Liverpool care pathway

[stella1w]

Posting here for traffic, not debate,
distraught friend just told her mum, demented, at home with 24 hour care has been put on liverpool care pathway. She spoke to the gp about palliative care thinking it would mean a nursing home and was not consulted about lcp. Gp is refused to let her mum have sedatives or water and my friend is v v v upset and feels this is like euthanasia. She doesn,t seem to know what to do or if she has any rights to stop it. It could take four weeks.
I said if she had doubts she should ask for lcp to be postponed until the children had been consulted and undertood and consented.
What can she do?

[colleysmill]

claig with regards your post including " lack of punishment for those charged with their care" are you implying that by consenting to the LCP family members should also be charged?

[colleysmill]

Actually can I reword that to do you believe by consenting to the LCP family members are complicit and therefore also accountable?

[claig]

No I wasn't referring to the LCP, I was referring to the people not providing water to patients who were dehydrated like the man in his twenties who dialled 999 to ask the police to help him get a drink, and the people responsible for the shocking care in places like Satfford.

[claig]

I believe directors and managers should be personally liable for systemic neglect and poor care in their trusts. I believe that would change teh culture and put patient care as the top priority and ensure that mnany of these poor care scandals no longer occur.

[colleysmill]

Ok thanks. I do agree that poor care should be made accountable for - but when looking at the cause accountability should be at all levels - if the problem is chronic understaffing or too large caseloads, limited equipment etc then management should also be held to account.

[colleysmill]

X posts

[claig]

I also think it should be made illegal to put anybody on a DNR or LCP without gaining consent or the family's consent.

[colleysmill]

Would it not run into difficulty though making it a legal requirement? There would have to be contingencies for people with no family, not in contact with their family, if the family members disagreed, if the next of kin didn't have the capacity to consent?

[claig]

The buck stops with the management. They make policy and are responsible for everything including cleanliness standards and quality of care. The public pays large salaries to these people and they are doing a very responsible job, but as a consequence they also have duties that they must fulfil and they need to be held accountable for the care that is delivered in their hospitals.

That will force change and checks and improve standards.

[claig]

Yes, good point. For some people it may not be possible and they will not be able to have a say. But in most cases, I think the duty must be to gain consent and people should be able to decline and opt out if they are not happy with it.

[colleysmill]

I don't disagree with that but the primary concern should always be the patient and their needs, if they are not able to consent themselves.

I think families should be involved and informed in the decision process but its a hell of a decision for some people and a burden they might not necessarily want to take. If you make it a legal requirement there may be instances where the families needs come first and not the patient's.

[claig]

I think in most cases, people tend to do what doctors advise. But some people will not want their relatives to go on certain pathways and I think their wishes should be respected. That way we may no longer have cases of DNRs being issued without patient or family consent.

[lustybusty]

claig your argument all along that the LCP is bad has been based on the fact that Mrs Greenwood wasn't allowed fluids and her family had to give her liquids. This is the fault of the Liverpool Care Pathway. Yet you then mention the case of the 20yr old who dialled 999 from his hospital bed because he hadn't been given fluids. I'm guessing he WASN'T "being sentenced to death" by the hospital? Can you not see the similarities between these two cases and that the issue is NOT the LCP, but rather over worked/under trained/uncaring/whatever HCPs (and I do know they are in the minority!!)?

[LadyHullyEyes]

I had a long emotional post going on about the death of my Mum, but I deleted it
TBH I really can't be arsed. Claig, you don't get it and I hope you never will.
To make the decision about your elderly parent can never be taken lightly, we do what's best, and as many posters on here are speaking from personal experience, your examples of some stranger on the news is not a good argument.
Just bugger off and find another cause to fight for why don't you.

[claig]

LadyHullyEyes, why don't you leave this thread? You're a very good person, but the subject seems to bring out the worst in you.

[claig]

lustybusty, the difference is that the withdrawal of fluids from Mrs Greenwood was not an error or due to an oversight or lack of staff etc; it was policy, and the fasmily were advised by a nurse not to give her water.

[claig]

'claig your argument all along that the LCP is bad'

My argument all along is that people should not be put on it without their consent or family's consent, just as I believe that no one should have a DNR note added to their files without their consent or their family's consent.

