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Government launches independent review into use of Liverpool Care Pathway



The Government has launched an independent review into the use of a major palliative care pathway, after allegations patients were being put on it without their consent or their families’ knowledge.

Health minister Norman Lamb called for an overarching independent review after a roundtable debate with medical experts and critics of the Liverpool Care Pathway.

The independent review will bring together the findings of three ongoing reviews which have already begun – by the Association of Palliative Medicine, by Dying Matters and by the NHS end-of-life care team.

Mr Lamb said that there had been ‘too many cases where patients were put on the pathway without a proper explanation or their families being involved. This is simply unacceptable.’

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.

But it has been the focus of numerous media stories claiming elderly patients have 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.

There has also been controversy over the incentives paid to hospitals to put patients on the LCP.

Mr Lamb said that the review would be published early next year and it would also ‘consider the value of locally set incentives, and whether they are leading to bad decisions or practice.’

‘It is vitally important that everyone can be confident in the findings of this work – and that we learn lessons where they are needed, so we can ensure that end of life care is as good as it can be.’

But Dr Petula Chatterjee, cancer and end-of-life care lead at NHS Manchester and South Manchester CCG, told Pulse that in itself the LCP was a ‘useful guide to clinicians supporting patients at the end of life.’

‘The problem has come in the way that it has been interpreted.  I know that some people have interpreted it as meaning denying food and water. 

‘Common sense must prevail and patients should only be put on the LCP by those who have been trained to use it properly,’ she said.

She said that she hoped the review would highlight where there needed to be additional training of staff to use the LCP appropriately.

Dr Chatterjee also said that it was important that medical professionals explained clearly to relatives and families why patients has been put on the LCP ‘to avoid any issues’.

What is the LCP ?

·        Aims to improve the quality of care in last hours/days of life

·        Should only be implemented after a multidiscplinary team assessment of the condition of the patient

·        Includes an assessment of pain, any distress, and any urinary or bowel problems

·        Does not preclude nutrition, hydration or antibiotics

 

Source : Marie Curie Palliative Care Institute, December 2009

http://www.mcpcil.org.uk/media/livacuk/mcpcil/migrated-files/liverpool-care-pathway/updatedlcppdfs/LCP_V12_Core_Documentation_FINAL_%28Example%29.pdf