In the following article, The Telegraph reconsiders the LCP.
The Telegraph retracts...? See here -
Liverpool Care Pathway – An Unforgivable Offence
Can we have an independent and thorough investigation into
the intrusion of the CQUIN scandal across all care services? See here -
Liverpool Care Pathway - The CQUIN Scandal Spreads!
The Telegraph concurs –
The clouds now engulfing the LCP became particularly stormy last week with the main professional body, the Association for Palliative Medicine, a co-signatory to the consensus agreement, breaking ranks to propose that fresh research explores public and professional doubts around what it prefers to call “integrated care pathways”.
This is a term for LCP-lookalike systems. The association’s president, Oxford-based Dr Bee Wee, wrote on the association’s website: “Instead of simply defending the concept [of the LCP], or reiterating that if only it were used properly, it would be OK, it might be more helpful to stand back a bit, identify and explore the concerns properly.”
She declined, through the association, to explain what precisely she means, but her words appear to imply that her doubts extend beyond bad practice to something potentially more fundamental. Indeed, what is striking is that so many of the organisations that put their names to the consensus agreement have, when contacted, refused invitations to make their positions clear.The Telegraph article follows -
Families left grieving and angry by the Liverpool Care Pathway
Distraught families allege that the NHS protocol designed to allow the terminally ill 'a good death’ is being abused
Janet Davies’s eyes well up with tears when she recalls her husband’s death. Colin Davies, an 83-year-old retired prison officer, had spent 11 days in the intensive care unit of the Queen Elizabeth Hospital in King’s Lynn, Norfolk, in November 2010 with septicaemia, before being discharged on to a general ward. Though he was still gravely ill – not least with a perforated bowel that he had sustained in hospital – his wife had been told he was on the mend.
“He’d arrived in the ward on the Friday. On the Saturday, I went in with my niece, a retired nursing sister, and the on-call consultant came to my husband’s bedside. He’d never seen Colin before. After a brief examination, he informed us that the bowel problem was inoperable, that Colin had two to three days to live, and that he was putting him on the Liverpool Care Pathway” (LCP).
This controversial programme was developed in the 1990s at the Royal Liverpool University Hospital in conjunction with that city’s Marie Curie Hospice. It was intended to enable the terminally ill in hospitals to have the sort of “good death” available to patients who are cared for in their last days in hospices.
Widely praised by many in the medical establishment as “taking the sting out of death” by ending artificial efforts to prolong life and focusing instead on making the end as comfortable as possible, it has been widely adopted throughout the NHS.
However the LCP is fast becoming one of the most contentious of health issues with the relatives of dying patients queuing up to denounce it as tantamount to ''euthanasia’’ and claiming that patients who are not dying are being placed on the LCP and denied food and water.
The programme has rarely been out of recent headlines, with disturbing suggestions by some senior doctors that it is being used to hasten the deaths of thousands of elderly patients in an attempt to free up NHS beds. Last week, the row escalated further when the NHS was accused of handing out a £30 million “bribe” to hospitals who hit targets for the number of patients who die on the LCP. The influential Association of Palliative Care Medicine then announced a rethink of the “Pathway of Death”, as it is chillingly dubbed by opponents.
This was superseded at the weekend when, as The Daily Telegraph reported, the NHS confirmed its own inquiry. Several organisations, including the Association for Palliative Medicine, and Dying Matters, will be involved and co-ordinated by the National End of Life Care Programme as the delivery of the LCP is assessed.
It seems that an attempt by the Department of Health last month to stem the tide of horror stories from patients’ families about the programme being arbitrarily imposed on their loved ones has failed. The DoH’s “consensus agreement” – backed by 22 medical organisations, including the Royal colleges of nursing and general practitioners – laid down a “framework for good practice”. Patients and their families, it seems, want more.
Certainly, ''good practice’’ is not what Mrs Davies saw for her husband. “We were just told what was going to happen by the consultant,” she recalls, “and then he walked off. The nursing staff followed his instructions to the letter. They wouldn’t listen to me. I sat at Colin’s bedside as he was left to die without any treatment.”
This account, one of many similar ones, seems to contradict what the LCP stands for. The Marie Curie Palliative Care Institute’s website claims that the LCP “inspires, motivates and truly empowers the generic workforce in caring for the patient… in the last hours or days of life”. It clearly contradicts the terms of the consensus agreement, according to which the decision to put Colin Davies on the LCP should have been reached by the senior doctor and other medical professionals with prior knowledge of his care. Mrs Davies and her niece should have been included in discussions. They did not give up the fight: the next day Janet Davies sought out the consultant who had overseen Colin’s ongoing kidney dialysis. That consultant went to see him on the ward.
