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If there is bad practice, its causes must clearly identified so that it can be put right. But that will not happen unless a light is shone on the stories that have been told.

The Liverpool Care Pathway - what are we to make of the controversy?

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Press stories can be helpful in raising awareness that something may be wrong. But, unless they are followed up with painstaking research and careful analysis, they can do more harm than good.

What are we to make of the current controversy surrounding the Liverpool Care Pathway (LCP)?  It has been attacked by some as a 'pathway to death' and defended by others - including, it should be said, the Department of Health and organisations such as Marie Curie - as a successful and beneficial guideline for giving dying patients the best care in the last hours or days of life.  

The LCP is an attempt to introduce the best practices of hospice care into the wards of hospitals, into nursing and care homes and into care in the community.  And the regular audits of it suggest that it has to a very large extent succeeded in this. 

But even the best of tools is only as good as the worker who uses it.  It is certainly possible that there are times and places when the LCP's guidance has not been followed as intelligently as it should and the result has been poor end-of-life care.  The NHS is no more immune from shortcomings in performance than any other walk of life.  But, if we are to correct deficiencies in end-of-life care, we need to know where and why they are happening

Most patients and their families can understand the need for care of the dying to focus on comfort and dignity.  But they need reassurance that in focusing on such care and avoiding unnecessary clinical procedures the LCP is not predetermining the outcome, that the door to recovery is not being closed and that, where appropriate, the care given will allow for such happier endings.

Press stories can be helpful in raising awareness that something may be wrong.  But, unless they are followed up with painstaking research and careful analysis, they can do more harm than good.  The Government's decision to launch an investigation of the LCP is to be welcomed.  It is to be hoped that it will subject the various stories that have been told to factual examination. 

This isn't just a matter of ascertaining whether the stories are true: undoubtedly they have been told in good faith.  It's more about identifying the characteristics of any emerging bad practice - is it, for example, occurring disproportionately in some health care authorities than in others? is it occurring mainly among some groups of patient or some groups of medical and nursing staff?  is it happening because the guidance in the LCP isn't clear enough?  Only in this way will it be possible to pinpoint what is wrong and set in hand the necessary corrective action.

We should not forget the impact of the recent furore on dying people and their families, some of whom are now hesitant, because of the stories they have read, to accept the end-of-life care they or their loved ones need.  They need to know that, if there is bad practice, its causes have been identified and it is being put right.  That will not happen unless a light is shone on the stories that have been told.

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