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Peer calls for Liverpool Care Pathway to be abolished

By on Wednesday, 30 January 2013

Lord Carlile says doctors who put patients on the end-of-life pathway without their consent should be struck off (Photo: PA)

Lord Carlile says doctors who put patients on the end-of-life pathway without their consent should be struck off (Photo: PA)

One of Britain’s leading legal experts has said that the controversial Liverpool Care Pathway should be abolished and replaced with a new end-of-life framework.

Lord Carlile of Berriew also suggested that doctors who placed patients on potentially lethal end-of-life regimes without their consent should be struck off the medical register.

The Liberal Democrat peer said reforms to the system must begin with dropping the term “Liverpool Care Pathway”.

“It does no good for Liverpool, it does no good for care and as pathways go it is nearer to the River Styx than the Mersey,” he said in a reference to the torrent that in Greek mythology separated the earth from Hell.

He said that following the independent inquiry under the chairmanship of Baroness Neuberger, who will report to the Government in the summer, the “best elements” of the LCP “could be part of a much-improved end-of-life strategy”.

But he told a meeting in the House of Lords that “whatever is put in its place, and I have every confidence in Julia Neuberger, it cannot be the Liverpool Care Pathway”.

He said that best practice would also have to be applied consistently if a replacement to the LCP was to have the confidence of the public.

Lord Carlile also expressed shock at the large number of families who have complained that relatives had not given their consent when they were placed on the pathway, which often involves heavy use of sedatives and narcotics and the withdrawal of food and fluids, resulting in death in an average of 29 hours.

He suggested that the situation warranted the intervention of the General Medical Council, the regulatory body of the medical profession.

“I spent about 10 years, as an MP, as a lay member of the GMC,” he said. “If a surgeon decided not to tell a sentient patient that in order to save his or her life he was going to have to remove a leg he would be struck off the register for serious professional misconduct.

“The Liverpool Care Pathway is being provided without the consent of either its sentient patients or – where they are not fully sentient or do not have full (mental) capacity – their relatives.”

He added that he also believed that patients should never be placed on an end-of-life pathway by doctors who did not know them.

Lord Carlile is one of the most highly-respected barristers in Britain and was sought for his legal expertise when he was appointed by Tony Blair as the independent reviewer of terrorism legislation in 2001.

The son of a Lancashire GP, he has taken an interest in end-of-life issues that recently led him to co-chair the anti-euthanasia group Living and Dying Well.

His comments in the Lords, expressed in public for the first time, contrast starkly with the insistence of Government Ministers that the LCP is “good medicine” and an effective framework for the treatment of patients in their final days and hours.

The Government insists that any abuses stem from the misapplication of the pathway and consequently the Neuberger inquiry’s terms of reference will focus solely “on the use of the LCP model rather than on re-evaluating the model itself”.

Lord Carlile’s remarks came during a meeting arranged by Baroness Knight of Collingtree to give peers the chance to hear from doctors convinced that the LCP is flawed, rather than misused, and that the inquiry does not go far enough.

These include Prof Patrick Pullicino, a consultant neurologist with East Kent University Hospitals NHS Trust, and a Catholic, who told the meeting the LCP was “dangerous” because it was founded on the “irremediable flaw” that doctors were able to predict when a patient might die when there was no objective way of making such a diagnosis.

The meeting was held just days before Auxiliary Bishop Tom Williams of Liverpool, chairman of the healthcare reference group of the Bishops’ Conference of England and Wales, said in a letter to The Tablet that Catholics applying the LCP well in palliative care were “doing the Lord’s work”.

  • Johnny Meehan

    i cannot thank lord carlile and professor patrick pullchino enough in the suggestion to abolish the liverpool care pathway because of the huge amounts of complaints with relatives like me who lost my wife on it, the main  point is the serious flaws it has such has like one mp fiona bruces father supposed to have hours and days to live is still alive over six months on, and loads of others taken of it and still survived it does not help those who have died and not been taken of this guese work   system, it should be abolished give termially ill painkillers but dont starve them to death its very wrong. 

