The Liverpool Care Pathway (LCP) was developed in the 1990s in order to standardise the way in which patients are to be treated when close to death. The LCP is a scheme that intends to improve the quality of care in the final hours or days of a patient’s life to ensure a comfortable death. It aims to guide doctors, nurses and other healthcare workers who are caring for a dying patient on issues including patient comfort, whether artificial fluids should be given or stopped, or whether further medication is sensible.
Despite some recent criticism of the scheme, the LCP has been highlighted by doctors as being a best practice module both nationally and internationally. Indeed, The Health Secretary, Jeremy Hunt, has announced his wish for new NHS rules to include rights of treating clinicians to inform families and carers about the application of the LCP.
Further, the British Medical Journal has argued that the LCP has transformed end of life care and offered a good death when used properly. It is recommended by the Department of Heath as best practice for care of the dying in a number of its publications, including:
- End of Life Care Strategy: Quality Markers and Measures for End of Life Care (2009)
- End of Life Care Strategy – Promoting High Quality Care for all Adults at the End of Life (2008)
- Our Health, Our Care, Our Say: a New Direction for Community Services (2006)
The LCP is widely regarded as a way of transferring a best practice module in hospice care to other healthcare settings, including at home, in hospitals and care homes. It emphasises the need for multi-disciplinary team meetings, review, re-assessment and communication to allow for discussions to continually take place in relation to the patient. It emphasises the need to review whether there is a potentially reversible cause for the patient’s condition, whether the patient is actually in the final stage of his life and whether a specialist referral is needed.
The criticisms made of the LCP appear mainly to relate to individual communication failures between clinicians and families. The NHS response via its "NHS Choices website" has confirmed that any such failings could stem from failure by clinicians not following the recommendations of the LCP, rather than inherent faults of the LCP itself.
The LCP recommendations are clear that:
- Legal consent is not required to place a patient on the LCP. The fact that the plan is being considered should always be discussed with a relative or carer and, if possible, the patient themselves.
- There should never be an occasion when a relative or carer who is named as the main contact is not informed about a diagnosis being made that the patient is dying.
- Withdrawal of nutrition and fluids should never be a routine option but done only if it is considered to be in the best interests of the patient, judged on an individual basis following discussion with clinicians, the patient (if possible), family and carers.
When taken in the round, one would hope that the concerns about the LCP are temporary or indeed, unfounded. As long as clinicians discuss the LCP with the family and the patient in a constructive manner, it seems clear that the LCP endorses a best practice model to provide comfort to dying patients.
I am confident that the LCP provides sufficient guidance for clinicians. Whilst concerns should not be ignored, I consider they raise issues of training individual clinicians as opposed to a complete overhaul of the LCP itself.