Friday, 9 November 2012

Liverpool Care Pathway

Good talk at the departmental meeting today on the integrated care pathway for the dying patient (aka. Liverpool Care Pathway for the Dying Patient (LCP)) which covered a lot of the recent media coverage.

Cancer expert who treated Mo Mowlam brands Liverpool Care Pathway 'the most corrupt practice in British medicine'
Mo Mowlam's doctor condemns Liverpool Care Pathway
The Liverpool Care Pathway leads away from pain
Liverpool Care Pathway: minister orders report into cash rewards
'A dog would have been treated better': Daughter's heartbreak over father's death after he was put on Liverpool Care Pathway without family's permission
Liverpool Care Pathway: Relatives 'must be informed'
Hospitals bribed to put patients on pathway to death: Cash incentive for NHS trusts that meet targets on Liverpool Care Pathway
Doctors defend Liverpool Care Pathway as 'dignified' way to die

A figure came up (in our discussion) that someone had read a report in the newspapers that the average time on the pathway is 33 days but that must have been a mistake - more like 33 hours.

The LCP was developed by a team led by John Ellershaw Consultant (now Professor) in palliative care from Marie Curie Centre, Speke Road Woolton, Liverpool [1] and has been demonstrated to be useful in other specialties [2].

When it won NHS Beacon status in 2000 it was referred to as the LCPDP. I think its name should have always been used in full 'Liverpool Care Pathway of care for the Dying Patient LCPDP' to prevent suspicion of some euphemistic cover for some other agenda. However, it's probably now too late as everyone has heard the term. There's a lot to be said for a name that is clear and clinical. Perhaps it was inevitable that the 'for the Dying Patient' was dropped when non-clinical staff were trumpeting its uptake.

The general mood in our meeting was one of incredulity that politicians and the media simply didn't understand the practicalities of caring for people who die.

1. Ellershaw et al. (1997) Developing an integrated care pathway for the dying patient. Eur.J Pall Care. 4 (6): 203-207
2. Jack C, Jones L, Jack BA, Gambles M, Murphy D, Ellershaw JE. Towards a good death: the impact of the care of the dying pathway in an acute stroke unit. Age Ageing 2004 Nov;33(6):625–626.