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Clinical Negligence Solicitor James Bell discusses the Liverpool Care Pathway

By Principal Lawyer, Clinical Negligence

Earlier this year I concluded a claim for the family of Pamela Goddard. Pamela fought breast Cancer for over 50 years. She led a full and active life and had a loving and supportive family. 

When she fell ill with Cancer again in 2008 her family were with her all the time at her hospital bedside. Pamela was not well treated however and she developed Pressure Sores as a result of not being mobilised enough and not having the right mattress. Due to her Pressure Sores becoming infected, she developed Septicaemia. On 23rd October 2008 a decision was taken to put her on the Liverpool Care Pathway (LCP). The Liverpool Care Pathway means the withdrawal of fluids and water and the use of morphine to sedate the patient as they pass away.
Neither Pamela nor her family were asked to consent to this. A "do not resuscitate form" was filled in on 21st and 23rd October and two doctors placed Pamela on the Liverpool Care Pathway stating , falsely, that the family were not told or consulted because they were 'not present.' This was not true at all. I took statements from all of the family. They were at the hospital everyday from the moment Pamela was admitted.
Pamela died 4 days later. She was clearly a fighter as the average life expectancy of someone placed on the LCP is just 29 hours.

The Goddard family's claim alleged negligent treatment of the Pressure Sores and an allegation of battery for imposing the LCP on Pamela without her consent. We argued that the imposition of the LCP was an active "treatment" which neither the patient or her family had to specifically consent to. The legal claim settled with no admission by the Trust that the LCP had been imposed without consent. This case settled earlier this year and it was hard to obtain media interest in this story despite these revelations. I think it was perhaps too much to accept for some sections of the media.
The controversy over the LCP was given fresh impetus in the summer when a group of doctors, led by neurologist Professor Patrick Pullicino from the University of Kent, claimed that death on the LCP was a ‘self-fulfilling prophecy’ and a form of backdoor euthanasia, being used to get rid of difficult patients and to free hospital beds.
The Telegraph has again added a new twist today. The paper has discovered, via a Freedom of Information request, that,
"The majority of hospitals in England are being given financial rewards for placing terminally-ill patients on (the LCP)"Almost two thirds of NHS trusts using the Liverpool Care Pathway have received pay-outs totalling millions of pounds for hitting targets related to its use…The LCP was originally developed at the Royal Liverpool University Hospital and the city’s Marie Curie hospice to ease suffering in dying patients, setting out principles for how they to be treated.
It involves the withdrawal of treatments or tests from patients which doctors believe could cause distress and do more harm than good." Protocols say that doctors should consult the patient, if possible, and their families. But the system has been mired in controversy amid claims that it can actively hasten death.A series of cases have also come to light in which family members said they were not consulted or even informed when food and fluids were withheld from their loved-ones. In some instances patients placed on the pathway because doctors judged that they were nearing the end of their life went on to recover."
Now I can accept that a financial payment for certain treatment can be warranted in some cases but financial inducements should never lead the treatment, they should follow. But ...
"Central Manchester University Hospitals - 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 per cent in the past year."
The article quotes, Dr Gillian Craig, a Consultant Geriatrician who was among the first doctors to raise the concerns over the possible flaws of the LCP, described the use of the incentives as “absolutely shocking”.
“I think there should be questions in Parliament as to who instigated this policy and I think the cash payments should be stopped forthwith,” she said.
“You can’t pay people to use a certain protocol that everybody knows to be lethal.”
The lack of consent is a key issue for me. Studies have shown that up to one third of patients/families are not consented for the LCP. Now add to that the concerns that hospital managers now have targets to meet in order to obtain extra cash and I think we should all be seriously worried about what has been going on in the NHS for the last 7 years since the LCP was rolled out across the NHS.
I think there is a place for the LCP but it's use on such a large scale (over 100,000 deaths per year) and the issue of the financial inducements means that the Government's urgent review of the LCP cannot begin soon enough.
I would also say that that the financial inducements need to be suspended until the review has been completed.

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