This week, Jeremy Hunt the Health Secretary, announced plans for a detailed investigation into the controversial 'Liverpool Care Pathway for the Dying Patient' program. The program is an NHS service which aims to offer special care and support for terminally ill patients who are assessed to be in the final days- or even hours- of their lives. But the LCP program has come under lots of heavy criticism over the years for failing to meet the complex needs of the elderly patients who join it. The latest worries come as a result of announcements that the program was never fully trialed or tested at its inception over ten years ago.The LCP program is the NHS's established process for assisting patients who have very advanced stages of cancer, heart disease, dementia or other incurable diseases. It is meant to be the last health care option available to those patients when no appropriate reversible treatment is available. Despite the emphasis on the final stages of life, the LCP has the aim of providing these patients with the very best care during the end of their lives. In addition, it aims to include family members and close friends in the process by pledging to offer them a consistent level of communication, care and compassion while their relatives are assigned to the program.
News of a full inquiry into the program earlier this week after reports emerged that the LCP has never been subjected to a randomised clinical trial to test the well publicised claims that it is the best way to treat dying patients. According to new reports, a study conducted as far back as 2010 concluded that it was unable to recommend the LCP program due to lack of clinical trials to prove its success rate.
Many people will be delighted with the new LCP inquiry because there are many people who disagree that it is an inappropriate procedure for serving people at the end of their lives, In fact, the program has received heavy criticism since it was launched, mostly from relatives of patients who claim the services or treatments provided by the LCP program "kills off" patients. it has come to be known as the "death pathway" by those who feel that once a patient is placed on the LCP program, the doctors and nurses around them give up on them, limiting the medical attention they receive and essentially just waiting for them to die.
According to the details of the program, food and drink can be withdrawn when a patient is close to death, and if it will make them more comfortable. Nevertheless, despite a patient's fragile state, the hospital must ensure that their need for medicine, food, drink and personal hygiene are satisfied and maintained. Importantly, if there are signs of improvement in their health, medical staff must respond accordingly- including removing them from the program altogether if appropriate.
However, there have been numerous accounts of this program working in a less dignified way than it should: many families whose relatives were placed on the program complain that more should be done to prolong lives, and in other cases families complain that in some of the NHS trust hospitals where the Liverpool Care Pathway has been introduced, the nurses and doctors who treat the LCP patients have very little training of how to look frail, dying patients who would usually be sent to hospices to receive care at the end of their lives.
During it's existence, the program has received hundreds of complaints from the families of LCP patients who, they claim, died unnecessarily and before their time because according to the regulations, flaws in the system are reported to include placing non- terminally ill patients on the program (including one 48-year old man who was deemed fit for the program, but was removed by his family and actually survived 5 weeks instead of the hours or days that the medical staff treating him estimated that he would live). According to reports, on average, 3 percent of patients are likely to recover after being placed on the LCP, so hospitals need to ensure that medical staff are trained enough to assess when patients can be removed from the program.
The NHS targets aspect of the LCP program has also gained a lot of negative press. It is well documented that NHS trusts are given financial incentives for increasing the percentages of dying patients assigned to the program. Naturally, this has increased fears that people might be assigned to the program unnecessarily. In addition, hospitals are given targets to make sure that those people dying in hospital are registered with the LCP. Additional financial rewards are then given to those trusts which achieve those set targets. According to the statistics for 2012, nearly 66% of NHS trusts using the Liverpool Care Pathway have received payouts - and the money awarded is not insignificant. As an example, Central Manchester University Hospitals received £81,000 for meeting LCP targets in 2010, and this amount was set to increase in the future, considering that by last year the number of the patients placed on LCP at those hospitals had more than doubled.
The idea that struggling NHS hospitals can gain up to millions of pounds for hitting LCP targets has generated a lot of ethical discussions and has brought the whole scheme into question again. Last week's announcements were strongly criticised by some doctors who felt that media reports had exaggerated a small number of incidents and created conflict between family members and the health services. On the many other occasions when LCP has worked, it has succeeded in offering a short, painless and humane death for the elderly patients and good, clear communication for their friends and family.
This latest inquiry has been called to ensure that the majority of patients experience exactly that. It is hoped that the investigation will take a closer look at the information from patients, nurses, doctors and families to understand what happens during the last hours and days of a patient's life. In the future, the revised LCP will ensure that those who are terminally ill spend the last 48 hours of their lives comfortably, and receive around the clock attention.