Friday, 16 November 2012

Liverpool Care Pathway – Anonymous Voices And The Silence Of The Lambs

They have broken their silence…

Why have they kept their silence, and for so long? How could they not speak up and speak out on the monster they have spawned? Something that needs to be said cannot remain unspoken.

And when, at last, they do so it is only to repeat the platitudes, the insipidities; expound upon the altruism of their aims, the nobility of their intent, how harmless was their purpose.

Like Justice blindfolded, they perceive only the objectivity of their intention, askance at the evidence of what is plainly the outcome of their doing.

A word to the wicked: How can you not condemn the travesty your Pathway has become? How can you not accept the error of its conception?

People behind the controversial Liverpool Care Pathway (LCP) speak out in its defence

by Helen Hunt, The Liverpool Post   Nov 15 2012

Deborah Murphy, who set up the Liverpool Care Pathway
Deborah Murphy, who set up the Liverpool Care Pathway

THE architects of the Liverpool Care Pathway (LCP) today broke their silence about the controversial model of care that has faced an onslaught of criticism in recent weeks.

One national newspaper has even branded the end of life plan now adopted throughout the UK as being a “pathway to death”.
Worryingly, critics of the LCP said that hospitals are even being given financial rewards worth millions of pounds to put patients on the regime.
Senior cancer doctor Prof Mark Glaser accused NHS managers of using the pathway to clear beds and achieve targets.
But today the people behind the care plan hit back.
Prof John Ellershaw, director of the Marie Curie palliative care institute Liverpool and Deborah Murphy, associate director, said: “The sole purpose of the LCP is to provide the best possible care for people in the last days or hours of their life.
“That was the purpose when we at the Marie Curie and our partners in Liverpool set out in the 1990s to design a framework for health professionals to use to ensure that people who are dying have as comfortable and dignified a death as possible, and it remains the purpose today.
“It was a response to the poor care and suffering of dying patients in hospitals in this country, and we had a simple aim: to bring best care of the dying – of the type that people experienced in hospices – to the wards of general hospitals.
“Since the 1990s, the LCP has been developed, supported by evidence and research of the highest quality. Remaining central to the LCP, however, are good care, compassion and communication.”
It has been reported the LCP involves the withdrawal of life-saving treatment with patients sedated and the majority denied nutrition and fluids by tube. But The Post was told that the LCP is not a ‘one size fits all’ prescription but tailored to each patient.
And medics say the LCP – a document that helps them manage end of life care – does not recommend continuous deep sedation but a review of medications and open discussions with relatives. If possible, patients may stop unnecessary treatments and interventions, shifting the focus of care to comfort and dignity.
Supporters strongly refute the LCP is a form of “euthanasia”.
Families fear loved ones are being put on the pathway to hasten death.
But Prof Ellershaw and Ms Murphy said: “Many, many thousands of patients and their families have benefited from improved care as a result of the LCP.
“The provision or withdrawal of interventions with the direct aim of hastening death is contrary to the rationale of the LCP, contrary to GMC (General Medical Council) guidance, and illegal.”
While Prof Ellershaw and Ms Murphy are the main architects of the LCP, responsibility for day-to-day implementation lies with individual hospitals, GPs and care homes.
Experts argue that before the LCP, there was not such a formal approach to end of life care which led to poor care in the final days of life in some instances, including unnecessary medical treatments.
While written consent is not needed before a patient is put on the plan, Prof Ellershaw and Ms Murphy added that “there should never be an occasion when the relative or carer who is named as the first contact or next of kin is unaware of the diagnosis of dying or of the subsequent care plan”.
Peter Williams, medical director at Royal Liverpool Hospital – part of the collaborative along with Liverpoool University – added: “Hospitals receive payments for ensuring patients are provided with high quality care across a range of measures. These may include preventing patients from dying from pneumonia, stroke and heart disease.
“They may include ensuring patients are kept safe from MRSA or that in the last moments of their life, patients are supported with the type of best practice, evidence-based care outlined in the LCP.
“The key word is ‘Care’. When it comes to my own death, I would like to be supported by the LCP.”

The Anonymous Voices cry out -

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Score: 1


10:20 PM on 15/11/2012
So what 'terminal illness' did poor Rustie Lee's mum have exactly???? Just a way of clearing NHS beds if you ask me...we've told our GP our family NEVER want this ...suggest other people do as well...and as for that poor guy in the Mail photos...they could have saved that leg with antibiotics...100% sure of that.
Score: 2


10:39 PM on 15/11/2012
@ Dora...totally agree - once they start making a living off of this sort of thing, they seem to find the research that supports their views , and sweep the rest under the carpet. Whole thing is disgusting...old people deserve as much treatment as the young, as they built the NHS with their NI and tax all their lives. This is like A4E and Emma Harrison saying it was a hugely successful government contract...didn't these people see those photos in the mail etc????? We did...anyone tries this on a member of my family in hospital isn't going to get slightly more than an NHS complaint to think about after they've died I can tell you. This woman in the story even says you can be put on it without your consent too!!! When did they twin the Mersey with the Styx?? Comes to something when old people and the disabled are too scared to go into hospital in case they get put on this care pathway, isn't it?
Score: -1


