Liverpool Care Pathway - A Reckless Course

'Dr. Reckless' is an unfortunate name to have when committing yourself to making what can only best be described as some pretty reckless statements. Even so, in true Pythonic fashion, true life out-bests the most far fetched Monty Python sketch imaginable and produces this.

This is Oxford Mail -

Care programme for dying 'is not euthanasia'

7:00am Tuesday 29th January 2013 in NewsBy Reg Little, Oxford Times Chief Reporter. Call me on 01865 425434

Dr Bee Wee

Oxfordshire health staff have defended the use of a controversial care programme for patients who are dying.

The Liverpool Care Pathway was set up in Liverpool in the 1990s, and allows doctors to withdraw care from patients but this has led to accusations it is a “backdoor form of euthanasia”.

The pathway was introduced in Oxfordshire about three years ago and it remains in use on a number of wards at the John Radcliffe and Churchill hospitals in Oxford and the Horton Hospital in Banbury.

Care Services Mnister Norman Lamb launched a review into the nationwide service November, over concerns families were not being properly consulted on the care of their loved ones.

The results of the independent inquiry are due to be published in the summer.

Compared with other parts of the country, the Liverpool Care Pathway has not been widely used in Oxfordshire.

About 3,000 people a year die in Oxford University Hospitals NHS Trust hospitals and the trust’s Sobell House hospice, representing about half of the total number of deaths a year. The pathway was used in 209 cases in 2011/12, while nationally it is thought to be used in the deaths of 130,000 hospital patients each year.

The trust’s assistant medical director, Dr Ian Reckless, says he does not know of a single local complaint about the pathway from families or doctors within the trust.

Dr Reckless, who treats elderly patients as a geratology consultant, believes the pathway has a useful role.

It is not a treatment, he maintains – it is not something that puts people on particular drugs, deprives dying patients of food and drink or something to hasten a patient’s death.

“This is it,” he says, dropping a small folder on the table. “It’s a bundle of papers.”

The crucial thing for patients, families and the wider public to understand, Dr Reckless argues, is that the Liverpool Care Pathway is merely a framework for good practice in helping deliver the best care to patients in the last hours or days of life. In some cases that means delivering a comfortable and dignified death.

His colleague at Sobell House, Dr Bee Wee, is president of the Association of Palliative Medicine and can expect to contribute to the independent inquiry.

She said: “The Liverpool Care Pathway is really just a check list for things to consider when someone is recognised to be in the last days and last hours of life. It tells them, ‘you need to think about this’.

“The great frustration for me is that the pathway issue has diverted attention from the need to developing good palliative care.”

“This is it,” says Dr. Reckless, “It’s a bundle of papers.”

It all sounds so innocuous. A bundle of papers...

That's all the most awful of programmes ever devised in history were, a bundle of papers, a series of instructions or guidelines to follow. Of course, that's all it is. 

It is always more than just that. 

A signature, a simple flourish of loops and curves, may have monumental impact on the course of history. A 'bundle of papers' is never just a bundle of papers.

The End of Life Programme has as its purpose to identify, in an 'if the hat fits wear it' fashion, suitable candidates for the programme to gear down expectations to more readily accept palliative rather than curative options, to groom the failing in health to accept finality rather than hope.

Everywhere, in regard to the NHS, you will hear this mantra -

Affordable, Sustainable.

Community-Based Care Strategies are aiming to cut those costly hospital readmissions.

This report published this month says that "local commissioners and providers will work together to transform the local older people’s services to reduce acute admissions by one third and to redesign outpatient services to reduce volumes by around 6% per annum for three years."

"It is not a treatment," Dr. Reckless maintains in reference to the LKP (Licence to Kill People). "It is not something that puts people on particular drugs, deprives dying patients of food and drink or something to hasten a patient’s death."

Of course that is what it is.

A judgement is made that the patient is dying; a decision is taken to invoke the protocols in the bundle of papers; anticipatory prescribing is embarked upon - whether the symptom is present or not, prescribe in any case.

Here is one of your medical colleagues, sir, having a jolly time on Facebook and Twitter -

"Ellie Morys  RIP sir - you were kept alive far too long - I'm glad your suffering is at an end and I hope your family can find peace and understand that this was the best decision for you."
(LCP Clinician - posted on anti-LCP Facebook page)

"We are all dying. The question is when. And who is to say when. And who thinks they have that right to say when."

Who thinks they have that right to say when? Those who make judgements on quality of life and decide that the life not worthy or fit for life should be extinguished.