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THE BIG QUESTION

The big question: do you welcome the withdrawal of the Liverpool Care Pathway?

  • 3 Comments

Following the review of the Liverpool Care Pathway, the government has confirmed that it will be phased out.

The controversial pathway will be replaced by end-of-life care plans, which senior clinicians will sign off.

The review, headed by Baroness Julia Neuberger, was established by care and support minister Norman Lamb after concerns were raised that the LCP was flawed.

The review concluded that in the right hands, and when operated by well-trained, well-resourced and sensitive clinical teams, the LCP helped patients have a dignified and pain-free death.

But it also found too many cases of poor practice, poor quality care and relatives not being properly engaged.

The review made 44 recommendations most notably that the LCP should be phased out and “replaced by a personalised end-of-life care plan, backed up by good practice guidance specific to disease groups”.

Do you agree with the decision to replace the LCP?

Your comments could be published in NT.

  • 3 Comments

Readers' comments (3)

  • michael stone

    The LCP had to go, because as the report pointed out, misuse of it has led to it becoming 'tainted beyond repair'.

    I don't really want it replacing by an 'EoL Plan', and would like to see a comprehensive 'behaviour set' covering the entire period from terminal diagnosis to death introduced, called the 'National End-of-Life Framework', which instead of being written in prescriptive terms, instead stressed the principles which should guide behaviour at all stages of that progression: however, and this is where I have some doubts, this would require proper training.

    Clinicians would need to get the principles correct, first, though, and I'm still working on that - for example:

    http://www.bmj.com/content/347/bmj.f4085/rr/654490

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

    http://www.bmj.com/content/346/bmj.f2656/rr/644149

    By the way, something which will doubtless enrage my gang of 'loyal followers': according to the BMJ, all three of the above 'are published articles'.

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  • In my opinion the LCP was another framework to use in planning care of the dying patient. I believe you can not use frameworks but only individualised care plans for the dying patient and also that of anyone rather than standardised plans. The ethical dillemas around death and dying in this country are extremely subdude.We are not a society that is open to communication of death and I believe this is where the LCP hindered within the lay persons understanding of it.

    Im a little sceptical over the timing of this review considering its gold standard award initially. As soon as this is discussed the amber care bundle has come to the fore. Reinventing the wheel is not always a good thing but good communication and care of the dying patient across the board.

    My experience of the LCP was good but it was only ever used in conjunction with the MDT, family members and the wishes of the patient if it was possible at that time.

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  • protocolising the handling of patients and their process through the system even to the extent it is used when somebody dies is the ultimate in utilitarian, supermarket style service and has little to do with care, humanity and supporting an individual to die with dignity and in their own manner and time. instead of following their own designated pathway they are following another that has been imposed upon them which is how the LCP might be perceived.

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