CNK has maintained a keen interest in the issue of the Liverpool Care Pathway and what might succeed it, contributing to media reports, being represented at Ministerial round table talks and of course responding to the original Neuberger review. The Alliance has now submitted a response to the Leadership Alliance for the Care of Dying People (LACDP).

The creation of the LACDP under the chairmanship of Dr Bee Wee, National Clinical Director for End of Life Care at NHS England, was announced on 30 August 2013 with the aim of building upon Baroness Neuberger's report, published the previous month. This report, entitled 'More Care, Less Pathway', contained 44 recommendations and concluded that the LCP should be phased out 'over the next 6 to 12 months' and replaced by an individual end of life care plan, 'backed up by good practice guidance specific to disease groups'. The LACDP has been seeking 'engagement with patients, families, carers and professionals' on its vision for bringing the individual plans into reality, in a consultation process which ends this week. You can download the document here (and are advised to have this to hand when consulting our submission).

In our submission, we note that the LACDP's proposals are broadly in line with our submission to Lady Neuberger and that we are 'heartened by the renewed emphasis on communication, re-evaluation, mutual goal development, and a holistic understanding of the patient's needs', but offer commentary on issues of note, key examples of which include:

• 'The LACDP must recognise that the LCP provided a framework within which individual patients could be assessed and certain, suitable tools then used better to serve a patient. The personal care plans should be viewed as a progression in that clinicians, patients and families are committed to a dialogue which ensures that all understand what is happening, and why. Families must be heard and advised, but experienced clinicians must not be impeded in acting for the good of their patients'
• 'the language of "Personal Palliative Care Plan" is too cold and professional; it explains the document's purpose but does not give a sense of ownership to the patient'
• 'It should be clearer to patients that palliative care is a multi-disciplinary concept, but only some cases require specialist palliative intervention'
• 'inability to swallow does not necessarily preclude capacity to communicate, as suggested by the immediate link with "best interests" [as stated in the document]'
• The need 'to strike a balance between recording necessary information adequately without the process becoming so laborious that it engenders a 'tick box' mentality'
• '...there has been no explanation of how this [re-evaluation of patients] will be better ensured than under the LCP. There is no mention of how the new system will guard against suggestions of budgetary considerations coming into play, as with the CQUIN payments, nor is there sufficient attention paid to how failings on the part of clinicians should be dealt with.'