Social work and end-of-life care

Social work is important in end-of-life care

Liverpool Care Pathway has become a tickbox exercise, not a thoughtful shared process

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As I said in a recent post, there have been increasing concerns about the Liverpool Care Pathway, and this has finally led the government to set up some inquiries to get the heat out of the situation.

Link to BBC News report about the inquiries.

The BBC’s Health correspondent, Nick Triggle has written a clear and balanced account of the issues.

Link to Nick Triggle’s article.








The newspapers (the Telegraph) who have been drumming up criticism have reported the Department of Health statements. Attached to these articles are some good comments.

Link to the Telegraph article and comments.









Link to an alarmist Mail Online article

My comment

It’s important to understand what the LCP is. It is a protocol, basically a list of things to do, once you have identified that a patient is nearing the end of their lives. The purpose of the LCP was originally to transfer experience of hospice care to general hospitals. An important aspect of the LCP is discussion with patients and relatives about what you are doing.

But the situation is different. Hospitals are busy places focused on treatment, whereas hospices are calmer environments focused on care. Hospitals cover a range of illnesses at lots of different stages of treatment, whereas hospices deal mainly with cancer (still) and other illnesses where there is a clear prognosis that the patient is nearing the end of their lives. The different situations mean that identifying when someone is approaching the end of life and then having a thoughtful discussion with patients and their relatives is more difficult to do in hospitals. It requires judgment and planning, but the hurried ‘acute treatment’ environment in many general hospitals does not make that very easy.

Another problem is that the government has pushed for the rolling out of LCP to improve the care of patients in hospitals; there is talk of financial incentives as ‘bribes’ to clear beds of people who are dying. But the real problem is the assumption that a list of things to do can be ‘rolled out’. What happens is that it becomes a tickbox exercise instead of a thoughtful shared process. And this unfortunate campaign against it is the result.


Written by Malcolm Payne

28 November 2012 at 3:04 pm

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