Liverpool Care Pathway scrapped in end-of-life care overhaul

The Liverpool Care Pathway (LCP) will be phased out as part of an overhaul of end-of-life care designed to end undignified treatment of dying people and their families.

The government announced the demise of the LCP after an independent review, published today, found “repeated instances of patients dying on the LCP being treated with less than the respect that they deserve”.

More broadly, the government-commissioned review urged significant improvements in end-of-life care, particularly in hospitals, after finding a lack of compassion, staff skills and person-centred care in the support offered by some acute trusts.

About the Liverpool Care Pathway

The LCP was developed by the Marie Curie Palliative Care Institute Liverpool to support people in the last days or hours of life in any setting, by ensuring emotional and social needs were met, alongside physical ones. It includes prompts for staff to consider whether treatments or medications are conferring benefit and whether they should be continued or not.

However, it has recently been subject to substantial media criticism, based on concerns that the use of the LCP had hastened people’s deaths through the over-prescription of painkillers or the withdrawal of hydration or nutrition, prompting the government to commission the review.

The review found that the when used properly, the LCP provides patients with a peaceful and dignified death. However, review chair and crossbench peer Baroness Neuberger said: “Evidence given to the review has revealed too many serious cases of unacceptable care where the LCP has been incorrectly implemented.
Examples include leaving patients without adequate nutrition, hydration and inappropriately sedated. This is not only awful for the patients, but it is deeply
distressing to their relatives and carers.”

Poor communication with carers

Many of the criticisms of the LCP were the result of poor communication between clinicians and family members. It heard many reports of treatment decisions being made without relatives being informed, of family members not being told that their loved-one was dying, compounding the distress caused by their subsequent death, and of doctors communicating information hurriedly and inappropriately.

The review also concluded that the LCP was too generic to meet the needs of certain people, and that using the term “care pathway” in relation to people who were dying was inappropriate. It recommended that the term be dropped and all people given personalised end-of-life care plans instead, a recommendation the government has accepted.

The review found the problems with the LCP reflected wider issues with end-of-life care and called for a “system-wide approach to improving the quality of care for the dying”. While most acute trusts had a palliative care team, these were often small, played only an advisory role and were not accessible at evenings or weekends.

Clinicians were “sometimes particularly poor” at discussing death with patients and relatives, with some seeing such communication as “time-consuming”; more broadly, medical training in palliative care was “neither consistent nor adequate across the board”.

Recommendations

It also recommended that:

• Funding should be made available to enable palliative care teams to be accessible round-the-clock, in hospitals or the community;
• Good practice guides should be developed for hospital staff on end-of-life care, with technical guidance for specific medical conditions;
• The Care Quality Commission should carry out a thematic review of care for the dying within the next 12 months;

As well as agreeing to phase out the LCP and provide personalised end-of-life care plans for people who are dying, the government also said the CQC thematic review would go ahead. It also said that relatives could have an independent assessment of the end-of-life care of their loved-ones carried out if they had concerns.

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