Sunday 26 June 2011

Liverpool Care Pathway - A Deterministic Pathway

An End of Life Care - Symptom Control document from NHS Milton Keynes takes the form of a flowchart. Flowcharts are used by programmers to write computer programs to tell the microprocessor, (or CPU),  what to do. However elegantly the program is written so that it is not just a basic ' number- cruncher' it is still a binary choice of ones and zeros to force a yes/no response.

Computers are logical machines; they think in one direction. In the real world, life is not as straight forward as that. Sometimes, more often than not, it is required to think in more than one direction.

People are capable of thinking in more than one direction; we think laterally, vertically, and are capable of understanding that a question is not always answerable with a simple yes or no response - there are qualifications, there are ifs and buts. Whereas people may think round this situation, machines cannot and it is precisely this situation which may cause a progamme to 'hang' or crash.

It is forcing people to adopt a mechanical yes/no attitude that is sending patients on a pathway to death that might otherwise have resulted in recovery.

The aim of this particular End of Life Care flowchart document, however, appears to be to blindly ensure that the pathway to death is adhered to with a deterministic strictness that defies even logic:


                        1. Management of Pain
             ____________|_____________
Patient is in pain                                Patient not in pain
                                                        at this time

If the patent IS in pain, it is recommended to continue with opiates.
If the Patient is NOT in pain, it is recommended to Avoid Delay & Crisis by prescribing Oral MORPHINE in any case!
             
              2. Terminal Restlessness and Agitation
                _____________|____________
        Present                                          Absent

If present, it is recommended to prescribe MIDAZOLAM.
If not present, it is recommended to prescribe MIDAZOLAM in any case!

                3. Respiratory Tract Secretions
                    __________|_________
           Present                                 Absent

If present, it is recommended to prescribe GLYCOPYRRONIUM.
If not present, it is recommended to prescribe GLYCOPYRRONIUM in any case!

                     4. Nausea and Vomiting
                     ________|________
              Present                        Absent

If present, it is recommended to prescribe CYCLIZINE.
If not present, it is recommended to prescribe CYCLIZINE in any case!

                             5. Dyspnoea
                    ________|________
             Present                        Absent

If present, it is recommended to continue with opiates or begin prescribing them.
If not present, it is recommended to Avoid Delay & Crisis by prescribing morphine in any case!

A YES/NO flowchart choice response is presented when, in fact, there is no choice and the end result is the same.


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Friday 24 June 2011

Liverpool Care Pathway - An End-of-life Carousel

Welcome to the 23rd century: When your Lifeclock blinks red, you're all set for the Pathway...

The Department of Health committed to investing 286 million pounds over the two years to 2011 to support implementation of this End of Life Care Strategy. That is 286 million pounds spent to assist people on their path to the next world while denying the necessary funding to keep them alive and well in this!

Daily Mail article outlines how we in the UK have the worst cancer survival rate in the western world. Doctors in our local surgeries, hospitals and health care centres are providing us with treatments based on our illness, our age, our families. The Daily Mail article explains how doctors tend to late-diagnose older patients or provide them with less beneficial treatments. The elderly are routinely denied surgery or drugs.

Liverpool Care Pathway - An Indefensible Creed

Just Google a search for the Liverpool Care Pathway. The more you look, the more you find.

Here's a headline from The Daily Record of February 01, 2011 -

Death row drug fed to dying Scottish pensioners

The report is by Lachlan Mackinnon, and is as follows:


A DRUG given to US Death Row prisoners is being used on dying old folk in Scotland's hospitals.


Medics use the sedative midazolam as part of a highlycontroversial "pathway to death" care plan for people judged by doctors to be in the last hours of their lives.


But patients' leaders warned yesterday that the widespread use of the Liverpool Care Pathway (LCP) in Scotland's NHS is robbing pensioners of the chance of life.


They claim that, for some old folk, being put on the LCP is effectively a death sentence.


And research has found that many doctors decided to put patients on the pathway WITHOUT the consent of their loved-ones.


Margaret Watt, chairwoman of the Scotland Patients Association, told the Record: "The LCP can be used to bring patients' lives to a premature end.


"We have patients on our records who should be dead but are not. Their families had to fight to get them appropriate treatment.


"If the relatives had not had power of attorney, it would have been 'ta ta' to the patients. And we're convinced this is only the tip of the iceberg.


