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Scrapping Liverpool Care Pathway was 'too extreme'

Scrapping Liverpool Care Pathway was 'too extreme'

Scrapping Liverpool Care Pathway was 'too extreme'

Getting rid of the Liverpool Care Pathway (LCP) was "too extreme" a leading ethics expert has argued. 

Writing the the Journal of Medical Ethics, Dr Anthony Wrigley said that LCP had been poorly applied by healthcare professionals and misunderstood by the general public. 

The LCP, which was intended to transfer the principles of hospice care to hospitals, was scrapped last year following persistent media reports suggesting it was deliberately being used to hasten the end of life. 

The independent Neuberger Review recommended that the LCP be phased out and replaced with individually tailored care plans after identifying that it had been associated with poor communication with relatives and a failure to treat patients with compassion and/or dignity.

This was despite extensive published evidence showing that its correct use improves end of life care, and widespread endorsement by professional bodies, Dr Wrigley points out.

“One reason why this [recommendation] seems too extreme is that end of life care in the UK is of a quality that is world-leading, recently being ranked as having the best overall palliative care in the world,” he writes.

There was widespread agreement that before the introduction of the LCP, “poor care and suffering were the norm for patients dying in hospitals,” he adds.

“That hospital staff were purportedly using a care pathway that explicitly states the importance of good communication, highlights an underlying problem over care provision in hospitals rather than with the LCP,” he points out.

He suggests that scrapping the LCP because some people didn’t know how to apply it properly is rather like recommending that morphine or insulin be phased out because some people don’t know how to use these properly.

A much better approach would be to keep the LCP but recommend proper training on its correct use and on how best to talk to the relatives of those put on it, he suggests.

“Seeking to end an approach that is widely seen as best practice and which can genuinely deliver high quality care because of negative impressions that have been formed from failing to implement it properly is not a good basis for radically overhauling our approach to end of life care,” he concludes.

The full letter is available to view on the Journal of Medical Ethics website. 


I was very upset when the Liverpool care pathway was removed from use. As a district nurse, we had embraced it as a tool which brought GPs into the patients care well before the patient reached their last days. Good care and all possible ooptions were discussed with the lpatient and their families, so when the last days arrived , syringe drivers, catheters etc were not as foreign as they might have been, but seen rather as part of their care. Patients had some idea of what to expect, and symptom control was timely, as prescriptions, drugs etc were written up and available in the house fir use when the time was right. Our patients ate and drank right up to the end if they were able to. Families were involved as much asvtheyvwished. We didn't always get it right, but the pathway certainly helpers us to achieve the best. We still follow the principles of it because it's what we were doing before it came out, but it helped us to get the gp more involved in a proactive way than before.

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