Sunday, 24 June 2012

Liverpool Care Pathway – The Truth Will Find A Way

The following report is quite noteworthy for its candid, forthright and outspoken honesty -


Elderly patients 'helped to die to free up beds', warns doctor

NHS hospitals are using end-of-life care to help elderly patients to die because they are difficult to look after and take up valuable beds, a top doctor has warned.

Young look to state to fund elderly care
Professor Pullicino claims some patients put on the Liverpool Care Pathway could live longer.

Donna Bowater 
8:15AM BST 20 Jun 2012
Professor Patrick Pullicino has claimed that doctors are using a care pathway designed to help make people's final days more comfortable as an equivalent to euthanasia.
The Liverpool Care Pathway (LCP) is used in hospitals for patients who are terminally ill or are expected to die imminently. Under the pathway, doctors can withdraw treatment, food and water while patients are heavily sedated.
Almost a third of patients - 130,000 - who die in hospital or under NHS care a year are on the LCP.
Professor Pullicino said he believed the LCP was being used as an "assisted death pathway" with patients placed on the LCP without clear evidence, according to the the Daily Mail.
The senior consultant at East Kent Hospitals told the Royal Society of Medicine he had personally intervened to have a 71-year-old man taken off the LCP and be treated successfully, despite claims he was expected to die within hours or days. He had arrived in hospital with pneumonia and epilepsy.

"I removed the patient from the LCP despite significant resistance," he said. "His seizures came under control and four weeks later he was discharged home to his family.
"The lack of evidence for initiating the Liverpool Care Pathway makes it an assisted death pathway rather than a care pathway."
Professor Pullicino said the 71-year-old man lived for another 14 months before he suffered pneumonia again and was admitted to a different hospital. He was put on the LCP and died five hours later.
"Very likely many elderly patients who could live substantially longer are being killed by the LCP. Patients are frequently put on the pathway without a proper analysis of their condition," he added.
"Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically. This determination in the LCP leads to a self-fulfilling prophecy.
"The personal views of the physician or other medical team members of perceived quality of life or low likelihood of a good outcome are probably central in putting a patient on the LCP."
He said those who went on to come off the LCP and live longer than expected were costly to the taxpayer because of the extra health care and support needed.
The LCP was developed as a template for health workers to make the last days of terminally ill patients comfortable.
The guidance recommends patients' on the pathway are regularly assessed, and they can be taken off the LCP if they are no longer close to death.
A Department of Health spokesman said: "The Liverpool Care Pathway is not euthanasia and we do not recognise these figures. The pathway is recommended by NICE and has overwhelming support from clinicians - at home and abroad - including the Royal College of Physicians.
"A patient's condition is monitored at least every four hours and if a patient improves, they are taken off the Liverpool Care Pathway and given whatever treatments best suit their new needs."

Those on the receiving end will take exception to the DOH view. The Telegraph also reported  -

Doctors face ban on denying treatment to elderly

10:30PM BST 11 Jun 2012

Doctors and NHS managers will be banned by law from denying older patients treatment simply on the grounds of their age, ministers will announce.

An elderly woman's hands on walking stick

Paul Burstow, the care minister, said the new law would ensure that health and care workers had the right attitude to help Britain’s ageing society.
“We know that older people are not always treated with the dignity and respect they deserve because of ageist attitudes – this will not be tolerated,” he said.

“Our population is ageing as more of us live longer. The challenge for the NHS is to look beyond a person’s date of birth and meet the needs of older people as individuals.”

Mr Burstow said he recently met an 84-year-old woman who was diagnosed with a leaking heart valve. When she asked to have the problem fixed, doctors said: “What are you bothered about, at your age?”

“This is exactly the kind of discrimination we want to rule out in the NHS,” said Mr Burstow.

The Telegraph article goes on -

For several years, NHS trusts have been under instruction not to allocate treatment solely on the basis of a patient’s age. But statistics suggest that older patients are still less likely to be treated than their younger counterparts.

Most notably -

Research in 2009 by the King’s Fund think tank found that older people had “differential access to services”, meaning that they waited longer than younger people in casualty departments and were less likely to be referred to intensive care or to have surgery following a traumatic injury.

The study also found that older people with cancer had less access to palliative care than younger counterparts. They were also examined and given less treatment than younger patients for conditions including heart disease and stroke.

The elderly have "less access to palliative care" the King's Fund has stated. It would appear that Ministers now recognise these discriminatory practices.

This is clearly at odds with the DOH sponsored Commissioning for Quality and Innovation (CQUIN) payments made to Trusts for setting in place LCP protocols. Instead of access to appropriate and adequate palliative care, the elderly are more likely to be placed on the LCP death pathway.

Perhaps this is not so at odds in consideration of necessary belt-tightening in a cash-strapped NHS that can ill afford recuperative care for someone already on the downhill slope of terminal old age!

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