Liverpool Care Pathway - "Anecdotal And Without Substance"

Earl Howe:

"... there may be less substance to some of these stories than may first reach the eye."

Baroness Knight of Collingtree: My Lords, is my noble friend aware that large numbers of people with personal experience of how the LCP is now operating complain that their relatives were denied hydration in hospital and died in acute pain and discomfort, with no knowledge whatever or agreement of having been put on this pathway? Is he aware that patients often survive if relatives step in in time and give their dear ones help and water? One rang me a few days ago and she is now going on a cruise. Will my noble friend assure us that there will be an inquiry, which has been 

5 Nov 2012 : Column 761promised and announced in the press, and that it will be truly independent and not carried out by those who have vested interests? Nothing else will do.

Earl Howe: My Lords, there is never any cause for complacency in a matter of this kind, and I can reassure my noble friend that the Government will keep this issue under review. At the same time, I hope she will allow me to respond in slightly more forthright terms than I normally do, because there has been an enormous amount of misreporting and misinformation around the Liverpool Care Pathway, which has been endorsed publicly in a consensus document by 22 of the leading professional organisations and patient organisations in this area, including Marie Curie. We cannot ignore that. As I mentioned in my Answer, some of those organisation are looking carefully at the reports to which my noble friend alluded. It is notable that not a single complaint has reached the regulators in this area, which I suggest indicates that there may be less substance to some of these stories than may first reach the eye. However, I emphasise that there is no complacency.

[House of Lords Business - Monday 5 November 2.30 pm]


Earl Howe (Parliamentary Under Secretary of State (Quality), Health; Conservative)

My Lords, there is no procedure, as there is no such inquiry. A number of organisations, led by the National End of Life Care Programme, Dying Matters and the Association for Palliative Medicine, are looking into complaints, patient experience and clinical opinion on the Liverpool Care Pathway. We do not make policy decisions based on anecdote. If the work in hand suggests cause for concern, we will respond on the basis of that evidence.
(They Work For You.com)

Baroness Knight of Collingtree:

To ask Her Majesty's Government what procedures will be adopted in carrying out the NHS inquiry into the Liverpool Care Pathway announced on Monday 26 November 2012.

Earl Howe: The review will [not examine the Liverpool Care Pathway but will] examine how the Liverpool care pathway is used in practice

This is the DoH (Department of Health) -

DH   Media Centre

Independent review invites public to share their 

experiences of the Liverpool Care Pathway

February 16, 2013

Members of the public are invited to share their experiences of the Liverpool Care Pathway for Dying Patients (LCP), both good and bad, as part of the review being chaired by Senior Rabbi and Crossbench Peer, Baroness Julia Neuberger.

Their views will feed into the independent review of the pathway, which was announced in November 2012 by Care and Support Minister Norman Lamb to investigate concerns about the pathway, particularly accounts of the withdrawal of foods and fluids from dying patients and the use of financial incentives.

Speaking today, Baroness Neuberger said:

“I am honoured to have been asked to lead this review. It will tackle a really important area of concern and, I hope, be able to make recommendations that will improve how dying people are treated within our health and social care system.”

The review will examine various elements of the LCP, including:

• the experience and opinions of patients and families;
• the experience and opinions of health professionals;
• hospital complaints;
• the role of financial incentives in respect of the LCP;
• the literature about benefits and limitations of the Liverpool Care Pathway.

Care and Support Minister Norman Lamb said:

“Experts agree the Liverpool Care Pathway, if applied properly, can help patients die a dignified and pain free death, but, as we have seen, there have been too many unacceptable cases where patients or their families were ignored or not properly involved in decisions. There have also been reports of food and fluids being denied to people inappropriately.

“It is vital for relatives to have complete confidence in the care that their loved ones are receiving. This is why we want to hear from people with experience of the Liverpool Care Pathway, where it met the high standards expected and where things went wrong. 

“I urge people to get in touch to share their experiences, so we can ensure that lessons are learned and things put right.”

As part of the review, Baroness Neuberger will be holding meetings with families who have had experience of the LCP.

Today, Baroness Neuberger also announced full details of the panel of independent experts she has appointed to run the review:

• Denise Charlesworth-Smith – Has experience of the Liverpool Care Pathway when her father was placed on it
• Tony Bonser – fund-raiser for Macmillan Cancer Support; North Western Champion for the Dying Matters Consortium
• The Rt Revd Richard Harries – Former Bishop of Oxford
• Lord Charles Guthrie – Chancellor of Liverpool Hope University; Chairman of both the Hospital of St John and St Elizabeth and St Johns Hospice.
• Professor Emily Jackson – Dean of Law at the London School of Economics
• Dr Dennis Cox – Royal College of General Practitioners
• David Aaronovitch – Columnist for The Times
• Lord Khalid Hameed – Chairman of the Alpha Hospital Group; Chairman & CEO of the London International Hospital,
• Sarah Waller – A former trust chief nurse and director of human resources: currently leads The King’s Fund’s Enhancing the Healing Environment Programme.

