Senior doctors say that the Liverpool Care Pathway (LCP) will be rebranded rather than abolished, raising concerns that many of the problems identified with the controversial end-of-life care plan will be repeated under the new replacement scheme.
Abuse
A review into the LCP, headed by crossbench peer Baroness Julia Neuberger, reported on “shocking” instances of abuse, including cases where patients had died from dehydration after being heavily sedated.
The review concluded that the scheme should be axedwithin 12 months and replaced by personalised care plans for individual patients.
But doctors said that new draft guidance, with details of the replacement scheme, would permit the abuse of dying patients to continue, and allow patients to suffer dehydration for days, or be sedated, leaving them unable to request food or water.
“Perpetuates errors”
Professor Patrick Pullicino, a consultant neurologist with East Kent Universities NHS Foundation Trust commented that the new scheme “lacks essential key components of the Neuberger report and perpetuates errors that were central to the dysfunction of the pathway”.
The new plans will allow a patient who is unable to swallow to be denied food and water unless practitioners decide that it is in their “best interests” to receive them.
Baroness Neuberger had also said that more evidence was needed as to whether it was possible to predict death with any degree of certainty.
But the replacement scheme includes proposals for patients who are “likely to die within the next few days”.
“No indication”
Prof Pullicino said: “There is no indication about how patients who are in the last days of life are going to be diagnosed as such. There is no mention of a research base to improve this prediction. This was a main central concern of the Neuberger report,” he said.
Any replacement scheme should be studied before being introduced, or risked simply repeating the same problems, he said.
“The Liverpool Care Pathway not only produced many instances of suspected hastening of death but also repeated instances of poor care.”
“The fact is that little seems to have changed, including the use of syringe drivers, anticipatory prescribing, use of sedation and narcotics and limitation of hydration and nutrition by a ‘best interest’ team decision.”
Alliance
In repose to the review, NHS England established the Leadership Alliance for the Care of Dying People which has been asked by the Government to provide advice on future end-of-life care regimes.
The alliance has published its proposals in an “engagement document” and is presenting them to medical and palliative care professionals across the country up until the New Year.
“Stitch-up”
Denise Charlesworth-Smith, who represented family and patient groups on the Neuberger committee, described the replacement scheme as a “stitch-up”.
“This alliance has come up with a product that looks very similar to the LCP,” she said.
“It has rebranded and repackaged the LCP. It is not good enough.”
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