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Good news about the Liverpool Care Pathway

There are increasing concerns about the way the system is working

By on Monday, 15 July 2013

People at the end of life should be treated humanely (AP)

People at the end of life should be treated humanely (AP)

Having blogged about this subject before, it was good to read the headlines in the Telegraph for Saturday 13 July: “Care pathway to be axed.” This, of course, refers to the controversial Liverpool Care Pathway (LCP), when food, fluids and invasive treatment are withdrawn from patients assessed as being at the end of their lives. Begun as a hospice practice, it was adopted across the country by the NHS, which standardised the protocols to be put in place for dying patients. Inevitably, this was often done at the expense of their needs or their relatives’ wishes.

Even as I write this I highlight the problem: how do you decide when a patient is dying or indeed if he or she is dying? It is questions like these which have given rise to stories in the media which suggest all was not well with the LCP – not least the fact that financial incentives were paid to NHS hospitals which implemented the Pathway. These incentives were to encourage best medical practice, no doubt; but the lure of bonus points, as it were, would have made it fatally easy to overstep the boundaries between what was in the patient’s best interests and what was in the interests of a particular NHS trust’s balance sheet. According to the Telegraph, apparently two thirds of NHS trusts using the LCP had received “millions of pounds for hitting targets related to its use”. It sounds sinister and in practice it was sinister.

Now Baroness and Rabbi Julia Neuberger has conducted an official review of the procedure, to be published this week. According to the Telegraph report, her team interviewed relatives of those placed on the LPC, many of whom were critical of it. Norman Lamb, the care minister, stated, “I took the decision to launch this review because concerns were raised with me about how patients were being cared for and how families were being treated during this difficult and sensitive time. We took these concerns very seriously and decided that we needed to establish the facts of what was happening so we could act where needed.”

He emphasised: “We need a new system of better end-of-life care tailored to the needs of individual patients and involving their families.” Interestingly, he also commented that “we all want our loved ones’ final hours to be as pain-free and dignified as possible.” We all know what he means by the word “dignified”. Or do we? It is not for nothing that Dignitas, the “assisted dying organisation” as Wikipedia describes it, makes play with this potent word. For Christians who are dying, it will include recognition of their unique status as human beings made in the image and likeness of God. Other religions have their own rituals which reflect their sense of what this means. But if you have no religious beliefs, “dignity” can easily become what is convenient to the professionals looking after you, what your relatives might subjectively feel or what you yourself, in a state of depression or despair, might agree to.

At least in the case of the LCP and the NHS, it now seems likely that doctors will be told that “rather than an inflexible national system, each patient in the final days or weeks of their lives should have a personalised treatment plan agreed with their families”. Amid all the recent revelations of neglect and poor treatment in our hospitals, this is surely good news.

A final thought: in memory of the magnificent and pioneering work of the late Dame Cicely Saunders, founder of the hospice movement, why can’t the NHS, which is the recipient of an enormous budget, establish hospices alongside every hospital as a matter of course?