Liverpool Care Pathway to be phased out

THE Liverpool Care Pathway is to be phased out in England in response to the findings of an independent review published this week.

Headed by Baroness Julia Neuberger, the review was established by Norman Lamb after concerns were raised by patients, families, carers and a number of clinicians that the system for providing care in the last days and hours of people’s lives was flawed.

The review found that in the right hands and when operated by well-trained, well-resourced and sensitive clinical teams the LCP does help patients have a dignified and pain-free death but findings also included many cases of poor quality practice with families and carers not being properly engaged in the patient’s care. Because of these failings the review has recommended it should be phased out.

In its initial response the Government will ask all NHS hospitals to immediately undertake clinical reviews of all care given to dying patients and to make a arrangements to ensure that every patient has a named senior clinician responsible for their care in the final hours and days of life.

The LCP is to be phased out over the next 6-12 months and replaced with an individual approach to end of life care for each patient, which will include a personalised end of life care plan backed up by condition-specific good practice guidance.

In addition, patients and families concerned about inadequate care will have access to an independent assessment of their case, and anyone who previously made complaints about care received on the LCP but left unsatisfied will have the opportunity to have their case reviewed.

Care and Support Minister Norman Lamb said: "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."

The RCGP supports the move away from the LCP. Chair Dr Clare Gerada said: "The College has always supported the principles behind the Liverpool Care Pathway as a useful, evidence-based framework to support the delivery of excellent care to patients in the last days and hours of their lives. However, we have expressed concern about the implementation of the LCP and so welcome many of Baroness Neuberger's recommendations to address this.

"We support the introduction of the term ‘end of life plan’ as our consultation with RCGP members found that the word ‘pathway’ is misleading and has contributed to the negative publicity that the LCP has received.

"The added focus on personalised, holistic care – including the emphasis on shared decision making and on delivering care to patients away from hospitals and into communities where they need and want it most – is a positive step forward in providing excellent palliative care.

"However, it is important not to throw the baby out with the bathwater. We need to take what has been shown to work from the existing LCP and make sure that it is implemented consistently across the country to ensure that all patients receive high quality and compassionate end of life care."