Wednesday, 28 December 2011

Liverpool Care Pathway - A Complicity Of Involvement

Action against Medical Accidents

According to several comprehensive studies of the issue, medical errors are far from rare. That is alarming.

But diagnostic errors - a subset of the overall problem - haven't received nearly as much attention as other medical errors.

"Diagnostic error is barely on anybody's radar screen," according to  Dr. Mark Graber, 62, a nephrologist in Long Island, N.Y., and an expert on diagnostic errors. That is a cause for grave concern, grave being the operative word.

Misdiagnosis may result in any one of many outcomes. Misdiagnosing death that results in being placed on the Liverpool Care Pathway will have only one outcome. Clearly, LCP is a one-way ticket on the NHS (National-socialist Health Service) into the next world. Our concern is well-founded!

Action against MedicalAccidents (AvMA – the charity for patient safety & justice) has campaigned for the introduction of a legal duty of candour in healthcare in the UK – the so-called 'Robbie's Law'.

There are laws set in place to protect consumers. Transparency and the free flow of truthful information are key features of such legislation. Say that again: Transparency and the free flow of truthful information are key features of such legislation!

But what of a human life, our very selves, our human flesh and blood, the only thing any of us, each of us, will truly possess throughout our lives, in luxury or in penury? Can this be said enough, that it should have to be said at all, that this is something utterly beyond value, invaluable. To take any stance other than unconditional support for such legislation diminishes human life such that it becomes quite, quite worthless.

The Health Secretary, Mr. Andrew Lansley, has declared himself against this measure. Shame on you Mr. Lansley! Clearly, the opinion of the medical lobby carries great weight at Westminster. Their reluctance to throw out the bad apples is well documented.

The truth is more ugly and more messy than could it ever have been conceived to be.

The fact that the culprits are not served their just deserts bears out what we were told.

The truth is that what goes on – and what has gone on for years – continues to go on.

This is from the AvMA home page:

Action against Medical Accidents (AvMA) is the independent charity which promotes better patient safety and justice for people who have been affected by a medical accident. A 'medical accident' is where avoidable harm has been caused as a result of treatment or failure to treat appropriately. AvMA believes that whatever the cause of a medical accident, the people affected deserve explanations, support, and where appropriate, compensation. Furthermore, we all deserve to know that the necessary steps will be taken to prevent similar accidents being repeated.

But what of diagnostic errors, a subset of the overall problem, and which haven't received nearly as much attention as other medical errors? What is AvMA’s stance on those?

What is AvMA’s stance on the Liverpool Care Pathway? This is problematic. A diagnosis of impending death which then results in death can hardly be said to have been in error or be considered to be a ‘misdiagnosis’. The LCP protocols, however, applied judiciously and to the letter, will guarantee only this one outcome.

Dr. Patrick Pullicino echoes the views of a not insignificant body of medical opinion when he states:
“It is not scientifically possible to diagnose impending death as the LCP purports to do. The LCP is instead an assessment of the perceived quality of life of the patient by the medical team and as such is euthanasia.”
And what is AvMA's position in that regard?

The Liverpool Care Pathway is a legal document established as a legal "therapy". Through the Department of Health CQUIN incentives, it has been made the subject of cost/benefit assessment by health managers and economists. In a cost conscious health service, a short sharp end will be a tempting therapeutic option to £500 per week and more for ‘continuing  care’.

CQUIN is the DOH funding policy. CQUIN has set targets for 2011/2012 with regard to the End of Life LCP program. The forward plan is to increase the number of patients identified to be on the end of life care pathway from a baseline of 0% to 20%; it is further planned to have 30% of all patients who die in hospital dying on the Liverpool Care Pathway.

To ensure they receive their provider income in full, Trusts have to comply with or exceed these goals.

Clearly a misdiagnosis is a medical error and, therefore, is called to the remit of AvMA.  Clearly, this is a connived medical error through the involvement and policy of the DOH.  Can Government Ministers, then, be said to be complicit in it? 

This is madness. This is Kafkaesque.

1 comment:

  1. Dear Eldoel,

    My name is Tom Warren and I am currently doing research for a documentary on palliative care in the UK. I have read your blog and it is so thorough - and contains so many heart-rending stories. It would mean so much if I could talk to you.

    Would it please be possible for us to get in touch at some point? My email address is

    All the best,