Coffee House

Liverpool Care Pathway: what went wrong?

6 November 2012

The recent media storm over the Liverpool Care Pathway has obscured the progress doctors and nurses have made over the past decades in the UK in improving care for patients who are near death. Since the LCP was developed, patients in busy hospitals and other institutions are  less likely to be left to die in pain and discomfort.

The Pathway itself is simply a framework which reminds professionals to consider, and document, the process of care for people in the last days of life. Without it, some professionals may struggle to shift their focus to important aspects of care such as comfort measures, pain control, communicating with, and supporting, the family, carers and friends. It does not replace clinical judgement, and it is not irreversible – if the diagnosis of dying turns out to be premature, patients can be taken off the pathway.

However, it is clear from recent media stories that relatives believe that some seriously ill patients have died prematurely as a result of being treated, or mistreated, under the Pathway, and these concerns should be taken seriously and investigated.  If there is something wrong with the LCP or with the way it is being put into practice in certain quarters, we need to get at the facts and take corrective action.  Equally, if the allegations are based on, for example, misunderstandings, that too needs to be established so that dying people and their families are not caused needless anxiety.


If anyone should have any concern about the way clinical care is being provided, they should bring their concerns to the attention of the local health care trust so that they can be investigated.  I can understand why families may be reluctant to do that at such a difficult time. What is needed  is a careful and unbiased sifting of any evidence that exists to reach the truth and take steps to improve practice.

Recognising when somebody is likely to die within days or even hours requires skill and experience. Sometimes, it’s obvious; other times, it can only be based on judgement and experience. Even then, vigilance, repeated assessments and a willingness to revise the decision are all part and parcel of good care. When someone is close to dying, they are often unable to swallow food and fluids. That’s a natural part of what is happening. For some, providing artificial fluids may add comfort; in others, it often makes the situation worse. Every decision must be based on carefully balancing the benefits versus burdens to the patient of anything we do. In doing so, doctors and nurses need to talk to patients and families – communication is a crucial part of good care.

It is possible that some doctors and nurses are not putting the LCP into practice appropriately, or communicating with patients and their families, as they should.  Such shortcomings exist in all professions.  Equally, doctors and nurses themselves should not be over-defensive.  Britain is indisputably a world leader in palliative care but there is always room for improvement in the best clinical practice.  So this is a good opportunity to step back and look at the care we provide for dying patients, without necessarily defending or attacking the LCP, which is only part of the bigger picture of end of life care.

Dr Bee Wee is president of the Association for Palliative Medicine of Great Britain and Ireland and a Consultant/Senior Lecturer in Palliative Medicine at Oxford University Hospitals NHS Trust and the University of Oxford.

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  • DiscWorld

    Ditto here. My SON was put on a perversion of this damnable pathway in error. The error was never overturned and he died after four attempts to kill him more quickly failed. Eventually he was killed by overdosing him very heavily indeed. This happened despite clear clinical signs of recovery that only an idiot could miss during the 40+ days he was being deliberately sedated to death. Why that long? Shift one would reverse the damage that shift 2 was (I say again) quite deliberately inflicting on him. What went wrong? The Consulants, three of them in all, were trying to impress their registrars. How good their prognosis appeared to be was more important to them than a human beings life. That’s what went wrong gentle folk.

    • Neuberger’s Cocktail

      40 days is not ‘imminently dying’…PLEASE report it to the GMC… ….its called ‘burying your mistakes’….they dont just do it to one patient if they get away with the first few…

  • Denise Brookes

    My father is 90 and we recently discovered that he was on the Liverpool Pathway, he is not ill just old, tired, underweight through lack of care. He was denied medicine to improve a chesty cough and eye drops. We were not informed about this until a care worker told us that the codes next to his name hinted at how long he has left. He is in a Nursing Home and other family members are going in to feed residents as the weight loss in some residents is alarming. What action can be taken about this?

    • Will Young

      Denise, please contact the webmaster of who will do his best to contact me. I can no longer make further public comment as my case is now sub-judice. I have someone who can hopefully help you as he has for me.

  • Jemima Khant

    Q. Who blames inadequate training for the faults in the Liverpool Care Pathway?
    A. Dr Bee Wee.
    Q. Who was made national clinical lead responsible for e-training medics on the LCP?
    A. Dr Bee Wee…see page 8 of.

    Who suggested you give her column space for God’s sake?

