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HOME NEWS HEALTH HEALTH NEWS

Liverpool Care Pathway being 'rebranded' not axed

Plans show Liverpool Care Pathway is being rebranded, not abolished, say doctors
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Follow ing the review led by Baroness Julia Neuberger every patient w ould receive individual end-of-life care plans Photo:
Martin Pope

By Laura Donnelly , Health Correspondent

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The discredited Liverpool Care Pathway is to be rebranded rather than

abolished, senior doctors have said.
In July ministers said the end-of-life protocals would be axed, after a
damning independent review undercovered frequent and heartbreaking
cases of patients being denied water and left desperately sucking at
sponges used to moisten their mouths.

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Instead, every patient would receive individual end-of-life care plans,

following the review led by Baroness Julia Neuberger.
However, doctors who led criticism of the pathway say new draft
guidance, seen by the Daily Telegraph, outlining a replacement scheme
will perpetuate many of its worst practices, allowing patients to suffer
days of dehyration, or to be sedated, leaving them unable to even ask
for food or drink.
Professor Patrick Pullicino, a consultant neurologist with East Kent
Universities NHS Foundation Trust, said the new plan lacks essential

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key components of the Neuberger report and perpetuates errors that

were central to the dysfunction of the pathway.
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The independent review said relatives who had begged for water for
thirsty loved ones had been shouted at by nurses.
Under the new proposals, any patients unable to swallow could be
denied food and fluids by tubes unless a hospital team decides it is in
their best interests to have them.

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This goes further than current laws which only allows such practices for
patients asssessed and found to lack mental capacity.
Baroness Neuberger also said more research was needed to establish
whether it is possible to to predict death with any degree of accuracy
But the new guidance outlines protocals for patients who are likely to die
within the next few days.
Prof Pullicino said: There is no indication about how patients who are in
the last days of life are going to be diagnosed as such. There is no
mention of a research base to improve this prediction. This was a main
central concern of the Neuberger report, he said.
Any replacement scheme should be studied before being introduced, or
risked simply repeating the same problems, he said.

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The Liverpool Care Pathway not only produced many instances of

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The fact is that little seems to have changed, including the use of
syringe drivers, anticipatory prescribing, use of sedation and narcotics
and limitation of hydration and nutrition by a best interest team decision.

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pensioner

When ministers said they would abolish the pathway, Norman Lamb, care

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services minister said its use had become a national disgrace after the
review found widespread evidence of shocking abuse, including
patients dying of dehydration after being heavily sedated.
NHS England responded to the Neuberger Report by establishing the
Leadership Alliance for the Care of Dying People which has been asked
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The alliance has published its proposals in an engagement document

which it is presenting at meetings of medical and palliative care
professionals around the country up until the New Year.
Denise Charlesworth-Smith, who represented family and patient groups
on the Neuberger committee, last night condemn the replacement plan
as a stitch-up by a medical establishment which has always supported
the pathway.
This alliance has come up with a product that looks very similar to the
LCP, said Miss Charleworth-Smith, whose father Philip, 82, died on the
pathway in Nottinghamshire last year after he was admitted to hospital
with pneumonia.
It has rebranded and repackaged the LCP, she said. It is not good
enough - this whole matter stinks.

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A spokeswoman for NHS England said the alliance was keen to avoid the
mistakes of the LCP but would not say whether any research would be
undertaken to provide a science base for the new replacement.
Ultimately it will be the experience of patients and their families that
provide the real quality assurance, she said.
Defending the use of sedatives, she said that if used in the right way
and in the right circumstances they could help to alleviate distress and
allow someone to die in a more comfortable way.
Therefore they will be part of the alliances way forward regarding high
quality care for people in the last days to hours of life and the alliance will
be making sure that they are used appropriately and avoid problems of
the LCP, she said.
The alliance includes the Department of Health, the Care Quality
Alliance, the Nursing and Midwifery Council, NICE, the Royal College of
GPs, the Royal College of Nursing and the Royal College of Physicians,
as well as NHS England, the General Medical Council, the General
Pharmaceutical Council and the cancer charities Macmillan Cancer
Support and and Marie Curie Cancer Care.

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Many of the groups were signatories to a consensus statement of

uncritical support for the LCP last year as good medical practice at a
time when hundreds of families were complaining of their bad
experiences of the pathway.

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426 Comments

Telegraph

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approveds

a year ago

nafid has now said that if you go to an NHS hospital, the LCP will be forced on you whether you want it or not. He
said that only rich people can avoid it by going to a private hospital where they don't use it. So much for patient
choice then. The NHS will decide when you die, and how you die, a bit like they do in dictatorships.
3

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nafid > approveds

a year ago

Have I? I'm fairly certain your above assertions count as libel.

