Friday, 16 August 2013

Liverpool Care Pathway - Onward And Upward

Seldom do the arrogant recognise their arrogance or recognise and admit their wrongdoing.

This is murder, plain and simple.

This is BBC News Health –
"Nan didn't want to die, it wouldn't even have been euthanasia. So, as far as we're concerned, it would have felt to us as if our Nan would have been starved to death and killed," Alison said.

Mrs Vine was taken to hospital with a dislocated shoulder, and a few days after being admitted she developed pneumonia.

"All I remember is they weren't feeding me. Up above my bed they put 'nil by mouth' and I was begging for food," she recalled.

She said that when she asked doctors and nurses for food, she was ignored.
Mrs Vine developed pneumonia. The pre-LCP victims of the Barton Care Pathway also succumbed to pneumonia.

BBC News Health
This is Ellershaw:
"Nowhere does the Liverpool Care Pathway say you must withdraw hydration or you must withdraw food. What it says is you should be encouraging patients to take food as appropriate and oral hydration as appropriate.

"If the patient is unable to take oral hydration then you should consider whether artificial fluids are appropriate."

"I think if healthcare professionals are telling relatives or patients that they can't have hydration because the LCP says they can't, then they're not reading the guidance or interpreting it correctly," he said.
This isn't the point. The point is that Kathleen Vine wasn't dying.

This isn't the point. Ellershaw, your own team can't get it right.

Mr. Ellershaw... I won't call you 'Doctor' or 'Professor' or whatever else you profess to be; you should be struck off - wiped off! - of every medical register for this great wrong that has proceeded.

Mr. Ellershaw, I will say just two words. These two words are a name. That name is Jack Jones.

You may read more here.

You disgusting people.

"Features of opiate toxicity may be interpreted as un-controlled pain, leading to the administration of more opiate medication. The consequences are increased sedation, dehydration and further toxicity." (O’Neill and Fallon, 1997).

From the BMJ archives -
"... It matters not whether we discuss continuous deep sedation or a lesser degree of sedation. Any level of sedation, even a small dose of morphine in the frail elderly, can result in dehydration that may prove fatal if left untreated for days. Unfortunately palliative carers tend to overlook this basic fact. They prefer to discuss sedation and hydration as separate issues without linking the two in their minds. In doing so they are in danger of missing or evading the point, which is that sedation without hydration kills."

"I was being left to die. If it hadn't been for my family I would be dead now. I would just have been another statistic on the books."        - Mrs. Kathleen Vine
"When she was on morphine she was confused and not making sense - which was totally out of character. But they took her confusion as a sign of dementia.

"We were brought up to think that doctors and nurses know more than us about medical matters. So, our initial reaction was to believe the medical staff and we were almost made to feel silly for questioning them," said Helen.

As Kathleen says, without the intervention of her family, they would have taken her life.

That is murder.

So, Mr. Lamb, you have had your due process and now we must see the prosecutions proceed. Starting from the top.

Where there is no moral humility, there is no moral restraint. 

Their arrogance is compounded by their ignorance.

The LCP is tried but untested.

The PROMs (Patient Reported Outcome Measures) cannot be taken when the outcome is death.

With Midazolam, you put up and shut up. What is observed to be the case may not be what it is perceived to be.
Sedation does produce a sense of external calm, changes hyperalert to hypoalert delerium and, since most sedation is terminal sedation, prevents patients complaining about their intractable symptoms. Davis MP 2009

Further reading - 

Liverpool Care Pathway - The Steps Into That Darkness Are Always Gradual, But Ever Certain

The Independent reports that the government is to "test 'end-of-life' protocols for the terminally ill after complaints from relatives".

A randomised trial of the LCP is now to proceed.

Further reading - 

Liverpool Care Pathway - Over Here, Over There, And Coming Your Way Soon 

A randomised trial of the LCP is now to proceed...

So, what is proceeding here...?


This is Utviklingssenter -

At 1 July 2013 LCP is used in Askim, Eidsberg, Halden, Whales, Sarpsborg and Fredrikstad Westgate. Several of these municipalities have introduced LCP in both nursing homes and home care.

Purpose and objectives

  • Implementing the LCP to the nursing home in Fredrikstad that uses LCP today
  • Facilitate to provide optimal care for the dying in nursing homes
  • Facilitate better communication, collaboration and interaction within the team around the dying
  • Targeted use of drugs
  • Avoid unnecessary admissions to hospital
  • Serving as a catalyst for the LCP is dispersed in Østfold county
  • Arranging training days for the Østfold focusing on LCP
  • Increasing cooperation across municipalities in the county, and facilitate professional networks 


  • Establish contact and collaboration with the Palliative Unit at Smedbakken Nursing and Center for Palliative Medicine (SLB) at Østfold Hospital
  • Collaborate with Competence in Palliative Care Health Southeast (Ullevål)
  • Identify existing networks in palliative care / palliative care in Østfold
  • Training in LCP for participating municipalities in Østfold
  • Conduct start-up seminar and training days
  • Sharing experience in the use of LCP from existing users

Implementation and results

All nursing homes in Fredrikstad has appointed a nurse to be a resource person at his nursing home. Resource nurses attended the public conference about LCP at Ullevål hospital in November 2012. Further training and supervision of the implementation period is via established LCP administrator at each user location in close collaboration with the project manager. Progress keen follower milestone plan, with the goal that all merchants are registered and ready to start 2013.
Askim, Eidsberg, Halden, whales and Fredrikstad Østfold represents the group, as well as a representative from the trade union and a cancer nurse specialist center for palliative care health Southeast. These form a program committee for joint training days held in Østfold


Askim Municipality, Eidsberg municipality, Halden municipality, municipal Whales, trade union and Centre for Palliative care at Ullevål.
And can this be Version 11...?

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