The Liverpool Care Pathway - a family member's viewpoint

It is summer 2012. Sitting at the hospital bedside of a family member. The staff had just reviewed the continued appropriateness of the LCP – 'The Liverpool Care Pathway', a term we all came to know very quickly during those three traumatic weeks.

And then, at that very time, an article in a national paper. Then another…and now a crescendo of concern fanned by media outrage. At the time, this first piece (actually first read at the bedside on about day five) did cause a wobble within the family group – a ‘team’ who had come to understand far more about the murkiness of dying in those few days.

I like the idea from advanced driving of 'watch where you steer, for that is where you will go' – on a bike, if you focus on the pothole, you will probably end up in it. For journalists (as with other leaders) it is important to watch what you write and speak (and sub-edit). What are the intentions behind a provocative piece or headline, especially when it's about one of the biggest issues in our lives? Are they ‘troll’ like, designed to poke and wound, or an honest challenge to improvement?

Some of my friends and family members did struggle a bit with the clarity of the LCP. I think the comments my wife and I made on the impressive standardisation of palliative care regimes helped them. I recall at St Joseph’s Hospice (Hackney) in the early 80s there were similar protocols, but they didn’t go viral.

I nearly did a blog on the LCP three months ago, having been impressed with its sensitive and thorough use: it seemed an example of compassion in action, lean processes and evidence-based medicine, all in one. I was interested in how this innovation had been taken up so rapidly – quite unusually in my experience, with lots of ‘stealing with pride’ going on.

I asked lots of people about the wide adoption of LCP. Why has this happened? Was it due to policy (it has helped, but no), innate compassion (a help but, again, no)? The main answer offered was that it was a very clear response to a difficult problem for NHS professionals (with more old people, more families with consumer attitudes and higher expectations all round on comfort). Staff have embraced it as a sort of ‘distressed purchase’.

For me, and my experience of a being a relative to someone with a sudden and profound stroke, I was hugely impressed with how the LCP helped staff who can feel uncertain and relatives who are ‘all over the place’, emotionally and geographically. For me it was a very positive feature of a much improved ‘death pathway’, as one national paper refers to it.

It fitted with the improved system we experienced as a family generally, from rapid diagnosis and a specialist ward through to the helpful attitudes, slickness and flexibility of the hospital medical registrar and other staff at the point of death on a mid-Friday afternoon. And then, on the Monday morning, the new integrated one-stop-shop approach on registering a death.

In the late 1990s I became aware of a global collaboration of news and media professionals to promote 'Images and Voices of Hope'. We need positive stories to redress the harm the over focus on the risks of the LCP can cause. I applaud the recent piece by Stephen Thornton and hope this short reflection helps achieve a balanced debate and way forward.

Phil is co-founder of idenk.com, a consultancy helping leaders and their teams.