Endings.

It’s beginning to look like the end of the road for the ‘Liverpool Care Pathway’ – that is currently the way that hospitals ease the dying into death. It hasn’t been working too well, although I fear what may replace it.

There was a problem in hospitals where distressing and unpleasant procedures have been carried out on dying patients because doctors felt they had to do whatever they could. To be really simplistic about it – there’s a point where no one can do any more, although doctor’s have a duty to try.

As a result a practise arose of putting ‘DNR’ (Do not resuscitate) on some patient’s notes, to save them being saved but in a hopeless, vegetative state. When that was discovered, it became a scandal – some people were being written off when they shouldn’t have been.

In some ways the LCP came through as an extension of that – dying patients would be taken off intrusive treatments – they wouldn’t be forced to eat or drink, they wouldn’t be given unpleasant medication.

All of this was well meaning – hospitals are built to be places where people fight to save your life. There’s a point where that doesn’t work anymore. The hospice movement grew up to help make dying a better experience – the LCP came from that movement’s experiences.

The problem with DNR and LCP was that they only worked when kindly, caring clinicians and nurses had the time to talk things over with patients and relatives, when the decision was taken by patients and relatives and when there was plenty of time for everyone to get to the point where they accepted the way things were.

In reality, there was just too much pressure. The decisions were taken too quickly, by busy clinicians not patients or relatives.

There wasn’t enough time given to talk it over, to explain, to think things through, to get ready.

Essentially, there wasn’t any proper choice.

Soon the motivation wasn’t care it became convenience.

Soon it became a way of clearing a much needed bed.

Soon, people stopped bothering and just put people on this road too early.

Look at it this way, doctors often have to give patients bad news – some do it well, some do it pretty badly. Some couldn’t care less.  There aren’t any rules.

The LCP was an attempt to create a framework for ending things well – unfortunately it didn’t take account of the individuals who had to carry it out and the pressures they were under.

It’s the same with discharge from hospital – it’s fashionable now to get patients out as quickly as possible. A good thing – who wants to be there any longer than needed, except that now too many people are sent home too early, and are straight back in as a result. That’s because the pressure is on to clear beds.

So it was with ‘end of life care’. I’m glad LCP is going, I just fear what comes instead.

Actually I have a real problem with the whole concept of ‘pathways’, which is the new NHS buzzy for how you are dealt with by the system, I’ll deal with that another time.

Neil Harris

(a don’t stop till you drop production)

Home; helpmesortoutthenhs.blogspot.com

 If all this is getting you down, the fun is going on at;

helpmesortoutstpeters.blogspot.com