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

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The Independent Online

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.