"How many people's lives have been taken that should have been here today?"


"We're concerned to hear about cases where patients have been given drugs used on Death Row without properly consulting the patient or their family.


"Doctors are meant to save lives, not take them. If they do, that's murder."


Watt 's fears were echoed by angry daughter Patricia MacGillivray, who believes she and her family saved her dad John's life in 2009 by insisting that he be taken off midazolam.


Patricia, 44, said she was told by staff at Perth Royal Infirmary that John, now 80, was at death's door after a suspected stroke.


But she claims her dad started to improve after he accidentally knocked the line out of his arm that was pumping the drugs into his body.


And she says he recovered and went home after the family ordered doctors to stop giving him the sedatives.
John is still alive and well nearly two years later. And Patricia said: "What 's happening in our hospitals. is euthanasia by the back door, and society needs to wake up to it.


"People must ask questions when their loved-one is in hospital. They must ask, 'What's that you're giving them? Is there any alternative?' "This issue affects every single household in the land.


"My dad is lovely and enjoys life with his family. It terrifies him to think about what happened to him.
"He was horrified when we told him about it and insists he's never going back in to hospital."


MSP Margo Macdonald, who has fought for the rights of terminally ill patients, is also deeply concerned about the use of LCP.


She said: "People haven't got a clue about it.


"There's a suspicion, among a lot of elderly people in particular, that they lose control over their own wellbeing if they go into care."


The LCP was designed by Marie Curie Cancer Care to help hospice staff make the deaths of patients as comfortable as possible. It got its name because it was developed at a hospice in Liverpool .


The LCP can involve a decision to stop giving the patient food and f luids. And many pat ients are cont inuously sedated, with drugs including midazolam, until they die.


Midazolam also goes by the brand names Versed, Dormicum and Hypnovel. It's given to US Death Row inmates half an hour before execution in a bid to calm them down, and vets also use it to knock out animals.


Supporters of the LCP, including the Scottish Government, argue that it is a humane and well thought-out way to make the dying comfortable at the end of life.


Crisis Ministers told all Scotland's health boards in 2008 that use of LCP was "good practice".


Audit Scotland found that year that LCP was being used in acute hospitals. in Greater Glasgow and Clyde, Forth Valley, Borders, Dumfries and Galloway and Orkney. Ayr shire and Arran and Dumfries and Gal loway were using it in all community hospitals., and Orkney and Tayside in all NHS hospices.


But some senior doctors fear that patients who could recover are wrongly being put on LCP. And they say that once people are on the "pathway to death", the drugs they are given will mask any signs that they are getting better.


Professor Peter Millard of London University, who specialises in the care of the elderly, is one of the experts to have raised concerns.


He accused health chiefs in 2009 of causing "a national crisis in care" with what he called their "tickbox approach to the management of death" .


The professor added: "It's possible that what's going on could be seen as backdoor euthanasia.


"A national wave of discontent is building, as family and friends witness the denial of fluids and food to patients."


Professor Millard spoke of his fears that patients on the LCP were being "terminally" sedated.
And he claimed that cost was increasingly a factor in the treatment given to old people in the days before death.


He said: "We're not discussing how we care for old people - we're just discussing how we pay for them.
"The Government is rolling out palliative care, which is helping people die happy. What we should be doing is rolling out support to help them to live."


Ministers say doctors should talk to patients' families before putting them on the LCP.


But an audit of 155 NHS hospitals. in England in 2008 found that one in four families were not even told when their relative was placed on the pathway .


These figures alarm campaigners like Margaret Watt, who claim the use of LCP in our health service is not being properly managed.


And she fears the growing emphasis on LCP and other forms of palliative care could make it easier for rogue doctors to play God with patients' lives.


Watt said: "The pathway is not properly policed and is open to exploitation. We are extremely concerned we could end up with another Harold Shipman."


Margo Macdonald has similar fears.


She said: "Because of the experience of Shipman, no one should think it's being in any way hysterical for the Scotland Patients Association, who have a proven track record, or any family to draw attention to practices they do not completely understand or are not explained to them."


The vast majority of dying patients in Scotland's hospitals. get good care.


But the concerns over LCP will add to the anger of grieving relatives like Alex Chapman, who lost wife Marion last April after she went in to Monklands Hospital in Airdrie.


