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Practice comment

''The Liverpool Care Pathway is only as good or bad as its user''

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The Liverpool Care Pathway was never meant to be the answer to the question “how do we start difficult conversations?”

It was developed to enable staff to have more time to talk to patients and relatives about dying and, according to an independent review of it, More Care, Less Pathway, which was published last month, it aimed “to replace the contemporaneous medical records written by the clinical staff”. How ironic, then, that the very tool that was meant to improve communication has had the opposite effect.

The LCP has endured its own death by media, but if this tool is causing “horrifying widespread abuse” - as suggested by the Daily Mail - then shouldn’t it be withdrawn immediately? If we are to believe that, according to the crossbench peer Baroness Julia Neuberger and her panel, who carried out the review, it is the LCP that is causing “frequent cases of relatives to be shouted at by nurses for giving dying loved ones the water they crave”, then we need to abolish it now.

But let’s look at the facts. A chronic nurse shortage is imminent with the Royal College of Nursing calling for urgent action. Research commissioned by the government predicted that the NHS is likely to have 47,500 fewer nurses than it needs by 2016. This hasn’t happened overnight; there are around 7,000 fewer nurse training places available now compared with June 2009. Surely the issues that have helped to kill the LCP aren’t so clear cut?

If we are to regain the public’s trust in nurses, we need to have time to explain to people what is happening with their relative or friend and why we are stopping treatment. Until that happens “replacing the LCP with end-of-life care packages tailored to patients’ individual needs”, as vaunted by the Daily Mail, will become an urban myth. Another failed promise to everyone with a life-limiting illness and their families.

As the RCN makes clear in its response to the review, getting end-of-life care right is crucial:

“There is only one chance to get care right at the end of any person’s life. It is at the heart of all caring professions that patients must be treated with dignity, and that means that all treatment has to be properly communicated.”

But how are we going to achieve this without experienced nurses to help and support new nurses?

Is the criticism of the LCP justified? It seems this depends on who you speak to, what you read and to whom you listen. If we as a profession are confused, what hope do patients and relatives have?

I understand that for us to give equity of care we need a universal tool that everyone feels happy using, which can be translated into a format everyone understands. But I wonder whether our whole approach needs to be reviewed - after all, any tool is only as good as the person using it.

With the looming shortage of nurses and too few to cover the shortfall, the new end-of-life care package will likely become the new elephant in the room and suffer the same fate as the LCP.

Nicki Parry works in end-of-life care.

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Readers' comments (6)

  • We all need a step back to review and reflect on what is going on. There is too much happenig at the moment and we are in danger of loosing focus. Unfortunately we are living in a cluture that revels in the bad news and rarely celebrates the good. The loud voices are the ones who are dissatisfied and upset and the press listens to them as good news does not make sensationalist headlines.
    Lets all take a big breath, chill and think

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  • I watched my mother die of cancer after being put on this pathway. She wasn't eating or drinking much if anything and we were constantly struggling with finding the right balance of pain relief and antiemetics via the syringe driver. The Macmillan nurse started the pathway on the Wednesday before she died on the Saturday, it was not discussed with us but as the notes were kept in the house I read them; (we looked after her at home). To me it made sense, my Mom was comfortable, painfree and had all the medication she would or could need in the house with her. When I had to get the district nurse to see her in the early hours of Saturday we didn't have to wait for a doctor the medication was there for her.
    I think the pathway's use has been taken out of context and we should remember why it came about in the first place. I've also seen 3 of my dogs die of cancer and we didn't have to wait until they were greatly suffering before we had our trips to the vets they all had calm painfree deaths. A diginifed painfree death should be available for all of the seriously ill. Remember them before the pathway is disappears.

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  • George Kuchanny


    'any tool is only as good as the person using it'.

    Quite so. That is all that needs to be said.

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  • Agree completely with above statement.
    If used properly and coupled with a Preferred Place of Care document, plus open communication with families there ought not to be a problem

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  • As a nurse working within a palliative care setting I can agree with many of the above comments. The main issue with this is not the LCP it's self but those persons whom choose not to communicate with there dying patients an there families in a informative and honest manner.
    The patients an family members within mine an my colleagues care are completely informed, empowered an at ease with the care that themselves or there relatives are receiving and feel comfortable an confident to be able to ask any question at any point during and after care, all solely because communication is an essential basic nursing skill which many seem to of lost the ability to do.

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  • michael stone

    The Liverpool Care Pathway was never meant to be the answer to the question “how do we start difficult conversations?”.

    SOMETHING SHOULD BE MEANT TO DO THAT - WITHOUT THOSE CONVERSATIONS, END-OF-LIFE CARE ISN'T ADEQUATE ! Especially in community settings.

    Which is part of the problem - some clinicians think 'I follow the pathway - done my job, full stop', and that ISN'T proper holistic EoL behaviour.

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