This paper draws on the concept of ‘boundary objects’ 1 to provide an in-depth analysis of an unsuccessful attempt to provide palliative care at scale. When one such intervention is introduced with government support and with a vigorous programme of implementation, but then runs into significant difficulties, it is vital to make sense of the factors at work. Major policy innovations covering a whole jurisdiction are rare in palliative care. Conclusions: In contrast to most observers of the LCP story who refer to the dangers of scaling up clinical interventions without an evidence base, we call for greater assessment of the wider risks and more careful consideration of the unintended consequences that might result from the roll out of new end-of-life interventions. It also fostered a previously unseen critique of assumptions within palliative care. It exposed fault lines in the NHS, provided a platform for debates about the ‘evidence’ required to underpin innovations in palliative care and became a conduit of discord about ‘good’ or ‘bad’ practice in care of the dying. While the LCP had some weaknesses in its formulation and implementation, it became the bearer of responsibility for all aspects of NHS end-of-life care. Results: The rapidity of transfer and translation of the LCP reflected uncritical enthusiasm for ICPs in the early 2000s. We also draw on the ‘boundary object’ concept and on wider analyses of the use of ICPs.
We address three critical questions: 1) why and how did the LCP come to prominence as a vehicle of policy and practice? 2) what factors contributed to its demise? 3) what immediate implications and lessons resulted from its withdrawal? Methods: We use primary and secondary sources in the public domain to assemble a critical and historical review. We provide an in-depth account of LCP development and implementation with explanatory theoretical perspectives. Understanding the problems encountered in the roll out of the LCP has crucial importance for future policy making in end of life care.
It was discontinued in 2014 following mounting criticism and a national review. Background: The Liverpool Care Pathway for the Dying Patient (‘LCP’) was an integrated care pathway (ICP) recommended by successive governments in England and Wales to improve end-of-life care.
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