Report: Royal College of Physicians audit shows steady progress in end-of-life care

There have been improvements in the care of the dying in hospitals since a controversial end-of-life care regime was scrapped, experts have said.

In the two years since the Liverpool Care Pathway (LCP) was abolished there have been marked improvements in the care of the dying, according to a new end-of-life care audit by the Royal College of Physicians (RCP).

While the audit did highlight some deficiencies in care, researchers noticed improvements across many measures.

In 2013 it was announced the LCP regime – which involves the withdrawal of treatment, food and water from some sedated patients in their final hours or days – would no longer be used after an independent review concluded doctors had used it “as an excuse for poor-quality care”.

The review panel, chaired by crossbench peer Baroness Neuberger, said they were “shocked” and “upset” at some of the cases of appalling care.

Patients were left on the pathway for weeks without any review and some relatives were even shouted at by nurses for giving their loved ones water.

Professor Sam Ahmedzai, chair of the RCP’s end-of-life care audit steering group, said: “Many people and organisations felt that when the LCP was withdrawn that would lead to a breaking-down of, and a deterioration of, end-of-life care as we know it. Far from it.

“What we have found is that in almost every area there has been an improvement on how organisations like hospital trusts deliver end-of-life care and how patients who are dying and those important to them – their family members and friends – how they experience it.”

He added: “The period 2013 to 2015 saw momentous changes in how we look after dying people in England.

“These include the phasing-out of the ‘one-size-fits-all’ Liverpool Care Pathway and the introduction of individualised care, with an emphasis on assessing holistic needs, respecting the wishes of dying people and those important to them, including maintaining hydration where desirable.

“It is heartening that the results of the latest Royal College of Physicians audit largely reflect these changes positively in terms of improved statistics of care for people in the last days of life who were dying in the month of May 2015 in English hospitals.”

Download a copy of End of Life Care Audit Report March 2016