  • Davies

    Telephone 01914565449 18 Northfield Road South Shields NE33 3HJ Tuesday, 29 January 2013
    Doctor Ash, GP
    The Riverside Practice
    Flagg Court Medical Centre,
    Dale Street,
    South Shields NE33 2PG
    Dear Doctor Ash,
    You will have gather by now that the efforts to get my wife Marguerita referred to Newcastle hospital where they had knowledge and experience in dealing with my wife problems following her hysterectomy, e.g. rectal prolapse, cystosele rectocele, constipation etc., were in vain. Her hypertension remains unstable, although the Freeman team was successful prior to her triple –bypass.
    I made my usual daily visit to the stroke ward 8 yesterday, and I was approached by the Stroke Nurse with regard to my wife being installed at her home. This was similar to a previous audience with Doctor Iqbal where I was told that a hospital bed would be provided but only four visits a day to attend to her needs. According to a staff nurse she needs to be moved and toilet checks every 2 hours. I was told a few days ago by the Ward Manager that my wife is very ill, so I have serious doubts that I could cope over the 24 hours.
    My wife Marguerita was admitted on the 20th November 2012. Until the 30th November she was sitting up and feeding herself. Since that date she has slowly deteriorated, and suffered for some days a painful distension of her abdomen from the 30th.. After attempts by the staff to relieve the constipation by micro enemas, Epson salts etc. a massive haemorrhage followed on the 9th of December 2012.
    A surgeon, Mr .Milligan took me to a side room to tell me that the was doubtful about me wife’s survival, however I told him of a similar experience I had when my wife was in the Sunderland Royal General Hospital for a hernia repair. The staff nurse had told me that my wife had been vomiting and had severe headaches that was due to her high Blood pressure, I said that she never had headaches or vomiting when her blood pressure was high, and that it must be something else. The Nurse the aspirated and there was specks of dried blood in the kidney shaped bowl. Almost immediately a ranitine drip was put up and she was discharged the next day.
    Mr. Millligan immediate took action after s few more questions and had an Ompraszole drip up. The bleeding stopped a few days later. He also arranged for a endiscope examination of her stomach and said although there was scarring from an old ulcer, He said that he could not operate on the duodenum because of anti-coagulants.
    There were no signs of bleeding, however the stomach surface was sprayed with adrelinin.
    I stayed with my wife for three nights in a side ward until the early hours. I saw that when my wife was given her lumped crushed medication in a conscious state about 8pm that she became unconscious about 15 minutes after taking the medication and stayed that way until early morning.
    Marguerita continued to deteriorate and is now in a emaciated condition, The Auxiliary staff do their best to spoon feed her however it seems that she is really suffering from malnutrition and has saline or glucose drips.
    I have been told by the staff, that in the morning she is bright and smiling, However when I get there in the afternoon visit, she is usually comatose with the other visitors in the was showing their concern.
    The medication may be one reason for her being comatose however; the right hand that has been affected by the stroke is very painful to touch those shows by my wife face being contorted with pain. I have on many occasions pointed this out to the medical and Physio therapists, invariably I have been told the “it is the stroke”. In fact I was arrogantly ordered out of the physio office when asking if they had a record of my wife being struck as my sister in law (SRN) noted that my wife had been touching the side of her head for some days. I first thought that it was an infestation as she kept touching her head, however, I could feel a slight rise on her scalp that was some days old. I was asked with insufferable arrogance was I qualified.
    The daily comatose condition of my wife culminated into where she was in deep shock, probably from the pain from her physiotherapy. On Tuesday on my 7-8pm visit to the ward I tried to revive my wife and at 8pm I asked the Staff nurse to see her.
    She took her blood pressure and her systolic pressure was 109,
    Her ear temperature was 35,
    The Staff Nurse called the Doctor, who came with two others, and told me to go into the day room. Eventually the Doctor told me that my wife was dying.
    I then went back to my wife’s bedside and stayed with her until 8 am the next day, during which time I did all I could to resuscitate her, and by 10 p.m. that night her systolic pressure was up to 157.
    From yesterday’s meeting with the Stroke Nurse and a Physiotherapist, it would seem that the hospital is anxious to transfer to my home for care or a care home. Although the Ward Manager has said that she is a very ill lady”.
    My sons and I have requested her consultant many times, verbally and in writing that Marguerita be transferred to a Newcastle Hospital who have attended to her needs successfully for nearly 40 years.
    I also suggested to the consultant that my wife is transferred to intensive care, this request was refused.
    It appears that with her present treatment that is not likely to survive another deep shock unconscious state. Again, as the Ward Manager said she “is a very ill lady”.ain
    Yours sincerely 
    Fred. W. Davies

