Liverpool care pathway

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The Liverpool care pathway (LCP) is a end of life care plan designed to help formalise hospital based terminal care developed during the 1990s by the Royal Liverpool University Hospital and the Marie Curie Hospice, Liverpool. The aim was to transfer hospice practices of end-of-life care into hospitals. Although a framework for the evaluation of complex technologies that might be of benefit to the NHS had been developed by 2008[1], from 2009 onwards often a commissioning decision was made to introduce it into hospital care in the UK as a matter of health policy with incentives. This was before formal evaluation to the recommended standard had been done and indeed the first adequately powered randomised trial in cancer care from 2014 suggests it may not have advantages over best alternative in hospital care[2]. In 2013 the Neuberger report[3] commented that "It would seem that when the LCP is operated by well trained, well-resourced and sensitive clinical teams, it works well". However it identified that in the context of perverse incentives for suboptimal outcome due to regulation and reimbursement this pathway was presently unsustainable in the NHS. Many suspect it was made the scapegoat for poor communication and faulty decision-making[4]. However it also was a victim of other issues such as conflicting ethics, semantics, its misuse, and inadequate resources.