The review will report to ministers and to the NHS Commissioning Board in the summer.

This is DoH -

Department of Health

Liverpool Care Pathway independent review: Public call for evidence launched
16 February, 2013

Members of the public were today invited to share their experiences of the Liverpool Care Pathway (LCP), both good and bad, as part of an independent review being chaired by Baroness Julia Neuberger. Baroness Neuberger is Senior Rabbi at the West London Synagogue and former Chief Executive of the King’s Fund

Views will feed into the independent review of the pathway, which was announced in November 2012 by Care and Support Minister Norman Lamb to investigate concerns that were raised, particularly around accounts of the withdrawal of foods and fluids from dying patients, and the use of financial incentives.

Written submissions from the public can be sent via email to:liverpoolcarepathwayreview@dh.gsi.gov.uk or by post to the following address:

Liverpool Care Pathway Review
Department of Health
Richmond House
79 Whitehall
London SW1A 2NS

Those that have submitted evidence will be invited to attend one of the regional sessions with Baroness Neuberger. Details of these sessions will be announced shortly.

If anyone wishes to attend one of the regional sessions without submitting evidence, they can also request to do so by email or post.

Also announced are the full details of the panel of independent experts appointed by Baroness Neuberger to run the review:

• Denise Charlesworth-Smith – Has experience of the Liverpool Care Pathway when her father was placed on it
• Tony Bonser – fund-raiser for Macmillan Cancer Support; North Western Champion for the Dying Matters Consortium
• Professor Lord Harries of Pentregarth – Former Bishop of Oxford
• Lord Charles Guthrie – Chancellor of Liverpool Hope University; Chairman of both the Hospital of St John and St Elizabeth and St John’s Hospice
• Prof Emily Jackson – Dean of Law at the London School of Economics
• Dr Dennis Cox – Royal College of General Practitioners
• David Aaronovitch – Columnist for The Times
• Lord Khalid Hameed – Chairman of the Alpha Hospital Group; Chairman & CEO of the London International Hospital
• Sarah Waller – A former trust chief nurse and director of human resources: currently leads The King’s Fund’s Enhancing the Healing Environment Programme

Speaking today, Baroness Neuberger said:

“I am honoured to have been asked to lead this review. It will tackle a really important area of concern and, I hope, be able to make recommendations that will improve how dying people are treated within our health and social care system.”

The review of Liverpool Care Pathway was outlined in January and will report to ministers and to the NHS Commissioning Board in the summer.

This is NHS EoLC Programme -

Improving end of life careNEoLCP encourages people to participate in Liverpool Care Pathway review

February 16, 2013

With the Department of Health today announcing the panel for the review into the use of the Liverpool Care Pathway (LCP), the National End of Life Care Programme encourages individuals and organisations to participate and share their experiences.

Claire Henry, Director of the National End of Life Care Programme, said: "I am pleased that Baroness Neuberger is giving everyone, from members of the public to health and social care staff, the opportunity to express their thoughts and share their experiences of the Liverpool Care Pathway. It is only by listening to people and making continued improvements that we can ensure everyone receives high quality care as they approach the end of their lives.

"This review is an opportunity not to be missed for individuals and organisations and I would encourage as many as possible to contribute their experiences, whether good or bad.

"It is really encouraging to see such a wide range of people on the review panel.  With such a spread of backgrounds and experiences the review will be solidly independent, so we can all be confident that the review process and its findings will be credible. We look forward to supporting Baroness Neuberger and the review wherever possible."

Find out more about the independent review into the use of the Liverpool Care Pathway.

This is - POLITICS HOME 

Press Release

Press Releases

Saturday 16th February 2013 | 00:01

Marie Curie: Marie Curie welcomes public involvement in the Independent Inquiry into the Liverpool Care Pathway

Marie Curie press release

Marie Curie welcomes public involvement in the Independent Inquiry into the Liverpool Care Pathway Marie Curie Cancer Care has welcomed the announcement that the voices of patients and families will be heard by the Independent Inquiry into the Liverpool Care Pathway.

The announcement comes as a poll conducted by ComRes for Marie Curie, shows more than half of people in the UK (53%) doubt that the NHS will provide high quality care to them or someone close to them who is dying. The charity is calling for 'a change in thinking' about end of life care.

