Friday, 26 April 2013

Liverpool Care Pathway - A True Story

The story you are about to hear is true; only the names have been changed to protect the innocent. It's just the facts; it's just the facts...

The Big Kill -

May was a mother devoted to her children. She came from a large family and she had a large family. One sister wed into a West Country farming family. Another sister wed into money. May just had her kids.

This last sister ever bemoaned May never had enough money, forever scrimping and scraping to find the rent and pay the bills. May always replied she had her wealth in stock. Meaning her kids.

Seven years ago, May was was given a year to live. She had cancer of the liver. She refused treatment. Seven years later, May was still here. She had proved the medics wrong...

Seven years later, and May was a frail and fragile lady of eighty-nine years young. Her personal needs had been few and her pension had accrued in her account. May had 'stock' but her family had had troubles and brought troubles of their own to her door.

May had helpers come in to see to her personal needs. She had a son who lived with her, who shopped and cooked, but was impatient of her...

May stopped eating. The son noted this. The helpers, if aware, did nothing.

The family stepped in. The son was turned out. May went into hospital in March this year.

To bring this story up to date, this witness statement fresh from the crime-scene follows:
"THIS IS WHAT THEY DO... and we're powerless to stop it... I am currently experiencing an act of neglect and as of today LCP application, in a family member.
Now, this particular side of the family are totally estranged, have been for years; however, my mum is a close relation of this person and I have been advising and informing her since this relative was first admitted to hospital - beginning March.
This is a classic case - elderly, being cared for at home when required, experiencing problems swallowing, dehydrated. Taken into hospital. Lots of tests, inconclusive. SALT team involved for a short time. Finally find a growth in throat, cancer query - patient refused biopsy (too scared) but Doctors conclude malignant growth. (Won't treat because diagnosis not confirmed)
Cannot take food orally (small teaspoons of yoghurt consistency only) - my Mum asked for PEG tube and Doctor refused because of "the risks" (sepsis/infection) but as I said, the greater risk is starving to death, which basically is what has happened. She is skeletal in appearance and has wasted away, the fluids that they were administering have started "skimming" the nurse said - basically infiltration has occurred, and they have let the fluid build up under the skin in the arms with no attempt to reduce swollen arms. They say "she's put on a stone in weight!" but as she has no food in her system this is surely the excess fluid!
Bedsores are blistering and oozing (treat with cream apparently). Originally on a urinary catheter, then allowed to just wet the bed and change sheets each time.
Not in pain, only discomfort when trying to swallow (a reason for PEG feeding?) but asked repeatedly if she'd like painkillers, she refused. However, this morning the family were informed that after they had left last night, she asked for pain relief? Hmmm.
This morning family were called in, she'd had a bad night (due to the drug administered last night? Not sure which analgesic used at this point).
Now they say she has mild pneumonia (hospital acquired, of course) and breathing problems. No antibacterial treatment suggested - simply told that she is showing all the signs of "dying" and if they were all happy, they would bring her into a side room and start end of life care, which includes the LCP.
My mum has made objections clear, she has fought for food for her, for continuing care at home, but today all other family members (with the "support" from the MacMillan nurse) have concluded that she must have peace... They have set up the syringe driver and have told the family the drugs are "very mild" - they are all falling for it, apart from my Mum, but her words and concerns are dismissed...
I am so angry. I feel like a failure. I did not go through this deceit and cover-up of mistakes with my darling Nan in 2007 for nothing; I want to make everyone aware and STOP it from happening; yet it's happening again to a relation, right now! 
"I spoke to my Mum at 6.30 pm and she was still on the ward with the curtains pulled round her, syringe driver working away with its death drugs... they say they are trying to arrange the side room asap..."
It is the weekend. This is the time of choice to proceed with the deed.The LCP tends to be the opportunists crime.

The victim refused a biopsy. Had this gone ahead, no curative treatment would have been offered. The doctors had already determined that starving their victim to death was preferable to inserting a peg...

A positive result would only have confirmed the LCP to have been commenced earlier than it was. According to the GSF Prognostic Indicator Guidance, a choice for no further active care is the second of the three triggers that suggests that patients are nearing the end of life. And the doctors would have dismissed treatment as 'futile' in any case...

