Friday, 9 November 2012

Liverpool Care Pathway – A Belief Exposed

It is said that the Pathway is 'reversible' and, in this case, the lady returns home. However, it cannot be argued that the effect of the trauma of applying the Pathway is reversible. These measures applied to a fit and able person would be an ordeal; to an unwell person, frail and fragile, the effect would be devastating, perhaps fatal.

According to Dr. Sophie Harrison writing in the Financial Times, the patient is “LCP-ed” when you “believe” them to be dying. 'Belief' is not a sure enough parameter to use if attempting to ‘diagnose’ dying. And certain knowledge is impossible. As Dr. Max Pemberton says in The Telegraph:
I have often seen this happen; patients you are convinced will follow a clear, definable illness-trajectory prove you wrong. It's this unpredictability that makes medicine so fascinating; the fact that the body has a remarkable capacity to confound expectations. Even for those with a terminal illness, there can be no certainties.
This is The Press -

the press

Celtic pair all set for Lions bow

Daughter's fears after mother was put on controversial pathway at DDH...

THE DEATH of a popular Chickenley school cleaner has exposed the use of a controversial end-of-life care strategy at Dewsbury District Hospital.

Marian Ainsbury, 75, of Princess Road, was put on the Liverpool Care Pathway (LCP) by medics in July last year after being deemed to be terminally ill.

Known to many parents and children at Chickenley Junior and Infants, Marian recovered and lived for another six months against expectations.

LCP hit the headlines last week over allegations that it is used to withdraw food and water from patients, often without the knowledge of their family.

The Press understands a   freedom of information request was made to the hundreds of hospital trusts in England about whether they use LCP.

Only 72 replied, but now Marian’s family have revealed the Mid-Yorkshire Hospitals NHS Trust use it at Dewsbury on an elderly care ward.

Marian’s daughter, Karen Brown, co-owner of R&K Sarnies in Heckmondwike, said her mum was initially admitted with pneumonia.

She previously had a stroke which left her paralysed down her left side. 

Marian may have had another one during the pneumonia, as she fell into a coma.

Karen said: “A doctor pressed her fingers down hard on my mum’s eyes. It looked painful and I had to turn away, but there was no reaction from mum.

“The doctor then told us she was not for ‘resus’, which we thought meant if she had a heart attack or whatever they wouldn’t do anything.”

She said the family asked questions about that as neither Marian, due to her condition, nor they had consented to ‘no resuscitation’.

The doctor is alleged to have hinted it was a medical decision, after which the family left Marian’s room to think things over.

When they returned they found a leaflet about the LCP stuck in the door, but no staff ever came to explain what was happening.

The reality of the LCP became clear over the next several days. Marian was left without food or water, leaving stunned family to provide sustenance themselves.

Karen said staff even made that hard by moving water out of her mum’s reach and then, in a Catch-22, taking it away because she had not drunk it.

Marian eventually recovered and went home, spending a last emotional Christmas with family before succumbing to her condition in January.

Karen said: “I found the staff on that floor to be indifferent to patients. I don’t know whether that was just their way of coping.

“We’d never heard of the Liverpool pathway before. It seems to me to be like euthanasia, but mum was never asked and we weren’t either.

“Yet when that poor man who had locked-in syndrome wanted to die, the judges said euthanasia was illegal.”

A department of health spokesman told The Press how the LCP should work: 

“Each patient should be fully consulted, where this is feasible. 

“Their family must also be involved. Staff must properly communicate with the patient and their family – any failure to do so is unacceptable.”

Helen Thomson, Interim Chief Nurse at The Mid Yorkshire Hospitals NHS Trust, said: “This Trust places the highest priority on our patients’ care.

Good communications between them, their families and our staff is central to providing the very best care for our patients. 

“We would ask Mrs Ainsbury’s family to contact our Patient Advice and Liaison Service on 01924 543685 so we can discuss their concerns.”

The Press asked Mid-Yorkshire if they are paid to put patients on the LCP and, if so, who sets the targets and pays the money.

The trust denied being paid and also said there were no targets for the number of patients needed for the LCP.

A national media furore exploded last week with headlines about seriously ill patients being left to die in hospitals. The Press, after learning the body which runs Dewsbury District Hospital uses the controversial Liverpool Care Pathway (LCP), asked the NHS what the policy involves. Here is what they said:

"MEDIA emphasis on a supposed controversy is puzzling as the LCP has been standard practice in most hospitals for years. 

The LCP has gained recognition nationally and internationally as an example of good practice and is backed by more than 20 groups, including Age UK.

It was developed in the late 1990s at the Royal Liverpool University Hospital in conjunction with the Marie Curie Palliative Care Institute.

The system is intended to provide the best quality of care possible for dying patients in the last hours and days of their life.

It is aimed at transferring the model of “excellence” in the care provided in hospices to other healthcare settings, such as hospitals.

The goal of the LCP is to ensure a death is as dignified and as peaceful as possible. It may involve, for example, reviews of:

• Whether further medications and tests would be helpful;
• How to keep the patient as comfortable as possible;
• Whether fluids are given when a patient has stopped eating or drinking.

It was introduced as end-of-life care was seen as patchy, with some patients subjected to invasive treatments that offered no chance of preventing death.

While no legal consent is required, doctors using the LCP should strickly adhere to the following guidelines:
• A relative or carer and, if possible, the patient themselves, should be told;
• They must also be told when a diagnosis that the person is dying is made;
• Withdrawal of fluids should never be routine; • That must only happen in the best interests of patients case-by-case.

If there are failings, as alleged in the media, it could be due to doctors not following the guidelines, rather than faults with the LCP itself.

Communication with patients and their families is key and this appears to be where some of the alleged problems have emerged.

The media has also reported use of the LCP is being encouraged for financial reasons and is linked to targets. 

While these financial incentives do exist, they are designed to support the implementation of better care. 

The Department of Health doesn’t provide direct financial incentives. But local areas may choose to have these in place.

It is disappointing to see such cynicism in the media’s coverage, with the implication doctors routinely hasten deaths so their hospital can profit.

It is also a cause for celebration when someone who was believed by health professionals to be dying survives. 

Guidance for health workers using the LCP actually states: “A second opinion or the support of a palliative care team may be required.”

Those with a terminal illness or approaching the end of life may wish to think about plans for the future of their care. 

This is sometimes called 'advance care planning' and involves thinking and talking about how you are cared for in your final months. 

It lets families, carers and health professionals know whether a patient wants to refuse specific treatments in the future. 

This is so they will know what a patient’s wishes are if they become unable to communicate those decisions themselves.

Anyone who wants to find out how to do this should see http://www.end"

1 comment:

  1. My sister who is suffering from chronic pulmonary diseases
    Was shocked when her doctor turned up with a pathway pack intravenous syringes to administer drugs to aid her death
    She we know is suffering from a chronic disease but her facilities are all perfect she I'd frail but can get to toilet unassisted and is now eating well.
    This shock as set her back as she it'd afraid her life will be taken if she gets an infection which occurs often in such cases
    We need help prevent this excalting