Liverpool Care Pathway – reaction from the UK palliative care sector

Categories: In The Media.

Professor John Ellershaw, director of the Marie Curie Palliative Care Institute Liverpool which has overseen the development and dissemination of the LCP, said: “This is an historic moment when patients not only deserve but now demand the very best in care when they or their loved ones are dying.”

Going onto explain the purpose of the LCP, Prof Ellershaw said: “Before the Liverpool Care Pathway, poor care and suffering was the norm for patients dying in hospitals, with ad hoc guidance and support for clinical teams to care for dying patients. The LCP has helped transform care for dying patients.”

Many other organisations have shown support for the LCP and its underlying principles, while recognising that poor examples of care mean that improvements need to be made.

Prof Ellershaw said: “It is clear that there are still too many examples of poor care for dying patients in our hospitals. Each incident of poor care is a failure that we must learn from and it is clear that those failures, whether related directly to the LCP or to poor care generally, must be prevented. It is also clear that the name Liverpool Care Pathway can now sometimes be a barrier to communication and good clinical care. We hope that care for dying patients will now receive the priority it deserves both in health policy and within all hospital trusts.”

Following the review’s recommendations, the government plans to replace the LCP with a personalised end of life care plan for each patient, backed up by condition-specific good practice guidance, agreed with a named senior clinician.

Dr Heather Richardson, national clinical lead at Help the Hospices, highlighted concerns around the transition period: “We understand why the LCP is being phased out. However, we have concerns that this risks leaving a void in terms of how patients facing the end of life are cared for. We hope the transition to personalised care plans will be managed carefully and swiftly.”

Sue Ryder are also cautious about what comes next: “Whilst we welcome individual care plans … there needs to be a national position on what good end of life care looks like as a replacement for the LCP. Guidance can underpin this. However our report ‘Ways and means’ showed how there have been many frameworks around end of life care but that it is the poor implementation that has failed to improve standards adequately. A plethora of guidance may be problematic and as the review showed the existing General Medical Council guidance for doctors was not always followed.”

Those working in specialist palliative care have shown eagerness to help share their specialist knowledge.

Dr David Brooks, President of the Association for Palliative Medicine, said the APM’s 1000-strong membership of doctors are both well-placed and eager to help trusts, commissioners and practices respond to the challenges laid out in the report. He said: “Palliative physicians have the expertise and experience to advise and assist in the development of the guidance called for in the report. They can also provide the required training and support to implement it, as well as supply a vital resource directly caring for those patients with a complexity of need beyond the scope of the frontline teams.”

Dr Richardson, at Help the Hospices, commented on the part that hospices can play: “Hospices are at the forefront of moves to improve care for patients in other settings, particularly hospitals and have a huge contribution to make to help radically improve standards across the healthcare sector. The review must lead to stronger partnerships between hospitals and hospices to deliver high quality, dignified care for more people.”

Experts at King’s College London’s Cicely Saunders Institute have have welcomed the review, and emphasised the importance of using evidence to supports best practice. Dr Richard Harding said: “We believe that robust research must underpin any new methods, combined with an intensive programme to strengthen training and education in specialist palliative care for healthcare professionals.” They have also produced a podcast in which they discuss some of the key issues affecting end of life and palliative care.

SCIE’s chief executive, Andrea Sutcliffe, said: “It is sad that the good intentions of the Liverpool Care Pathway were undermined by its implementation in some places. But let’s use this as an opportunity to improve the care we provide at this most difficult time in people’s lives.”

Commenting on the recommendation that a system-wide approach was needed to improve end of life care, she said: “I hope in its response that the government will ensure social care is included within this system-wide approach. Care services deliver essential support to people dying in hospital, residential services, and in their own homes.”

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