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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.