- 2013 National Retired Members Conference
- 17 June 2013
This Conference notes that the Liverpool Care Pathway (LCP) has been the subject of emotive reporting across all media recently. These reports have included allegations that NHS staff are using the LCP to justify prematurely ending the life of older people who are bed blocking and/or costing too much to treat. It has also been suggested that there are “targets” for the use of LCP and NHS Trusts are rewarded financially if these are met.
The Pathway, developed in the late 1990’s for the care of terminally ill cancer patients and then extended to include all patients deemed to be in the last days or hours of life, involves a multi-disciplinary team caring for the patient agreeing that all reversible causes for the patient’s conditions have been considered and that the patient is in fact in the last days or hours of life. This team should then make suggestions for palliative care including whether non-essential treatments and medications should be discontinued. Continuing care would include treatments to manage pain, agitation, airway blockages, nausea, shortness of breath etc. In other words, anything to make the patient more comfortable. Used correctly the Pathway involves clear communication with the patient where possible, the relatives and ensures that everyone understands the procedure and is in the best interest of the patient.
This is the central premise of the Pathway. It is to enable the medical and caring team to act in the best interest of the patient to cover the medical, physical, emotional, social and spiritual and all other factors relevant to the patient’s welfare.
Regular reassessment of the patient’s condition may indicate an improvement in which case removal from the Pathway is indicated.
In a recent survey 90% of palliative care specialist doctors would be prepared to be placed on the programme if they were nearing death.
So much for the principles of the Pathway. Currently the procedure is mired in controversy. The Daily Mail and the Telegraph have run stories covering claims made by families that:
1)they were not told their relatives had been put on the Pathway,
2)people are put on the Pathway inappropriately in an attempt to save money and free up beds
3)people removed from the Pathway have lived for a period thereafter.
This Conference recognises there have been loud calls through the press to totally ban the Pathway due to adverse outcomes when it has been wrongly, inappropriately or mistakenly implemented. However, this criticism is misdirected. Criticism should be directed at the abuse of the procedure – not the procedure itself.
It is essential for our peace of mind that we are fully aware of:
a)the benefits of Pathway when used correctly by knowledgeable multi-disciplinary teams
b)the possible abuses that can occur
c)which local NHS services use the procedure
From this position of knowledge we can ensure we have a choice as to whether the Pathway is used and either our relatives or ourselves are treated according to the full principles of the Pathway.
An independent review was launched in February 2013 to investigate concerns, particularly around accounts of the withdrawal of foods and fluids from dying patients, and the use of financial incentives. It is being chaired by Baroness Neuberger, Senior Rabbi at the West London Synagogue and former Chief Executive of the King’s Fund. The review will report to Department of Health Ministers and the NHS Commissioning Board with its conclusions and recommendations by summer of 2013.
This Conference instructs the NRMC to:
i)work with Regions and Branches to promote awareness of the Liverpool Care Pathway and the possible abuses,
ii)encourage Branches to seek information from their own Health Board/Trusts regarding the use of the Pathway; and
iii)publicise the outcome of the independent review both through Regions, Branches, U Magazine and In Focus.