Problems with the Liverpool pathway for the dying

Members of the British Medical Association (BMA) have acknowledged that dying patients may sometimes have been put on the Liverpool Care Pathway (LCP) inappropriately because hospitals were offered financial incentives to use it. It was also acknowledged that some patients had been left on the LCP “for weeks” without being followed up.  However during a debate of this issue at the BMA conference doctors also supported the claim that the LCP was an important part of end of life care.

At the end of last year, ministers announced a review of the LCP in response to media coverage that reported the pathway was being misused. A GP from York, Mark Pickering, characterised the media coverage as a ‘frenzy’ but whilst he felt some of it had been ‘hysterical’ he also agreed that some valid points had been made. He referred to the financial incentives offered to hospitals who put patients on the LCP and said this risked the decision becoming a ‘tick box’ exercise.

Trefine Maynard, a solicitor specialising in medical negligence claims at Ashtons Legal, says: “I am very pleased that the LCP is being reviewed. I am deeply shocked by the idea that hospitals have been offered financial incentives to put patients on to the LCP in order, it is said, to ‘reward good practice’. It is horrific to be in a position where it is suggested that doctors have to be paid to give an acceptable service to their patients. That is what the medical profession is meant to do and what many health care professionals seek to achieve on a daily basis.  There seems no logic in offering a financial incentive in this context.

Whatever the reason for putting a patient on the LCP, it must be done with careful thought and should never be done without full explanation to the patient or/and their family. It should be regularly re-considered and the patient kept under daily review. There have been many occasions that I know of where the patient has been deemed to be dying and put on the LCP and there has been little or no further review. This has left the relatives with the impression that in their last days the patient has been ‘written off’ by those treating them and just left to die, with the LCP effectively potentially hastening that death or/and resulting in death in very distressing circumstances.

Whilst I accept and applaud sensible palliative care in the final days and hours of someone’s life, this must always be care that eases their last hours and that helps their relatives cope with the passing of their loved one. All the family members should be taken into account and fully informed of whatever treatment is proposed. There must be times when active treatment is no longer of any use and could merely prolong the inevitable to the detriment of patient and family; if this is the doctors’ decision then this must be fully explained to those involved.

A medical student has said that part of the problem might be that there was little exposure to the issue during training. She said that the focus was so much on saving lives that dying was given little attention. It is high time that this one health ‘issue’, which is the one certainty in everyone’s life, be given proper attention. Respect and care in our final days is something everyone has a right to expect.”