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I'll ask you only this once to stop misrepresenting what I say.
I've said absolutely nothing in relation to rich people, you are the one that keeps bringing that up - I've made
perfectly clear my opinion that wealth (or lack thereof) has absolutely no bearing on how professionals use
the LCP.
As for the LCP being forced upon someone, if a hospital uses the LCP, then that is their chosen framework, it
would be far too difficult for patient's to provide their own tools for care and expect staff to be using a dozen
different tools at one time.
1

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approveds > nafid

a year ago

I asked you if patients had the right to refuse the LCP, and you said that they would have to go to a
hospital that does not use the LPC, which excludes all NHS hospitals. So poor people, who have to
use NHS hospitals will be forced onto the LCP, according to you?
I don't think that repeating things you have said is libel, not in my court, or any in the UK. Perhaps in
Iran it might be libel.
3

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nafid > approveds

a year ago

You've not repeated anything I've said, either in summation or as direct quotes.
You've merely twisted what I've said to fit your own agenda.

Share

approveds > nafid

a year ago

approveds > nafid 8 days ago

Therefore all patients have the right to state that they do not want the LCP?
nafid > approveds 8 days ago
They'd have to go to a hospital that doesn't use it if that is their choice.
approveds > nafid
So patients who do not want the LCP in any form would have to go private, in other
words only rich pataients can avoid it?
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approveds > nafid

a year ago

You are waffling again, you did say that anyone who did not want the LCP would have
to go to a private hospital, which means poor people cannot avoid it?
i expect that this question will be left unanswered
3
approveds

Share

a year ago

Most people do not want the LCP, it is being forced on people to make life easy for health carers, not patients. Once
they have decided to use the LCP they fix a tube into someone so they can use any drugs they want to keep the
person quiet.
And as we have seen happening, they are then forced to die. We need to abolish the LCP completely.
1

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nafid > approveds

a year ago

The LCP doesn't dictate what drugs should be used, so the LCP cannot be held responsible for such actions.
It's as unjust as arresting someone for a crime they did not commit.
1

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approveds > nafid

a year ago

If the LCP does not dictate drugs should be used, then any drugs can be used. As I said the LCP
seems to be all about deciding someone is going to die, and then making it happen. The hospital
would not want people hanging about too long, blocking beds, if they have decided they are dying
would they?
1

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nafid > approveds

a year ago

"any drugs can be used"? Certainly not.

Perhaps you need to familiarise yourself with the rules of prescribing.

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approveds > nafid

a year ago

If the rules for prescribing are precise, how does the LCP add anything to those rules?

Share

nafid > approveds

a year ago

Can you make your question a little more clear please?

How does the LCP add to what?

Share

approveds > nafid

a year ago

Why do we need any more guidance, in the form of the LCP?

approveds

Share

a year ago

Perhaps the answer to this is the same as for transplants, unless someone is carrying a card, stating that they want
the LCP, then it should not be used. All hospitals could have LCP cards, and you just fill one in, so that when you are
in hospital, the staff know that you don't mind being staved to death?
1

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nafid > approveds

a year ago

The LCP doesn't say that staff should allow patients to starve.
1

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approveds > nafid

a year ago

If the are 'agitated', they are injected with drugs to stop them eating, or even asking for food, in order to
'speed up the dying process'.
1

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nafid > approveds

a year ago

Where in the LCP does it say that appetite supressants can be used?
1

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Retired Nurse > nafid

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You seem rather ignorant of basic pharmacology - side effects particularly...

Share

nafid > Retired Nurse

a year ago

I know what side effects are, as you'll note below, I made a comment saying that
steroids can be used for their side effect (i.e. increased appetite).

Share

approveds > nafid

a year ago

The LCP can be used for the wrong reasons, and that seems to be what has happened. It needs to
be abolished completely.
2

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nafid > approveds

a year ago

But anything can be used for the wrong reason, that doesn't mean getting rid of it is the way
forward.
You've been commenting on the article about needless deaths related to IV therapy, obviously,
IV therapy isn't being used appropriately in some cases, so shall we get rid of that?
The key is training and support. Something which seems lacking in many areas of healthcare.
2

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approveds > nafid

a year ago

Patient care should only be used to treat them, not to kill them.
1

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approveds > nafid

a year ago

IV therapy does not usually kill people

1

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nafid > approveds

a year ago

It doesn't, but used incorrectly, I'm sure it would

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approveds > nafid

a year ago

Yes IV therapy, used incorrectly could kill you, but LCP will kill you if used correctly.

Share

nafid > approveds

a year ago

How?
The LCP is about meeting basic needs, there is nothing in it that would be able to kill
anyone off.

