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The Liverpool Care Pathway: lessons learnt and implications for other care pathways

Deborah Murphy PresentationDeborah Murphy Presentation

Deborah Murphy today discussed the Liverpool Care Pathway, and the implications for other care pathways

Deborah decribed the history of the Liverpool Care Pathway and the events that led to the national review and the recommendation that the LCP should no longer be used. Deborah discussed the media debate and wider social and political debate around Care of the Dying more generally and particularly the challenging issues of communication, sedation, nutrition, hydration and generally instances of poor quality end of life care.

Deborah described how through national recommendation the Liverpool Care Pathway became the evidence base for many of the challenging issues described above that have no evidence and are still the subject of debate at a societal level. Her key message was that "good care doesnt come from a piece of paper - it comes from the healthcare worker delivering the care".

Deborah went on to discuss the 2013 Independent Review of the Liverpool Care Pathway and said the Review makes over 40 useful recommendations.

  • The LCP has been recognised by the Review as representing the right ethical principles for care of the dying patient.
  • The LCP has been recognised as providing good quality care when implemented properly.
  • The term LCP particularly “pathway” has become a barrier to communication and good clinical care.
  • Use of the LCP should be replaced within the next 6 – 12 months by an end of life care plan for each patient

Deborah also emphasised the NHS England recommendations following the review which stated that
“Where the LCP is being properly used then it must not be stopped abruptly. Many people have experienced good end of life care using the LCP….The principles of good palliative care, on which the LCP is based, must continue to be upheld.”

Deborah went on to discuss the role of the Leadership Alliance for the Care of the Dying People.  The alliance recently announced that they would not provide a replacement for the LCP – an interim statement is available here

In terms of lessons fore care pathways more generally Deborah talked about issues around language and public understanding of the pathway tool, ensuring the tool is explained to patients, the importance of quality governance frameworks, accreditation and assurance to monitor implementation - particularly when a pathway was not developed locally, and the importance of training and understanding that good care does not come from a piece of paper.

Deborah concluded that the review provides us with a historic moment in end of life care to take stock and review the care for dying patients. Quoting Mike Richards "How we care for the dying is an indicator of how we care for all sick and vulnerable people.It is a measure of society as a whole and it is a litmus test for health and social care services".

Deborahs slides are available if you scroll to the bottom of this page

Forthcoming events of interest:

Improving End of Life Care: Beyond the Liverpool Care Pathway
Tuesday 25 February
ICO Conference Centre
Clinical Audit for Improvement 2014
Wednesday 26 February— Thursday 27 February
Hallam Conference Centre

Raising Concerns & Developing Openness Including the Statutory Duty of Candour
Tuesday 25 March 2014
Hallam Conference Centre

Caldicott Guardian Training Masterclass
Tuesday 1 April 2014
Hallam Conference Centre

Patient Experience Insight: Demonstrating Responsiveness to Feedback
Monday 28 April 2014
ICO Conference Centre

Action Planning
Wednesday 30 April 2014
Hallam Conference Centre

Masterclass: Service Innovation and Improvement
Tuesday 20 May 2014
BPP Law School

Measuring and Monitoring Quality
Wednesday 21 May 2014
Colmore Gate Conference Centre

Masterclass: Performance Management
Wednesday 18 June 2014
BPP Law School

Masterclass: Patient Reported Outcome Measures (PROMs)
Tuesday 1 July 2014
Hallam Conference Centre

Download: Deborah Murphy Presentation

12 February 2014


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