the first is easier to understand.

    I hope that answers your question ?

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