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Liverpool Care Pathway

Volume 566: debated on Monday 15 July 2013

The independent review of the Liverpool Care Pathway has been published today. I commissioned this review in January 2013 in response to concerns raised by patients, families, carers and a number of clinicians. The review was undertaken by an independent panel chaired by the noble lady, Baroness Neuberger.

People who use health and care services have the right to be treated with respect, dignity and compassion by staff with the skills and time to care for them properly. We all want our own and our loved ones’ final days and hours to be pain-free and dignified, with individual needs prioritised and respected, and with families and carers fully involved.

I recognise and value the high quality of much of end of life care across the country. On behalf of the Government, I would like to convey my continued support and appreciation for the work that so many doctors, nurses and others do on a daily basis to care for the dying. While most patients certainly are receiving high-quality care and many families and carers are being properly involved, we need to make sure that this is the case for everyone.

The Liverpool Care Pathway was introduced to improve end of life care by setting out principles for how the dying should be treated, whether they are in hospital, at home, in a care home or in a hospice. The review heard that when the Liverpool Care Pathway is operated by well-trained, well-resourced and sensitive clinical teams, it works well. However, it also heard too many examples of poor practice and poor quality care, with families and carers not being properly involved and supported. This has to change.

The review made a number of recommendations to Government and other health and care organisations. The Government will consider fully the recommendations of the review and over the coming months will be working with these organisations, stakeholders and charities to inform a full system-wide response to the review’s recommendations in the autumn. However, I can announce at this point our intention for the Liverpool Care Pathway to be phased out over the next six to 12 months. Instead, an individual approach to end of life care for each patient will be introduced, with a personalised care plan backed up by condition-specific good practice guidance and a named senior clinician responsible for its implementation.

In addition, the Care Quality Commission will be undertaking thematic work on end of life care, and the three new chief inspectors—of hospitals, social care and general practice—will consider end of life care issues as they develop their new approach to inspections. To support these improvements to end of life care, I am also writing to the General Medical Council and the Nursing and Midwifery Council to highlight both the need for effective guidance on supporting nutrition, hydration and sedation for the dying, but also to stress the importance of the professional regulation issues raised by the report.

However, it is clear that we need to take action immediately. I can therefore announce:

to ensure immediate action for patients, families and carers, I have written to all NHS hospitals asking them to undertake a clinical review, led by a senior clinician, of each patient who is currently being cared for using the Liverpool Care Pathway or similar plans for the final days and hours of life to ensure that the care they are receiving is appropriate. I have also asked them to ensure that arrangements are put in place to provide assurance that every dying patient now and in the future has a named senior clinician responsible for their care. I will be writing in similar terms to those responsible for dying patients being cared for outside of hospital;

it is equally important that the concerns about care are properly investigated and resolved. I will ensure that people who have a complaint about the care given to a dying patient on the Liverpool Care Pathway or similar plans have access to an independent assessment of their case should they want it. I have also asked all NHS hospitals to appoint a board member with responsibility for overseeing any complaints about end of life care and for reviewing how end of life care is provided; and

the review also recommends that incentives paid to hospitals to promote a certain type of care for the dying should cease. In response, I am asking NHS England to work with clinical commissioning groups to implement this immediately.

I would like to thank Baroness Neuberger, the review panel and their support team for their hard work and commitment. Finally, I would also like to thank all the contributors to the review, and in particular the families and carers of patients.

“More care, less pathway: A review of the Liverpool care Pathway” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.