IN HIS article in this paper earlier this year, the Bishop of
Carlisle, the Rt Revd James Newcome, expressed disappointment at
the Government's decision to abolish the Liverpool Care Pathway
(LCP) (Comment, 19
Bishop Newcome was not the only one mourning the death of the
LCP. Professor Keri Thomas, a committed Christian and National
Clinical Lead for the Gold Standards Framework (GSF) for End of
Life Care, was also sorry to see its demise. Nevertheless, she
recognises that the evidence submitted to the independent review of
the LCP had effectively made it untenable to continue as it
So what now for end-of-life care? And where will the spiritual
dimensions be recognised and protected?
The independent review has made its recommendations, and in his
reply to the question in the Lords from the Bishop of Bristol, the
Rt Revd Michael Hill, Earl Howe stated that the LCP would be
"phased out over the next six to 12 months, in favour of an
individual approach to end-of-life care for each patient, with a
personalised care plan backed up by condition-specific guidance,
and a named senior clinician responsible for its
It is the implementation of the LCP that has been its most
serious failing. The pathway was experienced by many as the
withdrawal of care rather than its provision. Although the LCP was
successfully spread across the UK, in a few years its potential was
heavily diluted by a combination of the rapidity of its
dissemination, reduced funding, and a lack of accreditation or
quality assurance to ensure that it was being well delivered.
ONE of us remembers the impact on his family of seeing "Do not
resuscitate" written at the end of his father's bed. This lack of
communication was well before the LCP, and was partly what the
pathway had been developed to reverse; sadly, though, its approach
to the dissemination of this message was lost or misconstrued.
The LCP should have enabled patients and their families to be
informed, to be at peace, and to be where they would like to be at
their death - and it ought to be acknowledged that thousands have
been helped in this respect.
As the Government endeavours to put flesh on its revised
aspirations for personalised care-plans, they would do well to draw
on the more proactive elements expected in the GSF "gold
standards": early identification of patients' drawing towards the
end of their life (years or months, not weeks or days); clarifying
particular needs, and assessing condition-specific clinical ones;
and ensuring that the personal wishes of patients are engaged with
fully, through advance-care planning. These will help patients to
have choice, and a measure of control in respect of their care.
So where, explicitly, does "spiritual care" come in the
recommendations? A second question from Bishop Hill, which drew
attention to NICE end-of-life care quality standards, was addressed
by Earl Howe. This signalled the importance and necessity of
support's being holistic and encompassing spiritual and religious
Earl Howe's reply gave assurance that the Government regarded
"spiritual and religious support as an essential part of
first-class end-of-life care"; but, he said, he could not set out
any specifics at this point.
It is critical that the value of chaplaincy support is properly
recognised by the Department of Health, as it puts flesh on the
bones of that commitment. The independent review spoke of a need
for independent advocates to represent patients, carers, and
families; this is a part that chaplains occupy naturally, and would
be deemed a "specialist service" by NICE.
THE commitment of the Government to supporting the delivery of
holistic, patient-centred services in the NHS has been made clear,
and health-care chaplaincy for staff and patients is an important
part of the Government's "end-of-life strategy".
As the executive director of the London Institute for
Contemporary Christianity, Mark Greene, says, however, "culture
eats strategy for breakfast." End-of life-care is now a hot topic
in the NHS, and is at last being widely discussed. Whatever follows
on from the LCP must create an ethos, as well as structures, that
will shape a culture which enables everyone to live well and die
Given the ever increasing pressures on health care, and the
persistent sniping by secularists at chaplaincy, ensuring that this
happens is going to be a challenge. We must engage on the pitch,
and not just shout from the stands.
Ways in which we can do this are by getting involved in the road
shows due towards the end of the year across the country; by
becoming a lay member of the board of a health-care provider; by
supporting the part played by chaplains in our local areas; and by
becoming familiar with the Neuberger report and its
The independent review put a renewed and welcome emphasis on
compassion and the needs of the individual in first-class
end-of-life care. The review clearly differentiated between helping
people to die well, and assisted dying; it reiterated the secular
and religious consensus that attempts to shorten a person's life
are morally wrong, as well as illegal, and have no place in what
should succeed the LCP.
A piece written by one us for The Guardian in 2010
concluded: "If you want to help build a society which majors on
compassion and care, which changes the experience of those who are
dying, or fearful of growing infirm and a burden, there are far
better roads for us to travel [than Assisted Dying]." LCP may not
have been the right pathway, but it has shown us what is
Dr Lee Rayfield is Bishop of Swindon and a scientist. He is
an adviser to the Mission and Public Affairs Council.
The Revd Dr Brendan McCarthy advises the Archbishops'
Council on policy for medical ethics and health and social care
through the Mission and Public Affairs Council.