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Controversial end of life pathway dropped

Government announces that Liverpool Care Pathway will be replaced by individualised care plans

Ingrid Torjesen

Monday, 15 July 2013

The Liverpool Care Pathway, which has been much criticised by the press, is to be replaced and senior clinicians will have to sign off all end of life care plans, the Department of Heath says in its initial response to the findings of an Independent Review of end of life care.

The Review, headed by Baroness Julia Neuberger, was established by Care and Support Minister Norman Lamb because of concerns raised by patients, families, carers and some clinicians that the system for providing care in the last days of life was flawed.

The Review, published today, found that in the right hands and when operated by well-trained, well-resourced and sensitive clinical teams the Liverpool Care Pathway does help patients have a dignified and pain-free death. But it also found many cases of poor practice and poor quality care, where the individual, families and carers were not properly engaged. Because of these instances, the Review has recommended that the pathway should be phased out.

In its initial response to the review, the Department of Health says that all NHS hospitals should immediately undertake clinical reviews of all care given to dying patients. Led by senior clinicians, these reviews will ensure the care all patients are receiving is appropriate. It adds that all NHS hospitals should ensure that arrangements are put in place as soon as possible so that every patient has a named senior clinician responsible for their care in their final hours and days of life.

Local financial incentives offered by clinical commissioning groups for hospitals to promote a certain type of care for dying patients, including the Liverpool Care Pathway, were criticised and the Department of Health ordered that they end immediately. The Liverpool Care Pathway will be phased out over the next 6-12 months and replaced with an individual approach to end of life care for each patient, which will include a personalised end of life care plan backed up by condition-specific good practice guidance, agreed with a named senior clinician.

Finally the Care Quality Commission will conduct a review into end of life care. Anyone who has concerns about how a family member was treated at end of life will have access to an independent assessment of their case. All NHS hospitals will be expected to appoint a Board member with responsibility for overseeing any complaints about end of life care and for reviewing how end of life care is provided. Families who have previously made complaints about care received on the Liverpool Care Pathway will have the opportunity to have their case reviewed.

Care and Support Minister Norman Lamb said: "I have personally heard families describe staff slavishly following a process without care or compassion and leaving people suffering at the end of their lives. This is something we cannot allow to go on.

“People’s final days should be as comfortable and dignified as possible. That is why there is a place for thoughtful and careful end of life care that involves patients and their families, but it is clear what we have now needs to be replaced so we can create a better way of doing this.”

Mr Lamb has written to the General Medical Council and the Nursing and Midwifery Council to highlight the need for effective guidance on supporting nutrition, hydration and sedation for the dying, and also to stress the importance of professional regulation issues raised by the report.

Dr Clare Gerada, chair of the Royal College of GPs, said: “The College has always supported the principles behind the Liverpool Care Pathway as a useful, evidence-based framework to support the delivery of excellent care to patients in the last days and hours of their lives. However, we have expressed concern about the implementation of the Liverpool Care Pathway and so welcome many of Baroness Neuberger's recommendations to address this.”

"GPs have a vital role in caring for patients reaching the end of their lives and we are committed to engaging with commissioners and other partners to understand the proposals for a named GP to take overall responsibility for patients who are dying in the community, and to consider what this would mean in practice and how it could be delivered.”

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