Demise of the LCP: villain or scapegoat?

Abstract

The winding down and withdrawal of the Liverpool Care Pathway (LCP) following the Neuberger Report has been met with mixed reviews. It appears that responsibility for failures of clinical care has been laid at the feet of a care pathway rather than the practitioners who used it, a rather curious outcome given that the LCP was primarily a system of documentation, a tool with no intrinsic therapeutic properties. The Neuberger inquiry was the result of persistent and repeated reports of poor-quality end-of-life care associated with the use of the LCP. There were indeed problems with the LCP regarding the process of diagnosing dying and its approach to supportive care, particularly artificial nutrition and hydration. Some of the problems were the product of personal or professional ideology influencing goals of care rather than patient-centred considerations. These problems were not insurmountable, however, and were being addressed by the organisation responsible for the LCP. With the removal of the LCP, we are left with no bench mark for end-of-life care, only aspirational goals for individualised care plans. It seems unlikely that practitioners who could not provide appropriate care with the LCP will do so without it.

The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England

“…However, this was not the case as a careful examination of the documentation will reveal. Instead the LCP was interpreted as being a 'one size fits all' tool to practitioners without the required skills to read between the lines 90 (p651).…”

“…Other pieces quickly followed, usually taking the familiar form of personal stories - the first of these from a woman who claimed her father had been wrongly placed on the LCP 89 . A review of the correspondence in the Daily Telegraph undertaken subsequently by Mackintosh (2015) calculates that there were 431 individual comments in response to the original letter and the reports that followed 90 .…”

The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England

“…However, this was not the case as a careful examination of the documentation will reveal. Instead the LCP was interpreted as being a 'one size fits all' tool to practitioners without the required skills to read between the lines 88 (p651).…”

“…For example, there was no LCP-type reaction to the ‘Gold Standards Framework’ 116 or ‘Preferred Priorities of Care’ 117 , which were similarly high profile boundary objects promoted by the National End of Life Care Programme, each lacking supporting evidence from RCTs. Moreover, Mackintosh 88 has argued that the calls for better evidence in the LCP debate are misplaced ‘….since what is being measured is not the performance of the tool but the performance of the user’ (p651) . The RCT evidence that has since emerged from Italy 118 and from the Netherlands 111 powerfully draws attention to this point.…”

“…Other pieces quickly followed, usually taking the familiar form of personal stories - the first of these from a woman who claimed her father had been wrongly placed on the LCP 87 . A review of the correspondence in the Daily Telegraph undertaken subsequently by Mackintosh (2015) calculates that there were 431 individual comments in response to the original letter and the reports that followed 88 .…”