Intended for healthcare professionals


End of life care services are in limbo after phasing out of Liverpool Care Pathway, MPs hear

BMJ 2015; 350 doi: (Published 23 January 2015) Cite this as: BMJ 2015;350:h386
  1. Adrian O’Dowd
  1. 1London

Experts have condemned the “tiny” amount of funding allocated to end of life services, telling MPs that it undermines the quality of care for this universal experience.

They also voiced concerns about the absence of a reliable system to help with end of life care, after the enforced end of the controversial Liverpool Care Pathway (LCP) system last year. During the Health Committee’s first evidence session of its new inquiry into end of life care, MPs asked about the current state of palliative and end of life care.

Fliss Murtagh, reader and consultant in palliative medicine at the Cicely Saunders Institute in London, giving evidence, said, “I was quite shocked to discover that, if you look at the total NHS spend on palliative and end of life care—this is data from 2011, which is the last time it was detailed—it was only about £450m [€587m; $682m] for the whole country [England].”

Only 10p in every £100 of health service research spending was currently devoted to palliative and end of life research, she added, saying, “We are throwing peanuts of resources to try and crack a problem which is really important in people’s needs, and it’s not being addressed. The resources to deliver this are tiny in comparison to the demand as people get older with complex comorbidities.”

A fellow witness was Simon Chapman, director of policy, intelligence, and public affairs at the National Council for Palliative Care, who said, “The thing we have consistently struggled with is lack of importance being attached to palliative and end of life care and to this important universal time of life.”

MPs asked about the effect of last July’s national decision to insist that all acute hospitals stop using the LCP.1 The pathway was an integrated care tool intended for use at the bedside to improve the quality of a person’s last few hours or days of life. However, it generated a series of highly critical media stories claiming that patients were drugged and deprived of fluids in their last weeks of life, and a government commissioned review2 found that some hospital staff had wrongly interpreted its guidance and had received poor training in its use.

Mike Richards, chief inspector of hospitals at the Care Quality Commission, also giving evidence, said, “The problem was that the LCP had got such a bad name that I think it had to be phased out. But I would emphasise that, where it was being used well, it had been a useful tool and approach to making sure end of life care was delivered well.

“That does not mean that’s the only way of doing it, and I think that is now being replaced, but it is taking time and there has been a hiatus.”

Asked whether he was satisfied that hospitals had an adequate alternative in place, Richards replied, “I can’t say that I am satisfied. To the best of our knowledge, the Liverpool Care Pathway has been withdrawn as was planned and recommended. The pace at which different hospitals have moved to replace it has been variable.”

Chapman agreed that the pathway had to go given the loss of public confidence in it, adding, “The Liverpool Care Pathway was a pretty sophisticated clinical audit based tool, but it was designed as a prompt and it had become a crutch. Too often people at the top of hospitals were content to let the pathway be used by staff who were inadequately trained.”


Cite this as: BMJ 2015;350:h386