11:44 PM on 15/11/2012
She's screwed this up - what a mess! And to think , you can be put on the 'end of life care pathway' when THEY think you're past your sell by date! These women should either stick to nursing or get a job as saleswomen...the whole thing is just a 'brand' to them..they're trying to flog this LCP thing in 17 countries,but its been put in place by people who are clearly well out of their depth....I am a retired nurse..they DO use these drugs to 'hasten death'..but they're not allowed to say so, as technically its murder...everyone is what they call 'wilfully blind', because in the old days, there were no other pain relief measures and hardly any treatment. Nowadays it seems, they are identifying things like COPD and sllightly malfunctioning kidneys as 'terminal'..hardly anyone over 65 gets offered dialysis as its expensive....the one group of people this 'LCP' group are NOT asking for any feedback from are the patients should HAVE TO GET A CONSENT FORM SIGNED BEFOREHAND....I dont want a junior doctor or chocolate addicted nurse deciding my life can't be worth living because I'm old , or I'm black if they're racists. They have a nasty habit of playing god these 'important ' people in healthcare with 'important' sounding titles......I think the project should be shut down, ,as its caused so much damage to the reputation of the NHS....and I agree..Rustie Lee's mum would have died if her daughters hadn't made a fuss...its a way for doctors to bury their mistakes then just code them as 'palliative care patients' everyone thinks they were expected to die when they went into hospital anyway.....shut it down in my opinion....then they can all go back to REAL NURSING!
Score: 0


1:11 AM on 16/11/2012
Several of the bigwigs in the UK 'endoflifescheme' have studied and trained in Holland and Belgium, where euthenasia is allowed, and appear to be in favour of importing these drugs and treatments (eg removal of fluids and food)over to the UK. Some of them are professors , so quite influential in this area. Over there, you can have euthenasia for depression, even if youre physically fit and ...if these treatments cause physically fit people to die, its for sure that they caused the deaths of frail elderly and unwell people too....I cant see how any of these deaths considered to be from 'natural causes' at all??? I mean, just dehydrating someone causes blood volume to drop so the effective concentration of a drug is massively increased , which is exactly the same as giving them a much higher dose. How can a course of treatment that can kill a physically fit (but depressed Dutch person) NOT actually cause the death of a frail elderly one with COPD or pneumonia????
If its 'reversible'..why dont they all undergo the same course of treatment on a television programme and prove it???
Score: 1


2:13 AM on 16/11/2012

Professor Ellershaw and Deborah Murphy need to stop protecting the NHS

The Liverpool Care Plan, a palliative care system intended to be implemented during the last 72 hours of a terminally ill person's life, is widely used by NHS practitioners, but is very controversial - & not always used with the consent of patients or their families. Critics include academic Ros Coward, neuroscientist Professor Pullicino & eminent medical doctors Robert Hardie and Tony Cole, as well as Baroness Ilona Finlay. They believe that elderly patients are dying starving, sedated & dehydrated.Disability activists have also protested against LCP misuse during the Not Dead Yet campaign. People need to know they can opt out of this care plan, but are often too ill, traumatised or under informed to make the best choice, & have it imposed on them or their loved ones without proper consent. We need to know if there are alternative & humane alternatives.
Score: 1


2:27 AM on 16/11/2012
Prof John Ellershaw, director of the Marie Curie palliative care institute Liverpool and Deborah Murphy... did they not see these figures in 2009.. below. You people in these positions do not even know what is going on around you and nor do you care!

Audit of Care of the Dying, by the Marie Curie and the Royal College of Physicians in 2009 reveals that two thirds of the 3,893 patients whose deaths were assessed needed no continuous infusion of medication, and all by 4% only needed low doses of opiates. However, there have and are cases where patients have been started on high doses of opiates and sedatives via infusion and died prematurely.

My own mother was put on this pathway ... she was not in pain. she was not dying, she did not have cancer! A external doctor saw her 15 mins before they decided to kill her and she stated, "Happy, no complaints, waiting for her daughter".. guest what? I never spoke to my mother again... how about 25mg fentayl patch ..equivalent of 135mg morphine.. 50mg chlopromazine as they considered she was psychotic and who would'nt be after that drug kicked in, 40 mins after the Chlorpromazine they put a syringe driver in her back.. and walked her with 40 mg diamorphine 40 mg midazolam,, all this in 24 hours... happy that your LCP is working?? And we are still fighting for Justice but it is coming believe me the PCT held back the note from the doctor for 7years!... they call them selves carers.... Happy to meet you and discuss?


  1. In my opinion, all deaths on the Liverpool pathway are equivocal deaths, because the true cause of death - whether underlying illness, treatments given or withdrawn under the LCP (drugs administered or withdrawn, deliberate dehydration, withdrawal of nutrition) or some combination of these factors, or even complications arising from them - cannot be known.

    As I understand it, English law requires a post mortem to be held in the case of all equivocal deaths and requires Inquests to be held in the case of suspicious deaths.

    I've read that few post mortems are conducted in the case of those who die on the LCP - yet these must include many equivocal deaths. Is the legal requirement for post mortem being evaded in the case of those who die on the LCP? If so, why?

    Also, does the law not require the true cause of death to be recorded on the death certificate? Yet how can the true cause of death be recorded for those who died on the LCP and without post mortems being carried out?

  2. “Since the 1990s, the LCP has been....supported by evidence and research of the highest quality...”

    However, I am concerned about whether there might be considered to be conflicts of interest in respect of some of this research. This is what I was refering to in my message yesterday.

    A further, related, concern is the corporate nature of at least some of the charitable organisations carrying out and, or, funding the research into end of life care and the LCP and influencing government policy in this area. Once again, I am concerned about whether this might be considered to represent a conflict of interest. One of these organisations is a multi-million pound concern.