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Improving end of life care

Improving end of life care

Last updated: 18 December 2013

The Liverpool Care Pathway (LCP) was developed to spread the hospice model of end of life care into hospitals and other healthcare settings and it has enabled thousands of people to have a dignified death. However, press reports and feedback from families indicated that not everyone was getting the high quality care that the public has a right to expect.

In November 2012, Marie Curie called for the independent review of the LCP to be brought forward and for an action plan to be put in place to ensure improvements where care is below the highest standards.

In July 2013 the findings from an independent review, led by Baroness Neuberger, into the Liverpool Care Pathway (LCP) were published. The report highlighted failings in the implementation of the LCP and recommended that the Government replaces it with individual care plans over the following 12 months.

More Care, Less Pathway: A review of the Liverpool Care Path found that although when used well, by well-trained staff, the LCP did enable people to have a comfortable and dignified death, too often it was used inappropriately, by poorly trained staff, resulting in a breakdown in communication and poor end of life experience for not just the patient but also those close to them and their carers.

As a result of these findings the review recommended that the LCP be phased out over the following 12 months and replaced with individual care plans for people who are approaching the end of life.

Marie Curie welcomed the recommendations in the independent review, stating:
“This report’s recommendations, if implemented in full, will radically improve the quality of end of life care and ensure there is greater consistency across the country. We will work closely with the Department of Health and with our partners in the NHS to make this a reality.”

Marie Curie’s Medical Director, Dr Bill Noble said: “We welcome this report and its findings. In my experience as a palliative care physician, the best end of life care happens when it is tailored to the individual patient and integrated with care that has gone before.”

Leadership Alliance for the Care of Dying People

Following the publication of the report on 15 July 2013, the Leadership Alliance for the Care of Dying People (LACDP) was set up to respond at a strategic level and to lead and provide a focus for improving the care for this group of people.

The LACDP is chaired by Dr Bee Wee, National Clinical Director for End of Life Care, NHS England and membership includes a wide range of stakeholders, including Marie Curie, who also represent umbrella organisations, Help the Hospices, the National Care Forum and the National Council for Palliative Care. The aims of the Alliance are to:

  • support everyone who is involved in the care of dying patients to respond to the findings of the LCP review; and
  • be the focal point for the system’s response to the findings and recommendations of the LCP review

As part of the consultation process, the LACDP are holding a series of 12 public workshops across England this autumn to engage with the public and professionals on proposals to improve end of life care and to share their views and experiences.

The public workshops are being organised by Marie Curie, Help the Hospices, Macmillan Cancer Support and Sue Ryder with support from the National Council for Palliative Care on behalf of NHS England.

For those unable to attend the workshops but who would like to have input on the work being carried out, the engagement document being discussed at the workshops is available until 31 January 2014 to help people further understand the work of the alliance in this area.

The alliance is also:

  • developing advice for professionals on individual care plans and other arrangements in place of the Liverpool Care Pathway;
  • considering how health and social care can best address the recommendations in the review about the accountability and responsibility of individual clinicians, out-of-hours decisions, nutrition and hydration and communication with the patient and their relatives or carers; and
  • “mapping” existing guidance, training and development, as a prelude to considering how these impact on the care of dying people and the circumstances that might affect the adoption of good practice.

Find out more about the Leadership Alliance for the Care of Dying People