“She told me,” Mrs Davies recalls, “that although he might not live very much longer given all that was wrong with him, the perforated bowel could be treated with antibiotics.” And so Colin Davies was taken off the LCP. He lived for another 16 days. Janet Davies subsequently pursued complaints against the hospital and the doctor which were partially upheld. (A spokesman for the Queen Elizabeth said the hospital had identified '10 areas for improvement’ following Mr Davies’s death.
Earlier this year, another King’s Lynn resident, 79-year-old Mary Cooper, died at the same hospital after being put on the LCP. Her family has publicly complained that they were not consulted (although the hospital disputes this). ''To me it felt like she was put on death row,’’ her husband, Ray, said.
Peter Tulloch, from Bedfordshire, has taken his complaints further. He has asked police to investigate what he describes as the attempted murder of his 83-year-old mother at Western General Hospital in Edinburgh after she was put on the LCP, even though he contends she was not close to death. It took him 30 hours to get the decision reversed, and her treatment restored, after which she lived for a further two weeks.
There are four recurring charges made against the LCP: that, whatever the protocols say, families are not being consulted by doctors; that it is impossible for medical staff to predict when death is imminent – so the decision to start the LCP is at best guesswork and at worst a form of euthanasia imposed without consent; that by removing all drips, especially fluids, the diagnosis of death becomes self-fulfilling; and that the programme’s common use of heavy sedatives so dull a patient’s reactions that they cannot say a proper goodbye to their loved ones.
Defenders of the LCP insist that such generalisations mislead and that every case is different. So some patients on the LCP will be given hydration but, as Dr Sarah Bell, a consultant in palliative care at a Peterborough hospice, explains: “Frequently when patients who are dying are given fluids, it collects on their lungs, causing distress to the patient and their family. This is why the LCP advises – but does not mandate – that administration of fluid should usually be stopped.”
It is not, though, just families who are complaining. Some doctors and healthcare professionals – albeit a minority, and many from Catholic campaigning groups – have voiced their doubts. Prominent among them is Professor Patrick Pullicino, a consultant neurologist at East Kent Hospitals. He told a meeting at the Royal Society of Medicine in the summer that the LCP was nothing other than an “assisted death pathway” for elderly patients, used to reduce pressure on beds in hard-pressed NHS hospitals – a charge strenuously denied by the Department of Health.
According to the Professor’s figures – again disputed by Whitehall – 29 per cent of all those who die each year in our hospitals, or while under NHS care, are on the LCP.
There are also targets in place, linked to financial incentives, for hospitals to increase use of the pathway, with payment made through a framework called the Commission for Quality and Innovation, intended to enable the NHS to reward “excellence”.
This seems to risk creating a conflict of interest between patient needs and the overall performance of the hospital. Prof Pullicino recounted the story of a 71-year-old Italian patient at his own hospital who had been placed on the LCP. Prof Pullicino intervened to insist that treatment be restarted. The man was discharged four weeks later and lived for a further 14 months.
What seems to cause most distress, though, is that some families are kept in the dark. A 2011 study by the Royal College of Physicians stated that overall just 4 per cent were not told their loved one was on the LCP – but it also found that in a quarter of hospitals a third of families had not been informed.
The clouds now engulfing the LCP became particularly stormy last week with the main professional body, the Association for Palliative Medicine, a co-signatory to the consensus agreement, breaking ranks to propose that fresh research explores public and professional doubts around what it prefers to call “integrated care pathways”.
This is a term for LCP-lookalike systems. The association’s president, Oxford-based Dr Bee Wee, wrote on the association’s website: “Instead of simply defending the concept [of the LCP], or reiterating that if only it were used properly, it would be OK, it might be more helpful to stand back a bit, identify and explore the concerns properly.”
She declined, through the association, to explain what precisely she means, but her words appear to imply that her doubts extend beyond bad practice to something potentially more fundamental. Indeed, what is striking is that so many of the organisations that put their names to the consensus agreement have, when contacted, refused invitations to make their positions clear.
A process that was intended to bring a calm, peaceful end to life is turning into an issue that bitterly divides professionals and those they are meant to be serving alike.
No comments:
Post a Comment