This report sets out recommendations regarding the Liverpool Care Pathway and end of life care following an independent review of the LCP.
The recommendations include: phasing out the LCP and replacing it with an individual end of life care plan a general principle that a patient should only be placed on the LCP or a similar approach by a senior responsible clinician in consultation with the healthcare team unless there is a very good reason, a decision to withdraw or not to start a life-prolonging treatment should not be taken during any ‘out of hours’ period an urgent call for the Nursing and Midwifery Council to issue guidance on end of life care an end to incentive payments for use of the LCP and similar approaches a new system-wide approach to improving the quality of care for the dying.
The LCP was put into put in practice to insure the right palliative care for end of life for the service and family’s, The Liverpool Care Pathway for the Dying Patient (LCP) is a UK care pathway covering palliative care options for patients in the final days or hours of life. It was developed to help doctors and nurses provide quality end-of-life care.
The Liverpool Care Pathway was developed by Royal Liverpool University Hospital and Liverpool's Marie Curie Hospice in the late 1990s for the care of terminally ill cancer patients. Since then the scope of the LCP has been extended to include all patients deemed dying.
While initial reception was positive, it was heavily criticised in the media in 2009 and 2012.
In 2012, it was revealed that just over half of the total of NHS trusts had received or were due to receive financial rewards to hit targets associated with the use of the care pathway. These payments are made under a system known as “Commissioning for Quality and Innovation” (CQUIN), with local NHS commissioners paying trusts for meeting targets to “reward excellence” in care.
In July 2013, the Department of Health released a statement which stated the use of the LCP should be "phased out over the next 6-12 months and replaced with an individual approach to end of life care for each patient".
The pathway was developed to aid members of a multi-disciplinary team in matters relating to continuing medical treatment, discontinuation of treatment and comfort measures during the last days and hours of a patient's life. The Liverpool Care Pathway is organized into sections ensuring that evaluation and care is continuous and consistent.
It was not intended to replace the skill and expertise of health professionals.
In the first stage of the pathway a multi-professional team caring for the patient is supposed to agree that all reversible causes for the patient's conditions have been considered and that the patient is in fact 'dying'. The assessment then makes suggestions for what palliative care options to consider and whether non-essential treatments and medications should be discontinued.
In practice, the implementation of this guideline was found to be lacking. Many decisions are taken in ward settings without the oversight of an experienced doctor of medicine. In almost half of the cases neither patients nor family were informed or consulted that it was decided to place the patient on the LCP.
The programme suggests the provision of treatments to manage pain, agitation, respiratory tract secretions, nausea and vomiting, or shortness of breath (dyspnoea) that the patient may experience.
The care was not designed to be a one-way street to death. However in 2012 controversy arose indicating that in most cases it was, and even patients that might have survived longer otherwise died because of the LCP. In a response to negative media report claiming that the pathway was reversible, and stating that' approximately 3% of patients initially put on the pathway are removed from the pathway when reassessed' - although no source was cited for this figure.
Initial assessments of