"The Liverpool care plan."

About: The Great Western Hospital / Older people's healthcare

(as a relative),

I previously wrote a recent article entitled 'Upset by communications about my brothers care', but I now feel compelled to add another event to this which happened after my brother was transferred from Woodpecker ward to Saturn ward at the Swindon Great Western Hospital. I subsequently wrote to the chief executive of the hospital, and intend to do so yet again, after I have recovered from the shock of what has happened, and done all that I need to in the aftermath.

My 76 year old brother had been ill for about 3 1/2 weeks with pneumonia and signs of renal failure as his passing of water although it had shown signs of slight improvement had not recovered any further so we were told by the doctor on his rounds last Friday.What happened next was unbelievable as whilst my wife and 14 year old autistic son were around my brothers bed side, the doctor said to him, 'we would have expected your kidneys to have responded to the antibiotics and other drugs that we have been giving you, but there has been little or no improvement and so we consider that it is pointless continuing with the treatment, and so we will not put any more tubes in to you, as your condition will gradually worsen and all we can do is make you as comfortable as possible'.

This as you can well imagine was extremely frightening for my brother, and alarming for my wife and my son.

The doctor then took us to the patient day room to add to what he had already said to my brother, and said that my brother was now on what was referred to as 'The Liverpool care plan' which means that any further treatment does not happen from that point onwards and is supposed to be made as comfortable as possible until the inevitable happens. I felt like they might have well have said that to save the cost of any further treatment, we have decided not to bother.

I found this decision shocking and appalling, as every deserves the right to receive treatment for as long as possible no matter what their age may be, just in case they do happen to turn the corner and recover.

Sadly my brother lost the battle for life that evening, but the ordinary nursing staff were really excellent, and are in no way to blame for what I now perceive as being cost cutting especially when it comes to the elderly. If you have an elderly relative in hospital I would consider making it clear that you wish their treatment to continue until there is no chance of recovery, and I would reject the Liverpool care plan.

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Response from Great Western Hospitals NHS Foundation Trust We have made a change

I hope you find the post to your previous comment of some use and provides some reassurance that we are investigating the issues you have raised in your complaint to the Chief Executive.

With regards to the specific issues you have raised above (regarding the Liverpool Care Pathway) I appreciate that end of life issues are very senstive and often distressing for family members. The Liverpool Care Pathway (LCP) is a pathway that's used across the NHS using the experience and the expertise of hospices in caring for people at the end of their life and bringing that learning into the NHS in order to raise the standard of end of life care in hospitals. The focus of the LCP is to have a plan for the end of life which is designed around the needs of each individual supporting them to have a dignified and comfortable death. The issue that matters most is the care of the patient and not finances or other factors of that nature.

Clearly with these very sensitive issues it is important that staff clearly communicate with relatives about the LCP and what support is provided to the patient and additional information to support relatives is being provided for use on the wards. We also have some useful information for relatives outlining what the LCP is designed to achieve which can be found on our website here: http://www.gwh.nhs.uk/wards-and-services-a-z/a-to-z/palliative-care/liverpool-care-pathway

I have alerted the PALS department to the issue you have raised above so that it can be looked at as part of the complaint you have already submitted and which is in the process of being investigated. You will recieve a full response to the complaint once the investigation is complete but do not hesitate to contact the PALS Team if you have any additional concerns which we can help with.

Update posted by sovietski (a relative)

The Liverpool care pathway, meant that the tubes keeping my brother alive including those giving food, antibiotics and other medicines, were removed. As far as I am concerned this is wrong and my brother should have been treated right up until the point of death as the kidneys may have at some point started to function again.

In fact one of the nursing staff the day before said that there had indeed been a slight improvement in my brothers urine output. Any hope of recovery however slight was removed when the tubes in his arm were suddenly removed, and more to the point this was done without us being told about it.

I would like to repeat that I see the Liverpool Care Pathway as a way for senior clinical staff to make decisions over whether they think that treatment should end, and this I believe could be clearly down to cost cutting measures where the elderly are concerned.

I repeat that even doctors do not have the right to play God in such circumstances, even though they have now been given their own budgets.

I reject totally the reply to my original letter entitled 'The Liverpool care Plan' which should of course be the 'Liverpool care Pathway', and I stand by what I have said 100% and would like to make this reply as a clear statement to other friends and relatives of elderly sick people that may be in the Swindon GWH or other hospitals up and down the country to beware, and to reject the 'Liverpool Care Pathway' and demand that their relative is given total treatment right up until the point of death, or recovery.