Monday 31 December 2012

Liverpool Care Pathway – nine points for the government to consider in its review

Secretary of State for Health, Jeremy Hunt (pictured), yesterday hailed the controversial Liverpool Care Pathway (LCP) for patients who are dying as ‘a fantastic step forward’ in the way hospitals support the terminally ill.

I agree that the LCP is a useful clinical tool that has helped many thousands of people experience better care in the last hours or days of life, but like any tool it must be used with the proper indications and by properly trained staff.

Every airline accident should make our next air trip safer; in the same way every abuse or misuse of the LCP should mean that the same mistake never occurs again.

CMF has recently called on the government to consider nine key points in its recently announced review of the LCP which is currently used with around 130,000 people a year, about a third of annual deaths in the UK.

To iron out the abuses that have been reported, several key measures need to be implemented:

1.It should be made absolutely clear that no one who is not imminently dying within hours, or at most two or three days, should be placed on the LCP and anyone placed on it who shows improvement should be taken off it. These assessments should be made by senior clinicians.

2.No one should be placed on the LCP without it being discussed with the relative or carer (although the latter do not need to give consent).

3.Every patient placed on the LCP must be regularly monitored and reassessed by a multidisciplinary team.

4.The present documentation is far too complex and needs to be simplified and standardised so that those implementing it can easily follow the guidelines and supervisors can easily tell what is going on with each patient.

5.Training and supervision of those using the pathway needs to be standardised and improved and formal training should be required before any healthcare professional is able to use it.

6.An annual audit needs to be carried out and all suboptimal use identified promptly acted upon.

7.Non-clinical priorities in the use of the pathway, especially financial priorities, must be eradicated and every patient treated solely according to their need. In this connection it would be far better to link CQUIN payments to staff training in the use of the pathway rather than numbers of patients placed on the pathway.

8.Communication to relatives both by health professionals and organisations involved in LCP implementation needs to be substantially improved.

9.Those misusing the LCP should be quickly identified and in the case of abuse reported to the appropriate authorities (General Medical Council, Nurses and Midwifery Council or Health and Care Professions Council).

Writing in a recent review for CMF’s journal Triple Helix, Dr Jeff Stephenson, a Devon-based consultant in palliative care has said:

‘The LCP represents a pragmatic and effective response to some of the suffering experienced by many in the last days of life. It remains, however, a tool and it is only as good as those who use it. There is always potential for misuse and abuse and there are undoubtedly instances where this occurs. Where these arise by intention then those involved should be held to account, but more often they occur through poor understanding and inadequate training. We owe it to patients to not only furnish the means to better care, but also to equip adequately those who provide it.’

Stephenson’s whole article is well worthy of study.


  1. Finally some sense from one who knows. I just hope when i am at the end of my life some one lets nature take its course and i am given the drugs needed to make me more comfortable in those last stages

    1. Me too...but some of us have had relatives who were not 'terminally ill' murdered Anonymous....the drugs used are lower in dose than those which killed the Gosport War Memorial Victims...none of whom were remotely 'end of life',and the morphine doses in 'just in case' boxes are in excess fo the lethal dose in Howard Shipmans naxolone, and administered in combination with CNS depressantes with no ABGs and no ventilation assistance....fairly obvious why that is....even ruddy hospital cleaners know what goes on...

  2. Good article. Sadly taken by the Daily Mail and twisted in to a horrid headline:

    1. See my response to Daily Mail article here -


  3. This morning on radio 5 live David Cameron gave an endorsement of the Marie Curie Foundation as giving excellent care of the dying.Jeremy Hunt has already given his endorsement of the LCP. All this before an independent inquiry has taken place. Do I smell a rat? You bet I do.

  4. A good way of covering up past neglect by the Hospitals as I think was the case with my late wife.
    And a nice little earner for the hospital involved.
    I hope some day the medical world treats these people that we love with such disregard get the same treatment and suffer the same neglect.
    Shame on the lot of you that let this happen.


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