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Liverpool Care Pathway FAQs

By
WebMD UK Health News
Medically Reviewed by Dr Keith David Barnard
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27th November 2012 -- The Liverpool Care Pathway, or LCP, is an NHS scheme giving end of life care to people with terminal illnesses. 

There's been some criticism of the programme, which has been described as a 'pathway to death'. 

The government has announced an independent review of the programme.

What do we know about the LCP? Read our FAQs.

What is the Liverpool Care Pathway?

The NHS describes the Liverpool Care Pathway (LCP) as a way to improve quality of care in a terminally ill patient's final days.

The LCP can apply to a patient dying in hospital, at home, in a care home or hospice.

Doctors, nurses and other health professionals are given guidance on ensuring a peaceful and comfortable death. This includes avoiding inappropriate invasive procedures or unhelpful observations such as routine temperature taking, ending unnecessary medication and removal of any tubes supplying food and fluids. However the LCP does not preclude the use of assisted nutrition or hydration, or antibiotics. These are clinical decisions that should be made in the patient’s best interests. A key message is that use of the LCP aims to neither hasten nor postpone death.

The LCP stresses that the patient should be made as comfortable as possible and their spiritual or religious needs should be addressed.

Is LCP new?

No. The LCP was developed in the late 1990s by the Royal Liverpool University Hospital and the Marie Curie Palliative Care Institute.

At the time, some doctors felt end of life care standards were not consistent and that some patients were subjected to painful treatment and procedures which would not extend their lives.
The LCP has been in use in most NHS hospitals for some years.

Marie Curie Cancer Care says the LCP is "recognised nationally and internationally as leading practice in care of the dying to enable patients to die a dignified death and provide support to their relatives/ carers".

Why is the scheme controversial?

Some relatives have said the care pathway has been used without consent or inappropriately. There have also been claims hospitals have been given financial incentives to implement the LCP.

What do doctors say?

The newspaper coverage of the LCP has provoked an exchange of views between doctors writing in the BMJ. Dr Margaret McCartney has called some coverage "scaremongering".

Glasgow GP Dr Des Spencer said the LCP "has transformed end of life care from an undignified, painful experience into a peaceful, dignified death at home."

Under appropriate supervision, he believes the LCP "offers structure to a peaceful, pain-free, dignified death at home: a good death."

What safeguards are in place?

The NHS says legal consent is not needed for a patient to be put on the LCP, but consideration of the plan should always be discussed with the patient, if possible, and a relative or carer.

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