Sunday, 7 July 2013

Liverpool Care Pathway - A 'Stinker' Of A Plan

Twitter is like a machine gun, a burst of gunfire; it's all short, sharp shots. The lone voice of sanity gets mown down...

Still, those that dare dare and peer above the parapet!

On Twitter -

The Royal College of Nursing ‏@theRCN

"Our #RCNchat at 12.45 will focus on the Liverpool Care Pathway. Following media scrutiny, our expert will take questions on LCP. Join us!"

"Amanda Cheesley will be our expert on #RCNchat, discussing the LCP. Have you used it? Did you get training? What do you think?"

"Today's #RCNchat is on the Liverpool Care Pathway. Do you feel confident in using it? We'll be answering questions at 12.45"

"We know nurses have mixed experiences - positive and negative - of using the LCP - both as family members or carers, and as nurses#RCNChat"


"@theRCN my mum was put on LCP last dec nothing was done for her at the tunbridge wells hospital at pembury Kent I was left to do it all alone"


"@JillProbert do you feel nursing staff were not adequately trained? #RCNchat"


"@theRCN No confidence Open 2 abuse & dif interpretation. As a ret nurse the whole concept offends me. Hospice care√ gen ward NO NO."


"@pollygoves do you think that better training in end of life care would improve help with interpretation? #RCNchat"

"...& the misuse of LCP in some cases should not result in poor end of life care or prevent nurses having confidence to deliver this #RCNChat"

"@theRCN The word misused worries me. Thats exactly why the LCP should be flushed down the loo, its a stinker of a plan Death by misadventure"

25 May    
"Fellow nurses give yr care with love, sincerity, honesty and passion. Yr patients need 2 trust u at all times U dont need LCP"

In 2009, Rebecca Smith, Medical Editor, reported in The Telegraph -
Doctors and nurses need more training in how to care for people who are dying, Mike Richards, the Government's cancer tsar, has said, following concerns over the controversial 'death pathway' scheme.

Prof Mike Richards, who was involved in the introduction of the Liverpool Care Pathway, said it was "essential" that medical staff were skilled in deciding who should be put on the scheme for those at the end of their lives.
It follows concerns that patients with terminal illnesses are being made to die prematurely because they are incorrectly placed on the pathway, which can mean the withdrawal of food and fluids.
However, in an interview with The Daily Telegraph, Prof Richards said the Liverpool Care Pathway, worked well in the majority of cases.
Prof Richards said: "The Liverpool Care Pathway is very valuable but its success depends on the skills and experience of staff who deliver it. It is therefore absolutely essential that every member of team delivering the pathway receives training."
In a letter to the Daily Telegraph last month, a collection of palliative care experts warned that patients may be wrongly diagnosed as dying and that putting them on the pathway became a self fulfilling prophesy.

That was 2009. Here we are, four years later, and Sir Mike Richards, National LCP Reference Group UK Member, is being appointed England's first Chief Inspector of hospitals. What has happened in the intervening years in regard to those recommendations? 

Sir Mike has been doing the social round attending OPCARE9 with John Ellershaw and Thomas Hughes-Hallet (Marie Curie/Imperial College/the Kings Fund) and others. Yes, but what about the training? 

Doc Bee Wee has been rolling out fun e-training programmes. 

Yes, so what has been achieved? 

This is but one more of the countless voices that go unheard and unregarded by Hunt, Lamb, Neuberger, old Uncle Tom Cobley and all - 

This is mumsnet - 

stella1w Thu 31-Jan-13 19:05:59
Posting here for traffic, not debate,
distraught friend just told her mum, demented, at home with 24 hour care has been put on liverpool care pathway. She spoke to the gp about palliative care thinking it would mean a nursing home and was not consulted about lcp. Gp is refused to let her mum have sedatives or water and my friend is v v v upset and feels this is like euthanasia. She doesn,t seem to know what to do or if she has any rights to stop it. It could take four weeks.
I said if she had doubts she should ask for lcp to be postponed until the children had been consulted and undertood and consented.
What can she do? 

KatyTheCleaningLady Thu 31-Jan-13 19:23:10
Is dementia her only affliction?

Is there another condition that means the digestive system cannot handle any fluids?

Is she lucid or aware of anything?
NickNacks Thu 31-Jan-13 19:27:13
From what I understand of the LCP the family don't have to give consent but this GP's actions seem a bit OTT.
stella1w Thu 31-Jan-13 19:27:42
I don,t know the full detaild of her medical condition. Daughter says her carers were finding it difficult to eat but that she would eat when her daughter encouraged her. She is still mobile and gets agitated without sedatives which gp has just banned.
This case has parallels with that of Nats and May. 

In fact, four years later, the LCP in practice is still a disaster. There is a government review under way which is shortly to publish its findings. Mail Online has been fed a pre-release of these findings. 

Sir Mike has been National Cancer Director for 12 years. What may we expect of him in his current post as Chief Inspector of Hospitals? It is a dismal prospect. 

Further reading - 

Liverpool Care Pathway - The Six Million Dollar Plan

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