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Liverpool Care Pathway ‘needs to be replaced’ – Lamb

The Liverpool Care Pathway (LCP) is to be scrapped, after the Neuberger review found examples of poor practice and some families not properly informed about the process.

The Government has published its initial response to the review, calling for all NHS hospitals to undertake clinical reviews of all end of life care, appoint a named clinician for every patients’ end of life care, stop financial incentives for hospitals to promote the LCP, and for the CQC to conduct a review into end of life care.

Care minister Norman Lamb said: “We hope the actions we have taken today will reassure patients and their families that everyone coming to the end of their life is getting the best possible care and that concerns are being dealt with swiftly.

“I have personally heard families describe staff slavishly following a process without care or compassion and leaving people suffering at the end of their lives. This is something we cannot allow to go on.

“People’s final days should be as comfortable and dignified as possible. That is why there is a place for thoughtful and careful end of life care that involves patients and their families, but it is clear what we have now needs to be replaced so we can create a better way of doing this.”

Jane Cummings, chief nursing officer for England, said: “The review and NHS England recognise the good principles of end of life care in the LCP, but there have been failings in the quality of care in some areas and this is never acceptable. Caring for someone when they are dying is difficult and emotional even for experienced healthcare professionals. But the NHS exists to provide personal and compassionate care to patients and their loved ones when they most need it.

“Most of the time we do get it right but we have to get it right for everybody. Issues such as poor communication with relatives have nothing to do with any particular care plan. That is just poor care and we don’t want it in the NHS.

“Patients are at the heart of everything we do to ensure the NHS can deliver the right care to every patient at the end of their life to make sure it is the best it can possibly be. We will do this by listening to patients and their families and responding fully to the recommendations of this report to ensure that the principles of good end of life care are firmly embedded across the NHS.

“We will be carefully considering the findings of this report and working with our partners to respond fully in the autumn, to give the time and consideration such an important review deserves to meet the needs of patients and their families.”

Niall Dickson, chief executive of the GMC, welcomed the review and said: “Every patient deserves good care at the end of life and, as this report demonstrates, for some the care has been poor. Doctors need to work closely with patients and their families, making decisions together that will meet patients' wishes and needs. As the review acknowledges, our guidance Treatment and care towards the end of life is unambiguous and if followed will help doctors deliver the safe and compassionate care patients require.

“At the heart of this is effective, sympathetic communication and informed consent. The UK has led the world in pioneering the care of the dying and we have some of the most skilled and dedicated doctors, but we do need to make sure good care is practised everywhere. As for doctors who fall seriously below that standard, they are putting their registration at risk and we will look carefully into any specific cases highlighted in the report.”

Dr Linda Patterson, clinical vice-president of the Royal College of Physicians, said: “It is estimated that every year 355,000 new people require end of life care.1 Palliative medicine is a huge area and the RCP is clear that patients deserve high quality, appropriate and compassionate end of life care.

“Care of the dying needs to be fully embedded into doctor training and education for doctors and healthcare professionals, and we must ensure senior clinical involvement in end of life decisions across seven days a week. Full and clear communication is fundamental to end of life care. Clinicians must have adequate time to discuss available options with the families and carers of their patients.

“Medical leadership is key to improving end of life care, especially in acute hospitals. The RCP is keen to work with other organisations to act on the recommendations of this review.”

An NMC spokesperson said: “This is an important report in a sensitive area. We will consider the report and its recommendations carefully with our partners and respond in due course.

“We take very seriously any suggestion that nurses have falsified records relating to discussions about end of life care, and other allegations of unacceptable practice.  We will follow this up with the review team.”

Tell us what you think – have your say below, or email us directly at [email protected]


Jeremy Marchant   23/07/2013 at 21:57

My mother was put on the LCP in a S London hospital in January 2012. From my observation of the process and of how it was administered in this particular case (which I’d rate as “adequate”), I feel: 1 – The process is probably good enough, but it needs to be conducted intelligently and compassionately with an understanding of its ethos and objectives. This is clearly not beyond the wit and ability of most nursing staff. 2 – If some staff are not conducting the LCP properly, that’s an issue about them, and/or their training, and/or their management, and/or the auditing of the process (see 4). You can’t blame the process for that, any more than you can blame a properly functioning car if someone chooses to drive it into a wall. 3 – It strikes me that the intelligence and compassion needed (see 1) will be requirements of any end of life care process. If it turns out that the LCP is too difficult for enough staff to conduct well enough, lack of intelligence and compassion must be high on the list of reasons why. It seems unlikely, therefore, that the same staff will be able to conduct any other process any better. If they need training etc to be able to run some other process well enough, they might as well be trained to run the LCP better – at least that has been shown to be good enough in plenty of cases in the NHS when administered well. 4 – If the LCP does not include processes whereby its conduct can be routinely audited by a third party to ensure adequate compliance, then it is essential it does (but then it is essential in any procedure in any organisation). The scrapping of the LCP seems to me to be a classic case of treating the symptom not the illness. Maybe it’s an exceptionally egregious manifestation of the illness, but politicians always work on the principle that an action carried out quickly (however stupid) is necessarily to be preferred to a better one carried in good time. Politicians are too short termist to be bothered that the same thing will happen again in a few years if nothing is done about the underlying illness. Which is, of course, a perceived lack of compassion in a lot of staff. I don’t actually think that many NHS staff lack compassion but they get it suffocated out of them by the conditions/environment/context in which they have to work. I think what they are actually lacking is motivation, but that’s not politically acceptable since most politicians and managers cling to the egocentric belief that it is in their power to motivate other people (it isn’t – people motivate themselves). More on this here:

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