Wednesday, 9 January 2013

Liverpool Care Pathway - The MP Is In Danger Of Forgetting His Lines

This comment left on anti-LCP Facebook page: 

"I'm sorry, this is absolutely wrong. The Daily Mail is accused of "scaremongering"; why is the statement Mr Davies makes and indeed many medical professionals make - that the process of death is painful and scary, and the LCP is justified and needed in easing this - not scaremongering? Death is not necessarily painful or scary, and again, we are all individuals, and we suffer illness differently, and we die differently, so my argument about "recognition of death" comes back into play here - no one can be sure anyone else is "imminently dying". Care for people at the end of their life should be NO different than care for ill people, healthy people, or even little people just starting their lives. I can't get my head around this focus on giving someone a "dignified death" and changing active treatment to "end of life care" - whatever stage of life you are in, your individual treatment should surround your very personal symptoms and illness (if you have one) and treated accordingly. The decision to stop "futile" interventions, and focus on "making the patient comfortable" goes against the whole saving and preserving life ethos that Doctors and Nurses have always been so respected for! No hope, just an end in sight ... my own Nan would have been put on the LCP 8 years earlier than she eventually was if they had gotten their way! Her operation was by no means "futile" then, was it, and she was not "dying" then, even thought they claimed she had 6 months to live, back then!"

This is Wales Online -

NHS in danger of “forgetting” how to care for dying patients, claims MP

Montgomeryshire MP Glyn Davies Image 1
Montgomeryshire MP Glyn Davies

The NHS is in danger of “forgetting” how to care for patients at the end of their lives, it has been claimed.
Montgomeryshire MP Glyn Davies said he had been moved by Labour Cynon Valley MP Ann Clwyd’s description last month of the “inadequate and cruel care” of her late husband at Cardiff’s University Hospital of Wales.
The Conservative MP said that as the NHS embraced technological advances it must not forget to deliver basic care, describing this trend as a “wider malaise”.
Ms Clwyd last month compared the death of her husband Owen Roberts in October to that of a “battery hen” and called on the prime minister to ensure better care was provided in the future.
Ann Clwyd
Mr Davies, speaking in a debate he secured about a palliative care practice known as the Liverpool care pathway, which has been the focus of controversy and is now under review, said: “We are reading about too many such issues. Now, considerable advances have been made in medical science but we must ensure at the same time we do not lose commitment in the NHS to basic care.
“And I cannot help wondering whether examples of poor end of life care which some relatives believe was given to their loved ones, whether it stems from this wider malaise, forgetting how to care for the sick rather than any specific clinical protocols in the Liverpool care pathway.”
Mr Davies, who personally supports the pathway which is not used in Wales, said he believed most people did not fear death so much as the “process” of death and called for the highest standards of scrutiny and transparency.
He said: “Now, it would be surprising when there are 130,000 people a year dying on the Liverpool care pathway that there are not instances where the pathway has never been misapplied. There are good and less good doctors and nurses.
“There are well run and less well run hospitals. But to lay the blame at the door of the Liverpool care pathway is like tearing up the highway code because there are some bad drivers.
“Where there is bad practice, where there is poor care, it should be rooted out and replaced with good care.”
Martin Semple, associate director of the Royal College of Nursing in Wales, said nurses felt they were understaffed but they aspired to provide the highest standards of care.
He said: “They want to care for people. They get incredibly demoralised when they hear stories about poor quality of care.”
Mr Semple said hospitals were not the “ideal” environment in which to die and most people aspired to do so at home or a place of their choosing.
Dr Richard Lewis, the Welsh Secretary of the BMA, called for investment, saying: “The profile of older people requiring more care is becoming increasingly complex with many people now living with multiple chronic diseases – so the demand for palliative and end of life care is set to increase. The coordination of care to facilitate a dignified death, focusing on the person, and respecting their advance wishes as well as families’ views is of paramount importance and must be the ultimate objective.
“This includes their preference for being cared for at home. Investment is needed to provide adequate staffing levels for palliative care in Wales in primary and secondary care, and the role of out-of-hours care and supervision is something that many people need and must be readily available.”
A Welsh Government spokesman said: “Health professionals in Wales follow the Welsh Integrated Care Priorities for the last days of life. This is a patient centred approach which stresses the importance of the wishes of the patient and family in determining the care they receive when they know they are dying.
“We have recently consulted on a draft plan to further improve end of life care in Wales and address inequalities in NHS Wales care over the next four years. The Health Minister is clear patients should be supported wherever they die – at home, in hospital, in a care home or a hospice – and that services should aim to reduce the amount of distress in the terminal phase of illness for the patient and their family.
“Significant improvements have been made to patient care in recent years through a number of initiatives but we recognise that further work needs to be done to ensure that every patient in every ward receives high quality care consistently.”
The news article says:
"Mr Davies, who personally supports the pathway which is not used in Wales, said he believed most people did not fear death so much as the “process” of death and called for the highest standards of scrutiny and transparency."
Wales Online, regretably, is in error...
A Pathway by any other name is equally as fatal -
30 Dec 2012
The Welsh Government's Together for Health – Delivering End of Life Care plan sets out how NHS Wales will improve inequalities in end-of-life care up to 2016. It is hoped the plan will improve the options available to ...
25 Sep 2012
This paper describes the progression over 10 years of a project to implement a care pathway for the last days of life across Wales, leading to a major revision of the pathway in 2010. An initial 38 sites throughout Wales ...
07 Oct 2012
This paper describes the progression over 10 years of a project to implement a care pathway for the last days of life across Wales, leading to a major revision of the pathway in 2010. An initial 38 sites throughout Wales ...

