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Are you aware of the Liverpool care pathway?

The Liverpool Care Pathway was created to assist the withdrawal of lifesaving treatment in patients who are terminally ill.

It usually involves the withdrawal of nutrition and fluids and increases the amount of sedative and pain relief administered to the patient.   If the Care Pathway is initiated and progressed appropriately death usually occurs within 29 hours.

The Liverpool Care Pathway can be used as a structured measure to end the suffering of many terminally ill patients.  It is also a way for families to accept that their loved one is about to die.   It was created in a Hospital in Liverpool and has been followed by other NHS Trusts over the past 4 years.

Unfortunately the Pathway has seen vast criticism in the press recently as it would appear that the appropriate plans and communication with family members are not being carried out to an acceptable standard by the Hospital Trusts that are using the Pathway.

In the Mail on Sunday on 30th December 2012 a story was published which suggested that families are being kept in the dark when doctors commence the withdrawal of lifesaving treatment.

A link to the story can be found here:  http://www.mailonsunday.ie/news/article-2255054/60-000-patients-death-pathway-told-minister-says-controversial-end-life-plan-fantastic.html

The Report quotes a figure of 60,000 people having been put on the pathway in one year, without giving their consent, out of 180,000 patients that were on the pathway in that year.  A third of all patients.

The Liverpool Care Pathway is still being claimed as a fantastic step forward by the Health Secretary Jeremy Hunt and he is quoted in the press story as saying that one or two mistakes should not be allowed to discredit the entire end-of-life system.

An unfortunately familiar story to us is that the report goes on to indicate that people are left on the Pathway to die in pain because nurses do not do enough to keep them comfortable.  This is something that we are familiar with and are progressing claims of this nature on behalf of bereft family members who were left with the agonising memory of their family member suffering in the final few hours of life.

All of this is surrounded by the claim that health trusts are being incentivised to put patients onto the Pathway, with the Mail on Sunday quoting a figure of an extra £30 million.

The audit that provided these figures was carried out by Marie Curie Palliative Care Institute in Liverpool and the Royal College of Physicians by examining a sample of over 7,000 deaths during the months of April – June 2011.  It found that 44% of cases where conscious patients were placed on the pathway there was no record that the decision had actually been discussed with the patient themselves and in 22% of cases there was no evidence that comfort and safety had been maintained while medication was administered.   In addition 1 in 3 families never received the issued leaflet providing guidance on the process involved.

As a specialist firm dealing with clinical negligence claims we do welcome the Liverpool Care Pathway to assist the end of terminally ill patients, if dealt with appropriately and with the full consent of the patient and/or their relatives.    However, this report is shocking and only goes to highlight the lack of dignity in death in these horrifying cases.

A further review is planned of the system and we welcome changes to ensure that a structured methodical approach is applied to all cases where the Liverpool Care Pathway is appropriate.

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