Sunday 30 September 2012

Liverpool Care Pathway – A 'One Size Fits All' Approach?

A “one-size fits all” approach is “ingrained” in the NHS.

Doctors say hospitals need to improve care for “high risk” patients, such as the very old.

Doctors concede that there is simply not the money to provide such a level of care for all patients.

Enter the Communitarian solution - the Liverpool Care Pathway...

The Telegraph has this report (emphases are mine throughout) -

Surgery death rate 'twice as high as thought'

Twice as many people die after surgery in NHS hospitals as previously thought, according to a new report that finds serious shortcomings in the way many patients are treated.
Surgery death rate 'twice as high as thought'
People at a high risk of dying from surgery were routinely not being told of the dangers, said doctors,
often because hospital staff were not identifying them properly.  Photo: GETTY

7:00AM BST 21 Sep 2012



The overall chance of dying within two months of surgery is one in 28 (3.6 per cent), found the study published today (Fri) in The Lancet.

Dr Rupert Pearse, who led the research, described its findings as “very worrying” and said many patients were simply not getting the care they should. “We need to act,” he said.

People at a high risk of dying from surgery were routinely not being told of the dangers, said doctors, often because hospital staff were not identifying them properly.

Patients were also being sent back to general wards after surgery rather than critical care beds because of a “one-size fits all” approach that was “ingrained” in the NHS.

Dr Pearse, a reader in intensive care medicine at Barts and the London School of Medicine and Dentistry, said lessons needed to be learnt from cardiac surgery, where information on death rates was freely available and hospitals vied to be the best.

A previous report, published last December by the National Confidential Enquiry for Patient Outcome and Death (NCEPOD), found the chance of dying within 30 days of surgery was just one in 63 (1.6 per cent).

But Dr Pearse said the difference between the two figures could not simply be explained by more patients dying in the second month.

“The great majority of deaths happen in the first seven to 10 days after surgery.”

Dr Pearse, an intensive care specialist, designed both the NCEPOD and the Lancet study, but said the latter was “more robust” regarding mortality rates.

He warned: “We’ve always known that we had a problem, but this study shows it’s more serious than previously thought. It’s very worrying and we need to act.”

The latest study examined 10,630 cases in British hospitals during one week in April 2011. These included both pre-planned and emergency operations, but excluded those not requiring an overnight stay, as well as cardiac, neurological, radiological or obstetric surgery.

Patients undergoing specialist surgery are treated differently, for example by dedicated teams on dedicated wards. Dr Pearse argued that meant they essentially received better care.

He said the mortality rate among adult cardiac patients was now less than two per cent - even though they tended to be older, have worse health, and require more dangerous surgery than average.

“If we did the types of things that we did in cardiac surgery, in all types of surgery, outcomes would improve.

“With most surgery, the only thing that’s different is the surgeon. But this ‘one size fits all’ approach to care isn’t really working for the overall surgical population.”

Cardiac patients are treated by specialist teams of surgeons and anaesthetists and cared for by specialist nurses on dedicated wards.

Dr Pearse also said outcomes for cardiac surgery had improved markedly since the mid 90s, partly due to changes triggered by the Bristol Royal Infirmary scandal. Between 1990 and 1995, 35 babies died in its cardiac unit and dozens more were brain damaged due to lack of staff, leadership, and scrutiny.

This led to cardiac units being constantly audited, with results now published online.
“I think the reason we see such amazing care and excellent outcomes with cardiac surgery, is that hospitals compete with each other,” he said.

“If they find that their hospital is below par, they want to improve it.”

Doctors concede that there is simply not the money to provide such a level of care for all patients.

But they say hospitals need to improve care for “high risk” patients, such as the very old or those undergoing dangerous procedures like emergency bowel repairs, who account for 80 per cent of deaths.

However, Dr George Findlay, main author of the NCEPOD report, said “poorly organised services” meant hospitals too often failed to identify these patients. This meant some went under the knife when their chances of survival were slim.

He continued: “Risk is very poorly stated to the patient: very few have a statement of risk on their consent forms.”

Patients also encountered serious problems after surgery, he said.

“There are a lot of high risk patients who are just sent back to a normal ward, where they don’t have an optimal chance of recovery,” he noted.

“That’s so ingrained, it’s happened in the NHS for so many years, that it’s an accepted thing.”

However, he said that for most patients, who were relatively well and fit, the chances of dying from surgery were very low.
 
Medicine is also an 'art' and predicting death is not a hard and fast 'science'.

Doctors take the lives of their patients in their hands, effectively, as would gods the lives of mere mortals.

But nothing is ever a foregone conclusion: doctors are not Gods; they cannot tell with certainty, and must work not with assumption or protocol, but with the situation and the individual.

