Liverpool Care Pathway

Next Tuesday afternoon at 2.30, I will be opening a 90 minute debate on the Liverpool Care Pathway in Westminster Hall. I expect to speak for about 20 minutes, with perhaps another 10 minutes if there are a lot of interventions from fellow MPs. I may shorten my speech if there are many other MPs wanting to contribute as well. I intend to order my thoughts on this important issue on Monday, but this post is meant as an opportunity for visitors to this site to influence what I say.

The reason I asked for the debate was the horror with which I have been reading articles in the Mail/Telegraph (and others) describing the LCP as a 'Pathway to Death' and describing it as tantamount to euthanasia. I'm not in a position to challenge the truth of these allegations, but this debate cannot be conducted only in the sensationalist way that newspapers tend to do. Its vital that Parliament discusses all aspects of the issue in a considered and responsible way. We must try to limit the fear that this 'shocking' publicity must be creating in the minds of people suffering terminal illness, or of the frail elderly simply going into hospital. I hope we can have that responsible debate on Tuesday.

I will want to begin my speech by stating what the LCP is and what it is not. In the late 1990's the LCP was designed by the Marie Curie Palliative Care Institute in Liverpool, and is now widely used across hospitals in England - aand the world! The aim is to replicate in hospitals, care homes and at home, the high levels of palliative care that has long been typical of hospices. The LCP is not a treatment, but a set of 'guidelines' to help doctors and nurses who are caring for patients in the last hours/days of their lives. It does not instruct doctors in how to treat patients, but prompts them to consider whether certain care regimes or treatments are appropriate in the circumstances of individuals who are dying. And every case must be treated as 'individual'. Its also crucial that there be no 'secrecy' and that the patient (if appropriate) and/or next of kin are involved in the discussions.  The LCP is not about ending life, but about providing the best possible end-of-life care.

We will not be able to ignore the serious allegations that have been made. The reality, as in every occupation or branch of medicine is that there will be examples of excellence and bad practise. Tens of thousands of people die on the LCP every year. Its seems probable that there will be instances of bad practise (hopefully rare). We must do all possible to eliminate these instances. When allegations are made (and there should always be avenues through which its easy to make them) they should be thoroughly investigated. If not, the integrity of the LCP was be seriously compromised.

The Gov't is conducting a review of how the LCP 'guidelines' are being used. I hope its comprehensive, and ruthless in its honesty. The LCP  is hugely important in ensuring that end-of-life care is delivered with compassion and as little suffering as possible. Over 20 of the leading health-related voluntary organisations and the Dep't of Health have signed a 'declaration' in support of the LCP. I agree with them. But on its own, this will be not enough. Its vital that allegations which have the potential to undermine trust in the LCP are faced and investigated. It must not be left to the media. These are the messages I hope will emerge from Tuesday's debate.