Liverpool Care Pathway: What are your thoughts?

Liverpool Care Pathway

http://www.bbc.co.uk/news/uk-england-21141281

It seems this Liverpool Pathway death route was devised by people who meant well, but were not realistic enough to foresee how it could and probably would be cynically abused and misused within the morbid systems of our sick NHS.

If the cases recently reported of patients slowly killed by hunger, thirst and cold in hospitals, and families not informed, are true, the Liverpool Pathway is a failed idea.

This is an incredibly difficult issue;

How do you provide palliative care without striving officiously to prolong life beyond its natural end?

LCP, applied sensitively, tries to manage this. Does anyone have any better ideas than this?

Does informing the family the patient has been put on the Liverpool pathway to death count as 'striving officiously'? No. Unacceptable misuse of the Liverpool Pathway has discredited it already. Something better organised, rather more foolproof will have to be arranged.

It's not Liverpool Pathway that's the problem, it's the application.

Striving officiously never used to be a problem - the doctors lost far more than they won, but now, we believe another week is worth any agony - so in some cases do the relatives.

Play ing God is about keeping alive too long as much as evicting too soon.

Yes, it's the application, it's the sort of system that depends entirely on it's application. The Liverpool Pathway is, to a great extent, an administrative system, and one that, apparently, fails badly.

cyfrifia wrote:Yes, it's the application, it's the sort of system that depends entirely on it's application. The Liverpool Pathway is, to a great extent, an administrative system, and one that, apparently, fails badly.

Which is why ALL our institutions, the NHS in particular, is failing to do the job properly and efficiently. TOO MUCH ADMIN - NOT ENOUGH DOING. Farming the available monies out to all in sundry to come up with crackpot reports, cost cutting exercises, re-vamps of this and re-arranging that whilst keeping a 100,000 paper-pushers in work is not a recipe for success in those places that need things DOING - and PROPERLY.
And until that is addressed NOTHING WILL CHANGE.

BBC I "The Big Questions" on now the next debate is about The Liverpool Care Pathway !

It was a fairly brisk discussion, Jackie, the lady in the grey and black striped jumper gave a realistic account of her experience, and said care of the elderly in the NHS is "appalling".

The doctor who said families were always consulted was howled down, although he seemed to believe what he was saying was accurate.

The hospice movement does have a much better reputation.

It seems the professionals who worked out the Liverpool Pathway must exist in theoretical ivory towers and not understand the realities of hospitals.

The idea someone put forward, that those who do not have families to protect them from the Liverpool Pathway are most at risk from it, is frightening.

Yes Cyfrifia plus the Doctor who stated "there is no scientific evidence that someone is ready to die"

The thing that worry's me deeply is how often it is decided to put an elderly person on this Pathway without informing the relative/s

Wasn't the idea that relatives would be consulted? In almost half the cases, relatives are not even told.

It's surprising some hospitals don't keep records of how many patients they put on the Liverpool Pathway, especially as they get cash awards for doing so.

The awards are a bit complicated though, involving training nurses to spot suitable patients on the wards. It's not clear if those nurses then get an immediate bonus, or, just a qualification for higher pay.

Quote: "The money is paid if the hospital meets targets in training nurses in palliative care in the eight wards where there are the the most deaths, and in identifying terminally ill patients."
http://www.bbc.co.uk/news/uk-england-21141281

Tens of thousands of patients are being put on the Liverpool Pathway which involves witholding food and water, so, that must save on time.

Patients have been known to cheat by getting up in the night and drinking from flower vases in the ward.

Not only is food & water withdrawn but also sedation is commenced via a syringe driver into the patients abdomen, and just how many elderly end up with pneumonia as the cause of death ?

As someone who has worked in the NHS since 1972 my fear for my future is that l will not be allowed to die of old age. It appears to be that regardless of age or physical condition healthcare staff are obliged to keep me alive no matter what, for fear that my relatives will sue. I can honestly say in over 40 years working for the NHS l have never met a health care worker of any grade that would want to be resuscitated or kept alive by any type of machinery. As for the Liver pool pathway, any pathway used the way it is designed will work. In my experience relatives have more of a say in the care given than the patient.

hovis wrote:As someone who has worked in the NHS since 1972 my fear for my future is that l will not be allowed to die of old age. It appears to be that regardless of age or physical condition healthcare staff are obliged to keep me alive no matter what, for fear that my relatives will sue. I can honestly say in over 40 years working for the NHS l have never met a health care worker of any grade that would want to be resuscitated or kept alive by any type of machinery. As for the Liver pool pathway, any pathway used the way it is designed will work. In my experience relatives have more of a say in the care given than the patient.

The sad thing is hovis far too many "targets" were set and approved by the last Labour Government for our hospitals to become foundation trusts, the only way managers could see a future was to agree to many closures and down gradings leaving our healthcare in a mess and unsafe, it isn't the fault of the staff it is greedy managers who have caused this chaos and were has it got them???

No-where except in a bigger mess than they were already in and costing a lot more than leaving well alone !

As for the Liverpool Pathway the biggest problem is "communication with the relatives" regarding putting a loved one on this pathway and I sadly have lot's of evidence which I will share with you all

Bury has a new hospice
http://www.burytimes.co.uk/news/10213567.Look_inside_Bury___s___5m_new_hospice/
Do hospices use the Liverpool Pathway, or is it only used in hospitals?

Thanks Hinch, like many people I know very little of these things. Could you say something about how and why some people end up dying in hospitals and others in hospices?