Westminster Hall speech: Liverpool Care Pathway

8 JANUARY 2013
Sir Tony Baldry (Banbury) (Con): When I first entered the House of Commons some 30 years ago, I became the founder secretary of the all-party hospice support group, and Jack Ashley was the founder chairman. I am glad to say that that group has now become the all-party parliamentary group on hospice and palliative care. During those 30 years, an enormous amount of work has been done on enhancing palliative care in hospitals. We are fortunate in this country in having an outstanding hospice movement. Part of the purpose of the Liverpool care pathway was to ensure that the good practice of palliative care, which had been developed in hospices, could be spread to other health care settings, such as hospitals and care homes. Extending it to people’s own homes was also important because if people are asked where they would like to die, most say at home. The reality for each one of us is that we will die.
The Liverpool care pathway requires staff to ensure that all decisions to continue or to stop treatment are taken in the best interests of each patient, and emphasises that patients should be involved in decisions about their care and that carers and families should always be included in the decision-making process. An evaluation in 2011 showed that in 94% of cases, there had been such involvement. The idea of documenting conversations, which the hon. Member for West Lancashire (Rosie Cooper) mentioned, is sensible. In our own professional lives, and, indeed, as Members of Parliament, we all know that people, especially family members, do not always take on board news that may be distressing. Often it is quite a shock to be told that a loved one is near to death. Very often, the instinctive reaction is to want to ensure that life can be preserved for as long as possible, but we also have a duty of care to ensure that in people’s last days and hours they die well and painlessly and with as much dignity as possible.
I was very struck by two contributions in the Library briefing. One was a brave article by a specialist registrar who herself is a terminally ill cancer patient. Of the Liverpool care pathway, she said:
It prompts us to have open discussions with relatives, and, if possible, patients, to stop unnecessary medication, to discontinue futile medical interventions, and to shift our focus of care to symptom-control, comfort and dignity… Most patients on the LCP, in my experience, are too poorly to eat or drink, but where a patient is alert enough to swallow we certainly continue to offer them food and fluids in my hospital. They are not ‘starved to death’. The problem with intravenous fluids is that cannulae need to be inserted to administer them. This is painful, often very difficult and sometimes near impossible in patients who have been in hospital for a number of weeks.”

Jim Shannon (Strangford) (DUP): Although the hon. Gentleman makes a pertinent point, surely the issue must also be about those people who are not convinced about the system and who are suspicious and worried about what they have been told. There are people who have been denied fluids, and also drink and food. Does the hon. Gentleman think that there should be some protection in the system for such families so that they can feel assured that there is care? The point I am trying to make is that this should be about care and not killing, but many of us suspect that there is more emphasis on the killing than on the care.

No, I will not give way because others want to speak.
Sir Tony Baldry

Sir Tony Baldry: Very few of us can have the confidence of Cardinal Basil Hume who, in his book “The Mystery of the Cross”, observed:
“Death is a formidable foe until we learn to make it a friend. Death is to be feared if we do not learn to welcome it. Death is the ultimate absurdity if we do not see it as fulfilment. Death haunts us when viewed as a journey into nothingness rather than a pilgrimage to a place where true happiness is found . . . Death is not the end of the road, but a gateway to a better place.”
Few of us, irrespective of our faith, have that clear courage and confidence, but we all recognise that we will die. There is nothing about 21st century medicine that is going to keep the hon. Member for Strangford (Jim Shannon) or myself, or any of us, alive for ever. Death, and the process of death, can be extremely painful, and it is our collective duty and responsibility to try to ensure that people die as painlessly as possible and with as much dignity as possible.
I can assure the hon. Gentleman that people do not go into the medical profession to kill. My father became a doctor and my mother a nurse to ensure that they could give people the best quality of care. Although the press have published a number of stories about relatives who have expressed concern about how the local care pathway has been used, there is no systemic evidence to suggest that the policy is being abused. A consensus statement was published last year by several non-governmental organisations and charities, all of which are much respected in this House, supporting the Liverpool care pathway. They include Age UK, the Alzheimer’s Society, the British Heart Foundation, Help the Hospices, Macmillan Cancer Support, Marie Curie Cancer Care, the Royal College of General Practitioners, the Royal College of Nursing, the Multiple Sclerosis Society and the Royal College of Physicians.
Jim Shannon rose —

Sir Tony Baldry: No, I will not give way because others want to speak. This is an important issue, but we must ensure that we put it in perspective. If we are not careful, all the work that has been done over the past 30 years by a whole number of organisations, including those that I have just mentioned, to enhance and improve palliative care could be undone. Sadly, people die every day; that is the reality. It is not a failure of the NHS that people die. It is only a failure of the NHS if people do not die well. We need to ensure that all improvements, whether they be to records or to communication with patients and their families, are undertaken, but nothing should deter us from trying to ensure that everyone in this country gets the best possible end of life and the best possible palliative care.

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