The more care, the better the outcome. But care costs money. Far better a set of cost-effective protocols.

What is a life worth?

There are no 'untermenschen', but there are 'ubermenschen'.

Thursday 27 September 2012

Liverpool Care Pathway – The Evidence Is Out There


There are countless anecdotal accounts of abuses of the Liverpool Care Pathway to be found in print and on the Internet, in the news and posted on social networks.

This has been posted on a ProBoards forum page -

Liverpool Care Pathway. My 67 year old father was murdered in hospital because they were not prepared to treat his sepsis. My father was not terminally ill and did not consent to the withdrawal of food and medication. I accept that sepsis often is fatal but he was murdered. I kicked up merry hell trying to prevent it but consultants were not around at the weekend and Monday it was too late. This was last year - he had been in the care of a private consultant but as he grew progressively worse his wretched partner stole all the cash and left him to the tender mercies of the local hospital.
I have enduring power of attorney for an elderly friend and he has signed an advance directive refusing to consent to the LCP - I would be very wary about going into an NHS hospital as they have some unpleasant ideas..
http://www.liv.ac.uk/mcpcil/liverpool-care-pathway/
Jacks
« Last Edit: Sept 13, 2012, 9:54am by jacksfullofaces »

Are these accounts all mere hysterical and inaccurate hearsay? Is this all just idle talk, sensationalist and not to be trusted to contain even a germ of truth? Have they no basis at all in fact? These accounts are heartfelt, often angry.

Here is an account by Professor Pullicino –

U.K. ‘Death Pathway’

In June, Pullicino addressed the Royal Society of Medicine on the issue and related a personal example. One of his patients, a 71-year-old with epilepsy and pneumonia, was put on the Liverpool Care Pathway by a covering doctor on a weekend shift.

When Pullicino returned to work on Monday, "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."

Thanks go to Dr. Pullicino and his colleagues for their stand.

Thanks go to Baroness Knight of Collingtree for her noble attempt to gain rational debate in the House of Lords. She was bamboozled with flaccid, blatant denial of what is patently – and well-known to be by its victims - the truth!

Monday 24 September 2012

Liverpool Care Pathway – The Evidence Is Gathered

Meanwhile, the actual anecdotal evidence mounting up goes mostly unreported and ignored...

Comments left on the CARE2 LCP Petition site -

15:10, Sep 09, Mrs. Deborah Taylor, United Kingdom
This is being done now to my mother in law Hilda Taylor in Oldham Royal (09/09/2012). We are desparately trying to stop it.Euthanesia is not legal in this country. The NHS is not above the law. No one should die by starvation or dehydration. You wouldn't do it to a dog - you'd get prosecuted by the RSPCA.

13:06, Aug 05, Mrs. stephanie cooper, United Kingdom
the lcp method is a way of persecuting the weakest and most vulnerable of our society.My 83 year old, coherent, painfree mother has just been finished off at Good Hope Hospital, Sutton Coldfield by this method. It was callous and inhumane to see, we were not even consulted.

16:38, Jul 31, Charlotte Peters Rock, United Kingdom
Ralph Winstanley was murdered on the Liverpool Care Pathway. No-one will investigate that murder. He had not been dying. ralphwinstanleyofwath.blogspot.com

05:59, Jul 31, Name not displayed, United Kingdom
Euthenasia by the back door and should be prohibited by lawHow can they call this "care" ?

09:48, Jul 30, Mr. martin hogg, United Kingdom
deliberate ending of life is murder

16:23, Jul 29, Mrs. HEATHER BLENKINSOP, United Kingdom
MY GRANDMOTHER WAS PLACED ON THIS PATHWAY AND WE WERE NOT TOLD. MEDS, WATER AND FOOD WERE STOPPED. NAN COULD EAT, DRINK, AND TAKE MEDICINES UNTIL SHE WAS HEAVILY SEDATED. LEFT TO DIE WITHOUT TELLING US, HER FAMILY. THIS IS MUNCHAUSENS BY PROXY ON A MASSIVE SCALE. MURDER! AND THE NHS ARE GETTING AWAY WITH IT.

20:38, Jul 24, Mrs. irene morris, ON
very bad practise and a very slippery road who will be nextirene morris

18:18, Jul 24, Mrs. Jacqueline Jackson, ON
Denial of food and water to the ill is truly disturbing. I am shocked and appalled this is happening in the UK!

15:16, Jul 24, Mrs. maureen randa, United Kingdom
To watch your sister aged 59yrs be wiped out by the LCP in a hospital in the city she was born (liverpool) it makes me feel so ashamed that i stood by and allowed this situation to happen !!! i pray that people will now unite and stop this abuse of the ill and vunerable.I ask the question what is the difference between LCP and DR HAROLD SHIPMAN ?????nobody has the right to play god !! WHO < WHERE

12:44, Jul 09, Ms. janet kirkman, United Kingdom
FIRST, DO NO HARM.THE RIGHT TO LIFE IS ALWAYS PARAMOUNT.

