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What is the Liverpool care pathway and what went wrong? What is the Liverpool care pathway and what went wrong?
(2 months later)
What is the Liverpool care pathway?What is the Liverpool care pathway?
It is a set of guidelines originally developed by the Royal Liverpool university hospital and the Marie Curie hospice in Liverpool. The idea was to help hospital staff give people who are dying the same sort of high-quality care that terminal cancer patients get in a hospice.It is a set of guidelines originally developed by the Royal Liverpool university hospital and the Marie Curie hospice in Liverpool. The idea was to help hospital staff give people who are dying the same sort of high-quality care that terminal cancer patients get in a hospice.
What went wrong?What went wrong?
In some hospitals patients on the LCP have had wonderful care in their last weeks and days, but in others some of the staff have misunderstood the guidance. Training has been inadequate. There have also been some shocking stories about lack of compassion on the part of nursing staff. Busy hospitals have focused on treating patients who should recover at the expense of helping those who will not experience a good death.In some hospitals patients on the LCP have had wonderful care in their last weeks and days, but in others some of the staff have misunderstood the guidance. Training has been inadequate. There have also been some shocking stories about lack of compassion on the part of nursing staff. Busy hospitals have focused on treating patients who should recover at the expense of helping those who will not experience a good death.
Why were patients denied food and drink and put on strong painkilling drugs that made them unable to communicate with their families?Why were patients denied food and drink and put on strong painkilling drugs that made them unable to communicate with their families?
Some hospital staff wrongly thought patients might inhale fluids and choke. Others wrongly thought it was standard practice to withhold fluids and nutrition on the pathway. Some patients were put on syringe drivers to deliver constant pain relief even though they did not need it.Some hospital staff wrongly thought patients might inhale fluids and choke. Others wrongly thought it was standard practice to withhold fluids and nutrition on the pathway. Some patients were put on syringe drivers to deliver constant pain relief even though they did not need it.
Is it true that incentives were paid to put people in the pathway?Is it true that incentives were paid to put people in the pathway?
Hospitals were offered financial incentives to use the LCP, as a way of encouraging them to treat dying patients in accordance with best practice. But this has been interpreted by some families, distressed at the treatment or neglect their relative suffered, as a bonus for dispatching frail and elderly patients more quickly.Hospitals were offered financial incentives to use the LCP, as a way of encouraging them to treat dying patients in accordance with best practice. But this has been interpreted by some families, distressed at the treatment or neglect their relative suffered, as a bonus for dispatching frail and elderly patients more quickly.
What will happen if the pathway is withdrawn? How will my elderly relative be treated in her last days of life?What will happen if the pathway is withdrawn? How will my elderly relative be treated in her last days of life?
They should get the same care they should have received under the pathway, but once the LCP is phased out (within six to 12 months) they and the family should be involved, with hospital staff, in drawing up an individual end-of-life plan. They should be given nutrition and fluids for as long as they want and made comfortable. If they are in pain or very anxious, they will be offered drugs, but if it is agreed that life is nearly at an end there will no attempt to offer further treatment.They should get the same care they should have received under the pathway, but once the LCP is phased out (within six to 12 months) they and the family should be involved, with hospital staff, in drawing up an individual end-of-life plan. They should be given nutrition and fluids for as long as they want and made comfortable. If they are in pain or very anxious, they will be offered drugs, but if it is agreed that life is nearly at an end there will no attempt to offer further treatment.
How can we be sure that people who are dying will be better treated in future?How can we be sure that people who are dying will be better treated in future?
The Neuberger review of the pathway wants the General Medical Council and the Nursing and Midwifery Council, which regulate doctors and nurses, to get together with NHS England, the Care Quality Commission and others to ensure end-of-life care becomes part of the "core business" of the NHS. Hospitals should be inspected and held to account over the way they treat the dying, it says.The Neuberger review of the pathway wants the General Medical Council and the Nursing and Midwifery Council, which regulate doctors and nurses, to get together with NHS England, the Care Quality Commission and others to ensure end-of-life care becomes part of the "core business" of the NHS. Hospitals should be inspected and held to account over the way they treat the dying, it says.
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