Liverpool Care Pathway

Ucwpixnfortunately it is going to happen to all of us… no matter how much we ignore it and try to distance ourselves from reality… the cold stark fact of it is this.. each and every one of us one day is going to die.

Some people are frightened of dying.. maybe because they are uncertain of the unknown or simply because they fear dying in pain and in a distressing and disturbing manner. 

Now I don’t know about you, but when we fear and start to worry about dying we stop living a full life.

According to reports out due to a review of the Liverpool Care Pathway ministers are expected to announce that the Liverpool Care Pathway scheme will be axed.

The Guardian reports the following:

The government-commissioned review, headed by Lady Neuberger, found it was not the pathway itself but poor training and sometimes a lack of compassion on the part of nursing staff that was to blame, while junior doctors were expected to make life-and-death decisions beyond their competence after hours and at weekends. The review says individualised end-of-life care plans must be drawn up for every patient nearing that stage.

“Caring for the dying must never again be practised as a tickbox exercise and each patient must be cared for according to their individual needs and preferences, with those of their relatives or carers being considered too,” said Neuberger. “Ultimately it is the way the LCP has been misused and misunderstood that had led to such great problems.”

She said it was too late to turn the clock back and salvage the LCP, which was devised to try to extend the positive experiences of dying hospice patients into the hospital setting. But in replacing it, the NHS must make care of the dying part of its core business, she said.

“What we have also exposed in this review is a range of far wider, fundamental problems with care for the dying – a lack of care and compassion, unavailability of suitably trained staff, no access to proper palliative care advice outside of 9-5, Monday to Friday.”

The government confirmed it would phase out the LCP and said it would require all hospitals to review the care of dying patients. Every such patient should in future have a named senior doctor in charge of their care.

I totally agree there have been failings in the Liverpool Care Pathway as indicated in the review headed by Lady Neuberger.  But to scrap this and start again is fruitless to me.. If there are problems in the Liverpool Care Pathway, then it is best to tackle those problems head on.. and change the criteria and the care plan needed.  To me it seems as if the Government’s thinking in this is …. the Liverpool Care Pathway has a bad name.. so let’s scrap it and bring in something identical with a few changes and a new name.

Whatever you bring in.. unless the training is there for the medical staff and the communication skills between the patient, family and the medical staff are top notch, then nothing is going to change.  You can rebrand this scheme as many times as you like, but if you don’t tackle the failures head on then you are going to end up in years to come with another review, condemning the scheme that replaced the Liverpool Care Pathway.

Nobody wants to see a loved one die.  Nobody wants to sit around a bedside waiting for their loved one to die… and nobody wants to see their loved one die an agonising death. Being given the right to have a dignified and pain-free death is what each of us should have the right to.

Again this brings into the debate.. assisted suicide.  Shouldn’t we as part of the care plan, decide our own fate?  Shouldn’t we be allowed to say, I don’t want to go through all of that or I don’t want to put my family through that, can you please allow me to die by means of assisted suicide.

Personally, I am all for the Liverpool Care Pathway… I don’t want my family to have to sit there day after day, watching me deteriorate and die an agonising death.  I want a pain-free death even if it means I am sedated and put into coma.  I don’t want my death to by one of those where the family have to sit there for days on end, waiting for the inevitable to happen.

Apart from the Liverpool Care Pathway, there should also be the right to die.  A right that the patient has to end their life should they know that they are not going to recover…

I love my family like mad, but I don’t want them to have to live through days of agonising, whilst they watch me deteriorate..

One commentator on a Guardian article said this:

As a junior doctor working in the NHS, it is with great sadness that I read of the proposed end to the Liverpool care pathway (Report, 16 July). In the five years since I have been qualified, I have seen it used on numerous occasions to ensure that patients die peacefully and with dignity, pain-free and with their loved ones beside them. Not once I have I ever seen it used to hasten death or clear beds.

recent survey of doctors, including specialists in palliative care, showed that 90% would want to be cared for using this pathway and that 91% believed it to represent best care of the dying patient. Despite this, it seems that public scare-mongering has become malignant and the Liverpool care pathway (LCP) will now be entering its terminal phase. RIP LCP, you will be missed.
Dr Sonia Wolf

As you can see from the above comment even the Doctors and Specialists in palliative care believe the this is the best form of caring.. It must be otherwise 90% of them wouldn’t have voted to say that they would want to be cared for using the Liverpool Care Pathway.

From the same article another commentator said:

As a palliative care nurse in a hospice, I appreciate your article giving a more balanced view of the Liverpool care pathway. Hospices use the LCP, with individualised care plans built around the LCP framework, in which communication and openness with patients and relatives is paramount. What the article exposes are failings within the NHS to understand, implement and communicate the pathway. As a result of recent media coverage, it is clear that some people are associating this bad practice with all care establishments. This is certainly not the case in the hospice system. When the LCP is used in hospices, it is implemented with the full co-operation of patient and relatives who can see that it delivers good nursing care and a dignified death.
Sarah White
Welwyn Garden City, Hertfordshire

A hospice palliative care nurse has stated categorically that they use the same pathway and they provide individualised care plans around patients and relatives.  So if a hospice can run this sort of practice then perhaps it is time that their procedure was implemented across the NHS.

Another way of dealing with this.. would be to have hospices where people on the Liverpool Care Pathway are treated.. perhaps investment into rooms that are not like hospital wards and where hospices are given the funding to deal with not just terminal cancer patients but all people who are at the end of their life.

Perhaps hospices should be the way forward…

But no matter what they decide to bring in… unless the training is given and the procedures are laid down in black and white and are adhered too, nothing will change.   It will be just another scheme with another lot of failings.

And all these failings and their subsequent reviews, does nothing to help a family coming to terms with losing their loved ones and the manner in which their loved ones died.

When a relatives can feel that the level of care given to their dying loved one was exemplary, dignified and handled with compassion and empathy, that is when we know we have it right…

Until then we can only hope that whatever scheme is brought in, is a scheme that does give a dying person the dignified death they so deserve.


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