Will a new approach to patients near the end of life suffer the same fate as the Liverpool Care Pathway?

Medicolegal expert and MPS spokesperson, Dr Pallavi Bradshaw, questions the new approach to end of life care outlined by the government.

The government’s abandonment of the Liverpool Care Pathway was met withdisappointment from many figures in the healthcare profession, with some voicing concerns that the move has come too soon, is too extreme and simply a knee-jerk reaction to bad press and a poor public image. However, an independent report which said that some hospitals applied the pathway with a lack of expert knowledge and was managed by undertrained staff meant others were in support of the withdrawal.

But if anything can be concluded from the LCP failure it’s that better communication is needed throughout the care procedure of those nearing the end of life. Last year MPS published an article highlighting the need for clearer communication and collective decision-making for patients reaching the end of life, two areas that were deemed to be lacking when the government carried out an independent review of the LCP last year.       

Recently, a new approach to end of life care has been established and welcomed by the CQC. The Five new Priorities for Care place the emphasis on sensitive communication between staff and the person who is dying and those important to them. In order to ensure effective treatment and reduce complaints a need for clear communication is paramount – and not just with the patient but also their family members and any colleagues who may be involved in treatment.

"In order to ensure effective treatment and reduce complaints a need for clear communication is paramount – and not just with the patient but also their family members and any colleagues who may be involved in treatment"

The Five new Priorities for Care put people and their families at the centre of decisions about treatment, suggesting the need for clear communication will be more essential than ever. It also opens the door for potentially difficult situations concerning conflicts of interest with family members. However, this approach may help reduce the amount of complaints and claims, with patients having more input into the treatment they receive.

Although this new approach specifically focuses on the issue of communication there has been little discussion about how this will be implemented in hospitals throughout the country. For it to be successful there must be additional training for students and newly qualified doctors.  

A new study by the British Geriatrics Society exposed a failure to train medical students adequately to deal with the complex needs of older patients. The study, which included a major poll of British medical schools, revealed that some medical undergraduates received as little as 55 hours of specialist training in the area of elderly care over their five-year courses.

One of the benefits of LCP was to help young doctors develop a better understanding of the processes involved in end of life care. Although the Five new Priorities for Care give the patient more control, focusing on their wishes rather than processes, it is more difficult to teach and could make many situations and scenarios far more ambiguous. It remains to be seen how it will be taught and implemented and whether, over time, bad press will again put pressure on the government to change their approach.