Bad press over Liverpool care pathway has scared patients and doctors, say experts

BMJ 2013; 346 doi: (Published 10 January 2013) Cite this as: BMJ 2013;346:f175
  1. Ingrid Torjesen
  1. 1London

The media furore over the Liverpool care pathway, the widely used protocol for the care of dying patients that has been branded “euthanasia by the backdoor” in some sections of the press, has scared patients and their families and made some doctors reluctant to use it, experts in palliative care have said.

At a press briefing on Tuesday in London aimed at dispelling the myths surrounding palliative care, Bee Wee, president of the Association for Palliative Medicine, said that although she “would not want to overstate it” she had heard reports from colleagues of relatives frightened by what they had read and of terminally ill patients too afraid to go into hospital.

Reports in some newspapers in recent months have suggested that thousands of NHS patients were being put on the pathway and being denied treatment, including hydration and nutrition, because they were difficult to manage and to free up beds.1

Irene Higginson, professor of palliative care and policy at King’s College London, said that some doctors were also now concerned about using the pathway because of what was being said in the media.

In November Norman Lamb, the minister for care services, announced that an independent review of the pathway would investigate the concerns.

Higginson acknowledged that there were some problems with the pathway, whether with the way it was being applied, the environment in which it was being used, or with some aspects of it that might be confusing staff members. She said, “If what comes out of this [review] is increased training in palliative care and a better look at the evidence around what is done, then I think that would be a good thing.” But she also emphasised that palliative care involved much more than just the Liverpool care pathway.

Last month palliative care organisations, including the Association for Palliative Medicine of Great Britain and Ireland, Marie Curie Cancer Care, and the National Council for Palliative Care, published guidance on commissioning specialist palliative care to help drive up the quality of all palliative care services.2

The guidance points out disparities between primary care trusts in the services and also according to the condition a patient has. Patients with cancer, for example, were more likely than other patients to be able to access specialist services.

In England around 500 000 people die each year, of whom about 355 000 need end of life care—and a substantial proportion of these will need specialist palliative care. Currently, specialist palliative care is provided to between 160 000 and 170 000 people, a large proportion of whom will have advanced cancer. These figures indicate that between 95 000 and 150 000 people are not getting the level of care that they need. Primary care trusts’ average spending on specialist palliative care varies 30-fold, from £186 (€230; $300) to £6213 per death.

Wee said that England was short of 120 palliative care consultants, 25% of the number estimated by the Royal College of Physicians to be required per head of population.

Not everyone needed care from a specialist palliative care professional, she said, but the standard of training and support for other clinicians needed to be driven up to improve palliative care for patients in all settings, and specialist professionals had a role in achieving this.


Cite this as: BMJ 2013;346:f175


  • Medicine and the Media: The assault on the Liverpool care pathway (BMJ 2012;345:e7316, doi:10.1136/bmj.e7316)