The Soul Midwives had already moved in to ready the victim for induction and the family for indoctrination...

The victim had expressed verbally to family she was in no pain. After they had left, the Soul Midwives would have moved in to interpret a grunt or a nuance of voice to mean otherwise and administered accordingly. And did so.

The swelling of the arms to present as oedema would indicate infiltration...
"Just because it was soft at the insertion site DOES not mean you did not have an infiltrate. Fluid being pumped into the tissue will have to go somewhere and while it may appear as a classic lump above the site, it will often appear as generalized oedema of the arm and taut translucent skin. 
There is absolutely no point in keeping a IV in place that is NO good and especially one that is infiltrated. It does not matter how ill or unstable someone is..if the IV is BAD it's bad. If the patient needs another right away someone needs to restart it."
The victim was not only being starved of food, she was being starved of fluids.

The family, appropriately groomed by the Soul Midwives, agreed to the LCP.

The Soul Midwives were seen to confer with the doctor. The driver was set up, screens pulled round the bed. The one lone family member who had objected to LCP was heard to remark, "We won't see any more of them."

The Soul Midwives had done their job. They had instigated the LCP, advised the ward doctor, and they left to groom the next family...

News has come. She has been taken from this place and consigned to a side room to await her death...

The LCP is not about care; it is about a convenient solution. It is death on the dot. Death by induction. It is about a convenient outcome. No stress.

The victim, this lady, has a name; she is a person, not a category or a statistic. To protect the innocent, we have called her May.

If May dies, and it is certain now she must, she will not have died from her cancer, but of the prolonged and debilitating effects of starvation and dehydration.

It is not unheard of to have 'malnutrition' put on the death certificate. 
The Department of Health has increased the number of unannounced inspections by the Care Quality Commission, saying it is “unacceptable” for patients to go hungry or be malnourished in hospitals.
The announcement was made after it was reported that 1,165 people have starved to death in NHS hospitals over the last four years.
The Sunday Express said that figures from the Office for National Statistics revealed that for every patient who dies from malnutrition, four more have dehydration mentioned on their death certificate.
This is not mal-nourishment, however; this is non-nourishment. That is an assault.

And what will show on May's death certificate? What will they admit to?

EPILOGUE Saturday 27th April:

The results follow -

May slipped away after 9am this morning. A nurse initially declared her dead, but then found a pulse. May yet clung to life...

Moments later, her passing was once more announced. This time, it was authoritive and sure. May had left this world.

May had consented to the continuing care offered her. May had confided her belief they were all "a bunch of crooks" in there, meaning they weren't to be trusted...

May, may you find peace; may we yet triumph and bring an end to this monstrous caricature of care that is the Liverpool Care Pathway.

The NHS is beyond repair; it cannot be 'cured'...


  1. I do not know May but this brought tears to my eyes. This is so bad.

  2. I am sorry for your loss. However, even looking at the facts as you present them; the argument that May was killed by the NHS doesn't bare up to scrutiny. 1) You say she was a "frail and fragile lady". Frail and fragile people with pneumonia tend not to survive; 2)You said she stopped eating at home. Therefore, that's not the NHS starving her to death, that's herself starving her to death; 3) She refused the biopsy. This is her right, but if she won't let us find out what the matter is, we can't do anything to make it better; 4) She may have asked for a PEG, but this is a major operation. If she is frail and fragile, she is likely to die on the table. The doctors were right to refuse to do an operation that would kill her; 4) Nurses don't, as rule, put IV fluid along lines that have come out of the vein, they ask the doctors to put new lines in. If she had big blobs and oedema under the skin, it is most likely that she was having subcutaneous fluids which, as the name suggests, are meant to go under the skin. The fact that she got oedema is common side effect of subcutaneous fluids, which is why often don't use them. However, in May's case the hospital obviously tried to get fluids into her and save her life in the face of her refusing to drink; 5) If you have a frail and fragile person who is refusing to drink and potentially has cancer that they are refusing treatment for, and has a pneumonia; they are likely to die. I don't like it, you don't like it; but these patients tend to die. Is it not better that we are honest with ourselves and recognise that, rather than sticking our fingers in our ears and pretending it will all go away?