    A flurry of activity since the press furore, and they’ve tried to smuggle a ‘consent taking ‘ procedure into their documents at the ‘End of Life Care ‘ team website without anyone noticing.

    The fact is, the LCP was written in 2003, before the Mental Capacity Act 2005 came onto the statutes….to do anything without consent (particularly render unconcious with sedatives and withdraw medications, food, fluids and all treatments apart from morphine)…is manslaughter.
    Where DID they get her from?

  • Alica Jones

    “[The Liverpool Care Pathway] …is not irreversible – if
    the diagnosis of dying turns out to be premature, patients can be taken
    off the pathway.”


    ..the case of Mrs. Renate Overton in Howard
    Shipman’s case established that a mere 20mg of morphine caused an irreversible coma…the
    LCP allows unlimited ‘off licence’ daily doses of morphine in combination with other CNS depressants that guarantee your blood fills up with CO2 and you suffocate….even the BNF describes this as ‘dangerous prescribing’. Mrs. Overton wasn’t ‘terminally ill ‘
    either, she was 46 and had fairly mild
    asthma…she ‘survived’ in an irreversible, morphine-induced coma for 14
    months….then died. Don’t believe it when they claim ‘you can be put
    on the LCP and taken off it if you improve’… see paragraph 8 here..

    There is NO NAXOLONE in the Liverpool Care Pathway ‘Just In Case Boxes’ of drugs that they leave in people’s houses, and in Care Homes….there is no intention of ever reversing this once you’re on it!

    We think the fact that Dr. Bee Wee has only managed to hitch her name on 7 co-authored ‘research papers’ since qualifying in 1988 indicates her level of ‘expertise’… do these people latch onto the public funding teat for so long?

    This is what your money is keeping in shoe leather, folks!

  • NHSNaziHunters

    Jan 2012: Bulk of this organisations ‘expert members’ are nurse consultants /have PhDs in ‘nursing studies’ -or students! Absolutely obvious why they are killing non terminally ill people then! Nurse Consultants ? Say no more! – the DoH can’t even tell how many members are practicing abroad, or name the authors of some of their key End of Life Care Pathway documentation! And now Lamb is allowing them to review themselves and each other…….!!!!!!!!1 See FOI Act request here.. .Hunt is just getting one bogus ‘charity ‘ to vouch for the medical credentials of the other

  • Alica Jones

    Dr Bee Wee and her colleagues have been paid a sackload of money since 2008 to roll out this ‘care pathway’ (advisory role on – if they’ve managed to screw it up so badly for so long, why on earth is she still in shoe leather?

    and P.S. – most of the ‘consultants’ involved in this ‘palliative care’ pathway are ‘Nurse Consultants’ – they use the title interchangeably. Whole load of ‘Doctors of Nursing Studies’ are covered by the term ‘Palliative Care Doctors’ in their literature. Need I say more?


    As an American dr I had the privilege of working in New Zealand. We used the LCP on terminally ill patients after consultation with their loved ones. We would never start the LCP without one or even many family meetings. We monitored patients carefully and a few actually “graduated” and improved enough to be taken off the LCP. The key is communication with family and monitoring of patients. When I returned to the USA it was my hope that something similar would take root here. I guess no other medical procedures or systems are ever poorly practiced? The problem is with the clinicians implementing the LCP, not with the principals of the LCP. I guess it will be many years before we get something similar in the USA.

  • Mari Muir

    I have to correct a wrong statement I made 40 minutes ago when my previous post was accepted. When speaking to my doctor four/five years ago about how abhorent the Liverpool Care Pathway was, I also said I also hated the sound of the words ‘Palliative Care’ because I felt they would start with that then end up with the Pathway. It was then that he made his comment that it may be the kindest thing for a patient who has less than six months to live, to be put on Palliative care. (not The Pathway as I erroneously stated before).What I disagreed with was I felt nobody can possibly state that someone has less than six months to live. And in the same way nobody can possibly say that someone would be better dead, which is what the Liverpool Care Pathway presumes and then forces this idea onto the grieving next-of-kin. Incidently my sister’s husband was the only person consulted with and was forced into accepting the Pathway for his wife – ‘The doctors know best.’ (That doctor had never before seen my sister.) They didn’t like me because I had seen all the things that were not as they should be. Many of the staff in that Nursing Home had seen it too. A young nurse said to me, ‘We did not want to put H. on the Pathway but we have to do what the doctor says.’