  • majorcalamity

    Lord Carlile is NOT suggesting that we abandon the principle of a care pathway! He is merely suggesting that we drop the term “Liverpool” because it has been discredited, although actually I think it has been more misunderstood. He is in line with government policy in that he wants to see the LCP reviewed and it’s implementation improved. All perfectly sensible. He only parts company in wanting the name changed.

  • Flannery Liz

    Shameful misinformation is being peddled by influential Catholics without them having fully understood and reached the facts. The Lcp does not = sedation or withdrawal of fluids. It is about the relief of symptoms in the context of a patienr’s physical, social, psychological and spiritual needs.

  • Alidylan73

    This is nothing more than a license to kill. This should be abolished straight away.

  • LEngland

    We  are  terminally  tripping  on  our  euphemisms. It  is  good  that  the  Liverpool  Death  Plan  is  being  re – assessed.  We  want  human  kindness  factored  in  to  this.  An  openly  benign,  consulatative  approach.  Improving  a  sinisterly  ridiculous  name  has  to  be  part  of  this.

  • Fillipcharl

    (Disclaimer:

     

    The following
    information supplied to you is for reference purposes only and is not intended,
    nor should it be used, as a substitute for professional advice or judgement or
    to provide legal advice with respect to particular circumstances).

     

    Obtaining an order
    from the High Court to stop the use of the Liverpool Care Pathway (LCP) or it’s
    equivalent.

     

    The courts have held
    that there cannot be exemptions allowing assisted suicide to be lawful as this
    could lead to abuse resulting in murder and yet continuation of the LCP, which
    is open to abuse, is allowed to carry on.

     

    It appears from
    examining case law that the courts are slow to criticise the medical
    profession. The case law observed dealt with medical treatment and procedure
    whereas the LCP literature states that it is a ‘framework for best practice’.
    This also means that the issue of consenting to the LCP is not relevant as
    consent is only applicable to medical treatment. The LCP is not compatible with
    Section 2a of the NHS Constitution (the Health Act 2009 requires NHS to have
    regard to the constitution) which states “You have the right to be given
    information about your proposed treatment in advance, including any
    significant risks and any alternative treatments which may be available,
    and the risks involved in doing nothing.” As the LCP is not “treatment” it is
    asserted that the right to be given information is not accountable.

     

    It is for this reason
    that legal action might be more effective illustrating how the LCP cannot
    satisfy section 6 of the Human Rights Act 1998 and Article 8 of the European
    Convention on Human Rights and must therefore cease immediately.

     

    1       
    Section 6 of the Human Rights Act 1998;

     

    “Acts
    of public authorities.

     

    (1)            It is unlawful for a public
    authority to act in a way which is incompatible with a Convention right.

    (6)  “An act” includes a failure to act…”

     

    Article
    8 of the European Convention on Human Rights;

     

    RIGHT
    TO RESPECT FOR PRIVATE AND FAMILY LIFE

     

    1
                Everyone has the right to
    respect for his private and family life, his home and his correspondence.

     

    2
                There shall be no interference
    by a public authority with the exercise of this right except such as is in
    accordance with the law and is necessary in a democratic society in the
    interests of national security, public safety or the economic well-being of the
    country, for the prevention of disorder or crime, for the protection of health
    or morals, or for the protection of the rights and freedoms of others.

     

    It is argued that the European Convention on Human
    Rights places a positive obligation on the Government to protect the interests
    of the family – not a discretionary one as is the case under the inconsistent
    application of the LCP.

     

    If families give evidence to the court, in the form of
    sworn statements, that they were not informed by medical staff that their loved
    ones were to be placed on the LCP, then it is asserted that a legal challenge
    can be made on the grounds that this is a failure of the NHS to “act” and is in
    breach of Article 8 above.