Marion, 58, died of pneumonia after a severe chest infection.


But Alex, 66, accused staff of failing to properly care for his wife. And he claimed: "They had decided they were not going to revive her if she stopped breathing. Who are they to do that without asking permission?"
Nhs Lanarkshire said they could not comment on individual cases but were committed to effective and safe treatment for all their patients.


The Scottish Government last night defended the NHS over its use of LCP.


A spokeswoman said: "We recognise the LCP as one of a number of ways to make sure people get the most appropriate palliative and end-of-life care.


"It aims to make people as comfortable as possible, offering psychological and spiritual care and family support.


"Palliative care teams use their expertise and judgment to recognise when a patient is nearing the end of life.
"At the heart of the pathway is taking the patient's wishes into account about what kind of treatment they want to get, how much and until what stage.


"Every aspect of a patient's care covered by the pathway is assessed on a daily basis.
"Decisions made by staff in collaboration with family members are based on clinical and ethical needs."


The report may be seen at
-http://www.dailyrecord.co.uk/news/scottish-news/2011/02/01/death-row-drug-fed-to-dying-scottish-pensioners-86908-22890605/

Liverpool Care Pathway - Time to Stop and Sign to Stop



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Thursday 23 June 2011

Liverpool Care Pathway - A Medical Mischief at Work.

Google a search for the Liverpool Care Pathway. You won't have to look far to find this medical mischief at work.

Here's a headline from The Sunday Times of October 11, 2009 -

Daughter saves mother, 80, left by doctors to starve

The report is by the Sunday Times  Health Editor, Sarah-Kate Templeton, and is as follows:

An 80-year-old grandmother who doctors identified as terminally ill and left to starve to death has recovered after her outraged daughter intervened.

Hazel Fenton, from East Sussex, is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients.

Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying.

Fenton’s daughter, Christine Ball, who had been looking after her mother before she was admitted to the Conquest hospital in Hastings, East Sussex, on January 11, says she had to fight hospital staff for weeks before her mother was taken off the plan and given artificial feeding.

Ball, 42, from Robertsbridge, East Sussex, said: “My mother was going to be left to starve and dehydrate to death. It really is a subterfuge for legalised euthanasia of the elderly on the NHS. ”

Fenton was admitted to hospital suffering from pneumonia. Although Ball acknowledged that her mother was very ill she was astonished when a junior doctor told her she was going to be placed on the plan to “make her more comfortable” in her last days.

Ball insisted that her mother was not dying but her objections were ignored. A nurse even approached her to say: “What do you want done with your mother’s body?”

On January 19, Fenton’s 80th birthday, Ball says her mother was feeling better and chatting to her family, but it took another four days to persuade doctors to give her artificial feeding.

Fenton is now being looked after in a nursing home five minutes from where her daughter lives.

Peter Hargreaves, a consultant in palliative medicine, is concerned that other patients who could recover are left to die. He said: “As they are spreading out across the country, the training is getting probably more and more diluted.”

A spokesman for East Sussex Hospitals NHS Trust, said: “Patients’ needs are assessed before they are placed on the [plan]. Daily reviews are undertaken by clinicians whenever possible.”

In a separate case, the family of an 87-year-old woman say the plan is being used as a way of giving minimum care to dying patients.

Susan Budden, whose mother, Iris Griffin, from Norwich, died in a nursing home in July 2008 from a brain tumour, said: “When she was started on the [plan] her medication was withdrawn. As a result she became agitated and distressed.

“It would appear that the [plan] is . . . used purely as a protocol which can be ticked off to justify the management of a patient.”

Deborah Murphy, the national lead nurse for the care pathway, said: “If the education and training is not in place, the [plan] should not be used.” She said 3% of patients placed on the plan recovered.

Sarah-Kate Templeton, Health Editor
AN 80-year-old grandmother who doctors identified as terminally ill and left to starve to death has recovered after her outraged daughter intervened.

Hazel Fenton, from East Sussex, is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients.

Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying.

Fenton’s daughter, Christine Ball, who had been looking after her mother before she was admitted to the Conquest hospital in Hastings, East Sussex, on January 11, says she had to fight hospital staff for weeks before her mother was taken off the plan and given artificial feeding.

