Friday, 16 November 2012

Liverpool Care Pathway – A Matter Of Concern And Disquiet

Barrister James Bogle, practicioner in health and mental capacity law - Many legal and medical professionals have been concerned about the LCP for some time and the fact that the pathway is now on version 12 is indicative of ‘some disquiet.’

Senior Oncologist, Professor Mark Glaser - The LCP is ‘morally bad medicine.’

Professors Mark Glaser and Patrick Pullicino, have raised important questions about the pathway and have been critical of it.

According to palliative care physician Professor John Welsh, the failings of the LCP are in non-hospice settings.

This is Scottish Catholic Observer


Is it a pathway to peaceful dying?

— Sr Rita Dawson of St Margaret of Scotland Hospice speaks out on Liverpool Care Pathway
By Mary McGinty
Sr Rita Dawson, one of the most respected opinions in palliative care, has added her voice to the debate surrounding the Liverpool Care Pathway (LCP). The goal of the pathway is to ensure as dignified and peaceful dying as possible but it has been beset by recent controversy and criticism. Sr Rita, St Margaret of Scotland Hospice’s chief executive, spoke out in favour of an inquiry.
The LCP has come under scrutiny following revelations that patients have been put on the pathway without their families’ knowledge and claims that some were not dying. This week, Health Minister Norman Lamb announced that hospitals will be legally obliged to consult patients and their families about end of life care decisions.
Sr Rita (above) has supported calls for an inquiry into the pathway saying ‘anything that reassures the public has got to be a good thing when so much doubt has occurred.’
“Good education and communication delivered by a multi-professional team with empathy, experience and maturity are essential,” Sr Rita said. “The problem with the LCP is the frailties in its implementation and it is dangerous in the wrong hands. When staff are busy the first thing to go is communication but that is an inexcusable failure.”
According to palliative care physician Professor John Welsh, the failings of the LCP are in non-hospice settings.
Sr Rita warned about the over-reliance on frameworks and guidelines at the expense of basic care.
Barrister James Bogle, who practices in health and mental capacity law, told the SCO that many legal and medical professionals have been concerned about the LCP for some time and the fact that the pathway is now on version 12 is indicative of ‘some disquiet.’
“What concerns many professionals is the extent to which their professional experiences with the pathway, and with the results and effects of the pathway, have sometimes been rather airily dismissed as merely ‘anecdotal’ by some non-clinicians,” he said

This week, senior oncologist Professor Mark Glaser branded the LCP ‘morally bad medicine.’
“Senior clinicians of the quality of Professors Mark Glaser and Patrick Pullicino, have raised important questions about the pathway and have been critical of it,” Mr Bogle said
The LCP was developed in the late 1990s at the Royal Liverpool University Hospital in association with the Marie Curie Palliative Care Institute. It was intended to give the best quality care to dying patients in their last days and hours whether in home, hospital, care home or hospice.


  1. The NHS whistleblower and the £500,000 ‘supergag’

    In February 2010, newspapers reported that a senior NHS manager had been sacked for ‘swearing too much’ in meetings. Gary Walker, who had been credited with bringing Lincolnshire’s NHS trust back from the brink of overwhelming debt, had lost his £165,000 a year job after what The Daily Mail referred to as ‘four letter rants’.

    But this morning, the Today Programme uncovered a darker side to the story of Gary Walker’s dismissal. An investigation by BBC reporter Andrew Hosken revealed that Walker had agreed to a £320,000 settlement linked to a gagging clause so secret that he is forbidden from even discussing its existence. This was not about swearing at work; at the time of his dismissal, Walker had used whistleblowing legislation to make a disclosure about concerns over patient safety.

    David Bowles, the former chairman of Lincolnshire NHS trust, and someone who worked closely with Walker for three years, believes that the official reason for Walker’s dismissal – swearing – was an excuse to get rid of someone who was causing headaches for management, by refusing to submit to government targets that he believed were jeopardising patient safety. Bowles calls the secrecy clause a ‘supergag’ and claims that, added to legal costs, the settlement would have cost the taxpayer at least £500,000.

