Sunday, 25 November 2012

Liverpool Care Pathway – "Six Steps To Success"

The 'Six Steps' is the North West end of life Care Model.

These are, quite literally, the six steps to Heaven!


There is no charge for the programme. All that is asked is that there is a commitment to the programme by supporting a Representative to attend the full programme, and support, embed and sustain the organisational change required which will be demonstrated in a completed portfolio of evidence. 

The network is responsible for coordinating and supporting the work and development of End of Life Care (EoLC). The EoLC team aim to achieve a 10% reduction in hospital deaths by using enhanced community services by 2012. (We are already seeing this with such innovations as the Rapid Discharge Pathway).

Ask yourself

• Can you identify those in your care who are approaching the end of life?
• Have you noted triggers that might indicate it is an appropriate time for discussion?

Your role

• Recognise when a patient’s signs and symptoms have increased or his or her condition has deteriorated
• Ask yourself: “Would I be surprised if this patient were to die in the near future?”
• Identify those who need to be receiving end of life supportive care
• Remember to take into account triggers such as recent changes in circumstances.

Triggers could be the death of a spouse, increase in hospital admissions or a change in care setting, e.g. a move from a residential to a nursing home.


Care Home staff, GP practices, those in the community, will be supported by an End of Life Care Facilitator from the local area who will deliver the Six Steps to Success workshops and provide support and education to all staff.

These questions are those that St. Mungo's staff are asked to consider. See -


Liverpool Care Pathway - A Worrying Development

Staff are encouraged to follow such LCP Protocols as:
Ask yourself the question “Would I be surprised if this person were to die at some stage in the near future?”

In the circumstances of the street lifestyle, living rough, that question hardly needs to be answered – or even asked!

A hostel staff member is quoted as saying:

“It can be very difficult to predict when a resident is going to die. We tend to try to find informal and supportive ways to broach the subject with each and every one of them if possible. Sometimes this is about picking up on a comment or remark made about their mortality, and using this as an entry point to further discussion.”

End of Life Care Strategy: Third Annual Report 

Hard to reach communities

The Coalition has worked with a range of organisations to reach out to those who might not naturally come across Dying Matters resources, relate to them or understand them: 
• with St Mungo’s and Marie Curie to produce leaflets aimed at homeless people and those who care for them and with Homeless link to ensure distribution to all homeless shelters; 
• with CHANGE and the NEoLCP to produce a film highlighting the importance of including people with learning difficulties in discussions around death, dying and bereavement; 
• with the Barnsley Black and Ethnic Minority Initiative, the LGBT Consortium and Social Action for Health to create joint messages and images targeting different communities.  This has resulted in a four new posters and a number of talking heads; and 
• with the LGBT Consortium to produce a report and associated film highlighting the inequalities faced by some LGBT people in discussing and accessing appropriate end of life care services as well as good practice which can be learnt from.  Both will be available in July.  
Future plans

The Coalition will be expanding its community engagement work with activities to reach out to its target groups and GP project over the next year in different parts of England.

Events are planned for 1st November and Dying Matters Awareness Week in May 2012 and the successful “Don’t die Home Alone at Christmas” campaign will be run again in
December 2011. The Coalition continues to measure progress and will be conducting further research at the end of the year to review its key performance targets.

Working together with members across all sectors Dying Matters has successfully shown the benefit of using a coalition approach in order to change public attitudes and behaviours to improve end of life care.

Dying Matters website:
The National End of Life Care Intelligence Network (NEoLCIN)

This is all very, very sick. I know people who volunteer with the Salvation Army. They're not asking questions like this. If they see someone who's on a definite downhill slope, they're not in to counsel them to die but to rush in with a helping hand to pick themselves up, dust themselves off and start all over again.

This is even more sick -

There are several versions of the Six Steps to Success document. This particular one is downloaded from Bolton Medical Learning Zone at
 Bolton NHS - End of Life Care.

Here follow a few pages from this document put together by
 Carmel Wiseman whose contact details are below.

It's the usual LCP liturgy.

And there's one how the Pathway is only as god good as the team that's implementing it...

Then comes the final slide.

Which is supposed to extort a chuckle from the gathered throng of healthcare professionals who haven't already dozed off!

This is sick...
They have been discussing a document to put someone, a year hence, onto The Pathway, a Communitarian version of the Final Solution.

Is this intended as an analogous representation, perhaps, the mousetrap signifying death, the cheese the Pathway, and the mouse the unfortunate victim?

If you find this objectionable, then do please contact -
Carmel Wiseman,
End of Life Care Programme Manager


  1. This is sickening. Why Cant those who produced this not see how crass it is?

    Six steps to success....when they're talking about forecasting people's deaths.


    Find your one though they're speaking of sales targets. This Refers to and treats human beings like objects.

    Thanks for your replies, Eldoel, I'll post a few responses to these when I can get my PC working again. I'm. On mŷ iPad at present and I'm struggling with it as I'm not used to using it.

  2. And that unbelievable photograph...

    If there was a competition for the most crass and inappropriate photograph of the year, this would win it by a mile.

    Yet why can't those behind this leaflet recognise this?