Ball, 42, from Robertsbridge, East Sussex, said: “My mother was going to be left to starve and dehydrate to death. It really is a subterfuge for legalised euthanasia of the elderly on the NHS. ”

Fenton was admitted to hospital suffering from pneumonia. Although Ball acknowledged that her mother was very ill she was astonished when a junior doctor told her she was going to be placed on the plan to “make her more comfortable” in her last days.

Ball insisted that her mother was not dying but her objections were ignored. A nurse even approached her to say: “What do you want done with your mother’s body?”

On January 19, Fenton’s 80th birthday, Ball says her mother was feeling better and chatting to her family, but it took another four days to persuade doctors to give her artificial feeding.

Fenton is now being looked after in a nursing home five minutes from where her daughter lives.

Peter Hargreaves, a consultant in palliative medicine, is concerned that other patients who could recover are left to die. He said: “As they are spreading out across the country, the training is getting probably more and more diluted.”

A spokesman for East Sussex Hospitals NHS Trust, said: “Patients’ needs are assessed before they are placed on the [plan]. Daily reviews are undertaken by clinicians whenever possible.”

In a separate case, the family of an 87-year-old woman say the plan is being used as a way of giving minimum care to dying patients.

Susan Budden, whose mother, Iris Griffin, from Norwich, died in a nursing home in July 2008 from a brain tumour, said: “When she was started on the [plan] her medication was withdrawn. As a result she became agitated and distressed.

“It would appear that the [plan] is . . . used purely as a protocol which can be ticked off to justify the management of a patient.”

Deborah Murphy, the national lead nurse for the care pathway, said: “If the education and training is not in place, the [plan] should not be used.” She said 3% of patients placed on the plan recovered.


Liverpool Care Pathway - A 'Legal' Euthanasia.

We’ve been following a complaint ever since 2007 about the treatment my mum received that resulted in her death.

Letters sent to the District Nurses Office to determine what had transpired were actually returned ‘refused’ by Royal Mail and the person to whom we had written and who had offered help transferred, or was transferred, elsewhere.

It soon became plain to us that there is a policy at Caterham Dene Hospital where her life was taken to make no great effort to intervene to preserve life, to ‘let them go’ and even to ‘help them on their way’. That is why there was no effort at all by nursing staff, as is now admitted, to monitor mum’s status. This was not as a result of a failure in the nursing procedure, however, but adherence to hospital policy.

We said this repeatedly, over and over, but, rather than comment or, you would think, dismiss our allegation, they chose, simply, to ignore it. This is, surely, euthanasia after all and euthanasia is still not legal in this land. Only now have we discovered it is not ‘euthanasia’ but the Liverpool Care Pathway and that, apparently, is legal!

Mum was taken from us these three and a half years ago. It was Thursday 19th July 2007. How vividly and how well I recall that Thursday morning. A nurse from the District Nurses Office had invited two specialist nurses to my mother’s home. The first arrived a half-hour early, accompanied by her daughter who was present on work experience. The second followed not long after. It was all so jovial, so happy, so promising, so positive. Mum was quite taken by all the attention. I joked that there were not two but two and a half nurses present. That appeared to provide some amusement.

My mother was not suffering a terminal illness of any sort by any standard except that set by those who actually view old-age itself as a terminal illness. Although, at 92 years young, mum fell well within that category. Mum went into Caterham Dene on the basis of core care-objectives she herself agreed with the two and a half specialist nurses upon their visit to her home that day; it was not to commit a seriously ill patient to hospital care.

These core care-objectives were clear and simple. A brief stay in a small, five-bed ward at Caterham Dene Hospital was recommended. This would give her the opportunity to improve her mental outlook and aid her recovery. A flattering description was made of this small hospital, apparently, more akin to an old-fashioned cottage hospital. This would also permit me to prepare the room downstairs while we awaited delivery of the motorised recliner chair/bed already placed on order.

Mum had been becoming more dejected by the day. Heidi confirmed my own concern in that regard but remarked to mum that this wasn’t depression; she was just down in the dumps and needed a fresh outlook. She was feeling that way wasting away in her bedroom. She needed a more positive outlook, uplifting. The steep stairs, noted as such by her GP, had become a hurdle, a barrier, in her daily life, and had confined her to her room for nearly two weeks.