Dr Jane Collins, Chief Executive, Marie Curie Cancer Care said: "We are pleased Baroness Neuberger and the inquiry panel will be listening to the voices of patients and their families, and health and social care professionals, about how dying people are being treated within our health and social care system. The Liverpool Care Pathway was developed to spread the hospice model of end of life care into hospitals and other healthcare settings but we know from the stories in the media, that not everyone who is terminally ill and dying is getting the high quality care they need and many are being badly let down. We look forward to providing any support and information we can to Baroness Neuberger and the inquiry panel and would urge patients and families with both positive and negative experiences of the Liverpool Care Pathway to come forward and take part."

Earl Howe has the evidence already pretty much summed up. The Baroness has the LCP pretty much sized up. 

The evidence... is "Anecdotal And Without Substance"

The LCP...?

Glyn Davies, MP, writes from Rural Wales about the inquiry and Baroness Neuberger.

"She is on record of being supportive of the Liverpool Care Pathway," says Mr. Davies.

That does not preclude her appointment. The review is not into the LCP but into how it is put into practice. What a game of semantics. They're playing with words whilst, back on the wards, they're still playing with lives.

Let's take a quick look at the team. 

Well, here is Mr. David Aaronovitch – Columnist for The Times, hand-picked by the Baroness. This is from the Times:

The Swiss way of death is a victory for optimism

David Aaronovitch

Published at 12:01AM, June 16 2011

I don’t have the courage to take my own life, but I admire the doctors willing to help those that are ‘ready to go’

"I don’t have the courage to take my own life, but I admire the doctors willing to help those that are ‘ready to go’" 

Should you really be on this team...?

One more... Here's Dr Dennis Cox – Royal College of General Practitioners, plum picked for the job. This co-authored offering is from Mills & Reeve on Lexology:

The Royal College of General Practitioners has issued new guidance to its membership, especially those who will be involved in a clinical commissioning role in English clinical commissioning groups (CCGs).

The guidance, Making difficult choices, authored by Malcolm Oswald and Dennis Cox, focuses on how GPs should decide what to commission when funds are limited and the consequences of those choices, and how they should manage the potential conflicts of interest involved in commissioning.

Although the guidance takes a well-meaning and not uninteresting meander down the philosophical path well trodden by Dworkin and others, the key practical points arising from the guidance are all too self evident:

• Commissioners should aim to use limited resources to maximise health benefit, whilst being fair (except where targeting a particular group to reduce health inequalities, when fairness trumps all).
• Every life is of equal and intrinsic value and every adult with capacity has responsibility for the governance of their own life.
• GPs have a responsibility to explain to their patients why rationing, as part of resource allocation, is a necessary part of any healthcare system.
• CCGs should have fair and open processes to consult the public on resource allocation and collaborate with health and wellbeing boards and others.
• CCGs should develop policies for priority setting and have procedures for considering exceptional cases.
• Commissioning must be cost-effective and evidence-based.
• CCGs should have a clear statement of the conduct expected of those involved in its governance, based on the Nolan principles.
• CCGs should maintain and update regularly a register of interests.
• CCGs should have a clear policy for handling conflicts of interest in meetings.
• CCGs should ensure that procurement and contracting procedures comply with the law and good practice.

The guidance also contains illustrative scenarios to provide food for thought although the analysis should not be regarded as either prescriptive or comprehensive (eg, example one – an individual funding request for breast augmentation by a young woman who self harms as a result of being teased – considers cost against clinical effectiveness but fails entirely to throw exceptionality into the melting pot).

Look carefully at the bulleted list.Do we not here see the essence of the Communitarian Pathway? In particular -

"Commissioners should aim to use limited resources to maximise health benefit, whilst being fair (except where targeting a particular group to reduce health inequalities, when fairness trumps all)."
"GPs have a responsibility to explain to their patients why rationing, as part of resource allocation, is a necessary part of any healthcare system."
"CCGs should have fair and open processes to consult the public on resource allocation and collaborate with health and wellbeing boards and others."
"CCGs should develop policies for priority setting and have procedures for considering exceptional cases."
"Commissioning must be cost-effective and evidence-based." 


Mr. Lamb said: "I urge people to get in touch to share their experiences, so we can ensure that lessons are learned and things put right." 

Mr. Lamb, it's a lesson too late for the learning. It's time for the transgressors to be made to answer for their misdeeds. 


Baroness Neuberger said: "I am honoured to have been asked to lead this review. It will tackle a really important area of concern and, I hope, be able to make recommendations that will improve how dying people are treated within our health and social care system."

What has she not heard? Patients have been determined to be dying who have not been dying... 


They've had the round table; now it's the craps table.

The die are already loaded. Ready for a game of Review...?