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Response to the LCP review from King's palliative care experts

Posted on 15/07/2013

The Liverpool Care Pathway should be phased out and replaced by individual end of life care plans, an independent review led by Baroness Julia Neuberger recommended today.
The review was commissioned by Care and Support Minister Norman Lamb in January 2013, because of serious concerns arising from reports that patients were wrongly being denied nutrition and hydration whilst being placed on the Pathway.

Commenting on the Liverpool Care Pathway review published today, Dr Richard Harding, Reader in Palliative Care at King’s College London’s Cicely Saunders Institute, said:

'We welcome the Independent Review of the Liverpool Care Pathway. Recent attention to the experience of end-of-life-care in England has raised awareness that the last days and months of life are often a time of stress, anxiety and concern for patients and their families. The review highlights the importance of adequate training, research and education.

'In England, we face a challenging problem with increasing numbers of people facing the end of life. We want to see care that is tailored to each patient and their family, in the form of individualised care plans. It is important to build the evidence so that we understand what works best for patients and families, and we must do this in a very careful and considered way to achieve best end-of-life care for all in the future.

'The recommendation to implement a new system-wide approach to improving the quality of care for the dying is an important one and it is absolutely vital to listen to what patients and their families tell us. At the Cicely Saunders Institute at King's College London, we have been developing reliable ways to hear direct from patients and families themselves about their pain, concerns, and other priorities. We have also been pioneering new support services for families. These are examples of some of the evidence but we need to build more if the right care is to be given to those who need it, at the right time.

'Our research highlights that the top three concerns of the public in England at the end-of-life are: being pain-free, not being a burden to others, and not wanting to be alone. In order to provide individualised, quality care as the report proposes, we need to understand the needs and concerns of patients and families first.'

Professor Irene Higginson, Director of the Cicely Saunders Institute at King’s College London, said: 'Palliative care is about enabling those with advanced disease to achieve best possible quality of life when cure is not possible. It is essential to improve pain and control of other symptoms, empower patients and families, support family caregivers and provide psychological and social support. This review of the Liverpool Care Pathway is important for doctors and nurses working in all of healthcare, as well as those in specialist palliative care, and we must all consider the review’s conclusions extremely carefully.'

'With the number of deaths expected to rise by 17 per cent over the next 20 years, there has never been a more important time to consider how we are going to cope with this increase in demand for palliative care.  It is crucial that patients receive the best possible care at the end of life and is important that their families, who share so much of the burden, are recognised and supported.'

'We already know there are inequities for patients and families. Expenditure on palliative care services is inconsistent across England, with the average spend per person at end of life about £900 in total. However, some Primary Care Trusts spend as little as £186 per person.

'Our research has also uncovered that older people with cancer missed out on the best in pain control in their last three months of life compared to younger people.  Someone aged 80 or over has less than half the chance of receiving a strong pain killer for cancer pain. Furthermore, there is a limited access to palliative care amongst Black, Asian and Minority ethnic groups. There is a clear need to address such inequities and improve care for people in the last days of their lives.

'Research spending is sparse, meaning that better ways to care and control symptoms are not developed and tested. It is unsurprising that the review highlights poor care, given that only 0.2% of money invested in cancer research is in palliative and end-of-life care. In non-cancer conditions, this is even less, below 0.1%. The review specifically recommends further investment in research to better understand the outcomes and experience of end-of-life care, and we welcome this.

'We believe, as Cicely Saunders herself said – ‘you matter because you are you, and you matter all the days of your life.’ At the Cicely Saunders Institute at King’s College London, we constantly strive to improve the evidence base for effective end-of-life care. We strongly believe more investment is needed in this important area to achieve best care for patients at the end of life and their families.'

Notes for editors

View the report.

For further media information please contact Emma Reynolds, PR Manager (Health) at King’s College London, on 0207 848 4334 or email

For further information about King’s visit our 'King’s in Brief' page.

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