  • Marie Muir

    “If the diagnosis of dying turns out to be wrong patients can be taken off the pathway.” Many of us don’t take very much medicine. How many patients are gonig to improve when put on morphine and given no food or liquids? When you start doing that to someone your intention is to make them die!!!!!!! The idea behind that treatment is certainly not to make them live.
    In every article I have read about The Liverpool Care Pathway I find that phrase particularly horrifying. ‘If the diagnosis of dying turns out to be wrong patients can be taken off the pathway,’ I can’t understand why nobody ever comments on how shocking that phrase is.
    The pathway should not exist. My doctor (no longer) told me after my sister’s death that if it was thought that a person had less than six months to live then it would be kinder to put them on The Pathway. What worries me is that he could see absolutely nothing wrong with that statement. What do doctors believe that they are? How important do they think they are? I think you have to get to a certain age – over sixty perhaps – and have seen the horror of a much loved relative being killed – before you can appreciate how wonderful, how sweet, how unique, how irrepeatable life is. When it’s gone it’s gone. And if you are the doctor who made it go, one day you will understand what you have done.
    The answer to the question, “What went wrong?” is that it never was right.

  • disqus_rq1yI97q3c

    guess what first option LCP not treatment

  • Daniel Maris

    To my mind, this just underlines why we need a legal framework for euthanasia.

    Some elements would be:

    1. The creation of a new profession of “mortologist” or similar. A mortologist could not be a member of the medical profession. His duty would be solely to the person dying. I think it is important we preserve the central notion of doctors being there to preserve life not hasten death.

    2. A straighforward procedure for people to elect in advance by say age 60 to be eased into death in the event of mental or severe physical incapacity.

    3. A similar procedure for people who suffer illnesses prior to age 60 which may result in severe incapacity.

    4. A law against relatives,or beneficiaries of wills, counselling or seeking the death of a relative through the euthanasia procedure.

    We have to face up to the ability of science to extend our lives in a very unnatural way, so that we linger on in incapacity.

  • Dr Jane V Bond

    Excellent, well-balanced article which underlines the need for fully qualified and experienced doctors and nurses to be involved in any decision and to continue to monitor the patient’s clinical state.

    • Judy

      The comments here illustrate vividly that the fully qualified and experienced doctors and nurses are likely to be just as much of the problem as untrained care assistants, “members of the team” who assign patients to the Liverpool Death Pathway. And they’re backed up by NHS study after NHS study which shows how often those with dementia and/or mental impairments are routinely failed by the medical care they receive. 12,000 unnecessary NHS deaths per year. Why is there not more of an outcry about this horrendous situation?

  • Rhoda Klapp

    So is Bee Wee coming back to answer any of the comments here? Or was this more in the nature of a drive-by intended to placate the public?. If so it has failed in its purpose, because it has brought out evidence of all sorts of practices which should cause considerable concern to the users of the NHS.

    This set of comments deserve an answer.

  • Judy

    I don’t know if you’re aware that a particularly pertinent programme, “Second Class Patients?” on the appalling death toll of the mentally disabled in NHS hospitals was broadcast on BBCR4 File on Four last night.

    It was based on a Mencap report from February this year, which documented very clearly how such patients are routinely treated with indifference and assigned to “DNR” categories simply by reason of their cognitive status.

    The programme brought out in a particularly shocking way how 50% of the deaths of such patients in hospital (which are alarmingly frequent) are found to be unnecessary deaths. (available online for a year, fortunately)

    The case histories included one appalling one from Barnet Hospital, my local hospital, of a young woman literally neglected in hospital to death.

    So that’s the context of implementing the LCP. Not only is it only too clear how readily such patients could be classified as “near death”, but how readily they will get to that point via prior neglect and/or diagnostic failures. This is another factor which the LCP lobbyists like Dr Bee Wee blandly brush over by saying that of course it should not happen, whilst ignoring the NHS evidence that it very frequently and even routinely does.

    One of the things that the programme didn’t say explicitly is that the parents and next of kin of people with learning disabilities often have similar issues themselves, or have very modest learning achievements. Thus, they find it very difficult to understand adequately what’s happening to their loved ones, or intervene appropriately till it’s far too late and their loved one is at death’s door. This was the heartbreaking case of the parents of the Barnet Hospital patient, who observed she wasn’t being fed–the food was just left by her bed, but she wasn’t capable of feeding herself–till she was down to weighing three stone. They obviously had no idea how to stop it happening.

