The Liverpool Care Pathway (LCP)

This week I plan write about the LCP, something which has featured in the news in recent weeks. Its aim is to provide a sustained quality of care amongst all patients in their last hours/days of life to ensure a peaceful and comfortable death.

It is described as the “best practice model for care of the dying” and can be used to support patients in care homes and their own homes as well as hospitals.

So, why was it introduced? In the 1990s end-of-life care was somewhat “patchy” for example some hospitals provided excellent care whilst others did not meet the same standards. Areas of particular concern were that firstly patients were often subject to invasive testing/treatment that offered no chance of preventing death and secondly that the patient was caused unnecessary pain and suffering by needlessly prolonging life.

Information regarding the pathway on the Marie Curie Palliative Care Institute website is split up into three main areas…

1.      Medication/treatment review.

Any medication that is not helpful at this time may be stopped. In addition it may not be appropriate to continue some tests at this time, for example blood tests, blood pressure and temperature monitoring.

Finally patient comfort must be considered, monitoring bed position to prevent bed sores, the potential use of a special mattress and regular mouth care.

2.      The diminished need for food and drink.

Such a need could be a physical sign that their condition is not going to improve. The patient may neither want nor need food/drink and decisions about the use of artificial fluids should be made in the patient’s best interests.

3.      Religious/spiritual needs.

Discussion with the relative and where possible the patient to ensure that the desires at the time of or after death are met.

The pathway has featured in the news throughout November, it has faced criticism and scrutiny from many newspapers. For some its use has become controversial, with relatives reportedly claiming it has been used without consent and others have reported it being used inappropriately to meet targets.

However the LCP has been standard practice for a number of years now, so whilst there have been recent allegations of individual failings within the procedure (mainly due to lack of communication between those involved), the model of care itself appears to be both appropriate and humane.

As a result of the recent accusations Care and Support Minister Norman Lamb said he would appoint an independent chair to report on the issue. He said,

"It is clear that everyone wants their loved ones' final hours of life to be as pain free and dignified as possible, and the Liverpool Care Pathway is an important part of achieving this aim. However, as we have seen, there have been too many cases where patients were put on the pathway without a proper explanation or their families being involved. This is simply unacceptable.”

"Today I have committed to appoint an independent chair to review how end-of-life care is working and oversee the reviews into the LCP. This will report back to me in the new year." (Source: BBC News)