Thursday, 12 July 2012

Liverpool Care Pathway – The 'Money Saver'

Further response -

Public Service - analysis_opinion_debate

Hospital deaths ''hastened to save money''

09 July 2012 

The Department of Health (DH) has denied claims that hospitals are putting increasing numbers of elderly patients on a 'death pathway' to hasten their demise and save NHS funds.

The department was replying to a letter from six doctors who specialise in elderly care, sent to The Daily Telegraph, that claimed that the established pathway scheme was being misused by hospitals to speed up the deaths of terminally ill patients. The so-called 'Liverpool Care Pathway' (LCP) is approved by the National Institute for Health and Clinical Excellence (NICE) and the DH.

The doctors reckoned that patients were deliberately not being given food and water, which is what happens when the LCP is implemented. But, the letter said, so many patients were having this done to them without their consent that they are now carrying cards that expressly state they do not wish to have food and fluids withdrawn in their final days.

A person's death is "essentially a prediction", the doctors wrote, but it may be hastened due to "the availability of resources".

"Members of the public have given examples of inappropriate use of the Liverpool Care Pathway," they wrote. "The combination of morphine and dehydration is known to be lethal, and four-hourly reassessment is pointless if the patient is in a drug-induced coma. No one should be deprived of consciousness except for the gravest reason, and drug regimes should follow the accepted norms as laid down in national formularies.

"In the elderly, natural death is more often free of pain and distress. The only certain way of assuaging thirst in the conscious is to provide fluids orally or occasionally by another route such as subcutaneous infusion. The matter of informed consent is another major consideration, and it is therefore not surprising that patients are refusing the pathway in advance directives, or carrying cards refusing this form of treatment, as a measure of self-protection."

One of the letter writers, Dr Gillian Craig, told the paper: "If you are cynical about it, as I am, you can see it as a cost-cutting measure, if you don't want your beds to be filled with old people."

The DH said: "People coming to the end of their lives should have a right to high quality, compassionate and dignified care. The Liverpool Care Pathway is not about saving money. It is an established and respected tool that is recommended by NICE and has overwhelming support from clinicians at home and abroad.

"The decision to use the pathway should involve patients and family members, and a patient's condition should be closely monitored. If, as sometimes happens, a patient improves, they are taken off the LCP and given whatever treatments best suit their new needs. To ensure the LCP is used properly, it is important that staff receive the appropriate training and support."

… And the LCP (Liverpool Care Pathway) continues to look like the option of choice to keep the financial wheels of the NHS (National-socialist Health Service) turning.

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