Liverpool Care Pathway - Affordable And Sustainable

What is Commissioning?

The core role of commissioners is to buy services for their population.

The Department of Health describes this as:

• To be the advocate for patients and communities, securing a range of appropriate healthcare services for patients,
• To be the caretaker of tax-payers money to secure best value in the use of resources.

The Commissioners' role is to secure appropriate but cost-effective, affordable and sustainable healthcare provision. This is still target-driven.

According to Health Service Journal -

Liverpool care pathway take-up plummets at Hampshire Hospitals FT

8 FEBRUARY, 2013

PERFORMANCE: The percentage of patients who were on the Liverpool Care Pathway at their time of death has fallen sharply at Hampshire Hospitals Foundation Trust

Health Service Journal  obtained information through the Freedom of Information Act that shows that the percentage of patients rose steadily from December 2011 to June 2012, peaking at 57 per cent. The provider’s governance report for November obtained by HSJ shows that the rate then plummeted to 36 per cent in July. Although figures recovered in August and September, these sank to 36 per cent again in October, the most recent available figure.

The local Commissioners have set a target of 50 per cent.

Clearly, the publicity has informed relatives, next of kin, to be aware, to be on their guard and to make their voices heard.

Clearly, the publicity has, likewise, made clinicians think twice about proceeding - as it is their legal right so to do!

This is Lexology -

Liverpool Care Pathway to be reviewed

• Mills & Reeve LLP
• Jacqueline Haines
• United Kingdom
• February 4 2013
• 

Author page »

Baroness Julia Neuberger has been appointed to carry out a review of the Liverpool Care Pathway (LCP). She is a crossbench peer, Rabbi and former chief executive of the King’s Fund.

The LCP gives guidance to doctors to help patients at the end of life but its use has recently been very publically criticised by patients and relatives. The complaints include allegations that people were not told when their relatives had been placed on the LCP and that patients on it were denied food and water. As we reported in our September Health Legal Update, the anti-euthanasia charity, Alert, has been distributing cards which read “please do not give me the Liverpool Care Pathway treatment without my informed consent or that of a relative”.

In order to conduct the review, a panel of experts is to be set up which will oversee investigations into complaints made by bereaved relatives. The review is expected to report by the summer.

The Care Service Minister, Norman Lamb, has said that the LCP should not be scrapped but accepts that it will need to change.

As we reported in our December Heath Legal Update, the DH has inserted a passage into the draft revised NHS Constitution confirming the right of patients and their family to be involved in all discussions and decisions about health and care, including their end-of-life care, and it is against that background that the review is being undertaken.

We will of course update you once the review is published but in the meantime we would simply remind you that relatives and patients may not understand what it means to be on the LCP and it is important to explain to them what end-of-life care will look like. Good communication will result in better understanding and hopefully less acrimonious complaints.

The Lexology article reports that the DoH has inserted a passage into the draft revised NHS Constitution confirming the right of patients and their families to be involved in all discussions and decisions about health and care, including their end-of-life care, and it is against that background that the review is being undertaken.

In that regard, the important point to make is that the revision means not a jot.

1. Although LCP protocols provide for discussions with patients and their families, almost half of patients placed on the Liverpool Care Pathway are never told that life-saving treatment has been withdrawn. [Telegraph]
2. "We dont always tell them we are putting the patient on the LCP, since in real terms,...it means nothing." [Ghostrider]
3. According to Norman Lamb in The Telegraph -

   "...doctors should not use the term [Liverpool Care Pathway] because it “means nothing” to patients."

   [Well, it certainly means something to the families of those who have perished on it!]
4. 
   

   Both Mental Capacity Act and Data Protection Act provide for clinicians to act without consultation and in [what they deem to be] the patient's "best interests" and to keep patients and their families out of the loop.
   

   
   

   
   
5. Neither Patient's Charter nor NHS Constitution may override the force of law.