Wednesday, 3 July 2013

Liverpool Care Pathway - The Devil Is The Detail

There are many paths says the scripture and they all lead to the One, but the Devil is always in the detail and the detail is oft overlooked.

Brighton & Hove City Councillors are concerned...

This has been discussed in these pages.

Further reading -

This is the latest 

A key cause for concern was the “Liverpool Care Pathway”. It is a way of caring for someone deemed to be dying. 
Councillors Mo Marsh, Mary Mears, Dawn Barnett and Anne Meadows spoke out one by one. 
They mentioned few personal details but Councillor Marsh was talking about the end of her mother’s life and Councillor Mears was moved to speak by what happened in her mother’s final days too. 
Councillor Mears said that she had not realised that she was watching a loved one effectively being starved to death and deydrated. 
She said: “It’s a very personal thing. Someone could have had a conversation with me but they chose not to. It’s very easy just to turn the morphine up and up. 
“I’m not alone in this. It’s happened to a lot of people. There are some excellent doctors and nurses but I’m not confident that (best practice) will happen across the piece. 
Councillor Mary MearsCouncillor Mary Mears 
“When nobody has bothered to have that conversation with you, that will always stay with the family. 
“The reality is it’s not happening in too many cases.” 
Councillor Anne Meadows said: “I remember looking after my father in hospital.
“I have been through this and I was told nothing and it was very upsetting.
“It is about families’ participation and understanding and having that chance in a way that Mary and I weren’t given a chance to do.” 
The Liverpool Care Pathway has been widely adopted in the NHS. It was designed for cancer patients in hospices. 
Most trusts are paid to hit targets linked to it. Senior medical figures have voiced concerns. 
One described it as a regime of sedation and dehydration. Another referred to state-sponsored euthanasia. 
Professor Patrick Pullicino, a leading clinical neuroscientist, called it “an assisted death pathway rather than a care pathway”. 
Councillor Barnett, a retired carer, also spoke about the distress of sitting with someone who was effectively being dehydrated. 
She said: “I have held a stick with a sponge on the end and that person has sucked and sucked on it.” 
Councillor Anne MeadowsCouncillor Anne Meadows 
Councillor Geoffrey Bowden said: “Sometimes carers don’t always think families can take the truth and withhold information. 
“They’re well meaning but as we’re hearing the consequences can be painful and long lasting. 
“Families can feel great distress and can sometimes transmit this distress to the dying person. 
“Doctors may need better training in how to have these difficult conversations. There is a need for honesty and openness.” 
Geraldine Hoban, chief executive of the Brighton and Hove Clinical Commissioning Group (CCG), said: “It’s sad to hear about your upsetting experiences but that’s not how it should work.” 
She said that the aim of the new policy was to improve communication. 
And Dr Christa Beesley, the CCG clinical lead for dementia, said: “What we’re trying to promote here is that people have a good death and they and their families have the care they want. 
“Anyone who is dealing with people dying needs a lot of training. 
“We’re going to be more upfront. We’re going to talk about dying. We’re going to be much more open with people. 
“It should be an open discussion. People should be talking about this.” 
It wasn’t hard to discern strong and deeply felt reservations among the elected members of the Adult Care and Health Committee. 
Urging his colleagues to adopt the “Sussex Integrated End of Life and Dementia Care Pathway”, Councillor Ken Norman said that the new approach would improve on current practice. 
With one exception, the committee voted in favour. 
The Sussex pathway comprises six phases:
  • Recognising that there is a problem (awareness)
  • Discovering that the condition is dementia (assessment, diagnosis and involving the person with dementia in planning for their future care including end of life)
  • Living well with dementia (maximising function and capacity and planning for the future to enhance wellbeing)
  • Getting the right help at the right time (accessing appropriate and timely support and reviewing advance care plans)
  • Nearing the end of life, including the last days of life (palliative care and ensuing advance care plans are reviews and respected)
  • Care after death (supporting relatives and carers to maintain wellbeing)
Posted in Latest NewsLocal

“With one exception, the committee voted in favour.”

“Father, forgive them, for they know not what they do.”

1 comment:

  1. Baroness Warnock, advisor on ethics to successive Governments, states that, Elderly people with Dementia are, " Wasting peoples lives,- Wasting resources of the National Health Service,- and should be allowed to DIE!"
    "If you're Demented, you're wasting peoples lives, you're families lives, and you're wasting the resources of the NHS."
    Could someone please remind this woman, that the people she's referring to, are the people who paid for the NHS in the first place.
    Does she even know the definition of the word 'Ethics' ?
    If Government is taking advice from someone like this, would you trust them with the care of your loved ones?