On this Liverpool Care Pathway

Yes, yes, I know. We all dies, there\’s no point in CPR for someone who is going to die in 45 minutes anyway. Going out in a haze of heroin is better than many other ways.

And yet:

Every year 130,000 patients are placed on the LCP, which usually involves heavy sedation with morphine or similar drugs.

If memory serves that\’s around one third of all deaths each year.

My reading of this, no doubt a highly partisan and partial one, is that what we really have here is a case of centralised bureaucratitis. Something that is indeed a good idea for some small portion of the soon to be ex-population is looked at, a committee thinks, oooooh, what a good idea and then it\’s imposed upon near all. With the usual financial incentives of a central command and control system.

The problem being that what might be appropriate for some is not necessarily appropriate for all.

17 comments on “On this Liverpool Care Pathway

  1. Plus something that works in a small controlled environment where all know what they are doing doesn’t work when rolled out nationally to everyone of many different abilities (or none at all) where the people in control care more about their empire than anything else.

  2. Where’s PaulB then, to comment on this piece of news? I thought the LCP was perfectly safe, after all he’s the one who said said it was because the rules were all written down somewhere, and no-one in the sainted NHS would ever do anything wrong at all.

    Or is it more the case that the NHS has been indiscriminately euthanasing its patients, particularly its bed blocking old ones, to the tune of tens of thousands of people per year?

    Of course even if they had, no-one on the Left would ever admit it, because it would mean the end of their sacred cow, and that would never do. Far better to sweep all those dead bodies under the carpet and pretend it never happened. Ignoring piles of dead bodies and focusing on the ‘big picture’ is something the Left does very well. The history of the 20th century proves that.

  3. it’s not a third – 68 million ish people in the UK, average life expectancy of 70-odd, so roughly 1 million deaths/year; it’s still one in eight or one in seven though

    And as I’ve said before, such will be the backlash against baby-boomers of a certain age that I reckon we will see legalised euthanasia quite soon, probably followed (if the Statists have their way) by the full Logan’s Run

  4. Passive euthenasia without consent. How on earth this got past the BMA is beyond me.

    On a very simple level of doctors forecasting a death timetable goes against the central ethos of medical care to preserve life.

    Its managerialism gone mad, the academics who have taken this out of its intended use must view Medics an somehow engineers. They need a trip to the bike sheds.

  5. The LCP sounds like a fairly typical example of something that works when introduced properly, but when instigated via fiat in the NHS it can break down. The examples in this morning’s Today summed it up quite nicely: one family knew what was going on, it went really well and the other saw no consent and an attempt at euthanasia by the NHS.

  6. Just a couple of points. First, the LCP is not a treatment, it’s a framework for practice. It does not replace clinical judgement.

    Second, it must ALWAYS be discussed with the patient where possible and approriate and ALWAYS with the appropriate relative or carer, whose views MUST be listened to, considered and documented, and in the case of disagreement and further discussion must be mediated independently. However, it seems that in a significant number of cases that hasn’t been happening – i.e. the full framework of the LCP hasn’t been applied.

    This is not in itself an argument against the LCP. Many of its strictures are, I would have thought, uncontentious, such as the requirement that all who care for terminally ill patients are trained to do so, and it would be a pity if the baby was thrown out with the bathwater.

  7. Nothing inherently wrong with the LCP and everything wrong with the bureaucrats that now run the NHS.

    An NHS hospital is no longer a safe place to be if you are old and infirm.

  8. Where’s PaulB then, to comment on this piece of news? I thought the LCP was perfectly safe, after all he’s the one who said said it was because the rules were all written down somewhere, and no-one in the sainted NHS would ever do anything wrong at all.

    Jim, if you want to know what I said you could use an internet search engine to find out. Here‘s an example of my views.

    If we abolish the LCP, patients will continue to be mortal, and doctors will continue to make decisions about end-of-life care. The complaints have been not about the LCP, which is unobjectionable, but about failures to adhere to it. It is unclear to me how abolishing guidelines for the proper implementation of end-of-life care will stop medical staff from getting it wrong. But I suppose the Telegraph and the Mail will be happy: perhaps that’s the important thing.

  9. It would appear that

    1) Some doctors (and other medical professionals) used the LCP as a way to deny proper care – they clearly did not adhere to the LCP, but claimed they were implementing it. Indeed it would appear to have become a defence, hardly an edifying sight.
    2) It would also appear that LCP was made a target that hospitals were expected to hit and this may have led to patients being put on the pathway without proper procedures.
    3) Neither of the above alters the fact that the LCP when properly done, was a good practice for end of life care.
    4) Yet another example of Labour targetitis, to be added to Mid Staffs, CQC etc. If only the Conservatives were to stick to the no targets mantra they recite, but appear to fail to implement.

  10. @PaulB: “If we abolish the LCP, patients will continue to be mortal, and doctors will continue to make decisions about end-of-life care. The complaints have been not about the LCP, which is unobjectionable, but about failures to adhere to it. ”

    So what should happen to medical professionals who did not adhere to the LCP guidelines? Should they be investigated and prosecuted, potentially for murder if necessary? Or should we just brush it all under the carpet and forget that the NHS has unnecessarily ended thousands of peoples lives early? Does this amnesty cover everyone? Can anyone smother Granny because she’s going to die pretty soon anyway, and you don’t fancy another few months of looking after her?

  11. It’s the hypocrisy that creeps me out. If the NHS is certain an oldster is about to die, why deny food & water when an insulin shot does the trick in a trice? Surely not because it don’t want it on the death cert?

    PS, Flatcap, There were 493,242 deaths registered in England and Wales in 2010. Google ons.

  12. Jim, to answer your questions:
    - no one should be prosecuted simply for not adhering to LCP guidelines, because guidelines are not laws
    - medical professionals who commit murder should be prosecuted for murder, just like anyone else
    - what amnesty?

  13. Fuck me PaulB you’re slippery bastard aren’t you? Do you work for the NHS by any chance?

    Look, its very simple. The LCP is not only a way of not prolonging an dying person’s life pointlessly, its also way that a person who might survive if given the correct treatment can be killed before their time (ie murdered) if incorrectly placed on it. If I place you on the LCP, sedate you and remove your food and hydration, do you think you might die? Would that be murder? Or is just ‘failing to adhere to the guidelines’ and a case of ‘Nothing to see here, move along please’?

  14. @ Jim:

    Does the LCP recommend continuous deep sedation?

    No.

    Does the LCP recommend stopping or not commencing clincically assisted nutrition or sedation?

    No.

    So what’s your point?

  15. For “clinically assisted nutrition and sedation” above, please read “clinically assisted nutrition or hydration”.

  16. Jim: I suppose you’re not medically licensed, so no, you can’t legally sedate me. If I have mental capacity, as I do, a doctor can treat me only with my informed consent. If I’m incapable of giving informed consent, the doctor must treat me in my best interests, which explicitly does not mean she has to keep me alive as long as possible.

    The role of the LCP is to offer guidance as to what experts think may be in a patient’s best interests.

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