Controversial care plan 'still in use' despite NHS decision to scrap it, expert claims

An article for the Nursing Times said health professionals were still using it because they had 'nowhere to turn'

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Some doctors and nurses are still using the Liverpool Care Pathway (LCP) for dying patients, an expert has claimed, despite an NHS decision to scrap the controversial care plan.

A major review recommended last year that the LCP should be phased out, following widespread criticism from the media and some patients.

The care plan, which gives doctors and nurses guidance on the management of terminally ill patients, was dubbed a “death pathway” amid allegations that patients were being placed on it without their families being told.

The Neuberger review said it should be abolished after finding many examples of poor implementation of the LCP’s guidance. 

However, Dr Anthony Wrigley, a senior lecturer and specialist in medical ethics and palliative care at Keele University, said he was aware “certain institutions have gone back to relying on it”.

The LCP, which was developed by experts at the Royal Liverpool University Hospitalin the 1990s, in collaboration with the Marie Curie Palliative Care Institute, represented “probably the best guidance in the world”, Dr Wrigley said, but added that professionals would be reluctant to admit they were still using it because of its tarnished reputation.

In an article for the Nursing Times he said health professionals were still using it because they had “nowhere to turn”.

“Practitioners have indicated you do need some kind of hook upon which to hang your approach to end of life care, and the LCP did give you that,” he said.

The LCP included guidance on which medications would and wouldn’t be helpful, on keeping patients as comfortable as possible, and on whether fluids should be given when a person has stopped being able to eat or drink. There have been allegations that some patients on the LCP were denied food unnecessarily.

An NHS England spokesperson said that it stood by the recommendations of the Neuberger review.

“We would not support the use of it but it is for the regulators and for professional bodies to look into this,” a spokesperson said.

In June a group of leading nursing and end-of-life care organisations – the Leadership Alliance for Care of the Dying – proposed new guidelines, which placed greater emphasis on individual care plans.

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