Factors affecting the successful implementation and sustainability of the Liverpool Care Pathway for dying patients: A realist evaluation

McConnell, T. et al. Factors affecting the successful implementation and sustainability of the Liverpool Care Pathway for dying patients: a realist evaluation. BMJ Supportive and Palliative Care Online – 7 November 2014


The Liverpool Care Pathway (LCP) for the dying patient was designed to improve end-of-life care in generalist healthcare settings. Controversy has led to its withdrawal in some jurisdictions.

The main objective of this research was to identify the influences that facilitated or hindered successful LCP implementation. There is a need to appreciate the organisationally complex nature of intervening to improve end-of-life care.

Successful implementation of evidence-based interventions for end-oflife care requires commitment to planning, training and ongoing review that takes account of different perspectives, institutional hierarchies and relationships, and the educational needs of professional disciplines. There is a need also to recognise that medical consultants require particular support in their role as gatekeepers and as a lead communication channel with patients and their relatives.

Caring for People in the Last Days and Hours of Life: National Statement

In December 2013 the Scottish Government accepted the recommendation that the Liverpool Care Pathway (LCP) should be phased out in Scotland by December 2014. This statement confirms the current position.

Health and Care providers across Scotland are committed to the provision of consistently high quality end of life care for all that reflects the 4 principles set out in the guidance ‘Caring for people in the last days and hours of life‘ published at the end of 2013:

  • Principle 1: Informative, timely and sensitive communication is an essential component of each individual person’s care
  • Principle 2: Significant decisions about a person’s care, including diagnosing dying, are made on the basis of multi-disciplinary discussion
  • Principle 3: Each individual person’s physical, psychological, social and spiritual needs are recognised and addressed as far as is possible
  • Principle 4: Consideration is given to the wellbeing of relatives or carers attending the person

How hospices can save hospitals

Below text is from The Daily Telegraph, 20 January 2015

In January the health select committee began taking evidence for a new inquiry into end-of-life care. This comes after considerable public concern about the quality of care that people receive as they die, and six months after the controversial Liverpool Care Pathway for the terminally ill was officially withdrawn from use in the NHS. The truth is that many frail elderly and terminally ill people are in hospital unnecessarily after being admitted via Accident & Emergency.

Often, they would be far better cared for elsewhere. But in many instances, patients head to their local casualty department simply because alternative – and, in many cases, more appropriate – care is not available. NHS community services are in short supply, health care professionals are frequently unaware that other measures, such as hospice care, could help, and planning to discharge patients from hospitals to community services is complex and difficult.

This means that of the 500,000 people who die in England each year, about half do so in hospital, even though many have no clinical need to be there and very few want to die there. The vast majority (80%) say that they would like to be cared for and die at home or in a hospice. Since the Sixties, hospices have been at the forefront of providing high-quality care for people approaching the end of life.