    The programme also brought out how arrogantly doctors write off such patients, and hospital staffs blandly tell the relatives that they don’t really cater for people with learning difficulties.

    I could hardly believe the horrendous account that emerged of one patient who seemed to have been literally have been committed to die by a doctor who had decided there was no justification for her to live, despite the anguished efforts of her parents to reverse his decision.

    So the whole notion of patient and relative consultation and consent are clearly totally unworkable for LCP to be implemented in ordinary NHS hospitals without it routinely leading to euthanasia for such patients, as well as those in comparable situations, eg patients with dementia.

    Meanwhile, the APM & Consultative Nurses in Palliative Care Reference pro-LCP pressure groups are fighting the corner of LCP by putting out letters claiming that LCP is being misrepresented by “sensationalist” reporting, which make it look as if they are supported by every relevant professional and charity group in the field, and they are systematically getting rosy-picture pleas for LCP put in every publication they can.

    Why, goodness me, here’s one that’s popped up on the Spec site by Dr Bee Wee, president of the LCP lobbyist group APM, herself.

  • Dr Liz Miller

    The Liverpool Care Pathway may be initiated by any Health Care Professional, who considers themselves part of “The Team”. The decision does not have to be confirmed by a doctor. There is no age limit. No review is necessary and no safeguards are built into the process. No diagnosis is needed, it is enough that the person “looks unwell”.

    The LCP may have started out as a way to prevent people dying in severe pain or discomfort caused by a known terminal illness. In my opinion, it has changed into something on a level with Dr Jane Barton and Dr Harold Shipman.

    The NHS has become a nightmare of State Based Medicine (vis Mid + North Staffs). The interests in the NHS are now largely financial. Massive contracts awarded to favoured companies behind closed doors, to secure life after politics for Blair, Cameron and other career politicians.

    The most expensive part of the NHS is looking after the frail and elderly. The commercial solution is the Liverpool Care Pathway, aka overdoses, inappropriate medication, starvation and general neglect.

    Conflicts of Interest

    • Jemima Khant

      and still no adequate protection for whistleblowers at the GMC- know why? They already know they’re culling the elderly, and couldnt give a stuff…..

  • Frank Sutton

    Why does it have that ludicrous – grotesque – name? You’d think that the notoriously chippy scousers would take offence at having their city named in a form of legalised murder.

    “Liverpool pathway” conjures up a hideous image of some piss-sodden alley with
    Cilla Black at the end of it, grim reaper’s scythe at the ready, intoning “You’ve had a lorra, lorra life, Chuck, and now it’s time to say cheerio…”

    • Jemima Khant

      They even have ‘palliative care ambulances’ now…specifically to take you on your final end of life thrill ride Frank…theres a video of on on Youtube at it even has a fridge and what they term an ‘air freshner unit’…ring any bells??

  • Blackpoppy What a naive Dr Bee Wee or is she?? Having just written to her recently with attached drug charts of my dear mothers abuse and the opportunity to research the hundreds of others at the same hospital, I don’ think she wants to know the the truth that the LCP has become a culture everywhere…power over the people!

  • Sharon Kinlin-Martin

    Dr Bee Wee is allowing herself to be

    blinkered when she suggests that those relatives who experience abuse of the
    end of life pathway should seek redress by asking the health care trust
    responsible to investigate. Anyone who has ever attempted to negotiate the NHS
    complaints procedure knows the system is deeply flawed and most complaints end
    up inadequately investigated. It is a system that seems determined to break the
    will of those who use it to unearth wrongdoing.

    It is also true, as is mentioned here, that
    no safeguards are in place to protect the sick and vulnerable from being placed
    on the pathway inappropriately. It is now admitted that individuals have been
    placed on the pathway without their consent or that of their families. Are we
    to believe that those in power had not already been alerted to these abuses and
    were not in some way complicit?

    The latest knee-jerk government reaction to
    quell growing and justified anxiety is that relatives or patients not properly
    informed can sue hospitals for failing to follow the new NHS constitution. How many grieving and traumatised
    relatives would have the stamina to take up a costly civil action even if they
    could afford it? If it is accepted
    that the person was terminally ill who would take up the case? Challenging “medical opinion” to end a life
    inappropriately through a medical negligence claim is also full of pitfalls.

    The word “civil” is also interesting as it
    is the polar opposite of what all those seeking justice need and that is a “criminal”
    prosecution. The latest initiative
    fails to address what action those relatives should take if their loved ones
    are placed on the protocol before they are ready to die and without any
    evidence of a terminal illness.