What I have found disturbing that some hospitals have been offered payments to introduce this plan, though it may have been withdrawn now.

Just how do they want use the plan I do not know but there seems to have been some disturbing reports and complaints made by relatives.

http://www.rochdaleonline.co.uk/news-features/78/opinion/77751/angels-flying-and-falling

The Liverpool Care pathway continues to get a bad press, with the possibility of legal action now against doctors who do not get proper consent.
http://www.telegraph.co.uk/news/uknews/9825342/Lord-Carlile-medics-should-face-GMC-over-Liverpool-Care-Pathway.html
Perhaps it will be less used with the threat of legal action. Perhaps it's a pity this method has not been used as responsibly as it needed to be.

cyfrifia wrote:The Liverpool Care pathway continues to get a bad press, with the possibility of legal action now against doctors who do not get proper consent.
http://www.telegraph.co.uk/news/uknews/9825342/Lord-Carlile-medics-should-face-GMC-over-Liverpool-Care-Pathway.html
Perhaps it will be less used with the threat of legal action. Perhaps it's a pity this method has not been used as responsibly as it needed to be.

An excellent report thank you Cyfrifia the last line in this report says it all
"The Liverpool Care Pathway was designed to ease the suffering of patients at the end of their lives,and can involve the removal of drugs and nutrition if these are not judged to be of benefit"

What about patients who have been put on this pathway survived and taken of put back on 3 times and still survived ??

My neighbour was sat up laughing and talking to us just a few weeks ago, then I saw the paperwork that they had left at the side of his bed saying he had been put on the pathway that morning I showed it to his daughter who knew nothing about it,the registrar told us the consultant had made the decision that morning and called in a chaplin who we never saw He died just 2 days later ?

Sorry but only one person decides when our time has come !

There are a couple of issues about the LCP.

There seems to be a lack of consultation with the family and, indeed, with the patient. All too often families have said to me 'oh, we've been told they've put him on the pathway, ' as if it was something that families are informed of rather than consulted about. Good palliative care, from my experience some years ago at St. Ann's Hospice, seeks to involve patients and families in planning the next step. The number of times families have said to me 'don't tell him; he doesn't know' only for the patient to tell me 'I'm dying, Father, but don't tell the family; they don't know'! Sometimes it is not appropriate or possible but very many times patients prefer to know and, in that sense, be in charge, having the chance to make plans, say good-bye, make their peace etc.

At a very slight caricature, what seems to happen is that relatives are told 'she's on the pathway'. Then hydration and nutrition (food and water to you and me) are withdrawn ('because they're not doing her any good'). If she shows signs of distress, the morphine is upped which decreases the consciousness.

Speaking personally, I want time, if or rather when I am dying. I want time to make my peace with lots of people, and especially God. I want time to plan my funeral because my choice of hymns keeps changing. I would quite like the chance to record my own sermon for my funeral; no disrespect to the Bishop who would normally preach. We can't choose the moment of our death but we can, by intelligent partnership with the medics, remain in charge/control for almost all the journey.

We're all in such a rush these days. I was blessed recently to be called to see a gentleman who was in the latter stages of cancer. He was conscious, bed-ridden, in the front room in front of the telly with the cat sitting on his feet, with family in and out. He wanted to sort things out and he used the time to do so. He waited for family to be there to say goodbye, waited for me to be called and then, as I prayed, 'Go forth out of this world, O Christian soul' he did just that. Springhill Hospice's new Hospice at Home team were out of this world.

LCP seems, in its laudable attempts to care for those who are dying, to have bureaucratised palliative care and rushed it as a series of boxes to be ticked.

One final comment: in my first four years after ordination my time at St Ann's Hospice was so privileged. That, together with my trip to Nigeria, and my meeting JPII, Mother Teresa, Leonard Cheshire and Br Roger of Taize, are the most formative experiences I have had. Sr Mary Turner, Deputy Matron, showed me round SAH. She pointed out the drugs trolley. In the top bit it had the morphine etc; on the bottom shelf was bottles of gin, brandy, whisky, cans of Guinness etc. In those days daily newspapers, having your hair done, etc were all free of charge and there was always a member of staff who would take you out for a pint if you felt like it! People said to me 'you go into the hospice to die' to which I replied 'you go into the hospice to live the rest of your life to the full.'

Excellent post Heywoodpp.
There is only one man who decides when our time has come and that is not the consultant in a hospital ward !

I want to know why they sent for his daughter telling her they had called a chaplain, when we got there the Chaplain had already been and left a calling card (no -name) along with papers stating my friend & neighbour had been started on the LCP !
He was sat up laughing joking and talking to us a bit agitated regarding having a catheter as he wanted to get up to toilet himself.
2 days later he was dead !!!

Well I've just been at the bedside of my sister who passed away on 7th.
I heard she was very ill and within 9 hours of getting the news I was on a flight to Philadelphia where I changed planes to fly to Washington then changed again to fly to Omaha . I got to spend about 36 hours with her before she passed.
I don't know if they have the equivalent of the Liverpool Pathway here in the USA or not but her food and water was discontinued one day then her oxygen removed the next day.
During the 3+ hours she survived after the support was removed , the 'end of life' nurse came in the room 5 or 6 times and gave her more drugs until she finally went.
To me it certainly looked as if they helped her on her way.
I'm now spending a week in San Diego with one of my sisters sons before I return home.
It's about 28C here so I hope you aren't all suffering too much with the bad weather