Monday, 15 July 2013

Liverpool Care Pathway

The Liverpool Care Pathway is "frequently used as an excuse for poor quality care" according to the BBC news at 10pm. It is fairly obvious that everyone wants dignity in death and that was the aim of the care pathway which was devised in Liverpool. However we are now told that there are shocking reports of poor treatment under this pathway. It was misused and misunderstood. How can this be?

We have protocols for this and policies for that and we have best practice which is carried out throughout the country and the Liverpool Care Pathway was part of this. It seems that junior doctors thought it was alright to put people on this pathway at times when they had no support from more experienced colleagues. Well you don't have to be a doctor to recognise when people are dying and you don't need to have read a protocol in order to provide dignity to those who are dying.

Communication may have been poor at times and we may have professionals who lack compassion but replacing one pathway with another isn't going to remedy the situation. It is well documented that patients died through lack of care in Mid-Staffordshire. The pathway didn't help them but neither did an NHS climate that focused on goals and needed boxes to be ticked. The more boxes and the more documents to be read then the less time to display the compassion that is needed.

Relatives know when things are going wrong. It is fairly obvious when a patient needs a drink but if you have to read notes and follow procedures and then find that the Liverpool Care pathway only allows the patient to receive fluid through a sponge when they could be drinking from a cup then you know everyone knows something is wrong. Unfortunately it is difficult for NHS staff to get bogged down in doing the right thing. They have to follow a certain procedure because they are told it is best practice. What is that best practice? They will have to read up on it and make sure it is carried out to the letter.

The problem wasn't the Liverpool Care Pathway, it was the red tape in the NHS that stops the staff from thinking for themselves. In the 1980s I spent five days in hospital and my biggest concern was that I couldn't speak with anyone apart from my visitors (at very limited times of the day) and the cleaner. The mixed economy in the NHS made it impossible for the cleaner to have any conversations with patients a couple of years later as they didn't have time. They had boxes to tick and managers to answer to if they weren't ticked.

So the Liverpool Care Pathway should be phased out within a year. I presume this means that appropriate training for a new pathway has to be phased in. In the meantime perhaps we could have employees of the NHS thinking how they would like to be treated and then act accordingly. The trouble with this is that it may just need a matron, not a line of managers and a pile of documents.

Change the world

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