    In a perfect NHS the Utopian “care pathway”
    might have a ring of sincerity but we are regularly faced with stories of the
    elderly being starved, dehydrated and neglected long before they get to the
    point they can then be pushed on the pathway when family members are looking
    the other way.

    In Dr Bee Wee’s account we are all being
    invited to buy into the myth of a hospital culture where everything is done
    properly, no rules are broken and “concerns” can be smoothed over with the
    right words and a few steps to “put things right”. I’ve witnessed the serious abuse of the pathway first-hand
    which resulted in the death of my mother who did not have a terminal illness
    and who wanted to live. I believe there is still much that remains to be
    uncovered about the scale of the abuses linked to the pathway.

    Peter Tulloch recently reported the
    attempted murder of his mother to the police when he discovered she had been
    put on the pathway without consent.
    The police did not see it as their place to investigate as it was a
    medical matter. While there
    remains no “pathway to justice” for its victims the scandal of the LCP will not
    go away and will continue to haunt us. It remains a stain on the soul of our
    nation. Dr Bee Wee is without doubt sincere and well-intentioned in wanting the
    very best of care for those imminently dying but the original benign LCP has
    let loose a monster that while offering a pathway of good intent has opened a
    doorway to something far worse than death itself – the institutionalised
    killing of our own people at their most frail and vulnerable.

    • Jemima Khant

      Agree-even the banner under the illustration misses the point …”The Liverpool Care Pathway has attracted criticism for the way some patients are treated at the end of their lives. “. Its attracted horror because of the way clinicians are deciding WHO is at the end of their lives. More or less anyone over 65 (median age = 82).

    • romeolima

      Sharon Kinlin-Martin has written a bang on rebuttal of the latest NHS attempt to pretend there is a redress system when there is not. I admit to being partisan after a two and a half year battle to prove a hospital drowned my mother although they said the fluid in her lungs was pneumonia. As all of us who have tried to use any NHS system know, the accused (the hospital) have full control of all the evidence, a situation that would not be tolerated in any other possible crime, and tracing ‘lost’ documents and proving that ‘angels’ lie saps your will to continue. Of course keeping such wrongdoing in the Civil courts is a deliberate policy and it should be a Criminal matter. By the way, we proved our version of events but the Inquest took two and a half years and the Hospital spent over £250,000 of public money on defending their version. We have yet to receive our costs for fighting them which were a little over £50,000.

      • Jemima Khant

        ditto…I’m £35K in life savings down…we asked for a computer audit trail …rather than printing the truth off, they typed an excel spreadsheet up by hand and passed it off as ‘evidence’. Ditto the fluid overload…11.5 litres went in and never came out…had pulmonary oedema and ascites post mortem, but coroner…’he was old anyway’. Perversely, I had to try to take HM Coroner to the high court in a bearaved state myself…HE (being paid for out of Council Taxes) was indemnified and had a QC from Temple representing him…on my own, in a bereaved state, I had to research ‘the law’ on the internet ..and risk his costs if I lost….basically, I was paying to shaft myself …..

  • David Lindsay

    This is what happens when you flog off the NHS to your mates and paymasters in the companies whose racket Obama is finally busting in their own country. People become refuse, to be disposed of.

    Although The Orange Book, the basis of the May 2010 coup, is behind this, the Lib Dems have in their time provided one of this country’s greatest ever pro-life MPs, right there in Liverpool.

    In fact, there have been many, many staunchly pro-life MPs from that area. But most of them have come from a different party. It is not peculiarly a Scouse thing. John Smith was totally pro-life. Gordon Brown was and is very eloquently opposed to assisted suicide.

    The present Shadow Health Secretary, Andy Burnham, is a practising Catholic who declined to back up Yvette Cooper’s condemnation of Jeremy Hunt’s expression of support for lowering the time limit on abortion to 12 weeks. Cooper’s support came instead from David Cameron and Nick Clegg.

    Save lives. Save life. Save, or restore, the National Health Service. You know what you have to do.

    • Rhoda Klapp

      I think it is evident from the stories here that there was a problem long before 2010, even if it did not then have the same label. The NHS has competing priorities and it may be that saving life doesn’t always win.

