In this series of articles, medical students from across the country will discuss a range of topics from medical ethics to the NHS to public health to medical conditions to clinical governance.
These articles give you an overview of the principles; understanding the overlap between topics will allow you to develop a more detailed insight into medicine.
❓ What Is It?
The Liverpool Care Pathway (LCP) was an end of life care plan developed in the aim of standardising care across hospitals and hospices. It was developed in the 1990s at the Royal Liverpool University Hospital alongside the Marie Curie Palliative Care Institute. At the time of its development the LCP was widely seen as a way of transferring high grade hospice care to other healthcare settings, such as care homes and hospitals. By doing so, this gave healthcare professionals a uniform format to follow, which would ideally make palliative care decisions clearer, while affording patients a standard level of care, with no discrimination on where they are being treated.
The LCP consisted of a checklist which aimed to guide staff, enabling them to perform the necessary tasks in order to give the patients' dignity and as much comfort as possible during their end of life treatment. Some of the pathway involves, for example, whether any further medications and medical examinations would be appropriate or helpful; how to keep the patient as comfortable as possible; whether or not fluids should be given. The pathway also takes into consideration the patients’ spiritual or religious needs. The pathway aimed to guide healthcare professionals in both their clinical decision making and holistically. In theory the introduction of the LCP allowed clear decisions to be made by healthcare professionals, in the best interest of all patients under their care tying in with themes of justice and non-maleficence.
💉Concerns with the LCP
However, the LCP very quickly became controversial and the media were fast to pick up on this. There were claims made about patients and family members not being informed about the placement of their loved ones on the pathway, while others claimed to have survived the Liverpool Care Pathway. This consequently implied they had been wrongly placed on end of life care when they could have been in recovery instead.
This culminated in the suggestion that the LCP was benefitting healthcare staff by prioritising them and their time over the care of patients. The Liverpool Care Pathway quickly became viewed as a tick-box exercise. There were serious issues raised focused on patient care, consent, justice and autonomy. In order to tackle concerns and evaluate the LCP system, a review to explore the LCP and its impact was called.
The review of the LCP was carried out by a panel chaired by Baroness Julia Neuberger and put together by Norman Lamb, MP. It was operated independently of the NHS and the government, and findings were asked to be reported by the Summer of 2013. In relation to ‘End of Life’ plans the panel recommended “use of the Liverpool Care Pathway should be replaced within the next six to 12 months by an end of life care plan for each patient, backed up by condition-specific good practice guidance.” The review highlighted the ambiguity of the pathway and stated that this in turn had caused it to be used inappropriately, in a way it had not been designed for. It brings into question whether there is ever an easy, step-by-step plan which can be used across the board for patient care, while still being of high quality.
The Liverpool Care Pathway was phased out in 2014 completely and replaced with the Priorities for Care which focuses on 5 priorities for care of the dying person and, unlike the LCP’s uniformed format, it is aimed at giving individualised care based around the five integral themes.