Whilst at Caterham Dene, they would also look into the persistent back pain her GP had put down to a posture problem, a result of inactivity, but which a visiting nurse thought might be a hip problem. He advised, upon his visit on the day prior to mum's consignment to Caterham Dene, that I assist her in walking about the room to get her posture back into shape.

They would also continue to treat the bullous pemphigoid that had recently afflicted her following application of a cream prescribed by another Dr. from the same practice. A new regime was also suggested to, finally, deal with the last vestiges of the Pemphigoid. This was in remission, but still obstinately hanging on.

Mum had some catarrh and this was presenting green. This was acknowledged and it was said that they would, no doubt, give her some antibiotics on the ward. It was also agreed that her leg weakness was a result of her confinement to her room.

It was decided that these would be the treatment goals in Caterham Dene to remedy her situation. On that basis, and that basis alone, mum agreed. An ambulance was arranged, most promptly, and I accompanied her to Caterham Dene that very afternoon.

Upon admission, a bed was already arranged and an x-ray revealed that she had suffered two crushed discs. So much for her GP who, clearly, could not diagnose a drunk in a brewery. Mum was made comfortable in her bed and I left her there with high hopes, looking forward to my visit the following day. When I rang that evening to check on her, I was told that mum had actually asked after me and that she was comfortable. What followed was a cruel betrayal of expectation and trust.

On Thursday, mum was alert and communicative. She was off her food but able to feed herself. By next day, everything had changed disastrously. On Friday, they had moved her into a side room. She was, at best, described as confused, but she imparted to me that she didn’t like them in there; those words were her last coherent words to me in this life!

By Saturday, mum was completely insensible. I could not believe it. The nurse to whom I spoke on Friday denied any knowledge of the agreed core objectives. My mother was in Caterham Dene, she said, because she could not be cared for at home. The treatment prescribed by the specialist nurse was wrong and would not proceed. The core care objectives were disregarded and denied. This was more than a betrayal of trust; this was a Breach of Duty to respect the patient’s wishes.

My mother went into Caterham Dene, ostensibly, for two or three weeks respite care; fundamentally, this was to ‘cheer her up’ as the nurse had put it. Her condition, though chronic, was not dire or perilous. Mum had only recently attended an appointment with Dr Nazir, Consultant Dermatologist at ESH in regard to the skin condition. Dr Nazir was pleased with my mother’s progress, not considering a further appointment necessary until September 2007. That is all the more reason, then, to wonder at my mother’s sudden decline and demise at Caterham Dene.

Within the space of just two days, she was reduced to a condition of complete, vegetative unresponsiveness; by the Saturday, she could not feed herself and was unable even to lift a beaker of orange juice to her lips. I am not certain that she was even aware of my presence as I spoon-fed her her meal!

Her pain killer, prescribed for the back condition, had been replaced by morphine. Morphine is noted for having such effects as sedation and producing extreme confusion, and particularly so in the elderly. I protested that my mother had always insisted she would never have morphine and expressed my concerns that, in an elderly person with a weak heart, the administration of morphine could lead to heart failure. The nurse just looked askance and calmly said that she had already administered two doses to my mother.

In my presence, the nurse asked my mother if she would like some more morphine, offering it almost as if it were a treat. My mother was clearly confused, incoherent and in a state of semi-consciousness, just grunting responses which could not in any way be interpreted as consent, barely aware, as I have said, of my presence even. When I objected that to proceed would be counter to mum’s wishes, the nurse became hostile and accused me of attempting to persuade mum against her wishes to refuse the morphine!

We subsequently discovered that my mother’s entire ongoing medication had been withdrawn, without our knowledge, and replaced with morphine, again, commenced without our knowledge. We were not even aware that this was a nurse driven hospital and that there was no doctor present at weekends.

Mum’s hearing aid was hanging out of her ear and the tube had been damaged. This would not have been at all helpful in the very necessary communication process to make her wishes clear and understood and yet it was insisted that she had assented to the morphine. Additionally, all knowledge of how this damage to her hearing aid might have occurred was denied. It was even suggested that it may have occurred in the ambulance transport to the hospital but I had to maintain that the ambulance personnel were both most particular in their care.

In the Healthcare Commission report, it is stated that, “solpadol and morphine act differently, and are effective for different types of pain.” Solpadol was  prescribed for mum’s back pain. For what, then, had the morphine been prescribed in the Dene? Explanation has been sought and demanded, but none has been offered.

