Liverpool Care Pathway – An 'Unlawful' Pathway

The Needle reported on the Liverpool Care Pathway recently. An update follows here -

Update: Liverpool Care Pathway, The Dirty Secret of the NHS.

Some readers of ‘The Needle’ may recall that I wrote a personal account of the death of my Mother-in-Law, ‘The Liverpool Care Pathway, The Dirty Secret of the NHS’, since then I’ve been in contact with Macmillan, Marie Curie, and Southampton General Hospital. More on those communications later.

First, I just want to direct readers to this story today in The Daily Mail, ‘Top doctor’s chilling claim: The NHS kills off 130,000 elderly patients every year.’

Professor Patrick Pullicino

“NHS doctors are prematurely ending the lives of thousands of elderly hospital patients because they are difficult to manage or to free up beds, a senior consultant claimed yesterday.

Professor Patrick Pullicino said doctors had turned the use of a controversial ‘death pathway’ into the equivalent of euthanasia of the elderly.

He claimed there was often a lack of clear evidence for initiating the Liverpool Care Pathway, a method of looking after terminally ill patients that is used in hospitals across the country.

It is designed to come into force when doctors believe it is impossible for a patient to recover and death is imminent.

It can include withdrawal of treatment – including the provision of water and nourishment by tube – and on average brings a patient to death in 33 hours.

There are around 450,000 deaths in Britain each year of people who are in hospital or under NHS care. Around 29 per cent – 130,000 – are of patients who were on the LCP.”

As you can see, ‘unlawful’ yet officially sanctioned euthanasia, in an often cruel form, is systemic within the NHS, accounting for almost one third of deaths in the UK’s hospitals. I say ‘unlawful’ because there has not been a single Act of Parliament passed which would ‘legitimise’ this practice. Few people realise that clinicians consider food and water as medicines, and so the withdrawal of medication includes the denial of nourishment and hydration.

Unlike those with long term debilitating illnesses who are able to campaign, often for years, for an humane death. The elderly and those with terminal conditions often never find out how they will meet their end, and so never have the time or opportunity to raise this issue into public consciousness.

As I wrote at the beginning of this article, I have been in contact with three organisations.

It is extremely difficult to choose between Marie Curie and Southampton General Hospital as to which, of the two, gave the worst response to the issues and concerns I raised.

The Head of Public Relations at Marie Curie responded promptly with a reply literally copied and pasted from here. [Marie Curie helped develop the LCP.]

While a ‘Patient Experience Advisor’ (Hospitals don’t have complaints departments as this would mean accepting that they have complaints) atSouthampton General Hospital took 3 weeks to reply, suggesting that I make a formal complaint, but as I replied:

“I think the problems of, lack of specialized palliative staff (you only have 4 part time nurses at Southampton), lack of training of ward staff, and a lax and cavalier attitude to the implementation of the LCP (a legally dubious procedure anyway), I think these are systemic problems at Southampton General Hospital and the NHS as a whole. To look at my mother-in-law’s case in isolation allows you to focus on a single tree and avoid looking at the wood.”

Head and shoulders above the other two have been Macmillan who have been fantastic, even if I do not agree with their position. They were genuinely concerned by the points I raised and urged me to make a formal complaint. But they still support the principles of The Liverpool Care Pathway, writing:

“You asked what Macmillan’s position was in relation to the Liverpool Care Pathway (LCP)and we are supportive of it. We are in support of the principles of the LCP, however would not condone poor practice or standards of care. The LCP is also recommended in the national strategy on end of life care for England.

The LCP is a research based tool intended to ensure that patients receive the best care in the last days and hours of life. As with any model, guidelines or pathway, the LCP is only as good as the healthcare professionals who are using it. A robust education and training programme regarding care of the dying should be in place within the organisation. The LCP aims to support but does not replace the clinical judgement and decision making of the doctors and nurses. The responsibility for use of the LCP document as part of a continuous quality improvement programme sits within the governance of the organisation and must be underpinned by a robust education and training programme.

The LCP as with any other tool is only as good as those who use it and is not an excuse for poor care. Poor care of the dying is completely unacceptable.”

My own response was thus;

” My own view is that the Liverpool Care Pathway is a utopian procedure, an ideal which, due to lack of training, human nature, and constraints on resources is unlikely to be realised in the real world. I personally consider it intellectually dishonest for any organisation to defend it’s general use on the basis of an unrealisable ideal. In the ‘real’ world hospital staff avoid consulting with the patient, even when it’s possible to do so, they do not consult with the family until after the decision has been taken and the LCP has already been embarked upon, ward staff are not trained adequately, if at all, and too many patients are left to die an agonising and often public death in an open ward.  That is the day to day reality of the LCP and hiding behind the ideal may be some comfort for organisations like Macmillan and Marie Curie who support it but it is a position which lacks any intellectual courage in the face of the facts on the ground.”

I should just point out that by pursuing this I am not looking for any financial compensation. My Mother-in-Law is dead and she would have been dead by now regardless of what treatment she received. My concerns are over the manner of her death and I just want others to be better informed than I was.

Knowledge is Power.