15 Jul 2013

Dignified dying? End-of-life regime ‘needs reform’

An independent review of the controversial Liverpool Care Pathway, the national guideline for care of the dying, is expected to recommend that it is phased out.

End of life care regime could be changed (Getty)

The review, chaired by Baroness Julia Neuberger, is likely to say that the NHS needs better end-of-life care which is more tailored towards individual needs.

The government set up the review after intense scrutiny of the existing Liverpool Care Pathway (LCP), a national guideline which recommends in some circumstances that doctors withdraw treatment, food and water from sedated patients in their final days.

The pathway faced intense scrutiny after reports suggested doctors had established “death lists” of patients to be put on the pathway. Articles have also claimed hospitals might be employing the method to cut costs and save bed spaces.

But medics have argued that the pathway has “transformed” end-of-life care, saying it can offer peaceful, pain-free deaths when used properly.

We need a new system of better end-of-life care tailored to the needs of individual patients and involving their families. Care Minister Norman Lamb

A Department of Health spokeswoman said at the weekend: “The independent review into end of life care system the Liverpool Care Pathway, commissioned last year by Care and Support Minister Norman Lamb and backed by Health Secretary Jeremy Hunt, is likely to recommend that the LCP is phased out over the next 6 to 12 months.

“The review panel, set up by ministers following reports from families concerned about the care of their loved ones, is due to report back on Monday.

“It is expected to say that when used properly the LCP can give people a dignified and peaceful death, but that they found numerous examples of poor implementation and worrying standards in care which mean it needs to be replaced.”

Better system needed

Norman Lamb MP told the Daily Telegraph: “I took the decision to launch this review because concerns were raised with me about how patients were being cared for and how families were being treated during this difficult and sensitive time.

“We took those concerns very seriously and decided that we needed to establish the facts of what was happening so we could act where needed.”

He added: “We need a new system of better end-of-life care tailored to the needs of individual patients and involving their families.”

Jason Suckley, director of policy and campaigns at healthcare charity Sue Ryder said that training staff properly in any new system was key to its success.

“We are clear that more needs to be done to improve the communication skills of healthcare professionals. This is evident from recent research that we have conducted with think-tank Demos around our campaign ‘Dying isn’t working’ which revealed that there is a lottery regarding the timing and quality of conversations that GPs and other professionals have with individuals who are at the end of their life.

“This inconsistency means that many people are unable to prepare in advance and express their preferences about the death that they want. To make this happen we strongly feel that Health Education England must include end of life training in its workforce mandate, it is currently excluded.

“When it comes to dying we cannot afford to get it wrong and health professionals need to be supported to communicate with people effectively at a very traumatic and emotionally difficult time.”