The requirement upon Caterham Dene made by the PCT to apply new guidelines regarding analgesics demonstrates that what I saw to be the case was indeed the case. My mother was dosed into a condition of utter insensibility. I could not believe it. I actually could not believe the condition they had reduced her to in such a brief space of time, a matter of mere hours! Hence the persistent calls I made in utter desperation to the District Nurses’ office throughout her brief incarceration. I truly believed that they would pick up the calls on the Monday and we could get her out of there. I never believed they could possibly dispose of mum in the space of just one weekend.

In the Healthcare Commission report, the nursing adviser refers to poor nursing practice and there is an admission that the medical notes kept are inexact and slapdash, not to be trusted and not to be relied upon for their accuracy. It must be significant therefore that, following the Healthcare Commission report and the PCT’s review, recommendations were made in respect to the administration of analgesia that Caterham Dene were required to put in place!

The Commission’s GP advisor expressed concerns about “undated entries being entered on to the wrong notes” and cast doubt upon the accuracy of blood pressure readings. These are damning words which cast into actual doubt the validity of the medical evidence! Lack of care and attention to properly and accurately maintain the written record constitutes a negligence which directly threatens the well-being and safety of the patient.

What record is there of administration and dosages of analgesics? How much morphine was my mother plied with to reduce her to that state I found her in? Was there proper care and attention to accurately maintain the written record in that regard? Given the slackness to record the detail in other regards, it is fair to surmise there was slackness in this. The Commission expressed concern that no ‘learning has been identified’ by the Trust.

The nursing sister took me aside and spoke to me in her office upon the day of my mother’s admission. She asked me, if anything should happen – not that it would! – do I want them to have my mother moved to ESH. I thought nothing more of that. Yes, of course I do! That went without saying. In the context of what we now know, that all makes sense.

They permitted my mother to present cyanosed on the Saturday and did nothing. I received a call early on Sunday morning to say she was suffering from heart failure and that they were getting the doctor. Still unaware of the reality of the situation, we thought they were actually getting the doctor on the ward. No, they had called Thamesdoc! This we discovered an hour later when they called us again. Thamesdoc were unavailable, they said, and so they had called an ambulance! Excuse me?

To recapitulate: We were not aware, had not been informed, that this was a nurse-led hospital and that there was no medical doctor on site at the weekend. My mother had presented cyanosed, been left to deteriorate to a catastrophic life-threatening condition - and they called Thamesdoc. Only after an hour of fruitless waiting for Thamesdoc to attend and following Thamesdoc's failure to attend did they decide to summon an ambulance!

My mother actually perished halfway between Caterham Dene and ESH, paramedics ramming tubes down her throat in frantic, vain attempts to revive her. This was reported to me in A & E in explanation of the very apparent bruising upon her person.

It is a duty incumbent upon every medical person to protect life and to do no harm. And yet, it is now plain to us that there is – or was - a policy set in place at Caterham Dene to make no great effort to intervene to preserve life, to ‘let them go’ and even to ‘help them on their way.’ That is why there was no effort at all by nursing staff, as is now admitted, to monitor my mother’s status. This was not as a result of a failure in the nursing procedure; they were following policy in not doing so, to permit nature to take its course and even to lend it assistance.

Our suspicions - we now know - were correct: that policy was - and is - set in place. The Hippocratic oath has been thrown out the window  in favour of the blind, tick-box dictats of the Liverpool Care Pathway!

Sign to ban this scandal now.

Tuesday 21 June 2011

Sign to ban this scandal now.

The Liverpool Care Pathway, (LCP), is in widespread use in the UK. It is flawed and dangerous. The Daily Telegraph has referred to it as the Death Pathway. There have been calls from victims families to have it banned. The old are particularly vulnerable because many of the so-called signs that are looked for to put a patient on the death pathway, such as frailty and declining mobility, are symptomatic of old-age in any case.

In fact, age is one of the factors also taken into consideration in putting the patient on the LCP! This petition is to call for its withdrawal. Every patient is an individual and deserves that individual consideration of their condition.

As it stands, anyone who falls into the clutches of the proponents of LCP and ticks all the boxes will be given assisted passage into the next world care of the NHS. This will apply particularly to the elderly who are, in any case, already suffering from that most terminal of all conditions - Old-Age! This will apply even contrary to the expressed wishes of patient and family, as this family has discovered.

