Tuesday, 20 November 2012

Liverpool Care Pathway – Wanting And Abysmal

Putting faces to names -

Jane Cummings, Chief Nursing Officer   Department of Health

This is from the Chief Nursing Officer Bulletin.

Media round up: end of life care and the Liverpool care pathway
Media coverage has highlighted examples where people have reported that care in the last days of life has not been of high quality. Several organisations, co-ordinated by the National End of Life Care Programme, are initiating projects tolearn from experiences so that improvements can continue to be made.
The majority of negative coverage centres on communication issues and the implementation of the Liverpool Care Pathway (LCP). The LCP is recognised as a model of good practice by the Department of Health, NICE and the General Medical Council. It is supported by more than 20 leading organisationsincluding the RCN, Age UK, Marie Curie and Macmillan.
A robust implementation model and continuous learning are key to the LCP, which is clear that patients and relatives should be involved in discussions, unless there are good reasons why this is not possible.
Contrary to media claims, the LCP is entirely patient-centred: it does not require hydration or nutrition to be withdrawn and does not replace clinical judgement.
In the ONS/DH national survey of bereaved people, published in July 2012, 75 percent of people rate the end of life care their loved one received as ‘good’, ‘excellent’ or ‘outstanding’. It is crucial, given the recent misinformation and misleading coverage that nurses continue to speak to their patients about their end of life care preferences and wishes.

Dear Jane, you say that Media coverage has highlighted examples where people have reported that care in the last days of life has not been of high quality. Your own survey indicates that, actually, 25% of people rated the end of life care their loved one received as less than 'good'. That is a lot of people, Jane.

By KPI (Key Performance Indicator) standards, that's a very poor level of service.

But, Jane, we are talking about dying here. Dying. A 75% KPI is wanting. Worse: It is dismal, abysmal by any standard.

And, Jane. One more thing. We are talking about people given a diagnosis of 'dying' and, on that basis alone, slammed onto your Liverpool Care Pathway.


  1. Do you have details if this survey on your blog, Eldoel? It would be interesting to have more information about the research methodology used, the questions asked, the number of people who were approached and the size of the sample that responded.

    Did, for example, all of the 25% who did not attribute excellence to their experience of the LCP, criticise the LCP. Or did they give a range of responses, ranging from, for example, 'okay' to 'neither good nor bad', 'don't know', 'poor', 'very poor'?

    Around 130,000 people are said to have died on the Liverpool Care Pathway in just one year. If only 5% of their families were critical of the LCP, that would represent around 6,500 complaints. If the figure is likely to be 25% then this represents over 32,000 complaints.

  2. If I recall the figures correctly, the government's Green Paper on the recruitment industry, which led to an Act of parliament, stringently controlling the industry, cited some 1% of calls for advice to its helpline and c POINT FOUR PERCENT RATE OF COMPLAINT.

  3. Some of those who defend the LCP in its current form criticise reports of abuse of the LCP as 'anecdotal' they appear to suggest that these reports are therefore inconsequential.

    However, almost all of the evidence used by the above Green Paper on the recruitment industry was anecdotal.

    The Green Paper on the recruitment industry nevertheless led to stringent statutroy regulation of the industry.

    Among the requirements of the regulation are:

    a requirement for best practice in accurately recording every stage of the recruitment process and for a fully comprehensive paper trail - one that applicants and regulators have access to.