What is replacing the Liverpool Care Pathway in the real world?
Nursing Times online has just (Oct 2nd) posted a 'big question' (to its readers) about the situation since the Liverpool Care Pathway (LCP) was 'abolished' - the piece is at:
The Nursing Times 'question' included:
'Nursing Times has been told that clinicians are continuing to use the controversial Liverpool Care Pathway for end-of-life care, despite a major review concluding it should be scrapped. ... However, Anthony Wrigley, a senior lecturer at Keele University, has claimed nurses and doctors are continuing to rely on the LCP, because they now have "nowhere to turn" for specific guidance on how to treat people in the last weeks, days and hours of life.'
The Nursing Times piece ended with the question - which I am also asking here, in the hope of gaining a better understanding of this issue:
'What end-of-life care guidance is being followed at your place of work?'
I have just mentioned the NT piece to NHS England's end-of-life care lead, and both of us would like to understand what is replacing the LCP at the front-line, both in hospitals and community care - so far there has only been one response posted in answer to NT's 'big question', and is it typical of what is going on in most places?:
'anonymous | 3-Oct-2014 9:21 pm
No-one seems sure what guidance they should be following, or what form of documentation we ought to be using.
There's one thing for sure...everyone that I've spoken to regrets the passing of the LCP.
Newly qualified and inexperienced staff are floundering and no longer have the structured support that the LCP provided.
In the end, the recommendations to phase out the LCP is to the detriment of our patients who only get one shot at dying.'
I (Mike Stone) might send out some e-mails to Dignity Champions who seem to be nurses involved in end-of-life care, although it isn't all that easy to identify the right people to ask using the champions search facility - if I do trawl champions, I'll add any answers I get to this piece so that everyone can see what seems to be going on.
I have started to send the same question to Dignity Champions, and the first reply follows - I will post subsequent replies in batches, if I get some:
Hi Mike, we are currently using an individualised end of life care planning guidance document in all clinical wards.
We are also piloting a symptom based observation chart and joined up care diary ( enables a shared approach between palliative care and ward teams) and an information booklet for family/ relatives etc on one ward.
There are a few replies to this question, which Nursing Times harvested via social media, on page 9 of the current edition of Nursing Times (volume 110 no 42).
The House of Commons health select committee has just published its report on, to use my phrase, 'what is replacing the LCP in end-of-life care' - you can get the report at:
http://www.publications.parliament.uk/pa/cm201415/cmselect/cmhealth/805/805.pdf
I only tracked it down a couple of hours ago, and I've so far only read about half of it - but I've been banging on for years about 'muddle and confusion over exactly what is Advance Care Planning (ACP), and the difference between instructions from the patient and 'patient wishes', so I can only agree with this section of the report !
79. Dr McShane, giving evidence for NHS England, commented on the confusion that exists around advance care planning: "I must admit that I have been trying to work out the lexicon around this and I am not sure it is entirely helpful: an advance care plan could lead to an advance statement and an advance decision to refuse treatment, and I think we are confused."
The next section of the report, is the reason I keep writing about the Mental Capacity Act:
80. The legal framework to support people's choices and preferences for their care is set out in the Mental Capacity Act 2005. Evidence received for this inquiry however suggests that it is not well understood. A recent House of Lords Select Committee report on the implementation of the core principles of the Act commented that "its implementation has not met the expectations that it rightly raised. The Act has suffered from a lack of awareness and a lack of understanding." Norman Lamb also acknowledged, when giving evidence to the inquiry, that there is still some way to go to fully embed an understanding of the Mental Capacity Act and the mechanisms it has made available.
Thank you Mike