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Friday 28 October 2016 Instagram
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Liverpool Care Pathway scrapped

Liverpool Care Pathway scrapped

Liverpool Care Pathway scrapped

The Liverpool Care Pathway (LCP) should be scrapped, with end of life care moved into the community, according to an independent review.

The review, carried out by Baroness Julia Neuberger, found many cases of poor practice and poor quality of care when clinicians carried out the end of life plan. 

Despite finding that the LCP can help patients to have a dignified, pain-free death “in the right hands”, the independent panel has seen too many failings for the system to continue. 

The Liverpool Care Pathway appeared to be used correctly in hospice and community settings. However, in hospitals there are appear to have been too many misunderstandings over the LCP’s direction on hydration, with people in need of palliative care being refused water in some instances.

“People’s final days should be as comfortable and dignified as possible,” said Care and Support Minister Norman Lamb. “We hope that the action taken today will reassure patients and their families that everyone coming to the end of their life is getting the best possible care.” 

The Liverpool Care Pathway will be phased out over the next six to 12 months and replaced with a personalised end of life plan for each patient, agreed with a senior clinician. 

‘Inappropriate behaviour’

The Nursing and Midwifery Council (NMC) has been urged to create guidance for nurses on oral hydration and nutrition at the end of life, as none currently exists. 

The review panel suggested that this could explain why there were “so many examples of poor quality nursing of the dying”. 

Baroness Neuberger has urged the NMC to put together guidance on nursing the dying “as a matter of urgency”. 

An NMC spokesperson said: “This is an important report in a sensitive area. We will consider the report and its recommendations carefully with our partners and respond in due course.”

The review panel also heard many reports of staff incorrectly filling in the LCP document, for example recording observations that relatives or carers believed had not been made. 

The panel said “stern action” must be taken by the NMC and the General Medical Council (GMC) to look into evidence of deliberate falsification of documents and clinical records. 

The NMC spokesperson added: “We take very seriously any suggestion that nurses have falsified records relating to discussions about end of life care, and other allegations of unacceptable practice. We will follow this up with the review team.” 

Nurses and doctors should be required to demonstrate proficiency in caring for the dying, the review panel said. 

A significant number of relatives and carers reported that they did not feel involved in discussions about the care plan, with some handed a leaflet without any further explanation. Others were not told that their loved one was dying. 

GMC guidance had not been followed, according to the panel members, and the Royal Colleges should review how effective training is for shared decision-making.  

Jane Cummings, chief nursing officer for NHS England said: “The review and NHS England recognise the good principles of end of life care in the LCP, but there have been some failings in the quality of care in some areas and this is never acceptable. 

“Issues such as poor communication with relatives have nothing to do with any particular care plan. That is just poor care and we won’t want it in the NHS.” 

A full response will be issued from the government over the coming months. 

The full report is available to view online. 


My own mum died in our local general hospital, on a ward where there was inadequate staff, nursing and medical. The only dignity she had was 2 kindly nursing assistants who kept her clean daily.
It was a terrible, traumatic experience, one which stays with me. I left her in one side ward the evening before, being able to go to the toilet herself with a zimmer frame; and was shocked to find her the next lunchtime moved to a busy ward trying to suck splashes of gravy off her plastic apron as she was so dehydrated; blind, unable to communicate, with a full jug of water by her bed, dehydrated and hungry, with someone else's dinner in front of her. The inexperienced nurse in charge of her care knew nothing about her, insisted on speaking by her bed, declaring "she was ok at dr rounds this morning; and anyway if she has had a further stroke they wouldn't do anything......" I had to cover my mums ears.
I mashed a bit of dinner for her and fed her with a spoon, and she drank about 3 glasses of water, but it was obvious this would be the last she would be able to eat as she needed intravenous fluids and had difficulty in swallowing.
The SHO was the most senior dr there, who was obviously out of her depth. I had to ask for intravenous fluids and palliative care; and thankfully an agency nurse supported this and managed to get things sorted. It was 2 days later the Reg rang me at home to discuss her DNR, which I had asked about initially as it was clear she was not going to recover.
She eventually died after 3/7 on this busy, noisy, ward, alone, as I was not called back, with 3 other patients looking sadly on. The experience stays with me and I still cry about it, even though it is 5 years ago.
They would have to break my legs to keep me in my local hospital. I would rather take my chances at home.
There are even less staff at the hospital now than there were then. They didn't really do anything terribly wrong, as the staff didn't know any better they were so few on the ground and junior.
So whether they scrap the Liverpool Care Pathway or not - to me is irrelevant, as many in my area are not lucky enough even to access staff who are qualified to notice that patients need it, or even able to implement it.
And as for dealing with it in the community - where are the staff to deal with it?? Community care is non existent at the best of times.
This cut cut cut government has a lot to answer for.

I have only ever seen the LCP implemented well and as such have seen first hand the reassuring benefits of such a pathway, however I appreciate that if it is not being used correctly the impact on both patients and their relatives could be extremely harmful. While it saddens me to hear that something which can provide such comfort is to be phased out I fail to see an alternative when its coverage in the press , while mostly incorrect, has been so appalling that no family would ever agree to its use again. A great loss for our NHS and yet another win for the misinformed press coverage destined on damming our health service.


I was diagnosed with Grade 1V lung cancer in April of this year. I have been given 6-9 months to live, I'm 64 years. I was horrified when I looked through the District Nurse's paperwork to learn that I was on the Liverpool Pathway Scheme. It was not mentioned to me. Perhaps, you should get in bed and let someone starve and dehydrate you with only the minimal pain relief issued. Or perhaps you have already been through it and have come back to tell us the truth!!! I do not fear death but I do fear a painful death. I'm now contemplating taking my own life all out of fear.

I worked for the NHS as a Medical Secretary for 21 years and people who think the Staff are little angels are truly misguided like most people they are there for the money and one of the most uncompassionate bunch of people I have ever met. If a Vet did that to your darling little dog you'd probably be one of the first to complain. JET

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