The Liverpool Care Pathway is dead, but we must still address how we care for the dying

It is now clear that the "one or two mistakes" were in fact overwhelming problems, but phasing out the LCP still leaves the problems it was created to resolve

Share
Related Topics

Just six months ago, health secretary Jeremy Hunt described the controversial Liverpool Care Pathway as a "fantastic step forward" and urged that "one or two mistakes" should not be allowed to discredit the end-of-life system.

In an interview with LBC radio in January he said: ‘I would be very sad if as a result of something that is a big step forward going wrong in one or two cases we discredited the concept that we need to do a lot better to give people dignity in their final hours because it’s something we haven’t done well. Lots of people don’t want to die with lots of tubes going in and out of their body – they actually want to die in a dignified way.’

Today, Care Services Minister Norman Lamb will confirm that the LCP is to be phased out within a year following a review he commissioned from Baroness Julia Neuberger which found that the "one or two mistakes" were in fact overwhelming problems. Yet phasing out the LCP does not address the fundamental problem that Mr Hunt alluded to - we need to do a lot better to give people dignity in their final hours.

The problems identified by the Neuberger review were not with the principle of the LCP - providing that dignity - but with its practice. Hospitals exist to heal patients - to make them better so that they can return to their families. Hospitals  are much less good at caring for dying patients - those who are not going to recover and need to be kept comfortable and pain free in their final hours. The last thing such patients need is aggressive treatment with toxic drugs, violent attempts at resuscitation or invasive surgery - yet many still receive it.

Death is a process, not an event and when this irreversible point has been reached  the role of medicine must be to assist nature, not fight against it. Patients refuse food and drink as part of this natural process as the body shuts down. The LCP has been accused of leading to the deliberate "starvation" of patients when its intention is to avoid the force feeding of them.

It is in its practice that the LCP has failed. Far too many patients in far too many hospitals were placed on the pathway without their knowledge or consent or, most importantly, that of their families who were then faced with witnessing their loved ones decline without understanding what was going on.

To add insult to injury, hospitals received financial incentives to place people on the pathway. Again the intention was good - to ensure as many dying patients as possible had a dignified death. But it led to allegations that they were being "bribed" to put patients to death and the Neuberger review rightly says this must be ended.

Good communication, and good training for staff, is vital in this delicate are of medicine. The Neuberger review recommends "individual end of life care plans." But this does not address the central difficulty with the LCP - our reluctance to discuss issues surrounding death. The LCP itself may now be dead - but a better way of caring for the dying, sensitively implemented, is still desperately needed.

Same-Sex Marriage

Buy the new Independent eBook - £1.99 A collection of reports published in The Independent over more than two decades, allowing you to retrace the challenges, setbacks and bold leaps forward on the long road to equality.

kobo Amazon Kindle

React Now

iJobs Job Widget
iJobs General

Year 1 Teacher

£90 - £160 per day: Randstad Education Group: A Primary School in Bradford are...

Commercial Lawyer – Renewable Energy

£28000 - £32000 Per Annum: The Green Recruitment Company: Job Title: Commercia...

Solar PV - Sales South

£30000 Per Annum Bonus + Car: The Green Recruitment Company: Job Title: Solar ...

Renewable Heating Sales Manager

£25000 Per Annum basic + car + commission: The Green Recruitment Company: The ...

Day In a Page

Read Next
Sports Direct employs 20,000 people, 90% of its workforce, on a 'casual' basis  

What's so terrible about Zero-hours contracts?

Paula Whelan
 

I won't let the trolls win with #TwitterSilence - they want us to shut up

Vicky Beeching
Special report: How my father's face turned up in Robert Capa's lost suitcase

Special report: How my father's face turned up in Robert Capa's lost suitcase

The great war photographer was not one person but two. Their pictures of Spain's civil war, lost for decades, tell a heroic tale
The unmade speech: An alternative draft of history

The unmade speech: An alternative draft of history

Someone, somewhere has to write speeches for world leaders to deliver in the event of disaster. They offer a chilling hint at what could have been
Funny business: Meet the women running comedy

Funny business: Meet the women running comedy

Think comedy’s a man's world? You must be stuck in the 1980s, says Holly Williams
Wilko Johnson: 'You have to live for the minute you're in'

Wilko Johnson: 'You have to live for the minute you're in'

The Dr Feelgood guitarist talks frankly about his terminal illness
Lure of the jingle: Entrepreneurs are giving vintage ice-cream vans a new lease of life

Lure of the jingle

Entrepreneurs are giving vintage ice-cream vans a new lease of life
Who stole the people's own culture?

DJ Taylor: Who stole the people's own culture?

True popular art drives up from the streets, but the commercial world wastes no time in cashing in
Guest List: The IoS Literary Editor suggests some books for your summer holiday

Guest List: IoS Literary Editor suggests some books for your summer holiday

Before you stuff your luggage with this year's Man Booker longlist titles, the case for some varied poolside reading alternatives
What if Edward Snowden had stayed to fight his corner?

Rupert Cornwell: What if Edward Snowden had stayed to fight his corner?

The CIA whistleblower struck a blow for us all, but his 1970s predecessor showed how to win
'A man walks into a bar': Comedian Seann Walsh on the dangers of mixing alcohol and stand-up

Comedian Seann Walsh on alcohol and stand-up

Comedy and booze go together, says Walsh. The trouble is stopping at just the one. So when do the hangovers stop being funny?
From Edinburgh to Hollywood (via the Home Counties): 10 comedic talents blowing up big

Edinburgh to Hollywood: 10 comedic talents blowing up big

Hugh Montgomery profiles the faces to watch, from the sitcom star to the surrealist
'Hello. I have cancer': When comedian Tig Notaro discovered she had a tumour she decided the show must go on

Comedian Tig Notaro: 'Hello. I have cancer'

When Notaro discovered she had a tumour she decided the show must go on
They think it's all ova: Bill Granger's Asia-influenced egg recipes

Bill Granger's Asia-influenced egg recipes

Our chef made his name cooking eggs, but he’s never stopped looking for new ways to serve them
The world wakes up to golf's female big hitters

The world wakes up to golf's female big hitters

With its own Tiger Woods - South Korea's Inbee Park - the women's game has a growing audience
10 athletes ready to take the world by storm in Moscow next week

10 athletes ready to take the world by storm in Moscow next week

Here are the potential stars of the World Championships which begin on Saturday
The Last Word: Luis Suarez and Gareth Bale's art of manipulation

The Last Word: Luis Suarez and Gareth Bale's art of manipulation

Briefings are off the record leading to transfer speculation which is merely a means to an end