Doctors are continuing to use the abolished Liverpool Care Pathway (LCP) due to an 'arrogant' belief that they know best in end-of-life care, according to the National Institute for Health and Care Excellence (NICE). The health watchdog has issued new guidelines urging hospital staff to avoid 'snap decisions' about dying patients.
The LCP, introduced in the 1990s, involved withdrawing food, fluid and medication from the terminally ill. It was meant to reduce suffering but was widely abused, with patients denied sustenance for days or written off despite potential recovery. The Daily Mail highlighted these abuses, leading to an independent review in 2012 that recommended abolition by July 2014.
Professor Sam Ahmedzai, chair of the NICE committee, said 18 months after the ban, some 'teams' of doctors still use the pathway. 'They thought they knew how to give end of life care. It turns out they're the ones that don't know,' he stated. He warned that some teams 'bury their heads in the sand' and refuse to change.
NICE's new guidelines aim to eliminate the LCP permanently, calling for individualised care rather than a blanket approach. However, concerns remain that the pathway persists under different names. Adrienne Betteley of Macmillan Cancer Support told MPs that some hospitals have 'tweaked the original document and called it something else'.
Grieving families report loved ones placed on the LCP after its abolition, including 93-year-old Margaret Nellie Smart, who died at Warrington hospital in October 2014. Professor Ahmedzai stressed the need for respect and compassion, noting that inexperienced staff often fail to recognise when a patient is truly dying or could recover.
Professor Patrick Pullicino criticised the new guidelines as 'flawed', arguing staff are still asked to 'diagnose' dying. But Claire Henry of the National Council for Palliative Care welcomed the guidance, saying end-of-life care in the UK is 'world class' at its best but suffers from 'huge inconsistency'. Duleep Allirajah of Macmillan added that the guidelines should tackle 'unacceptable variation' in care.
