Liverpool Care Pathway - Missing The Plot

When the left hand hasn't been told what the right hand is doing, there's bound to be some lack of co-ordination...



Mail Online has reported a ten-fold rise in palliative care deaths –

Roger Taylor, of Dr Foster, explained how an elderly patient might go in to hospital with a broken hip, develop an infection and die.

Staff would then code this death as ‘palliative’ even though the patient was not initially expected to die.

This could be deliberate or a mistake, as the guidelines for recording deaths are unclear. Nonetheless it is very different from a true palliative death of a patient with terminal cancer.

Each year the Hospital Standardised Mortality Ratio (HSMR) collates the numbers of patients who have died unexpectedly.

But trusts can drastically lower this rate if they record high numbers of patients with terminal illnesses, termed ‘palliative care’.

The figures show that at one trust, London’s Guy’s and St Thomas’, the percentage of patients recorded as ‘palliative’ has increased from 1 per cent in 2008 to 32 per cent in 2012.

It has been reported in these pages how newspapers and political interest groups will report the news to suit their own particular perspective.

See, for instance -

Liverpool Care Pathway - A Political Football

In their report, Mail Online sees this as massaging the figures on the sly. It suits their editorial stance and all that LCP business has dropped out of the picture and is no longer, perhaps, newsworthy.

This is Dr Foster -

The report highlights Dr Foster’s concerns that current palliative coding encompasses a wide variety of palliative pathways. Patients admitted to hospital specifically for specialist palliative care cannot currently be distinguished from those who were admitted for treatment and whose subsequent deterioration in health led to them receiving palliative care.

Roger Taylor, of Dr Foster, explains how an elderly patient might go in to hospital with a broken hip, develop an infection and die...

Actually, Mr.Taylor, this is precisely what does happen and has been happening.

It could be a broken hip, it could be anything. Curious you should say a broken hip, though...

This is Chad -

Graham Bennett’s mum Gladys was admitted to hospital in October 2010 after falling and breaking her hip at her home at Burton Court in Bilsthorpe.

But she died later that month at King’s Mill after Graham was asked to sign forms that he now believes gave consent to put her on the Liverpool Care Pathway (LCP).

“It was never mentioned, that’s what annoys me,” said Graham (70).

“It’s taken a time to come to terms with it, even though my mum passed away at the end of October 2010.”

The Doc Foster graph fits well with the EoLC Strategy and the reported “Excess Deaths”.

Downsize care by downsizing care expectations. Initiate a programme of ‘identifying’ the One Percent who statistically die via a protocol of assessment involving statistical probability and intuitive judgement and earmark them for EoLC.

This will (of course!) trawl in many who would not have formed part of that One Percent cohort. By far the greater part of medical error consists of medical misdiagnosis. There will be excess deaths...

ITV Central have picked up the same story and have run with it -

The figures show that at one trust, London’s Guy’s and St Thomas’, the percentage of patients recorded as ‘palliative’ has increased from 1 per cent in 2008 to 32 per cent in 2012.

Actually, Guy's are very proud of their EoLC record, Mr. Taylor. How dare you slur good old Guy's, home of the Amber Care Bundle.

The impact of AMBER in King's College Hospital is being independently evaluated by the Cicely Saunders Institute. They are actually proud of their achievements!

£4.8 Million is being spent on EoLC across the local boroughs of Lambeth and Southwark.The Programme set up a groundbreaking single online patient register which identifies patients with end of life needs and shares information between GPs, hospitals and out of hours services 24/7 - a precursor to the pan-London register.


On this Guy's web page they still brazenly boast about the LCP -

Amber has been transported to Oz.

Dr. Adrian Hopper and his excellent team of roadies from Guy's & St. Thomas' have been a big hit.

Has everyone missed the plot...?

Further reading -

Liverpool Care Pathway - Still Pushing For Amber