Liverpool Care Pathway – nine points for the government to consider in its review

AP

The Christian Medical Fellowship (CMF) has nine key points it wants the government to consider in its recently announced review of the controversial Liverpool Care Pathway.

It suggests that only those who are in the last few days of life should be placed on the LCP and that placing someone on the LCP should be discussed with the relative or carer.

Latest figures suggest that around 130,000 people a year are dying on the LCP, amounting to about a third of annual deaths in the UK.

Writing in a review for CMF's journal for today's Christian doctor, Triple Helix, Dr Jeff Stephenson, a Devon-based consultant in palliative care says: "The LCP represents a pragmatic and effective response to some of the suffering experienced by many in the last days of life.

"It remains, however, a tool and it is only as good as those who use it. There is always potential for misuse and abuse and there are undoubtedly instances where this occurs.

"Where these arise by intention then those involved should be held to account, but more often they occur through poor understanding and inadequate training. We owe it to patients to not only furnish the means to better care, but also to equip adequately those who provide it."

Dr Peter Saunders, CMF chief executive says: "The Liverpool Care Pathway is a useful clinical tool that has helped many thousands of people experience better care in the last hours or days of life, but like any tool it must be used with the proper indications and by properly trained staff.

"Every airline accident should make our next air trip safer; in the same way every abuse or misuse of the LCP should mean that the same mistake never occurs again."

To iron out the abuses, several key measures need to be implemented:

1.It should be made absolutely clear that no one who is not imminently dying within hours, or at most two or three days, should be placed on the LCP and anyone placed on it who shows improvement should be taken off it. These assessments should be made by senior clinicians.

2.No one should be placed on the LCP without it being discussed with the relative or carer (although the latter do not need to give consent).

3.Every patient placed on the LCP must be regularly monitored and reassessed by a multidisciplinary team.

4.The present documentation is far too complex and needs to be simplified and standardised so that those implementing it can easily follow the guidelines and supervisors can easily tell what is going on with each patient.

5.Training and supervision of those using the pathway needs to be standardised and improved and formal training should be required before any healthcare professional is able to use it.

6.An annual audit needs to be carried out and all suboptimal use identified promptly acted upon.

7.Non-clinical priorities in the use of the pathway, especially financial priorities, must be eradicated and every patient treated solely according to their need. In this connection it would be far better to link CQUIN payments to staff training in the use of the pathway rather than numbers of patients placed on the pathway.

8.Communication to relatives both by health professionals and organisations involved in LCP implementation needs to be substantially improved.

9.Those misusing the LCP should be quickly identified and in the case of abuse reported to the appropriate authorities (General Medical Council, Nurses and Midwifery Council or Health and Care Professions Council).

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