not in the least theoretical in the consequences ....

[aka Calum Da Jazbo]

this is disturbing this aged gent no end ...

nhs hospitals paid to kill you

[Simon]

Like everything else, Calum, it depends how it's done. It is a way to avoid prolonging the life - and perhaps suffering - of the dying by artificial means, once it is clear that life is clearly closing. In other words, it is a way of letting nature take it's course.

However, as again with everything else, once MONEY and financial criteria come into the equation, the whole thing can change. Cynic that I am!

I was aware of this Pathway system, and as far as I knew (which wasn't much) it was OK, but the recent reports about financial incentives are disturbing and I think that all such should cease. I'd view them as not appropriate in the circumstances.

[salymap]

I'm 82 and it is important to keep ones 'marbles' as even if not in hospital certain services can be rationed.

Stay at home if possible and watch out for 'At your age' approach from doctors. I have 'wear and tear' on middle and upper spine. Fair enough, but if I was thirty treatment would probably be available.

Is this situation just in the Liverpool area or widespread?

[aka Calum Da Jazbo]

widespread salymap, Liverpool is the eponymous origin of the approach, not it's location

my mother was apropriately subjected to nil by mouth many years ago when she was in a coma and severely ill .... but this was discussed ... and so was the DNR notice for my sister

however i have seen this system adopted in the most awful way urged on by very poor care staff for a lively minded 94 yr old who was effectively murdered .... last year in the middle kingdom ...
the dear lady in question, frail as she was was also labelled 'aggressive' by care staff because she argued and was chemically coshed into submission prior to the pathway ...

[Curalach]

Like everything else, Calum, it depends how it's done. It is a way to avoid prolonging the life - and perhaps suffering - of the dying by artificial means, once it is clear that life is clearly closing. In other words, it is a way of letting nature take it's course.

I agree with Simon. My wife of 41 years died in July of pancreatic cancer at the age of 63.
The treatment and, particularly, the palliative care she received from the NHS in Glasgow could not have been bettered. In the last days of her life we agreed that the LCP should be invoked and as a result the constant intervention of taking bloods, blood pressures and medications ceased, although she was kept pain-free.
The result was a dignified and gentle departure. There was no possibility whatsoever of a different outcome. As a nursing professional she fully understood what was happening and we both had complete faith in the palliative consultant who was looking after her.

In my view there is nothing wrong with the LCP provided that it is responsibly used. The notion that financial rewards could be applied to its use is abhorrent as is the suspicion that some may be climbing on a compensation bandwagon. It would be unfortunate if the procedure were to be abandoned due to misuse, media sensationalism and political grandstanding, all of which has been apparent on Radio 4 today.

[salymap]

I agree with Simon. My wife of 41 years died in July of pancreatic cancer at the age of 63.
The treatment and, particularly, the palliative care she received from the NHS in Glasgow could not have been bettered. In the last days of her life we agreed that the LCP should be invoked and as a result the constant intervention of taking bloods, blood pressures and medications ceased, although she was kept pain-free.
The result was a dignified and gentle departure. There was no possibility whatsoever of a different outcome. As a nursing professional she fully understood what was happening and we both had complete faith in the palliative consultant who was looking after her.

In my view there is nothing wrong with the LCP provided that it is responsibly used. The notion that financial rewards could be applied to its use is abhorrent as is the suspicion that some may be climbing on a compensation bandwagon. It would be unfortunate if the procedure were to be abandoned due to misuse, media sensationalism and political grandstanding, all of which has been apparent on Radio 4 today.

I haven't heard the R4 programmes so am not up to date on this. Your post, Curalach, sets out the situation as it can be with dignity and courage. Saly

[Simon]

the dear lady in question, frail as she was was also labelled 'aggressive' by care staff because she argued and was chemically coshed into submission ...

Ah, now that's a different ball game. It's wicked, it's widespread and it's something that we should all resist with all the means at our disposal. Unfortunately, it's very difficult to prove and unless one is a family member the perpetrators hide behind medical confidentiality.

[salymap]

Ah, now that's a different ball game. It's wicked, it's widespread and it's something that we should all resist with all the means at our disposal. Unfortunately, it's very difficult to prove and unless one is a family member the perpetrators hide behind medical confidentiality.

Years ago,my mother aged 87 and crippled with arthritis, was called 'lazy' at a meeting I attended because she was unable to feed herself and her trays were taken away before she had eaten any food. She died quite soon after this and it has always upset me to think of what she went through.

[amateur51]

Ah, now that's a different ball game. It's wicked, it's widespread and it's something that we should all resist with all the means at our disposal. Unfortunately, it's very difficult to prove and unless one is a family member the perpetrators hide behind medical confidentiality.

Genuine question - is it really widespread? Are there any data re its incidence? I can't see how there can be.

[amateur51]

I agree with Simon. My wife of 41 years died in July of pancreatic cancer at the age of 63.
The treatment and, particularly, the palliative care she received from the NHS in Glasgow could not have been bettered. In the last days of her life we agreed that the LCP should be invoked and as a result the constant intervention of taking bloods, blood pressures and medications ceased, although she was kept pain-free.
The result was a dignified and gentle departure. There was no possibility whatsoever of a different outcome. As a nursing professional she fully understood what was happening and we both had complete faith in the palliative consultant who was looking after her.

In my view there is nothing wrong with the LCP provided that it is responsibly used. The notion that financial rewards could be applied to its use is abhorrent as is the suspicion that some may be climbing on a compensation bandwagon. It would be unfortunate if the procedure were to be abandoned due to misuse, media sensationalism and political grandstanding, all of which has been apparent on Radio 4 today.

A very moving testimony Curalach - many thanks.

My own experience of supporting a friend who was nursing an ex-partner for just under a year while he was dying with pancreatic cancer was essentially the same. Macmillan nurses and hospital nurses were all outstanding and the palliative care was pretty good, as you say.

[Anna]

Curalach's post emphasises the best aspects of Liverpool Care Pathway, a gentle and dignified death, which is what all of us would wish for family and friends.
However, start introducing financial rewards and targets - certainly alarm bells start ringing. There have been a lot of reports of patients being place on the LCP without consultation with relatives, this is part of an article on wiki: The Central Manchester University Hospitals NHS Foundation Trust - which received £81,000 in 2010 for meeting targets relating to the LCP - said the proportion of patients whose deaths were expected and had been placed on the pathway more than doubled to 87.7 from 2011 to 2012. The Bradford teaching Hospitals trust, which qualified for CQUIN payments of more than £490,000 from 2010 to 2012, saw the number of patients dying on the pathway more than double to 51 per cent from 2009 to 2012
Just looking at The Nursing Times online it seems there are further targets relating to organ and tissue donations. Very disturbing, as Calum says, but only one of us here has firsthand experience so it's best not to condemn the whole practice out of hand without some more facts.

[aka Calum Da Jazbo]

it is not the LCP as such but how it is being incentivised and abused that scares me ... as i hope i make clear i have had close personal experience as well as in-law relations [frail 94 yr old was aunt of partner] meeting varied ends ... some truly appalling ...