LDVideo: Norman Lamb on end of life care

Norman Lamb has announced that the Government will be gradually withdrawing the use of the Liverpool Care Pathway in the NHS in England. The controversial method was developed within the hospice movement but relatives had told of cases when their loved ones were distressed and suffering because of a denial of fluids or nutrition or that the dying had been put on the LCP without family knowledge or consent.

I have heard of cases where people who are still conscious have been denied fluid after being put on the LCP, becoming so thirsty that they are delirious and distressed. That should not happen. Not ever.

After concerns were aired in the media, Norman Lamb asked Rabbi Julia Neuberger to chair an independent review of how the Liverpool Care Pathway was used. It says:

Perfectly preventable problems of communication between clinicians, relatives and carers appear to account for a substantial part of the recent controversy and unhappiness surrounding the LCP.

And concludes:

Many of the problems in the care of the dying highlighted in this report are due to poor understanding among clinicians of existing guidance in care for the dying, and an unwillingness to discuss with patients, their relatives and carers the prospect of death and the clinical uncertainties that accompany it. The Government must therefore ensure that its arms-length bodies collaborate with the clinical professional bodies and other key players in the system, and inject considerable funding into the system, to ensure that guidance on care for the dying is properly understood and acted upon, and tick-box exercises are confined to the waste paper basket for ever.
The review has clearly affected the panel because:
The Review panel feels so strongly about this that it is going to continue to meet at its own expense and volition, to monitor closely what happens next in response to its recommendations.

“As a Liberal Democrat Minister I am completely focused on the need to deliver better care,” Norman Lamb  told the BBC. He said that the LCP itself was a useful tool, but it had not been used properly in some hospitals. He added that the Government would replace it with individual end-of-life care plans within a year. You can see his interview below.

I had been slightly worried that the use of sedation or other ways of making life more comfortable for the dying would end up being severely restricted as a knee-jerk reaction to the media scares around LCP. It does seem, however, that the review panel and Norman Lamb have taken a thoughtful and sensible approach. You would expect a Liberal Democrat to focus on the need to provide the best care for each individual. We are all different, our tolerance to pain, the way we feel symptoms is different. Good end of life care involves developing a plan that will work for the specific  patient and monitoring and adjusting as necessary to ensure their comfort and dignity.

It’s important, though, that nursing staff have the time to adequately monitor and care for their patients and some must improve their communication with relatives. Money can go so far by providing sufficient nurses on over-stretched wards, but the ability to provide instinctive and compassionately responsive care is as much about disposition and attitude as it is about knowledge.

The word “pathway” should be fairly innocuous. Its use in a medical context has in recent times caused fear and worry. Norman Lamb’s announcement will be greatly reassuring to anyone facing the end of their life or that of a relative.

* Caron Lindsay is Editor of Liberal Democrat Voice and blogs at Caron's Musings

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One Comment

  • My dad was put on the LCP and I would want the same for myself. This is Daily Mail kneejerk politics. Clinicians could communicate better than they do but this change has not been thought through.

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