  • 2trueblue

    We know that standards in some part of the NHS are appalling, so it cannot be right to deny a person of water or food. The fact that it is part of a process in our civilised world beggars belief. Why not just give a lethal injection that is clear, clean, efficient and causes the minimum of discomfort? I guess because it would have to be sanctioned by more than one doctor?
    To have targets makes one think of HItler.

    How can starvation and denial of water be any part of a course of treatment? You can call it what you want, but it is not care. It is distressing for the individual/patient and the relatives/friends.

    We are truely crossing serious boundaries here and it has to be clear what the intention is and what the true prognosis for the patient is. To give people a lisence to ‘dispose’ of a life has to be entered into with the full consent and knowledge of the patient (if possible) and the next of kin. To sanction anything else is to fail to protect any of us when we are at our most vulnerable.

  • Jemima Khant

    What went wrong BeeWee? The roll out’s been rumbled…….

  • LordBlagger

    Having seen a surgeon kill of his mistakes, the decision to bump someone off needs to be taken out of doctors hands.

  • AnotherDaveB

    I hope to see Doctors, nurses, and NHS management prosecuted for what to my eyes is murder.

    • Jemima Khant

      They wont be…readBlack poppy’s petition below….another of the 120+ Gosport War Memorial Victims families still trying to get even an Inquest 12 years on…..disgraceful!

  • Cogito Ergosum

    The euphemism “care pathway” says it all. It is a death pathway.

    • 2trueblue

      Care is kind, being concerned, offering comfort, looking after someone. What they are talking about is neglect, depriving someone of comfort, and the basics to die in peace and tranquility. It does not equate with this sordid method of neglect. The fact that there are targets says it all.

  • follyscorner

    What went wrong?

    I’ll tell you precisely what went wrong and why I leveled a formal complaint
    against the same NHS Trust that Professor Pullicino practices from.

    I commend and fully support Professor Pullicino’s claims that the LCP is, and
    has been, at times used inappropriately.

    I accompanied my partner for, what should have been, an everyday routine biopsy
    of a neck mass that began 6 months previously. Her GP made a rapid referral in
    April 2005 for the biopsy and the ENT Consultant performed a Fine Needle
    Aspiration in July ’05. With the FNA proving inconclusive, blood and debris only, she elected for a biopsy under general anaesthesia in August ’05. Following surgery she suffered respiratory arrest in the recovery area and an emergency Tracheostomy was

    As opposed to accompanying me home that day the surgeon explained the
    unfortunate events and that she was now stable in ITU. I next saw her consciously
    4 days later on the nursing ward where she then told me, “I have been through
    hell”. Because she expressed a wish to seek legal action, when she returned
    home, I took photographs of her condition.

    In absence of any past medical history of any cancer, at just 63 years young, she died 3 weeks later and death is recorded as Lung cancer. Not until I obtained 300 ward medical notes, that took the Trust 4 months to provide, now condemning the NHS Trust’s treatment, did I discover the surgeon had implemented the LCP without anyone’s knowledge. Also discovered was an undated DNAR notice.

    The shambolic “Kafkaesque” NHS complaint, where the Trust deliberately stalled their responses in order to expire the limitation period for litigation, followed by 2 Independent Reviews, concluded that there is no evidence of cancer. Lung nodules present on a CT scan are, in fact, multiple pulmonary embolisms.

    Not knowing their misdiagnosis my partner was placed on the LCP and the first
    treatment to be deprived of was her respiratory medication being withdrawn.
    Subsequent ward notes then document, breathing difficulties, concomitant use of
    Diclofenac, Tramadol, Oramorph and MST (Morphine Sulphate).

    Again, only after I obtained the medical notes did I discover an undated DNAR notice and the surreptitious administration of a Morphine syringe, together with Midazolam and cyclizine.

    As I said, “what went wrong”? In this instance, virtually everything went wrong and I intend to bring the Trust to account. The greatest lesson Trusts need to learn is that
    the past days of relying on their complacent lying are over, when so much
    information is freely available. A clear demonstration is how Twitter exploded this
    past weekend with everyone commenting on the LCP.

    Regards, Concerned

    • sir_graphus

      A common tale in the near future, if we allow euthanasia.

      • Jemima Khant

        already is …..

    • Jemima Khant

      100% with you concerned- there are hundreds of similar cases – see ‘LIVERPOOL CARE OR DEATH PATHWAY???? on facebook

    • LordBlagger

      Quite. You’re lucky to get the notes. In one case I was involved in, they disappeared only to reappear when it was convenient for the NHS.

