The Liverpool Care Pathway (LCP), a technique used to alleviate suffering in the final stages of a person’s life, is to be phased out following a review that heard hospital staff wrongly interpreted its guidance, leading to claims of patients who were drugged and deprived of liquids.
The Government-commissioned review, led by Lady Julia Neuberger, called for an overhaul in end-of-life care, highlighting poor training and lack of compassion on the part of nursing staff. It warned that junior doctors were expected to make life-and-death decisions beyond their competence out-of-hours.
The review heard harrowing stories from families who had not been told their loved one was expected to die and, in some cases, were shouted at by nurses for attempting to give them a drink of water. It lambasted communication, which it said was very poor, while medical staff were accused of dodging painful discussions with patients and families.
Lady Neuberger said: “Caring for the dying must never again be practised as a tick-box exercise, and each patient must be cared for according to their individual needs and preferences.
“Ultimately it is the way the LCP has been misused and misunderstood that has led to such great problems, along with it being simply too generic in its approach for the needs of some. Sadly, it is just too late to turn the clock back to get it used properly by everybody. That is why we have recommended phasing out the LCP and replacing it with a more personalised and clinically sensitive approach.”
The scheme was originally used in hospices until approved by the Department of Health in 2006 – which led to its being used in hospitals. Concerns were raised in 2009 when experts warned that in some cases patients had been put on the scheme only to recover when their families intervened.
The review made 44 recommendations, including phasing out the LCP over six to 12 months, as individual care plans for the dying are introduced. Under the new guidance, only senior clinicians must make the decision to give end-of-life care, along with the healthcare team, and no decision must be taken out of hours without strong evidence.
A Department of Health spokesman said that the Government will consider the review’s findings and issue a formal response in the autumn.