A Submission to the Independent Review of Liverpool Care

I notice that my pdf file, which uses sizing, bolds and coloured text to make reading easier and to highlight sections, is still awaiting approval.

Much of my submission is much harder to follow 'plain text', but I'm going to try and post two 'sections' from it here (I have tried to make the formatting sensible - but who knows how it will actually appear once posted !):
__________________________________

This probably cannot be changed - but why use the term
'LCP' ?

The LCP is clear about the importance of communication. It is designed to support professionals, who may not be palliative care specialists, to provide personalised, hospice style-care. It encourages staff to anticipate the treatment an individual may need, and to be ready to provide it swiftly, but it
does not dictate the treatment anyone should receive. The issue is therefore not about the merits of the LCP itself, but about how it is being used.

The wording above, is from the page describing the LCP Review.

I think calling 'the overall care' 'being on the Liverpool Care Pathway' is conceptually confusing - all people are doing, are changing behaviour when the patient's situation changes (from being cured, to dying, in essence).
There are clinically-proven methods of providing palliation, but these need not only be involved in the care of the terminally ill: likewise, a patient is entitled to refuse some active interventions but accept others (it is reasonable in some
situations, to accept all types of active intervention except for a blanket refusal of attempted CPR). The widespread confusion/conflation between clinical effectiveness, and a patient's right to refuse interventions (a right which is
ongoing and applies to each individual intervention), is probably one reason why the communication your webpage stresses as being so important, does not always occur - if every aspect of 'the LCP' were thought of as being a
separate 'intervention', and it were understood that these individual interventions required patient consent, then surely clinicians would be more-or- less forced to talk to patients (or for mentally-incapable patients, 'relatives') ?

Hospital or Home

If 'the LCP' is the gold-standard for EoL care, then it should presumably be used both at hospital, and also at home (even if some things would not be possible, or would need modification, at home).
Currently, most clinicians are coming round to the view that DNACPR Forms must stay 'with the patient' - usually, right at the top of the medical notes.
This has resulted in the odd situation, that most hospitals have guidance which does not state that patients must be informed of 'clinical' DNACPR decisions - but for patients who are home, if the DNACPR Form is also at home and sitting on top of their medical notes, it is effectively impossible to not 'tell the patient/relatives' of the DNACPR decision.
Presumably, this will also be true, if the LCP is employed in a home setting.

It seems to make little sense, to have an objective to allow more patients to die at home, and for the 'discussion/disclosure' to be effectively unavoidable for patients who are at home, if hospitals are to have a policy of only optional discussion/disclosure !

Hi,
Just to let people know that Wales has its own new integrated end of life pathway.
My mother died last summer and the new pathway was used.

As far as I am aware there is not supposed to be use of the Liverpool pathway and GPs get a payment for putting patients on the palliative care register here.

Regards,

Lorraine Morgan

The review was published yesterday and can be downloaded from:

https://www.gov.uk/government/publications/review-of-liverpool-care-pathway-for-dying-patients