NHS: Liverpool Care Pathway Inquiry

Earl Howe Excerpts

Monday 5th November 2012 Lords Chamber

[Baroness Knight of Collingtree]

To ask Her Majesty’s Government what procedure will be adopted in carrying out the proposed NHS inquiry into the Liverpool Care Pathway.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, there is no procedure, as there is no such inquiry. A number of organisations, led by the National End of Life Care Programme, Dying Matters and the Association for Palliative Medicine, are looking into complaints, patient experience and clinical opinion on the Liverpool Care Pathway. We do not make policy decisions based on anecdote. If the work in hand suggests cause for concern, we will respond on the basis of that evidence.

[Baroness Knight of Collingtree]

My Lords, is my noble friend aware that large numbers of people with personal experience of how the LCP is now operating complain that their relatives were denied hydration in hospital and died in acute pain and discomfort, with no knowledge whatever or agreement of having been put on this pathway? Is he aware that patients often survive if relatives step in in time and give their dear ones help and water? One rang me a few days ago and she is now going on a cruise. Will my noble friend assure us that there will be an inquiry, which has been promised and announced in the press, and that it will be truly independent and not carried out by those who have vested interests? Nothing else will do.

[Earl Howe]

My Lords, there is never any cause for complacency in a matter of this kind, and I can reassure my noble friend that the Government will keep this issue under review. At the same time, I hope she will allow me to respond in slightly more forthright terms than I normally do, because there has been an enormous amount of misreporting and misinformation around the Liverpool Care Pathway, which has been endorsed publicly in a consensus document by 22 of the leading professional organisations and patient organisations in this area, including Marie Curie. We cannot ignore that. As I mentioned in my Answer, some of those organisations are looking carefully at the reports to which my noble friend alluded. It is notable that not a single complaint has reached the regulators in this area, which I suggest indicates that there may be less substance to some of these stories than may first reach the eye. However, I emphasise that there is no complacency.

[Lord Alton of Liverpool]

My Lords, as the noble Earl comes to look at the consultation on the National Health Service constitution over the coming months, will he take the opportunity to look at the care pathway in Liverpool itself, where last week I was able to meet Professor John Ellershaw and those who devised the pathway? Given that 80,000 patients a year are treated on the pathway, does the Minister accept that it works very well for many of them; that while the philosophy is not the problem, the procedures used in some places have been; and that one of the principal concerns is dehydration? Does he agree that that is something to be looked at, as well as the level of training of those doctors who are responsible for the palliative care of people at the end of their lives?

[Earl Howe]

My Lords, I fully agree with the noble Lord. Training is integral to the care pathway, as is the need to consult the families of patients and, if possible, the patients themselves before a decision is taken to put them on the Liverpool Care Pathway. On the NHS constitution, I completely take the noble Lord’s point. The proposed change to the NHS constitution makes it absolutely clear that patients and their families and carers have the right to be fully involved in discussions and decisions about their care, including that at the end of life. We are clear that that should already be happening, but we understand from reports that that is not always the case. As regards end-of-life care, I think there is sometimes a taboo on discussing death and dying and press reports show how damaging that can be. I shall indeed take all the noble Lord’s points on board, particularly as regards nutrition and hydration.

[Baroness Wall of New Barnet]

My Lords, I am relieved by the Minister’s response to the noble Baroness, Lady Knight. He is absolutely right that the care people receive at the end of their lives is hugely important. National statistics show that 29% of eligible people are on the care pathway. In my own trust, Barnet and Chase Farm, 28% of people are currently on it. The involvement of carers in those discussions is huge and a whole protocol is attached. I, too, am extremely worried about the publicity, some of which I am sure is well meant, but it can be very damaging to a system that provides a great deal of care. My mother-in-law was on the Liverpool Care Pathway in Liverpool hospital and had a very good experience. Please can we ensure that in any discussions we look at the overall benefit to elderly people at the end of their lives?

[Earl Howe]

The noble Baroness is quite right. So often, good experiences are not reported. Predominantly we hear from patient organisations and the Marie Curie organisation that in the vast majority of instances where the Liverpool Care Pathway has been used, it has resulted in better care for the dying person. She is absolutely right. Nevertheless, where the pathway is not being properly followed, we have to take the matter seriously and ensure that there is proper training and communication with care staff.