According to Dr Peter Hargreaves, Consultant in Palliative Medicine, P. H. Millard, Emeritus Professor of Geriatrics University of London and others, in the year 2007-2008 alone, 16.5 per cent of deaths came about after terminal sedation through the, quote, disturbing blanket application of the Liverpool Care Pathway being rolled out across the NHS in the UK.

Currently, an estimated 20,000 patients have their lives taken each year while receiving care under the LCP which also prohibits administering artificial nutrition and hydration to those assessed as dying and states that doing so is ethically indefensible and, in the case of patients lacking capacity, is prohibited under the Mental Health Act.

To my comments that my mothers life was taken at Caterham Dene Hospital where LCP is in use, the NMC responded that I am, quote, at liberty to contact the police.

My mother was robbed of her life through application of the Liverpool Care Pathway. NMC registrants at Caterham Dene Hospital, even by the standards set out by that flawed measure of who is and who is not at Deaths door, were far too zealous in the liberal helpings of morphine they doled out to my mother. The PCT were actually required to set in place new practices at the Dene in regard to analgesics and their use on ward.

Following widespread application of the LCP, relatives of many hospital, nursing home and residential care patients have watched in horror as their loved ones are kept under sedation and food and fluids are withdrawn. Does the NMC therefore assert that, in like fashion, these relatives are, quote, at liberty to contact the police and that this is their advice to them? They make no reply.

The critic of the LCP mentioned above, Peter Millard Emeritus Professor of Geriatrics, warns that there is a risk that elderly people with chronic conditions and disorders may be easily dismissed as dying when that may not, indeed, be the case. Certain media have even compared the LCP with euthanasia. Euthanasia is still against the law in this land. Perhaps, then, the advice of the NMC does stand in good stead and these relatives should be, quote, at liberty to contact the police. And is that their advice to them? The NMC makes no reply.

The Liverpool Care Pathway was a tool designed to be used with patients already diagnosed to be terminally ill; it was never a diagnostic tool per se to determine a terminal condition. It was designed at the Marie Curie Hospice in Liverpool specifically for the terminally diagnosed patient and to recognise when a point had been reached that death was near or imminent so as to provide as peaceful and gentle path from this world as might be provided. These patients were already diagnosed to be dying from cancer; the Pathway was not the tool used to make that diagnosis, but a means - a 'pathway' to follow - to determine that point.

A culture of death is pervading the NHS in the UK. A dark shadow is stalking our hospitals and care homes. The right to death is becoming paramount over the right to life. The LCP is providing a newfound legitimacy and cover to an unspoken policy that has, actually, been in place for decades! Will the NMC, if it will do nothing more, not add its voice to that of Dr. Peter Hargreaves and others and raise a hue and cry to get this Care Pathway rolled back and removed? Will the Care Quality Commission, the new body set in place to investigate such matters not step in?

The NMC have stated that any further correspondence will be filed, but not answered. Then, let it go on record that the NMC were asked to add their voice to denounce this scandal and declined to do so. Posterity will look back in anger and horror!

An afterword:

The Department of Health committed to investing 286 million pounds over the two years to 2011 to support implementation of this End of Life Care Strategy. That is 286 million pounds spent to assist people on their path to the next world while denying the necessary funding to keep them alive and well in this!

A Daily Mail on-line article outlines how we in the UK have the worst cancer survival rate in the western world. Doctors in our local surgeries, hospitals and health care centres are providing us with treatments based on our illness, our age, our families. The Daily Mail article explains how doctors tend to late-diagnose older patients or provide them with less beneficial treatments. The elderly are routinely denied surgery or drugs.

It is a duty incumbent upon every medical person to protect life and to do no harm. And yet, through the LCP, there is a policy set in place at Caterham Dene - and across the NHS - to make no great effort to intervene to preserve life, to let them go and even to help them on their way.

So much of the public purse to spend on death, so little to spend on life. There is something very wrong here. The elderly, suffering from the most terminal of all illnesses - OLD-AGE - are on the sharp end of this cutting-edge of end-of-life policies. A culture of death really is pervading the NHS in the UK. A dark shadow is stalking our hospitals and care homes. The right to death is becoming paramount over the right to life!