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Liverpool Care Pathway to be 'phased out' within a year

The DH is expected to announce the phasing out of the Liverpool Care Pathway within a year later today, but GP leaders have said they expect it to be replaced with similar end-of-life guidance, calling into question the Government’s motives for removing the LCP.

The independent review into the pathway, led by former Kings Fund chief-executive Baroness Julie Neuberger, will recommend that it should be phased out within six to 12 months and replaced, the DH said.

The review team, which heard evidence from patients, families and health professionals encountered ‘numerous examples of poor implementation and worrying standards in care’, the report is expected to say at its launch at a King’s Fund event later this morning.

GP leaders said guidance that replaces it is likely to be very similar, just with another name.They suggested that the need for a review was driven by ‘certain sections of the lay media’ as the LCP represents good clinical practice.

The DH gave no indication of what would replace the LCP, though there is speculation that it would mean a move towards individual care plans for patients rather than a national framework.

The DH told the BBC: ‘The independent review into end of life care system the Liverpool Care Pathway, commissioned last year by Care and Support Minister Norman Lamb and backed by Health Secretary Jeremy Hunt, is likely to recommend that the LCP is phased out over the next six to 12 months.’

The DH said it will also tell hospitals to refer doctors to the GMC if they find procedures have been abused.

The LCP is recommended by NICE and the Department of Health as the best practice model for end-of-life care, and it is designed to improve the care of the patient in the last hours or days of life.

Baroness Neuberger’s review was set up by the DH last year, amid media reports that elderly patients had been refused food and water to speed up death and that neither they, nor relatives have been told doctors consider their case to be terminal. Trusts were accused of being incentivised to put elderly patients on the pathway to cut costs.

GPs have remained in favour of the care pathway but the RCGP found they were less likely to put people on the LCP because of the adverse publicity. A Pulse survey earlier this year revealed that one in five GPs had reported an increase in patients’ concerns about the care pathway.

The BMA’s Annual Representatives Meeting even called for the LCP to be put on medical schools’ curriculums.

GPC deputy chair Dr Richard Vautrey said the LCP had made ‘significant improvements’ in the way people are dealt with, and that the decision to phase out the pathway was not based on clinical evidence

He said: ‘This yet again seems to be policy driven by certain sections of the lay media rather than any real clinical evidence. People want the fear taking out of death, and to know they will be cared for and supported when that time comes.

‘The LCP has helped to make significant improvements in the way people are dealt with at what can often be a very difficult time. I suspect that any guidance that replaces the LCP may look very similar but just with a different name, as the guidance is simply good clinical practice and what most of us would want for ourselves as we approach our final hours.’

RCGP chair Professor Clare Gerada agreed that the benefits of the LCP should not be overshadowed by its failings, but said she was pleased improvements were being made.

She said: ‘I am pleased that improvements are being made to the LCP and that these include a change of name from pathway to plan and the emphasis patient centred care. It’s important that we don’t ignore that the LCP delivered excellent care to patients when they most needed and that it’s failings do not over shadow the benefits it delivered.’

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Readers' comments (12)

  • Yes, we should change this immediately to something else. Could I suggest the "Living Care Protocol" which will be vastly different and not just a rebranding exercise.

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  • Whatever it is replaced with MUST be a lot lighter on paperwork.
    Spending an hour filling in forms for a terminally ill patient takes away from the patient's care.

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  • Surely well trained doctors, palliative care physcians and support from macmilan and hospice at home, etc are what is needed to ensure a good death, rather than a 'pathway'. In other words, education and training should be emphasised over and above protocols.

    Do we therefore need any sort of pathway at all?

    Admittedly, I write from a community rather than a hospital focus.

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  • Daily Mail wailing Banshees now dictating medical care perhaps it is time for The Daily mail to be registered with the GMC.

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  • It's probably not needed in the hands of an experienced clinician who knows the patient well.

    As the service is becoming increasingly fragmented & 24/7 work (despite the sound bites from Mr Hunt), it becomes less and less likely the patient can be managed by the said doctor. So a framework will be needed.

    Also, most of us start off as inexperienced clinician without in depth knowledge of the patient or the end of life care, so again it would be useful for some

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  • No nurse would unwittingly deny a dying patient food and water - they probably don't have the time due to lack of staff. Why don't the relatives provide the food and water instead of slagging off the NHS?

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  • Some people want non-oral fluids - rectal, sub-cutaneous, gastric tube when people who are dying are not able to drink. Relatives cannot do this - it is then part of medical care.

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  • When someone is dying, without the hope of recovery, and unable to drink, then without medical intervention life will end, nature not medical neglect. When I was a medical student the adage 'better die dry' was used, instead of letting patients drown in their own secretions- that is horrid to see.
    12 months is not long enough to produce new evidence on the best way to treat a dying patient. Reactionary tampering with an appeasing politically driven outcome works with the health service to make it better all the time, doesn't it?
    I've only seen improvement in terminal care in my community.

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  • Why dont we just let the politicians and the Daily Mail run the NHS?....or hang on...THEY ALREADY DO....

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  • Vinci Ho

    Please read Steve Nowottny 's editor blog

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