With the furore over Liverpool Care Pathway showing little sign of going away it may be a good time to pull together some of the threads. Margaret McCartney has written about the issue in this week’s BMJ (http://goo.gl/VeqY1)
She founded St. Christopher’s Hospice in 1967 as the first research and teaching hospice linked with clinical care, pioneering the field of palliative medicine.
I was a medical student in the 80’s at Monash University, Melbourne. An element of the curriculum included palliative care, especially pain management. We even has a pocketbook to help with prescription of analgesia. Even so, people were still suffering with pain, sometimes horrible pain, right up to death on the wards. The interns and other doctors in training feared giving too much morphine to our patients. The nurses hovered like hawks to ensure we never over-stepped the mark with pain relief. Patient-controlled analgesia was introduced onto surgical and medical wards to improve pain management with variable success (e.g. Macintyre, 2001).
So fast forward to the Liverpool Care Pathway or LCP
The LCP affirms the vision of transferring the model of excellence for care of the dying from hospice care into other healthcare settings. We have demonstrated a process that inspires, motivates and truly empowers the generic workforce in caring for the patient and their family in the last hours or days of life.”
Deborah Murphy, National Lead Nurse-LCP, Associate Director MCPCIL
A detail of the process is here
So we get to the recent storm.
Did NHS kill my mother to free bed? The profoundly disturbing story by son of patient at controversial terminal illness care home
Peter Tulloch believes doctors sought to hasten his mother’s death
He was informed that mother Jean Tulloch had just weeks to live
Without his knowledge, doctors removed her drip but Mr Tulloch believes she was still aware of her surroundings
Care? No, this is a pathway to killing people that doctors deem worthless
But, as Margaret McCartney discovered, the Daily Mail was a fan only last year of end of live care that worked:
I’ll always be grateful to the GP who eased Mum’s pain – even if it hastened her death
This was after an example of poor nursing care at end of life was reported in 2009 in the same paper
Many NHS nurses are still the finest in the world. But they let my poor father die in agony like a dog
We were treated to a celebration of the care UK citizens receive at the end of life in 2010.
The country tops the Quality of Death Index, which ranked 40 countries according to the care offered to dying people. In second place was Australia, followed by New Zealand, Ireland, Belgium and Austria.
It cannot be emphasised enough that the model of care exemplified by LCP helps reduce, if not eliminate, the disasters highlighted in the 2009 article. The knowledge, skills and attitudes which the LCP training gives healthcare professionals has virtually eliminated the scenes I witnessed as a medical student in the 80’s.
Now we come to the present again. The Association of Palliative Medicine will review end of life procedures
the Association of Palliative Medicine has ordered a review of the concerns expressed by countless bereaved relatives, with a promise to explore ways of improving practice.
And the new Health Minister, Jeremy Hunt, has chipped in. (Surely not to gain political points)
NHS Constitution: Families To Get Consultation On ‘Death Pathway’ Decision, Says Jeremy Hunt
But wait! Is there anything actually wrong with the LCP?
Consensus Statement: Liverpool Care Pathway for the Dying Patient (LCP)
Published misconceptions and often inaccurate information about the Liverpool Care
Pathway risk detracting from the substantial benefits it can bring to people who are dying and to their families. In response to this we are publishing this consensus statement to provide clarity about what the Liverpool Care Pathway is – and what it is not.
Read full statement
The Catholic press also expresses view that nothing is wrong with the system two years ago.
A dependable pathway to the life beyond
It is important that death and dying in our community is being debated. With the erosion of spirituality in our lives, our mortality is denied. However, it is so sad that some of the most vulnerable amongst us are being used to sell newspapers and gain political points.
Death and dying is part and parcel of excellent healthcare. The healthcare professionals who work in the NHS (and in private sector) understand this. It is a sign of the times that the authority of healthcare professionals (and priests) at the end of life are being called into question. We are the people who witness more death and dying in civilian populations not at war than any other group in our society. General practitioners with their teams are the midwives to dying process and the grief which follows for those left behind.
To give you an idea of the scope of knowledge and skills involved a selection books has been added.
Helpful Palliative Care resources for healthcare professionals
Journals & websites
General and popular books
A selection of books at Goodreads.com