End-of-life care to be overhauled

Social Care Minister Norman Lamb: "There has to be a more personal approach."

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There needs to be an overhaul in the way dying patients are cared for in England, ministers have conceded.

The government has ordered hospitals to carry out immediate reviews of their practices and announced the Liverpool Care Pathway will be phased out.

It comes after an independent report concluded the pathway, which can involve the withdrawal of food and treatment, was being "misused".

It will be replaced by individual end-of-life care plans within a year.

These plans will be tailored to take into account different conditions.

One of the major criticisms of the independent review - chaired by crossbench peer Baroness Julia Neuberger - was that the LCP had become a "tick box" exercise, which did not take the individual patient's circumstances into account.

The Care Quality Commission, which regulates hospitals, has also been told to ensure end-of-life care becomes a more important component of the inspection regime.

'Deeply distressing'

Care and Support Minister Norman Lamb said: "We hope the actions we have taken today will reassure patients and their families that everyone coming to the end of their life is getting the best possible care and that concerns are being dealt with swiftly.

"I have personally heard families describe staff slavishly following a process without care or compassion and leaving people suffering at the end of their lives. This is something we cannot allow to go on.

Replaced or renamed?

The notion that the Liverpool Care Pathway is being phased out is a little misleading.

No-one is advocating not intervening at all. In fact, the review team was adamant that how people are looked after in the final days of life should be a "core business" for hospitals.

But by recommending such a drastic step as phasing out the LCP - which has now been accepted by ministers - the experts are in effect trying to administer a jolt to the system.

Chairwoman Baroness Neuberger admitted as much when she unveiled the report. She said the problems identified went much deeper than just one element of NHS care.

She said there was a cultural issue with how vulnerable and elderly people were being cared for.

This has echoes of the Francis Report into the Stafford Hospital scandal - and is another reminder of the scale of the challenge facing the health service in the 21st Century.

"People's final days should be as comfortable and dignified as possible. That is why there is a place for thoughtful and careful end-of-life care that involves patients and their families, but it is clear what we have now needs to be replaced so we can create a better way of doing this."

The review was set up at the turn of the year amid concerns with the way the LCP was being used and the fact that hospitals were being financially rewarded for using it.

The LCP is recommended as best practice in Scotland and Northern Ireland as well as England. Wales has its own system

The review, which took evidence from patients and health staff as well as reviewing literature, said a "deeply distressing" picture had emerged.

It described patients being left without adequate nutrition and hydration with reports of some people desperately trying to suck sponges used by staff to dab their faces.

The experiences of several families were included in the review's report - many of which concerned the incorrect denial of fluids.

One said: "We were told that if we wanted anything to drink then the only way would be for the family to soak a paper towel from the dispenser in the toilet and let her suck it."

Baroness Julia Neuberger: "Panel were hugely shocked at some stories"

But the review also said they had found evidence that when the LCP was used correctly and in consultation with the patient and their relatives it could help ease the dying process.

Nonetheless, Baroness Neuberger said the LCP had to be phased out as there were now just too many unacceptable cases to "turn the clock back" and get it used properly by everybody.

Eve Richardson, chief executive of the National Council for Palliative Care and the Dying Matters Coalition, said: "There can be no excuse for not treating people with dignity, compassion and respect when they are dying, at the very time that they most need this."

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