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OPINION EXTRA

Is there a real alternative to the Liverpool Care Pathway?

  • 3 Comments

The LCP Review heard terrible tales of poor care delivered by professionals to those who were dying. I have worked in palliative and end of life care for over 20 years and cannot condone such poor care.

 

Opinion from Philip Ball, a registered nurse, and Helen Sanderson, a personalisation consultant, who has advised the Department of Health in person-centred practices.

 

Philip says: The Liverpool Care of the Dying Pathway (LCP)  Review, published 15 July 2013, heard terrible tales of poor care delivered by professionals to those who were dying. I am a nurse and have worked in palliative and end of life care for over 20 years – I am currently a hospice manager.  I cannot condone such poor care.

Used properly, the LCP helps ensure we give the best care with minimum interventions when dying is the outcome within a short space of time. When it is audited, it helps identify areas where staff can improve care and I have no doubt that LCP and the team behind it worked hard to create the opportunity for a dignified death when further interventions and treatments cause distress.

However, the review shows how corners are cut by missing out the key communications about dying. Add to that low staff numbers and reduced access to training and it is little wonder that messages get confused and the dying person and their loved ones are left foundering at the critical point of the end of life. I feel strongly that many people do not feel empowered enough to complain when things don’t go well. This leaves the sense that the LCP is being used to make poor care look better and when that happens it is a tool mishandled.

However, removing the LCP won’t make poor care better either and the review rightly makes strong recommendations for the future that try to address this. Included in these is making the effort to develop an end of life care plan (recommendation 38) and moving away from the “care pathway” or LCP. As well as thinking about the future of LCP, a broader question is what does the personalisation agenda mean for people at the end of their life? The recommendations are useful and important, but there is more that can be done to deliver great person-centred care and support, and focus on people having as much choice and control as possible throughout life and death.

Helen says: Helen Sanderson Associates has been working in partnership with Sue Ryder to explore what best practice in personalisation looks like for end of life care. We have been working with Philip and hospice managers, health professionals and local authority commissioners to develop a “Progress for Providers” around end of life care. Progress for Providers is recognised self -assessment for providers (www.progressforproviders.org ) and Sue Ryder has commissioned one to be written for end of life. An increased focus on personalisation is a common thread in the recommendations from their demos reports, “Ways and Means” and “A time and a Place” (2013).

This is our challenge for the future – to deliver personalised support at end of life, which builds on the lessons learned from the implementation of LCP, and addresses the recommendations from the review.

 

“Progress for Providers - end of Life care” is being launched by Sue Ryder at the Help the Hospices conference on October 23, 2013. It is a downloadable free resource and will be on the progressforproviders.org website from 1st November 2013.

 

  • 3 Comments

Readers' comments (3)

  • michael stone

    The hope is that the Liverpool Care Pathway will be replaced by better care of the dying - more individualised, and by something which intrinsically promotes the difficult conversations which are all-too-often avoided at present. The danger, is that the LCP will not be replaced by better care of the dying, but by worse care of the dying: the LCP's objective, of replicating as far as possible the end-of-life care provided by expert staff in hospices, in acute hospitals where the staff are not EoL experts, was of course admirable.

    I commented on the 'communication issues' about a week before the LCP Review was published:

    http://www.bmj.com/content/347/bmj.f4085/rr/652862

    Philip also commented on the problem of bad communication:

    'However, the review shows how corners are cut by missing out the key communications about dying. Add to that low staff numbers and reduced access to training and it is little wonder that messages get confused and the dying person and their loved ones are left foundering at the critical point of the end of life. I feel strongly that many people do not feel empowered enough to complain when things don’t go well. This leaves the sense that the LCP is being used to make poor care look better and when that happens it is a tool mishandled.'

    Philip's comment about staffing numbers is also relevant - I suspect, that many hospice nurses would say that they are given more time 'to be with our patients' than is often the case in acute hospitals, and 'time spent with the patient and relatives' is fundamental 'during the dying phase'.

    I just hope we end up with something better, not a worse situation than we already had.

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  • There was - and is - NOTHING wrong or inappropriate about the LCP. What was wrong were the occasions when the LCP was used incorrectly and inappropriately.

    Disturbed people have taken their lives by jumping from bridges we do not therefore abolish all bridges.

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  • Phillipe Cook | 4-Aug-2013 5:28 pm


    that may be, but it should not be that it was so open to misinterpretation.

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