Review of Liverpool Care Pathway outlined

The review looking at how the Liverpool Care Pathway (LCP) is being used in practice is to be chaired by crossbench peer Baroness Julia Neuberger.

Baroness Neuberger, who is Senior Rabbi at the West London Synagogue and former Chief Executive of the King’s Fund, will oversee the review, which will examine various elements of the LCP, including:

the experience and opinions of patients and families
the experience and opinions of health professionals
hospital complaints
local payments made to hospitals in respect of the LCP
the literature about benefits and limitations of the Liverpool Care Pathway.

Following this work, the review will make recommendations about what, if any, changes are needed to improve care, to ensure that patients are always treated with dignity and that, wherever possible, they are involved in decisions about their care, and that carers and families are always involved in the decision-making process.

Care and Support Minister Norman Lamb said:

“Everyone wants their loved ones’ final hours to be as pain free and dignified as possible.

“Experts agree the Liverpool Care Pathway, if applied properly, can play a vital role in achieving this aim, but, as we have seen, there have been too many cases where patients or their families were ignored or not properly involved in decisions. This is simply unacceptable.

“I have also been extremely concerned about what loved ones have said regarding the withdrawal of food and fluids. It is so important for relatives to have complete confidence in the care that a loved one is receiving.

“I am delighted that Baroness Neuberger has agreed to chair the Review. End of life is a culturally, medically and spiritually sensitive area and her unique knowledge and experience make her the ideal person to lead this work.”

Baroness Neuberger said:

“I am happy to accept the challenge that the Minister has offered me. How we care for people at the end of their lives is a reflection of our society’s values and civilisation. At its best, Britain leads the world in end-of-life care, but it is not always prefect, and we need to work hard to get it right for everyone, providing the personal care individuals and their families both want and need.”

Baroness Neuberger will be inviting a small panel of independent experts to support the work of the review. It will hold a number of evidence sessions, invite written submissions, as well as host a session dedicated exclusively to hearing personal stories from families. It will report to ministers and to the NHS Commissioning Board in the summer.

The contact address for the review is LiverpoolCarePathwayReview@dh.gsi.gov.uk

Terms of reference

The Liverpool Care Pathway for Dying Patients (LCP) is internationally recognised as best practice in care in the final days and hours of life, and is recommended in the department’s End of Life Care Strategy. However, over recent weeks and months the LCP has been subjected to repeated media attacks, quoting poor care for people at the end of life and making a number of serious accusations about the pathway and its implementation.

Accusations include that:

it is a form of euthanasia
it is a pathway to death and a self-fulfilling prophecy
it deprives people of food and fluids
it sedates people into unconsciousness
it hastens death because the average length of time on it is 29 hours
people linger in misery for weeks on the LCP because food and fluids have been withdrawn
doctors select people to be killed on the LCP without telling them or their relatives
it is used to clear beds and save money
hospitals are bribed to use it.

The LCP is clear about the importance of communication. It is designed to support professionals, who may not be palliative care specialists, to provide personalised, hospice style-care. It encourages staff to anticipate the treatment an individual may need, and to be ready to provide it swiftly, but it does not dictate the treatment anyone should receive. The issue is therefore not about the merits of the LCP itself, but about how it is being used. This reporting suggests that it is not always being used as intended. In order to restore confidence in NHS care – and in particular, hospital care – of dying people, this review focus on how the LCP is being used by professionals and how it is experienced by patients and families. The focus will be on the use of the LCP model rather than on re-evaluating the model itself.

The review will:

examine systematically the experience of patients and families of the use of the Liverpool Care Pathway
examine the experience and opinions of health professionals about the use of the Liverpool Care Pathway
examine hospital complaints about end of life care and in particular those about the Liverpool Care Pathway
review the literature about the Liverpool Care Pathway in practice;
consider the role of financial incentives in this area
make recommendations about what steps can be taken to:
- improve care
- ensure that patients are always treated with dignity and are involved in decisions about their care wherever possible
- ensure that carers and families are always properly involved in the decision-making process
- restore public confidence.