I believe it is about patients' rights and consent to approve treatment.

If a patient wants to go on it, then that is a different matter. But I don't believe that doctors should make a choice for patients without seeking consent, and I don't like the financial incentives given to place people on it. That is why I am glad that a review into it will be carried out.

[Fishandjam]

You've obviously never read Melanie Phillips...

claig, with those few words you've destroyed what little credibility your argument ever had.

[Piecesofmyheart]

Oh come on Claig. Your argument was 'never' about patient consent. It was a clumsy attempt to regurgitate the hysterical 'death pathway' sensatioalism peddalled by the wail. In the face of overwhelming opposition to your premise you've toned down the scary declarations and decided that actually, the LCP is ok if famil members consent to it. Does that mean that you withdraw all the allegations you made earlier in the thread aboit the motivations of HCPs and the conspiracy which exists to starve healthy patients to death by using the LCP?

[JakeBullet]

I haven't read Claig's earlier posts but I do agree that there needs to be a review of how the LCP is implemented. In the case of my family it was discussed and used appropriately for a relative dying from cancer. I have no complaints.
It is clear though from some of the cases highlighted that there have been times where it has been started very in appropriately and guidelines not followed. The lack of giving fluids is a case in point....that is just very bad care and has no relevance to the LCP which does not forbid fluids or food.
Claig, I read a really good book last year called "How We Treat the Sick" which highlighted many of the issues you have raised on this thread. I believe it should be required reading for EVERYONE who comes into contact with patients. In the end people who are sick or dying just need adequate food and fluid for their needs, to be kept clean, comfortable and have their pain or other medical needs met and they need all that with warmth and a smile.....it isn't rocket science and its shocking that in this day and age we still get it so wrong.

[claig]

You've misunderstood what I said. Nowhere have I said that LCP should be banned. I haven't said that nobody should go on it. I have consistently argued that it is about consent and that doctors have an obligation to gain consent and should not be allowed to place anyone on it without consent. I have made no allegations about HCPs or a conspiracy to starve patients to death.

I have said that I think the withdrawal of fluids is part of the process of causing death and hastening death. I think it is in the open, there is no conspiracy about it.

I am glad that pressure from newspapers has been a part in bringing an inquiry into it which will look at families' experiences (good and bad) and will look at cases of fluids being withdrawn from people who were compos mentis and will also look at the role that financial incentives play in the decision to place people on the LCP. Many people are placed on it without their knowledge as the Telegraph reported. I think that is wrong and why that is occurring and whether financial incentives are involved needs to be established.

[claig]

'people who are sick or dying just need adequate food and fluid for their needs, to be kept clean, comfortable and have their pain or other medical needs met and they need all that with warmth and a smile.....it isn't rocket science and its shocking that in this day and age we still get it so wrong.'

Excellent point and I wholeheartedly agree with that. I think the LCP, on which some people are placed without their knowledge, removes the rights of the patient in those cases, and I think that is unacceptable. I think the number one duty of hospital staff is for care, and placing people such as Mr Greenwood on the pathway without consent is wrong. She thought the same. That is why we need it investigated and we need to uncover if financial incentives play a role.

[claig]

I said to a HCP on here that these decisions and guidelines about the LCP etc are made way above her head. They are nothing to do with the HCPs who deliver treatment. The HCPs only carry out what is in the guidelines that come from above. Similarly, the financial incentives do not come from HCPs, they come from above.

[HelenMumsnet]

Morning. Just posting in the hope of catching the OP's eye.

OP: we have emailed you but it's clear from our inbox this morning that you haven't seen it. We will reply to your further Report to us but we want to be sure we've got the correct email address for you first.

Please can you check you mail and either reply to the mail we sent you yesterday or mail us at contactus @ mumsnet.com to let us know you haven't received that mail?

[KateSMumsnet]

We welcome open and robust debate about the LCP but we would ask you all to try to post with some sensitivity and respect, however strong your feelings about this.

We don't want to censor discussion but this is clearly a very difficult and emotive subject and we'd urge everyone to bear that in mind please