Liverpool Care Pathway

Meg Hillier Excerpts

Tuesday 8th January 2013 Westminster Hall

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

I am pleased to serve under your chairmanship, Mr Weir. I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing this debate on such an important issue.

I represent St Joseph’s hospice on Mare street in Hackney, which is a beacon of good practice in end-of-life care. Under the expert leadership of its chief executive, Michael Kerin, its medical director, Dr Anjali Mullick, and the Sisters of Charity, who founded it more than 100 years ago, the hospice ensures that people in their last stages of life receive care and die with the respect and dignity that they deserve, and that is what we are talking about today.

It is worth reiterating here what end-of-life care should offer. It is about treating someone who is dying as a person, and not as a number or a patient, and about looking at that individual’s needs in the round. It is not about giving a mechanistic response. As my hon. Friend the Member for West Lancashire (Rosie Cooper) said, surely once a clinical decision has been made about someone’s life chances, we, as a compassionate society, should try to ease suffering and support them to die well. The Liverpool care pathway, which is used only when someone is in the last hours or, in some circumstances, the last days of their life, aims to provide the tools to enable rest and care rather than making active interventions that would cause a person to die less well.

Those fine principles are great, although they may not always be adhered to fully. Good leadership and training of staff are vital, and that is one of the issues I want to address in the short time I have to speak.

We face an important challenge as a society as we consider the end-of-life care we aspire to. Most of us want a choice of where we die. If we had a free choice, most of us would choose to die at home, supported by organisations such as Marie Curie or hospices such as St Joseph’s, whose nurses go out and care for people in the community. Where individual practitioners are out and about and are not being overseen, that will create greater challenges in the future for regimes such as the Liverpool care pathway, but that is no reason to dismiss it or not to see it as an important way of helping and supporting people as they die.

That raises an important issue for us as a society. If we agree that dying well is important, we need to recognise that practical and policy issues need to be addressed. Patient and family choice about where to die works only if proper 24/7 care is provided, whether in the home, the hospice, the hospital or another setting, and we need to make sure that proper resources and support are available. Often, that is about training practitioners in general so that they know what best practice is. If we look to our inner humanity, we all know what we would want, leaving aside all the medical trappings, if we were dying: we would not want to be poked and prodded in the last hours of our lives; we would want to have a good, well-supported death.

Training and development are vital, and I welcome the work done by trainee doctors in Liverpool, which my hon. Friend mentioned. When the hospice movement started, it was rare for doctors to get proper training; indeed, I think they spent about a day on the bedside manner for dealing with a dying patient and speaking to their family. Things have moved on a lot since then, and it is vital that, in the debate about the Liverpool care pathway, we do not throw out the baby with the bathwater. The LCP has done good things, although improvements could probably be made at any point to any such approach. None the less, it is vital that we maintain the approach that dying well is important and should be available to all in every setting.