RIP Liverpool Care Pathway

There has been much talk of the Liverpool Care Pathway on the news this week. It looks as if it may come to an end and I, for one, say hurrah. When I first heard about it I thought it was a great idea. Using the Hospice model people should be allowed to die with dignity, surrounded by family rather than machines. However it didn’t always work out that way.

I know of one woman who found out that her husband had been marked down as DNR without any conversation with her. Perhaps they did speak to her husband but as he had dementia he might have said anything. She was deeply upset and not ready to let him go.

I know my own mother’s death (in a hospice) was just awful. Not a happy death at all. But as I’ve spoken about this elsewhere on this blog I won’t go into it again.

However, this week something reminded me of an occasion, not so long ago, when I was visiting one of my old folk in hospital. She had been going downhill and as I sat there I recognised that it would not be long before she died. I knew she had no family or anyone to be with her so I asked a nurse what the doctors were saying and was she likely to go soon. Firstly the nurse said she couldn’t discuss the patient with me because I was not ‘family’ but after much persuasion (and I mean much) she did agree that she possibly might die soon. “How soon?” I asked. Because I’d thought I’d like to sit and be with her so that she wasn’t on her own.  It was then that the nurse started telling me about the Liverpool Care Pathway. I told her I did know about it, having been a p/t hospital chaplain. “Well,” she retorted, “we will be taking care of her.”  I mentioned that there was also a ‘spiritual’ part to the LCP and I would like to help in that part. “Oh that’s not about religion!” she said, “Spiritual is all about her having clean clothes and nice things about her.”

I don’t think I had anything to say to that. Somewhere along the way, in a teaching class, or on a busy ward, this nurse had been taught the LCP. In all possibility she was taught by someone with no religion, or even someone who was hostile to it. I’m not saying that having a clean nightie and brushed hair is not part of your spiritual needs but it certainly isn’t all of it. I had been bringing communion to this woman for months and we had talked often about her imminent death.

Perhaps this is partly why the LCP is not working. Perhaps ignorance, hostility, or embarrassment is why some hospital staff just don’t know how to talk about end of life things in a religious context. Or maybe it was just this one nurse. All I do know is that there needs to be more communication, and especially listening.

PS And yes she did die that night on her own. If they’d phoned I would have gone.

PPS I love nurses.

headstone celtic blossom

6 thoughts on “RIP Liverpool Care Pathway

  1. You know I used to teach the LCP, and when it was done well and properly is was amazing. The first time a document said assess a patients spiritual needs as part of holistic care dying in hospitals homes hospices. There have been problems and a lot is lack of training and fear of talking to family about death – medical staff feel they have failed….. So its with sadness if it goes, I can see better education what’s needed. Your experice Ruth you should have been called give evidence !!

  2. Oh how sad is that! Lets hope it was just that one member of staff and not all are like that. Agree with Pamela, more training is needed, but presume the Hospice staff have that training.

  3. One of the other problems about the LCP is that once embarked on it can be hard to reverse as a member if my staff found out when against all odds her father began to recover. She was told that ‘legally I don’t know if we can reverse the decision once made’ Suffice to say it was reversed and he is still at home and doing well! Again common sense v teaching and protocols. The idea is good but the practice needs attention.

  4. Thanks for your wise thoughts on this Ruth. My experience of being part of the Palliative Care team at the Marsden in London was that most palliative care professionals were already using the principles of the LCP and it was really designed to make sure that general clinical staff considered all the relevant issues for a particular patient as they approached the end of life. I did, however, encounter one or two clinicians who had similar views to the nurse you described. I remember one putting down ‘bingo’ as a patient’s spiritual needs… But on the whole, NHS staff are reasonably alert to the spiritual and religious needs of patients, especially in more ethnically diverse communities. This is an area where the NHS needs good healthcare chaplains to make sure that religion and spirituality are addressed seriously and in an informed way.
    I hope that the demise of the LCP will not signal a retreat from a commitment to good end of life care.

  5. The Protocol for the Liverpool Pathway originally stated that it was to be for 48 hours. If the patient had not died after that time, it was to be discontinued. We now hear that hospitals were given financial incentives for implementing the LCP…..

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