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Who will be accountable for the media storm over the Liverpool Care Pathway?

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If you kick a beehive, you have to expect a lot of buzzing; don’t then demand that someone do something about the noise. The Daily Mail has been doing just this by attacking end of life care, and the Liverpool Care Pathway (LCP) in particular, on an almost daily basis throughout October, and protesting loudly about ‘growing criticism’ of the pathway.

This sustained campaign by the Mail, supported in part by The Daily Telegraph, has led to the announcement of a major review of the LCP by the Association of Palliative Medicine, and the release of a consensus statement in defence of proper use of the LCP signed by the leader of 22 professional bodies, including the Royal College of General Practitioners. Before the professions browbeat themselves any further, however, the depth of the ‘controversy’ reported by the Mail deserves detailed scrutiny. Is there really deep concern about the LCP within the profession, or is this a storm in the Mail’s teacup?

Since the beginning of October the Mail has published no fewer than 19 articles about the LCP, all in a critical vein.1 They have used emotive language, such as re-naming it the ‘Death Pathway’, and ‘Liverpool Killing Pathway’, and discussing ‘Death Lists’, which are reminiscent of the Nazi term totenbücher. Their articles use inappropriate imagery such as a young woman on a ventilator or two perfectly fit-looking elderly patients chatting on their hospital beds - neither of which are suitable scenarios for using the LCP and can only serve to add to misconceptions about its use.

The Mail has covered every angle of the story from accusations that GPs are to single-out’ 1% of their patients for end of life care, to very serious accusations that the NHS ‘kills off 130 000 elderly patients every year in order to free up beds. Where there is no new twist to the story they have resorted to frequent use of heart-rending anecdotes of suffering patients and families kept in the dark in order to keep momentum to the story.

While individual patient stories should never be ignored, neither can they be used as evidence that the LCP is fundamentally flawed - real evidence concerning the LCPshows that 94% of carers and families felt they had been involved in decisions.2 The only significant omission from theMail’s extensive coverage was a failure to report the release of the consensus statement - this is referred to in passing in some of their articles, but has been kept in low profile.

In place of this important document from bodies which together represent the majority of doctors and nurses working within the NHS, as well as those of several major charities, The Mail refers repeatedly to a ‘growing number’ of doctors who are worried about the LCP. Predominantly this means Professor Patrick Pullicino, a consultant neurologist who has been vocal in his criticism of LCP, and is quoted again, and again, and again in the articles.

In total the articles contained negative quotes from eight further doctors - each either representing just themselves or a pressure group such as The Medical Ethics Alliance, or the Catholic Medical Association. These groups are entitled to their opinion, and we should listen dispassionately to their concerns, but we should not be deceived into believing these eight views are representative of the profession.

But nor should we blindly defend the LCP without question - if the Mail’s campaign tells us anything it is that in some cases there have been problems which should be looked into, and that good communication is essential to proper use of the LCP.

Had the Mail been manufacturing controversy about which colours are in fashion this winter, none of this would matter, but the impact of this malicious campaign has been to instill fear into patients who are dying and their relatives, already being felt on the ground. There are enough difficult conversations to be had in palliative care without having to deal with the unnecessary fears this campaign has generated.

Just as with the debacle over the MMR vaccine in the late 1990s, the balance of media coverage has been heavily distorted towards the views of a small minority of doctors, and the patients are the ones to suffer. No doubt an investigation into the LCP will be necessary in order to restore public confidence, but where will the parallel investigation be into the behaviour of The Daily Mail, and who will be able to hold it to account for such blatantly irresponsible reporting?

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.

Reference

1 Search on the Daily Mail for ‘Liverpool Care Pathway’, last 30 days. http://tinyurl.com/DailyMailLCPsearchOctober

2 The Marie Curie Palliative Care Institute Liverpool (MCPHIL) and the Royal College Of Physicians (RCP). National Care of the Dying Audit – Hospitals (NCDAH), Round 3 Executive Summary 2011/2012. 2012. http://Www.Rcplondon.Ac.Uk/Sites/Default/Files/National_Care_Of_The_Dying_Audit_-_Hospitals_Exec_Summary.Pdf

Readers' comments (3)

  • time they scrapped it and used good old common sense with terminal patients involving them and their families all the time rather than adhering to these pathways from which people like Mcmillan nurses etc seem to justify all their actions.

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  • What do you expect ?
    the Daily Mail is not exactly the Lancet !!
    The L.C.P will be replaced by something else but probably very similar in an attempt to please 100 % of people affected which is impossible, and in the meantime , clinicians will be confused on to what to do and more people will suffer an agonizing death..
    well done Daily Mail !!

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  • I spent yesterday morning having the end of life discussion about my Dad, following an LCP approach. I now feel more than ever that the Daily Mail/Telegraph campaign is malicious and damaging.
    You need a pathway to ensure that all the necessary steps are followed and the necessary paperwork put in place. 'Common sense' may miss the need for the ambulance service to have DNACPR forms for example

    It does require the health professional communicating sensitively with the family - this happened in our case, but I can imagine that sometimes it doesn't, however that is not a reason to abandon the whole approach.

    A particularly misleading point which the DM and DT hammer on about is withdrawing food and water. As the nurse explained very clearly to us, in the last few days of life may people lose the ability to swallow, therefore giving them food would choke them and giving water would drown them - it's a shame this isn't explained properly.

    The whole agenda fits in very well with the ongoing attacks on every aspect of the NHS which both papers are pursuing and which it is hard not to see as politically motivated.

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