05:21, Jun 23, Name not displayed, United Kingdom
In the Hippocratic Oath we promise to treat honestly & preserve life. Nowadays we speak about benificence & non-maleficence, but we must make sure we do not interpret this too widely.

11:43, Jun 22, Mrs. J Johnstone, United Kingdom
LCP is absolutely disgusting.Who, in God's name, would deny a dying person a drink of water?

17:01, Apr 13, Ms. katherine wentworth, KS
The Catholic Church teaches us that "no commitment to a hoped for 'greater good' can erase or diminish the wrong of directly taking innocent human lives." As believers who recognize that each human life as the gift of an infinitely loving God, we insist that every human being matters to God.

05:53, Mar 15, Paul Lucas, United Kingdom
I'm afraid it's no good medical people telling us that they wouldn't put patients on the LCP without consultation because it's patently obvious that they do. How can someone die with dignity when they are having all nutrients and fluids withdrawn, if a healthy person doesn't have water he will die in about 2 weeks and it wont be with dignity. The medical profession should hang its head in shame, even if it's a government authorised proceedure they should protest that it is against all they're supposed to represent. After all it's no good saying I was only obeying orders when you are causing people to die in pain and without any dignity whatsoever.

13:47, Mar 06, Mr. Peter Dowling, United Kingdom
You can tell a lot about a society by the way it treats its old people, the very young and the very sick. I was born very sick and one day I'll die, hopefully when I'm very old.Hopefully the same spirit of humanity and compassion that welcomed me into the world will see me out of it and into the next. BAN THE LCP

12:12, Mar 06, Mrs. Amanda West, France
It is a duty incumbernt on every medical person to protect life and do no harm.

15:10, Feb 06, Mrs. catherine prentice, United Kingdom
Please all sign , my father has just died on lcp, we were not informed at all that he was on this programe . We were told he had hours to live , he lasted 8 days . Im devasted and i feel so guilty . we were led to beleve was best for him . Was not so . This must stop . ITS MURDER .

11:55, Feb 01, Name not displayed, United Kingdom
Please do not let your loved ones go on the lcp,it is wrong in so many ways. My dad died on this lcp,they never even give him a chance to recover,they stop water going into your body,take you off the meds and give you so much morphine,there is no way to see signs of progress. This sounds horrible but its the goverments way of getting people to die faster and clear up hospital bed space. If i could turn back time i would never allow my dad to go on this. My dads words when he died was. "they are animals"

13:06, Jan 01, Ms. Dagmar Spencer, United Kingdom
My Dad died with horrible cracked lips and a tongue like cracked leather. There is nothing caring about it

23:40, Dec 02, Dr. Patrick Pullicino, United Kingdom
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.

18:15, Dec 02, Mr. John Trask, United Kingdom
Particularly when the patient is a wife, a mother, a business partner and only 49years old!

13:45, Dec 02, Dr. Margaret Taylor, United Kingdom
It is a duty incumbent upon every medical person to protect life and to do no harm.

13:38, Dec 02, Name not displayed, France
YESYES

15:04, Nov 25, Ms. Christine Griffiths, United Kingdom
Can we trust that the LCP is only being used to ease the process of dying and not to hasten death itself.There is always talk of 'evidence based medicine.' I insist on the right to 'evidence based trust.'

10:56, Sep 23, Ms. Linda Bates, United Kingdom
It is a duty incumbent upon every medical person to protect life and to do no harm.The right to life is always paramount

11:48, Sep 11, Mrs. kim steward, United Kingdom
My mother was killed on the liverpool care plan at the james paget hospital she was given two days to drink before they removed the drip it was later found that her false teeth had been stuck together because of a paste like food they had given her and she could not open her mouth to drink she had recieved no mouth care.Who gives the nhs the right to play god

05:02, Sep 04, A Omisore, United Kingdom
Absolutely

17:34, Aug 15, Mr. Stephen Seery, United Kingdom
YesYes


Comments left on the GoPetition LCP Petition site -

Petition signature comment by susan davies

Date: September 21, 2012
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Date: August 23, 2012
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Date: August 23, 2012
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Date: July 31, 2012
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Date: July 9, 2012
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Date: March 5, 2012
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Date: February 15, 2012
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Date: December 1, 2011
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Date: December 1, 2011
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Date: November 25, 2011
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Date: November 19, 2011
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Date: October 24, 2011
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Date: August 19, 2011
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