Better Care For The Dying

[naomi24]

The controversial Liverpool Care Pathway is to be axed in favour of individual treatment plans. Good idea? I think so.

http://www.telegraph.co.uk/news/politics/10177308/Liverpool-Care-Pathway-to-be-axed-in-favour-of-individual-treatment-plans.html

[woofgang]

I just read the article.
It is an absolute lie that anywhere in the pathway, it suggests or advocates withdrawing food or fluid. The pathway talks about what to do when food and fluid are refused or cannot be ingested.

Financial incentive for its use is just plain bizarre. I would like to see more information on that.

[pixie373]

Ah. It does say that on naomi's link. Then how is the LCP any different from what was happening anyway? My phone won't download that link, so not very helpful.

[pixie373]

Thanks woofgang. Just saw your previous post. So the LCP was no different from what has always happened. They just gave it a different name

[anneasquith]

someone may be able to enlighten me re this practice, are fluids withdrawn if so that imo is barbaric.

[pixie373]

Apparently not. On woofgang's advice, i googled it and read it through. There is no suggestion of foods or fluids being removed. In fact, we have had the LCP in practice for much longer than I've been in care (20 years) but it has always been called"end-of-life care". I can't see any difference with this "pathway" whatsoever.
What confused me were the suggestions that people were "taken off" the pathway and lived for many more years. That made it sound as though they would have died if they had been left "on it". Clearly not the case!

[woofgang]

The LCP codified best practice pixie. Where people were doing it right, it made no changes, where people were not doing it right, it gave them guidance about what to do and how to do it.

Anneasquith, I don't mean to be awkward, but what exactly do you mean by "withdrawing fluids"?

If you mean someone wanting a drink and not being given one, then no that should never happen unless the patient has been made nil by mouth in preparation for a medical procedure or because they have a bowel or digestive obstruction which will mean that anything ingested will be vomited up which, believe me is very distressing for the patient. in such case, frequent small sips of the chosen drink should be given and frequent mouthcare. such people are also likely to be in extreme pain so the pain relief given will mean that they will probably spend much of the time asleep.

[woofgang]

thank you pixie, I am not a nurse but know a bit about end of life care and the LCP both personally and professionally and it annoys me no end when it is blamed for bad practice or held up as a nasty dangerous thing, especially by papers like the Telegraph, from whom I expect better standards.

[pixie373]

That clearly was an outright lie in the paper, which is also unfair on relatives in that situation. I appreciate you letting me know about it, as hadn't read the details before.
People do need to take into account that there is a massive difference between using and abusing any system

[woofgang]

It just really frosts my underwear when people LIE either, deliberately or by failing to check the facts, about something so important as end of life care for our loved ones.

[peg131]

the pathway was wrong,my brother was put on that ,its sorrowfull just to see cotton buds to wet the lips.something i wl never forget.

[seadogg]

Whatever system is decided, uncaring carers will foul it up. We have nursed three family members and the appropriate time to withdraw food and liquids was never an issue.

[woofgang]

peg what was wrong about the pathway?

[naomi24]

The report isn’t ‘lying’. The pathway does involve ‘the withdrawal of treatment and even fluids from patients assessed to be approaching the end of life’. Woofgang’s link states ‘your relative or friend will be supported to eat and drink for as long as possible’, but in some instances this hasn’t happened – and it would appear that when relatives have stepped in, some who have been deemed close to death by medical teams, have recovered. Questions have also been raised on the financial incentives of the scheme. The point is the Pathway was founded with the very best of intentions, but it has been abused. If it hadn’t, there would be no reason to review it.

http://www.telegraph.co.uk/health/healthnews/9904650/Leading-doctors-fears-about-Liverpool-Care-Pathway.html

[woofgang]

Naomi, its not the document but people who have done these things and if they are going to do them, then they are going to do them regardless of what document is used. I agree that unilateral withdrawal of food and drink should not happen when people are dying. My concern is that if the focus is on the document and not on the actions of people, the document will be reviewed, withdrawn, whatever and that will be seen as the problem addressed when in fact the bad practice will continue.

[woofgang]

The behaviour in your second link, if true, is disgusting and not supported by the LCP. I would agree that it is not always possible to tell when someone is dying, but in my experience, it is not always impossible to tell.
This is what I mean by blaming the document. if it had never existed, what happened in your link could still have happened.

[grumpy01]

Just a short contribution to this debate.My Mother sadly passed away about 18 months ago,she had been in a nursing home for 2 and a half years.In the last few days of her life the staff tried to make her as comfortable as possible and to keep her hydrated but her swallowing mechanism had ceased to function and therefore other than keeping her mouth moist the water or squash had very little effect.Whilst in some cases, I am sure,people who could eat are not being fed in the majority of cases they just can't.

[naomi24]

Perhaps the bad practice will continue, but if that happens, it won’t be with the perceived endorsement of the Liverpool Care Path. The perpetrators will have to find another reason. I actually think that, as in many other areas of poor health care, financial considerations are, in the main, responsible – and that is a sad indictment of the management of the NHS.

[woofgang]

naomi I agree. I have also encountered a very subtle problem where people think that there is another unspoken message in what is said. An organisation will say, and mean, "we require you to stop doing xxx" They really mean it, they want whatever the bad, dangerous, illegal practice is to STOP. Some people will interpret that to mean "we don't want any reports of xxx, we don't want to know that it is happening, nod nod wink wink." In this event, it takes wholesale disciplinaries and dismissal to get people to realise that what is said really is what is meant.
I would still like to see actual factual information (not newspaper reports) of financial incentive to put patients on LCP.

[mushroom25]

just another example of tick box culture - wholly inappropriate for health care provision. obviously there are financial advantages in using LCP - and they are clearly substantial when 6 figure incentives are on offer for those hospitals that meet the targets set.

[woofgang]

mushroom, have you got a factual document regarding the cash incentive for using LCP please, not a newspaper report?