Share

approveds > nafid

a year ago

That does not explain why the LCP is being forced on most patients against their will? I
thought more choice was being introduced, not less?
1

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nafid > approveds

a year ago

You seem to be avoiding the key questions:

1) Where in the LCP does it say that patients should not be fed or watered?
2) Where in the LCP does it say what drugs should be used or even in what dosages?
You're the one that keeps saying the LCP suggests starvation and dehydration and
using drugs to kill patients off, so just give me an answer to the questions please..
1

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approveds > nafid

a year ago

It does not say, that is the problem. The LCP is a document that can be used to do, or
not do anything you want. It is too wishy washy, and gives carte blanche to 'health care
professionals', leaving patients, and relatives in the dark.
2

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nafid > approveds

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It does not say what?

Share

approveds > nafid

a year ago

It does not say anything that cannot be interpreted in six different ways. It gives carte
blanche to abuse patients, or not, without any rights for patients.
2

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nafid > approveds

a year ago

You're the one harping about individual care.

If the LCP could only be interpreted in one way, how would professionals use the LCP
to individualise care?
The LCP allows professionals to INDIVIDUALISE care, it does not state that patient
should be mistreated in any way and nor can it be interpreted in such a way.
And as for patients' rights, they have all of their statutory rights (under The Human
Rights Act), so stop coming out with such idiotic statements.

Share

approveds > nafid

a year ago

Therefore all patients have the right to state that they do not want the LCP?

Share

nafid > approveds

a year ago

They'd have to go to a hospital that doesn't use it if that is their choice.

Share

approveds > nafid

a year ago

So you have finally admitted that poor people, who have to use the NHS will be forced
onto the LCP, against their will.
1

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nafid > approveds

a year ago

You don't need consent to follow a framework.

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Should patients also have to consent to the ABCDE approach to assessment as well?

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approveds > nafid

a year ago

So you are saying that anyone can refuse the LCP?

I suspect this is another question left without a reply. Patients should have choice, and
should have to agree to the results of assessments.

nafid

Share

a year ago

"Instead, every patient would receive individual end-of-life care plans, following the review led by Baroness Julia
Neuberger".
The LCP should be tailored to individual need anyway, so the perceived 'need' for an individualised care plan proves
that the LCP is not being used effectively or as intended.

Share

approveds > nafid

a year ago

You are right when you say, ' LCP is not being used effectively or as intended'. Once someone has been
'written off' as dying, they then just become 'bed-blockers', (a NHS term, not mine).
1

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nafid > approveds

a year ago

You may want to review your understanding of what the term 'bed blocker' actually means.
A patient is referred to as a bed blocker when they no longer require any hospital based healthcare
input, but for other reasons (usually social care input), are unable to leave hospital.
In short, bed blockers are medically fit for discharge, but do not have a home (nursing or otherwise) to
be discharged to.

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approveds > nafid

a year ago

So people who have been accessed as dying, who do not die, are not bed-blockers?
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approveds > nafid

Share

a year ago

What if some patients do not want the LCP in any form?

1

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Mark > nafid

a year ago

A possible danger is that the LCP was auditable across organisations, with variance analysis, etc. How much
substandard care will go under the radar if it's replaced by something less cohesive?
1

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Retired Nurse > Mark

a year ago

no it wasn't...they only had to submit their ''best'' 30 datasets for the various rounds of the national
audit of care of the dying...so were able to bias the data from the outset.
sets submitted online for round 1 represented a mere 0.04% of the total usages of the LCP...yet these
cretins appear to have used 'statistical analysis' on them! Even a 4th form maths student can see
how ridiculous that is!
1

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Mark > Retired Nurse

a year ago

Audit and variance analysis are two different things. The LCP was well known for its strong
support of variance recording, tracking and analysis, probably more so than any other ICP.
From a data point of view, what they were generating was actually of considerable interest.

approveds > nafid

Share

a year ago

No, rich patients,and the Royal Family, never have the LCP. Poor NHS patients should have the same right
NOT to have anything to do with this LPC? Thos people ho want the LPC should carry a signed card asking
for it?
1

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nafid > approveds

a year ago

Why?
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The LCP is merely a tool to help plan care, just like the many other tools that are used to plan care
which don't require consent.

Share

approveds > nafid

a year ago

Most care is aimed at keeping people alive, the LCP is aimed at not keeping people alive, there
is a huge difference?
2

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nafid > approveds

a year ago

No, it's not.

The LCP does not aim to kill people, it's a framework for providing basic care to dying
patients.
The ultimate goal of palliative care is to relieve symptoms and provide basic care,
without actively treating a disease, in order to prevent prolonging a patient's suffering
unnecessarily.

Share

approveds > nafid

a year ago

Most people do not want that 'framework', and should be asked when they are younger
if they want it?
1

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