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'The LCP is only as good as the people who use it'

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12 November, 2012

One of the worst examples in recent history was the hysteria whipped up about the MMR jab, on the basis of highly questionable evidence from a tiny sample of children. This evidence has now been utterly discredited, but not before vaccination rates dropped to dangerous levels.

The latest target is the Liverpool Care Pathway, or the pathway to death as the Daily Mail prefers. A torrent of stories about hospitals being bribed to put patients on the LCP, patients being routinely denied food and fluids, or health professionals being too keen put patients on the pathway and refusing to take them off if they show signs of recovery have bounced health secretary Jeremy Hunt into declaring that the revised NHS Constitution will require patients and or families to be involved in end-of-life care decisions.

Anyone who took the time to read less sensationalist sources – or to look at the LCP documentation itself – would see that the pathway is simply a tool to help health professionals to make the last hours of their patients’ lives as peaceful as possible. It is only to be used in patients who are dying, and any who show signs of recovery can be taken off the pathway. Food and fluids are only withdrawn in specific circumstances where this will reduce patient distress, and patients and families are already required to be involved in the decision-making process.

Of course, like any tool, the LCP is only as good as the people who use it, so it is vital that it is implemented by health professionals who understand its principles and purpose, and who stick to the guidance.

Properly used the LCP is a way of providing the best possible care to dying patients and their families. Attacks on the pathway on the basis of instances of improper us, or presenting opinions as facts will simply lead patients, professionals and families to avoid using a tool that has spared countless people distress in their final hours.

Readers' comments (23)

  • Why don't you send this article to the newspapers. Perhaps they should also be invited to attend the training days.

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  • who has suggested that the DM is 'popular press' - it's a horrid paper.

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  • I can fully support your statement, 'The LCP is only as good as the people who use it'. I also support, and endorse Professor Pullicino's claim that the LCP, when inappropriately administered, can hasted death my following account which has been forwarded to the 5 eminent physicians who raised concerns of its use in September 2009.
    My partner entered hospital for a day surgery biopsy on a neck mass that began development in March 2005. At no time had she been judged as terminally ill and certainly not hours away from death.
    As opposed to accompanying me home the Consultant surgeon told me that she suffered post-op respiratory collapse in the recovery room. An emergency Tracheostomy was performed and she was made stable in ICU.
    A week later, she was transferred from ITU to a nursing ward where the biopsy confirmed lung cancer and a discharge plan for home was made for 4th Sept with a referral for further out patient appointments. Post-op surgery notes, of 23rd August, record a follow up out-patient appointment for 5th September.
    But no one can comprehend how just a fortnight following a supposed cancer diagnosis, my Partner passed away at just 63.
    Only upon gaining all medical notes did I discover an undated DNAR notice and the surreptitious administering of a Morphine syringe with Midazolam and Cyclizine.
    Independent medical expert reports confirm the cancer nodules as multiple pulmonary embolisms. No evidence of any anticoagulant therapy is documented.
    As the Trust involved stated, 'we want to listen and learn from complaints'.

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  • Anonymous | 12-Nov-2012 11:04 am

    There is an issue, over whether treatment provided for pain/distress relief can 'hasten death' entirely legally (I see no reason why not) but the LCP claims that nothing which is part of the LCP does this.

    Getting consent, is the answer !

    I have sympathy for your experience - but that is not of much use, is it ?

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  • It is distressing for relatives to watch somebody die after food and water have been withdrawn. I was a nurse of 30+ years experience when it happened to one of my parents and I found it deeply traumatic. There was no pain management offered. Nobody even mentioned LCP then and consent was never discussed with us as a family. I was afraid to leave the bedside and I'm still haunted by the possibility of unexpressed suffering.

    Now I campaign for active euthanasia as a choice. Passive euthanasia makes doctors feel easier in their consciences, but it's not a humane solution for nurses, families or patients.

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  • michael stone

    Anonymous | 14-Nov-2012 9:56 am

    Be careful if you use the word euthanasia.

    I think I support assisted-suicide but only provided the decision is made by the patient - 'euthanasia' has got a long history, of being a decision made by someone who isn't the patient.

    Our laws, get very tricky indeed, if a terminally-ill patient is suffering 'but not dying quickly enough' and the patient him/herself has not explicitly requested very heavy levels of pain-relief and sedation prior to a loss of mental capacity: the complication is section 4(5) of the Mental Capacity Act, clinicians seem very unsure about what that section means legally, and there is 'much fudging' in this area of 'dying'.

    It urgently needs cleaning up.

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  • Michael Whitehead

    Many say that as soon as patients are placed on the LCP, their right to food and fluid intake is withdrawn. This, as suggected in this article, is completely erroneous information.
    If anything,in my experience staff are extremely happy when LCP patients are able to eat and drink, and they are usually persistent in encouraging this till the very end of a patient's life. Where did this information come from? Perhaps it happens in other trusts but it certainly hasn't been the case for the ones I have worked for.
    In fact,in four years of nursing I have never seen an LCP patient who asked for food and fluids and been denied becasue they are on the LCP.

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  • Anon 11.04am
    Multiple pulmonary embolisms are likely the mode of death in your partners case, but where did they originate from is the question. Had they an undiagnosed heart arrythmia, peripheral vascular disease or some clotting disorder? If the original diagnosis was cancer, then why would they need anticoagulation> Was a VTE risk assessment done?
    As for the surreptitious use of opiates and midazolam, these both need presribing by a medic, and in the case of morphine, is kept in a secure area and counted every day ( by a 2 trained nurse process)to keep an accurate record ( any discrepancies of which are immediately called to the attention of the Police) so very much doubt that they were made with no-ones knowledge ( unfortunately I don't think that you are entitled to know, which is a difference).

    Parts of this need clearing up, as Mike Stone has said, but has no-one on this site heard of confidentiality? Doctors are NOT obliged to give out details of their treatment or condition to patients relatives, the patient themselves have to give this permission out! Go to any GP's in the land and ask to view a relatives casenotes and see what happens, doesn't matter if you are their son or daughter or they yours, or a wfe or husband, they are not your casenotes and never will be!

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  • michael stone

    redpaddys12 | 15-Nov-2012 6:13 am

    Patient confidentiality is a huge 'spanner in the works'.

    However, if the patient has become mentally incapable, and there is a Welfare Attorney, the law is very clear that the WA is the ranking decision-maker for section 4 MCA best interests decisions: logically doctors have got to provide all of the details re prognoses to the WA.

    And some of us think a very similar disclosure is legally necessary when there isn't a WA but people are trying to justify a section 4 decision - needs sorting out !

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  • surely if a patient, dying or not, 'mentally capable' or not is in pain or distress then health professionals have a duty to alleviate that as much as possible, otherwise what's the point in being in a hospital.

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