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Letter to the Catholic Herald about the Liverpool Care Pathway

As published on August 3rd 2012

It is right to warn people about the Liverpool Care Pathway (LCP). Those who have produced warning cards have done the public a service. Simon Caldwell's article (The Catholic Herald July 27th 2012 page 2) was helpful, as was that of Quentin de la Bédoyère (ibid page 9).

If all doctors were trained in the care of the elderly and had all the time in the world to discuss end-of-life care with patients and relatives there would be less cause for anxiety about the LCP. But given the current pressure on hospital beds and the number of frail elderly people needing attention there is a very real danger that some who appear to be dying, but have a treatable disorder, will be put on the LCP with fatal results.

Quentin de la Bédoyère mentioned some dangers of the LCP towards the end of his article. These are worth repeating lest they be overlooked.

  • Some medical staff may see death as a benefit for the patient or the NHS. It was suggested that death is sometimes hastened if the bed is needed for someone else.

  • Some health care staff will be too busy to follow the LCP protocol correctly.

  • Once on the LCP progress checks may be overlooked until the patient is dead.

  • Some doctors may not involve a multi-disciplinary team or seek advice before putting patients on to the LCP.

  • The importance of hydration was not mentioned in The Catholic Herald articles


When palliative care first emerged as a specialty in 1987 the only patients who received hospice care were those with pain that was difficult to control or those with significant anxiety about the prospect of dying. All the rest were managed by their GPs in the community or by hospital staff if they were admitted to hospital. Surprisingly few old people needed the services of palliative carers in those days and most died peacefully without the need for sedation or morphine. Syringe drivers were never used on geriatric wards in those days. If medication was needed it was given orally or by injection.

Palliative care is in overdrive and patients are in danger. (For discussion see American Journal of Hospice and Palliative Care 2008; Vol 25: No 2.) The NHS is fast becoming a death service rather than a health service for the elderly. Attempts are being made to vet potential admissions and send the elderly home before they block a precious hospital bed. Those who are admitted and appear to be dying may be put on the LCP and die within a matter of days. People can no longer be sure that the elderly will be treated well so great vigilance is needed. Many people suffer long term distress after watching a loved one die on the LCP. It is surely time to review and reduce the role of palliative care in the NHS.

All these problems have followed the closure of far too many hospitals that cared for the elderly. We now have too few hospital beds to cope with the ageing population. Hospital facilities must be increased and care in the community improved as a matter of urgency, so that more people can remain at home until they die in peace.

Yours truly
Dr Gillian Craig. MD., FRCP

Retired Consultant Geriatrician and Vice Chair Medical Ethics Alliance.
Ed."No Water- No Life: Hydration in the Dying" 2004. ISBN 0 95454445 3 6

For a useful link about subcutaneous hydration from a world expert go to: Palliative Care Tips on Hydration