Q. What is the Liverpool Care Pathway (LCP) for dying?

A. This pathway is simply a way of ensuring that we care for people who are actively dying as well as possible and document that care.

Health bosses believe that most people whose death is expected and who are very near the end of their lives should be commenced on either the Liverpool Care Pathway or a similar pathway to ensure that they are cared for appropriately and that communication with all involved is as good as possible. It is a recognised model of best medical practice and is supported by 20 national organisations.

The pathway focuses on communication with the patient and family, decision-making and expert symptom management.

Patients on LCP are reviewed regularly by the medical team. Amongst many goals of care, patients are individually assessed for their nutrition and hydration status, and a plan made for what is clinically in their best interests, including food and fluid intake.

 

Q. Why is it called the Liverpool Care Pathway for the Dying Patient?

A. The Specialist Palliative Care Team at the Royal Liverpool and Broadgreen University Hospitals NHS Trust and the Marie Curie Hospice, Liverpool, developed the Liverpool Care Pathway for dying patients in 1997. It is for those in the last hours or days of life. Southampton became one of the first bands of hospitals to introduce the LCP five years ago.

 

Q. When is a patient started on the LCP?

A. It was introduced to enable health care professionals to focus on care in the last hours or days of life and to stop, think, assess and change care appropriately for the individual person and/or their relative and carers.

 

Q. When is it used and who decides?

A. It is used when the team caring for the patient agrees that the patient is dying and all reversible causes for the current situation have been considered.

 

Q. Is the LCP only used for cancer patients?

A. No. The LCP supports care in the last hours or days of life irrespective of diagnosis.

 

Q. What advantages are there in using the LCP?

A. The Marie Curie Palliative Care Institute in Liverpool believes the LCP supports the healthcare professional and the relatives and carers to achieve the best quality of care at what can be a very difficult time.

 

Q. How many hospitals implement the LCP?

A. Most hospitals will use the LCP, or a similar end of life care pathway. Residential homes, nursing homes and GPs are all able to put a patient on LCP.

 

Q. Is LCP only used in the UK?

A. No, 18 other countries are registered with the LCP Continuous Quality Improvement Programme.

 

Q. How many patients in Southampton are put on the LCP?

A. Around 750 to 800 patients a year are put on the LCP. The hospital strive to put 60 per cent of all dying patients in hospital on the LCP.

 

Q. Are the numbers increasing or decreasing?

A. Due to recent negative press coverage, those on the LCP has dipped to around 50 per cent.

 

Q. What are the objectives of using LCP in Southampton?

A. Bosses in Southampton have four main objectives for using LCP: l To provide greater choice for patients of place of care and place of death; l Fewer emergency admissions of patients who wish to die at home; l Fewer patients transferred from a care home to hospital in the last week of life; l Improved skills amongst generalist staff in the provision of end of life care.

 

Q. What is it that the LCP doesn’t do?

A. The LCP does not give hospitals a licence to hasten death. It does not recommend withholding food and water and putting someone on LCP is not irreversible. Patients should be reviewed every four hours and fully re-assessed every three days or in response to a number of triggers.

 

Q. Does the LCP help to deal with other aspects of care, such as how the family is coping?

A. Yes, the LCP includes specific goals of care related to communication, spiritual and religious care of the patient and the family and the changes that are expected in the last hours or days or life.

 

Q. What have been the concerns?

A. One of the major concerns is that those put on the LCP are starved to death to prompt the process of dying. Other concerns raised include the fact that patients and relatives are not told when medical staff take the decision to implement the LCP and that once you are on the LCP you cannot be taken off.

 

Q. Is there any truth in these concerns?

A. Health experts insist that patients are not starved. They say that patients put on the LCP are actively dying and at that stage nutrition and hydration is not needed by the body and can, in many cases, make the patient feel more uncomfortable because the body cannot cope with the intake. Food and fluids are not routinely withheld, but if they are, a person’s thirst can be addressed by regular mouth care.

Bosses at Southampton have said that whenever possible, patients, families, carers and staff are all involved in open discussion before starting the LCP.

They also insist that the LCP doesn’t cause a patient to die. There are cases when a patient gets better and they are taken off the LCP.

 

Q. Is there anything to worry about?

A. Health experts believe that the LCP is the best way to improve care for those within hours of dying, ensuring it can be as peaceful as possible. Regular four-hourly checks are made on patients put on the LCP to ensure they still need to be on that pathway and can be taken off if their health improves.

 

Q. Where can you get more information?

A. If you are reading this and your relative or friend is dying at University Hospital Southampton and you have any questions, please contact the ward team caring for your relative or friend. They can contact other support services, including teams with expertise in both palliative care and the care of the dying.