      • follyscorner

        All I can advocate my Lord is if you, or anyone, suspect foul play never approach the media. Before the Newspaper, TV or Radio can broadcast they need to get the defendents version of events and by doing so you’ve put them on high alert that a forthcoming complaint is expected, when incriminating evidence will get mislaid or lost. I heard alarm bells ring when the phone call from the hospital, primarily to inform me to come and collect the death certificate, quite voluntarily told me that because I was only a partner (we were together for 21 years) I would not be able to request a family post mortem? The Trust, during the Independent Review, have since admitted that they provided the wrong information. A quick look at my birth certificate will tell you I wasn’t born yesterday and therefore smelt a rat. The Trust deliberately lied to exceed and expire the limitation period to escape prosecution.
        Because I have all the medical records and facts I will continue to prosecute, or persecute, them in every available social network available.
        Still Concerned

        • Jemima Khant

          the same thing happens if you involve HM Coroner…who phones them up and points out which records need to be examined…ditto complaints to the CQC, who have to tell the hospital exactly which records/item of faulty equipment they want to inspect AND gives them a months advance warning of a visit to boot. HM Coroner simply walks all over the evidence

          • follyscorner

            Well Jemima, I didn’t mention it previously because we’re supposed to be concentrating on what is wrong with the LCP.

            The person that rang from the hospital, to primarily inform me to collect the death certificate, was in fact, a Coroner’s Officer. His precise words will haunt me until I have my day in court, as he said, “whilst I have you on the phone I can confirm that death will be recorded as LUNG cancer”. I questioned, “can you explain why LUNG cancer when only 3 weeks ago the Consultant surgeon diagnosed TONGUE cancer”?

            He replied further, “for the purposes of death registration I have to state from where the cancer originated”? As alarm bells were ringing I didn’t feel the need to challenge him any further.

            To reiterate, get all medical notes before approaching any media for publicity. Even though I did, and forwarded them to a London firm for an appraisal, I wasn’t ready for the further corruption to discover 18 months later that the solicitors had retained 100 of the 317 notes that I forwarded to them. I never checked the A4 envelope of the notes on their return, when I placed them in the office desk, because I had scanned all 317 notes to the hard drive before letting them go anywhere.

            Never trust anyone, or anything, until proven to the contrary. Never let the right hand know what the left hand is doing. And, most importantly, fight fire with fire.

            It took 4 years for the NHS complaint to conclude, including 2 Independent Reviews, where the clinical experts state, “from the CT scans and x-rays provided by the Trust none showed any definite evidence pointing towards a lung cancer”.

            A private independent report upholds the Healthcare Commissions findings but offers further opinion that the lung nodules were in fact multiple pulmonary embolisms.

            If anyone doubts my authenticity I have all responses from the solicitors including 6 years of archived emails.
            Otherwise ’tis a wonderful world we live in today? So long as you watch your back.
            Still Concerned!

            • Jemima Khant

              You are leaning on an open door here sir…i had to pay for private biopsy and immunohistology after a post mortem…coroners officer said ‘oi’ve never ‘erd of that’ and asked me to spell it for him! We had ‘cancer ‘ shoved on the death certificate for want of anything else to put- it was a benign renal mass…..NICE guidelines clearly state you cannot diagnose anything without a biopsy, but …why bother with anyone over 65? There no adequate legal remedy for contentious deaths in hospitals in this country….none at all. If you are elderly or disabled, you are what solicitors call a ‘low quantum death’….if you have no dependents, your executor can at most get the cost of your funeral in damages…and on a NWNF basis, 40% of a ww2 veteran’s funeral expenses are not worth a solicitors’ efforts. You are far from alone in your experiences ……

  • Magnolia

    No doctor can reliably tell when a patient will die or how long they’ve got to live but if you deny the elderly and frail food and water, then they will die rapidly even if there’s nothing else wrong with them. We now have a health system which is straining under the weight of its responsibilities to older people. In the past, seasonal flu used to kill a lot of frail old people who now survive (thankfully) due to the wonders of modern medicine. The modern NHS doctors are indoctrinated employees of the state and the state is short of cash. I believe that such doctors have already lost their professionalism because they are beholden to the political system for their training, career and job. They will be mindful of the state cost based restrictions rather than to give totally unbiased advise and unrestricted care to the individual patient in front of them.
    How many of us get the feeling that referral to specialists is being rationed by our GPs?
    In such a situation, what started out as palliative care could easily mutate in to a convenient and legal state killing machine. That is what might be wrong with the Liverpool Care Pathway.

