End of life care providers told to trust in personalised solutions

An independent review into end of life care practice has led to the Government scrapping the Liverpool Care Pathway, a widely practised form of terminal care.

The Liverpool Care Pathway was developed in the late 90s to inform care practice where individuals are judged to be at the end of life, but has been the subject of growing controversy for several years, with a number of high profile cases bringing into question its suitability.

Writing in the Foreword to the report ‘More Care, Less Pathway’, Baroness Julia Neuberger highlights the extent of the problem:

‘Where care is already poor, the LCP is sometimes used as a tick box exercise, and good care of the dying patient and their relatives or carers may be absent. Whether true or not, many families suspected that deaths had been hastened by the premature, or over-prescription of strong pain killing drugs or sedatives, and reported that these had sometimes been administered without discussion or consultation. There was a feeling that the drugs were being used as a “chemical cosh” which diminished the patient’s desire or ability to accept food or drink. The apparently unnecessary withholding or prohibition of oral fluids seemed to cause the greatest concern.’

In response, the Government is now urging hospitals and care providers to avoid religiously supporting one individual end-of-life care practice, instead ensuring that a personalised care plan is developed for each user, even though the review does state that where well-trained teams and appropriate resources are in place that the LCP has been successful in ensuring that ‘patients have a dignified and pain-free death’.

Care and support minister Norman Lamb believes the move was necessary for restoring public confidence in end-of-life care practice.

He comments: “We hope the actions we have taken today will reassure patients and their families that everyone coming to the end of their life is getting the best possible care and that concerns are being dealt with swiftly.

“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.”

Subsequently, the Government advises on a series of actions that NHS services should take, which include immediate reviews of dying patients and the naming of a senior clinician to be responsible for each individual.