     

    Putting a patient on the LCP without informing them and
    without taking reasonable actions to inform their family shows no respect for
    family life.  It is argued that in
    circumstances where this has occurred, then this effectively amounts to
    interference by servants of a public authority (the NHS) which denies the
    patient the right to communicate their wishes as to the treatment they would
    like to receive and denies the patient invaluable time to discuss any private
    matters with family such as their last wishes.

     

    It is argued that it is not possible to rely on the
    exception that a patient was placed on the LCP “for the protection of health”.
    The LCP is initiated by a “multi-disciplinary team” where they have determined
    that a patient’s health has deteriorated to a point where death is deemed
    imminent – the patient’s health being determined irretrievable and medical
    intervention is withdrawn from the patient. It is asserted that it would be
    difficult to successfully argue that the purpose of withdrawing treatment is to
    protect health when the whole purpose of the LCP is to deal with the dying
    patient.

     

    2       
    The effectiveness of a prohibitory
    injunction.

     

    A successful
    application to the High Court (Queen’s Division) to grant a prohibitory
    injunction to prevent the NHS using the LCP, may need to satisfy the following
    criteria;

     

    ·        
    That there is a serious question to be
    tried;

    If the NHS is allowed
    to continue with the LCP (and the DH has already acknowledged failures in the
    NHS administration of LCP by calling for a review) this would allow a
    foreseeable risk to breach of Article 8 of the European Convention on Human
    Rights.

     

    ·        
    Damages would adequately compensate the
    claimants;

    The purpose would be
    to stop the LCP being used and the award of damages would not provide a remedy
    to this. 

     

    ·        
    The defendant (NHS) would suffer from the
    imposition of an injunction that prevents the use of the LCP;

    It is argued that
    there would be no loss as the NHS would not be prevented from providing
    ‘ordinary’ care in the absence of the LCP framework.

     

    ·        
    An assessment of the ‘balance of
    convenience’

    It is asserted that to
    allow the continued use of the LCP poses a very significant risk to continued
    interference with family life. Valuable time that could be spent with patients
    and their families cannot be retrieved after the death of the patient.

     

    ·        
    Preservation of the status quo

    It is argued that the
    imposition of a prohibitory injunction to stop the use of LCP allows current
    and future patients to be spared the LCP and lowers the risk of the NHS
    interfering with family life and breaching Article 8. The sworn statements from
    family members should be persuasive as evidence where it is alleged that NHS
    staff had no regard to Article 8.

     

     

    3       
    Some case law that may support the
    application for an injunction.

     

    TP v UK (2002) 34 EHRR
    2 – where it was held that family members were denied the opportunity to
    participate in a decision-making process in violation of their human rights.

     

    Pretty v United
    Kingdom (2002) 35 EHRR 1 – where the judgement stated that “Clear risks of
    abuse do exist, notwithstanding arguments as to the possibility of safeguards
    and protective procedures.”

     

    Smith v Inner London
    Education Authority (1978) 1 All ER 411, CA – where it was held that an interim
    injunction against a public authority must be able to have a real prospect of
    success at a full hearing.

     

    R (on the application
    of OLIVER LESLIE BURKE) (Respondent) v GENERAL MEDICAL COUNCIL (Appellant)
    & THE DISABILITY RIGHTS COMMISSION & 8 ORS (Interveners) [2005] EWCA
    Civ 1003 – it was held to be unlawful to act contrary to the wishes of the
    patient that they be allowed to die a “natural death” and where the patient has
    expressly stated to clinicians not to withdraw ANH (artificial nutrition and
    hydration).

     

    A V B & ANOR SUB
    NOM GARRY FLITCROFT V MIRROR GROUP NEWSPAPERS LTD (2002) – where it was held
    that the court must be persuaded, by those seeking an injunction, that there is
    a real prospect of succeeding at a full hearing.

     

     

    Link to application
    form for an injunction http://hmctscourtfinder.justice.gov.uk/HMCTS/GetForm.do?court_forms_id=402

     

     

    (Disclaimer:

     

    The preceding
    information supplied to you above is for reference purposes only and is not
    intended, nor should it be used, as a substitute for professional advice or
    judgement or to provide legal advice with respect to particular circumstances).