Read these important arguments about the Liverpool Care Pathway

This past weekend's Catholic Herald contains two letters about the Liverpool Care Pathway (LCP). You can read more about concerns about the LCP elsewhere on my blog (13 Dec. 2011; 2 Dec. 2011; 26 Mar. 2011; 3 Sep. 2009; 13 Aug. 2009). The first letter is from Professor Patrick Pullicino, who is professor of clinical neurosciences at the University of Kent. The second letter is from Dr Gillian Craig, a campaigner and author against euthanasia. I reproduce both letters in full at the end below.

Interestingly, Professor Pullicino argues:

"[T]he diagnosis of being “within the last hours or days of life”, which is necessary for a person to be put on the LCP, has no scientific basis. This diagnosis is, in fact, a prediction and as such is likely to be in serious error about 50 per cent of the time."

Dr Craig warns that:

"[T]here is a very real danger that some who appear to be dying but have a treatable disorder will be put on the LCP with fatal results."

Letters, The Catholic Herald, 3 August 2012

The Liverpool Care Pathway is becoming a deadly machine

From Professor Patrick Pullicino

SIR – One worrying statistic about the Liverpool Care Pathway (LCP) that is not well known is that in both the First National Audit (2006/7) and the Second National Audit (2008/9) the mean time to death on the LCP was 33 hours. The fact that two large national audits two years apart came up with an identical mean time to death shows that effectively the LCP is a machine. Unless the LCP is quickly discontinued death occurs in less than two days, whether someone has terminal cancer or a potentially reversible condition such as pneumonia.

What is not mentioned in the Science and Faith column (July 27) is that the diagnosis of being “within the last hours or days of life”, which is necessary for a person to be put on the LCP, has no scientific basis. This diagnosis is, in fact, a prediction and as such is likely to be in serious error about 50 per cent of the time.

Although it is possible to discontinue the LCP if the patient improves, it becomes more difficult to detect changes in the underlying illness as a patient becomes more drowsy on the LCP.

Yours faithfully,
PATRICK PULLICINO
By email

From Dr Gillian Craig

SIR – It is right to warn people about the Liverpool Care Pathway (LCP). Those who have produced warning cards have done the public a service. Your report (July 27) was helpful, as was that of Quentin de la Bédoyère (Science and Faith, July 27).

If all doctors were trained in the care of the elderly and had all the time in the world to discuss end-of-life care with patients and relatives there would be less cause for anxiety about the LCP. But given the current pressure on hospital beds and the number of frail, elderly people needing attention, there is a very real danger that some who appear to be dying but have a treatable disorder will be put on the LCP with fatal results.

Count de la Bédoyère mentioned some dangers of the LCP towards the end of his article. These are worth repeating lest they be overlooked:

• Some medical staff may see death as a benefit for the patient or the NHS. It was suggested that death is sometimes hastened if the bed is needed for someone else.
• Some healthcare staff will be too busy to follow the LCP protocol correctly.
• Once on the LCP progress checks may be overlooked until the patient is dead.
• Some doctors may not involve a multi-disciplinary team or seek advice before putting patients on to the LCP.
• The importance of hydration was not mentioned in the Catholic Herald articles.

When palliative care first emerged as a speciality in 1987 the only patients who received hospice care were those with pain that was difficult to control or those with significant anxiety about the prospect of dying. All the rest were managed by their GPs in the community or by hospital staff if they were admitted to hospital. Surprisingly few old people needed the services of palliative carers in those days and most died peacefully without the need for sedation or morphine. Syringe drivers were never used on geriatric wards in those days. If medication was needed it was given orally or by injection.

Palliative care is in overdrive and patients are in danger. (For discussion see the American Journal of Hospice and Palliative Care 2008; Vol 25: No 2.) The NHS is fast becoming a death service rather than a health service for the elderly. Attempts are being made to vet potential admissions and send the elderly home before they block a precious hospital bed. Those who are admitted and appear to be dying may be put on the LCP and die within a matter of days. People can no longer be sure that the elderly will be treated well, so great vigilance is needed. Many people suffer long-term distress after watching a loved one die on the LCP. It is surely time to review and reduce the role of palliative care in the NHS.

All these problems have followed the closure of far too many hospitals that cared for the elderly. We now have too few hospital beds to cope with the ageing population. Hospital facilities must be increased and care in the community improved as a matter of urgency, so that more people can remain at home until they die in peace.

Yours faithfully,
GILLIAN CRAIG
Northampton

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