    • Jemima Khant

      you are 100% right… hardly any patient over 75 gets offered dialysis..yet they are the generation who BUILT THE NHS….so much cheaper to tell them ‘nothing can be done’ or ‘your performance status is too low for the operation’…no quality control at all on the quality of these clinical decisions…or the age or racial biases..and no ability to get an impartial second opinion…it’ll just get ‘rubber stamped’ by a colleague!
      Rusty Lee’s mother would be DEAD by now if she hadn’t had her girls nearby…

    • LordBlagger


      The fundamental problem is that the NHS is supplier, insurer and regulator rolled into one.

      They need to be separated.

      The reason is that there is a conflict of interest. Why regulate if you have to pay compensation?

      Why provide good care if it costs you in your role as supplier. Far better to look after your own financial interests.

      Given that the NHS itself reports it bumps off 20-80,000 a year, its not surprising they are looking to legitimise their errors and the LCP is just that.

  • Jemima Khant

    BeeWee- can you conceivably explain how this is ‘reversible’ in the non-terminally ill? How, for example, do you ‘reverse’ the irreversible comas induced by large doses of morphine (well in excess of BNF recognised safe limits)? How do you ‘reverse’ irreversible renal failure caused by not only withdrawing/witholding fluids, but prescribing drying agents like hyoscine too? NO exit strategy was published in any of the flow diagrams in any of the versions of the LCP ….. no safeguards are in place to prevent abuse…none at all…yet its not only been rolled out across the entire NHS, but you’re even exporting it to 17 other countries….by all means give those writhing in intractible pain a good death’, but tell them ‘we are injecting a substance that will render you unconcious and another to stop you breathing’…don’t just ask their relatives ‘can we make your mum comfy’ and dress that up as ‘informed consent’- there is 0 quality control on the clinical decision making process…and none was even planned…

    • Jemima Khant

      Why are you now saying patients can be taken off the LCP?? And isn’t that a bogus, clinically ridiculous notion…..

  • MikeBrighton

    My gradfather (in law) was clearly put in the LCP in his early 90’s in hospital and was essentially denied food and water. He rapidly declined and the consultant was saying he hasn’t got long left…. His wife sat with him and made sure he was fed and watered and unsurprisingly he got better. They “reluctantly” let him go home and he lived for another 6 or 7 years at home in comfort.

  • Mirtha Tidville

    These days the Medical Profession(?) treat all end of live illness as a medical emergency…people in their 90`s suffering broken ribs whilst Doctors try to resusitate them..ridiculous. .My mother was 91 when she went on this scheme, as she had gone into a coma and was clearly dying. They explained the scheme and we agreed, my Mum had simply had enough and we had to let her go. This scheme is good, maybe it just needs tweaking and explaining better but it also needs some relatives to become realistic and reasonable. We all die…..

  • A Suffering Relative

    I am delighted to see this sober judgement.
    My mother in law had a tragic painful death over a weekend. She was not put on any kind of pathway. The staff muttered Shipman and were unable to conquer her pain.
    Our last memories are of a proud lady in agony and seemingly choking.
    I would not put my fiercest enemy through that.
    I did not know where to turn then or afterwards.
    What were we her protectors and loving family doing to let that happen?
    You can call it what you like and perhaps the name will now have to change but please oh please do not let another soul die in agony when there are carers aroud who could prevent that.

  • biggestaspidistra

    Looks good on paper but ultimately this is bureaucratic waffle from Dr Bee Wee.

  • ALB

    Same here….Just amounted to a regime of denial of water and food….Fortunately my wife is a nurse and we stayed with her and kept her lips and mouth moist and had to keep asking for ‘stuff’ to do it. The staff were bloody useless.

  • herbaljet

    My mother was put onto the LCP after her hip replacement, resulted in an undiagnosed UTI which caused renal failure. I was told she’d been put on it and it was all about palliative care. There was no mention at any point that I had a choice in the matter. Nor was there a mention that this would mean she would be refused hydration or food. She died less than 48 hours later. All this took place over two years ago and I am not about to start complaining to the trust now for the series of errors that led to her death. BUT I do think doctors are culpable if they do not explain the full implications of the pathway before seeking approval – let alone not even seeking the approval in the first place.

    • LordBlagger

      The problem is that if you don’t, they will do the same to others.

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