    Although the gagging order meant Walker was unable to discuss his concerns with the Today Programme, his colleague Bowles, who quit his job in 2009 in disgust at the government’s non-emergency targets, believes their concerns were substantially the same. ‘Fundamentally the dispute was about safe care…. You can either treat your emergency patients safely and delay your non-emergency patients, or you give priority to the non-emergency patients to meet the target and then the emergency patients suffer.’

    It was the dangerous pursuit of these non-emergency targets that was a key factor in the scandal at Stafford hospital, where hundreds of emergency patients died after receiving inadequate attention in A&E. Whistleblowers who alerted managers to the ongoing problems were ignored.

    Gary Walker’s ‘supergag’ is the latest in a long line of similarly punitive gagging orders slapped on NHS whistleblowers. In 2010, research by the Bureau of Investigative Journalism uncovered evidence that a number of doctors were being gagged after they had blown the whistle on their concerns about patient safety.

    The most notorious of these cases is that of Dr Kim Holt, a paediatrician who was forced from her job at St Ann’s hospital in Haringey after warning management that staff shortages at the hospital would inevitably lead to a tragedy. Dr Holt claims that she was offered £120,000 to leave her job and remain silent, an offer she refused. Six months later, an inexperienced locum at the hospital missed obvious signs of abuse of a 17-month old child, later known as Baby P. Two days later, the child died at home.

    From the bureau of Investigative Journalism

    More to follow

  2. The NHS whistleblower and the £500,000 ‘supergag’

    Concern about doctors been [being] stifled by compromise agreements led the General Medical Council, the GMC, to write to doctors earlier this year telling them not to sign ‘gagging’ clauses.

    The NHS refused to answer questions from the Today programme this morning but issued a statement saying that the ‘culture of the NHS needs to change and confidentiality agreements need to be the exception rather than the norm’.

    But Dr Holt, who now chairs the whistleblowers’ campaign group Patients First, told the Today Programme that gagging orders continue to be used. ‘I am aware that compromise agreements with gags are being signed now, I mean very, very recently and we are also aware, through freedom of information requests, that millions are being spent on compromise agreements.

    By the Bureau of Investigative Journalism

    Time and again, the incentivised target culture of government and the NHS and the time and financial cost of emergency admissions are the root of specific problems with our health service. Underlying these, of course, is the more general problem of inadequate managment and funding of our NHS by government and the waste of existing resources on buying in service from PFIs.

  3. Yet how on earth do you manage a monster of a service like the NHS - which has some 5 or 6 million staff?

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  5. I caught nurses doing somthing and the police nhs safeguarding CQC and even the prime minister lied, I thought Mum had been given penicillin by mistake and her medication being stopped a coincidence.
    But I was told about the Liverpool Care Pathway super injunction and what happens a couple of weeks ago, I now believe Mum was killed by the Liverpool Care Pathway and it explains why BBC reporters with Newsnight and Daily Mail went quiet and the only solicitor I could find suddenly got suspended and the firm dropped our case.
    But Mums death was different and that also explains why we were being intimidated by police outside my home? Mums poisoning took place just 9 days after being diagnosed with Alzheimer and on a sheet clearly marked amoxycillin allergy given another penicillin, Mum was 92 but still living at home and sufferred for 2 months while her suffering was ignored by nurses who kept telling us lies
    Can anyone help
    John Humphreys 07767158166

  6. What frightens me are the numbers using simple arithmatic if 50 PCT adopted the pathway on a similar number to Liverpool which is 60,000 a year 20,000 in secret would be
    60,000 * 50 ovrr 5 years 15Million 5Million in secret numbers comparable with the holocaust of the second world war after what I have seen and can prove I am scared ever to attend any Nhs hospital.