On Tuesday the 13th January, Peter Tulloch together with Eddie Woodhead and Karen Colligan, attended the Westminster Health Forum. As a delegate he was entitled to submit an article for publication with the transcript. This he has done and his article can be read below. The transcript was made available to all the delegates and speakers `as well as parliamentarians and central government officials with an interest in the subject matter who could not be there on the day, and a wider audience of relevant organisations, businesses, academic groups and individuals. Here is Peter Tulloch`s article:
An unforgiving pathway
Introduction
Two years ago Baroness Knight wrote to me about the "Medical Mafia" and their determination "to keep their current practice of killing off elderly patients who are ‘blocking’ a bed." In the past few years there has been a widespread public outcry against deaths on the LCP, and Professor Mark Glaser characterised the LCP as being the "Most corrupt practice in British Medicine" (Daily Mail, 5 November, 2012). Glaser said that he personally has rescued "dozens" of people from certain death on the LCP. The day before the forum there was a report in the Health Service Journal (12 January, 2015) that there is a ‘sustained’ fall in the life expectancy of older people in some areas. The report suggests that this may be due to cuts in social care. I consider a contributory factor may also be the ‘Medical Mafia’ and their continued use of the LCP.
LCP confusion
The high mortality rate at Mid‐Staffs has been linked to the LCP and according to Anthony Wrigley in the Nursing Times (1 October, 2014), he is "aware that certain institutions have gone back to relying on it." And that there is a reluctance to admit this "due to its tarnished reputation." More worrying is his claim that the continued use of the LCP is due to "confusion" about the best approach to end of life care. All of this was swept under the carpet at Tuesday’s forum and I came away with the impression that, despite all their backslapping, confusion and chaos remain integral to palliative care.
The status quo
The LCP was introduced into hospitals by Palliative Medicine but the conclusion of the Neuberger Review that the LCP should be scrapped is evidence that their presence makes things worse. The only evidence‐based study on the effectiveness of the LCP was made by Constantini et al as reported in the Lancet (16 October, 2013) and the accompanying editorial concludes:
"that the benefits generated by the systematic implementation of the pathway are, at best, slight. In view of the little or no clinical benefit compared with standard care, any harms to individuals exposed to LCP, including premature death, are unacceptable."
This research paper showed that there was no advantage to palliative care over best medical practice. I suggest that there would be better patient outcomes if Palliative care teams were removed from general hospitals.
Parliament misled
In Hansard of 18 July 2014, Baroness Neuberger, speaking to the House of Lords of her review into the LCP, stated "It is important that we found no evidence that it had been used to hasten people’s deaths…" This is simply not the case. Her review panel had evidence from
me concerning my mother and this was acknowledged by them in a letter to me dated 7 March 2013:
"I would like to assure you that your account of your mother’s care will form part of the evidence to the review of use and experience of the Liverpool Care Pathway…"
My account is not necessarily proof, but it is evidence. I have obtained information that had been previously withheld from me and my account is now much more robust; and supported by clinical evidence. In any case, it was not the remit of the Neuberger review to investigate allegations of wrongdoing, and this of course they never did.
On Tuesday I said to Baroness Neuberger that I was "puzzled" why she thought it was "important" that they had not found evidence that the LCP had been used to shorten people’s lives. She replied that I had "misinterpreted" her. How? I only said that I was puzzled by her statement to the house.
Conclusion
If we really want to see ‘compassionate’ end of life care, I have a suggestion: instruct the police to conduct a thorough investigation into all allegations of misuse of the LCP. If criminal proceedings were brought against those who have misused the LCP, vulnerable patients would be given best medical practice care until the last moment of their natural lifespan.
Information about Health Forum below:
http://www.westminsterforumprojects.co.uk/forums/index.php?fid=westminster_health_forum
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