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 Post subject: Liverpool Care Pathway
PostPosted: Sat Dec 14, 2013 2:14 am 
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The discredited Liverpool Care Pathway is to be “rebranded” rather than abolished, senior doctors have said.

In July ministers said the end-of-life protocals would be axed, after a damning independent review under covered frequent and “heartbreaking” cases of patients being denied water and left desperately sucking at sponges used to moisten their mouths.

Instead, every patient would receive individual end-of-life care plans, following the review led by Baroness Julia Neuberger.

However, doctors who led criticism of the pathway say new draft guidance, seen by the Daily Telegraph, outlining a replacement scheme will perpetuate many of its worst practices, allowing patients to suffer days of dehyration, or to be sedated, leaving them unable to even ask for food or drink.

Professor Patrick Pullicino, a consultant neurologist with East Kent Universities NHS Foundation Trust, said the new plan “lacks essential key components of the Neuberger report and perpetuates errors that were central to the dysfunction of the pathway”.

The independent review said relatives who had begged for water for thirsty loved ones had been shouted at by nurses.

Under the new proposals, any patients unable to swallow could be denied food and fluids by tubes unless a hospital team decides it is in their “best interests” to have them.

This goes further than current laws which only allows such practices for patients assessed and found to lack mental capacity.

Baroness Neuberger also said more research was needed to establish whether it is possible to to predict death with any degree of accuracy

But the new guidance outlines protocols for patients who are “likely to die within the next few days”.

Prof Pullicino said: “There is no indication about how patients who are in the last days of life are going to be diagnosed as such. There is no mention of a research base to improve this prediction. This was a main central concern of the Neuberger report,” he said.

Any replacement scheme should be studied before being introduced, or risked simply repeating the same problems, he said.

“The Liverpool Care Pathway not only produced many instances of suspected hastening of death but also repeated instances of poor care.”

“The fact is that little seems to have changed, including the use of syringe drivers, anticipatory prescribing, use of sedation and narcotics and limitation of hydration and nutrition by a ‘best interest’ team decision.

When ministers said they would abolish the pathway, Norman Lamb, care services minister said its use had become a “national disgrace” after the review found widespread evidence of “shocking” abuse, including patients dying of dehydration after being heavily sedated.

NHS England responded to the Neuberger Report by establishing the Leadership Alliance for the Care of Dying People which has been asked to advise the Government on future practices for care of the dying.

The alliance has published its proposals in an “engagement document” which it is presenting at meetings of medical and palliative care professionals around the country up until the New Year.

Denise Charlesworth-Smith, who represented family and patient groups on the Neuberger committee, last night condemn the replacement plan as a “stitch-up” by a medical establishment which has always supported the pathway.

“This alliance has come up with a product that looks very similar to the LCP,” said Miss Charleworth-Smith, whose father Philip, 82, died on the pathway in Nottinghamshire last year after he was admitted to hospital with pneumonia.

“It has rebranded and repackaged the LCP,” she said. ‘It is not good enough - this whole matter stinks.”

A spokeswoman for NHS England said the alliance was keen to avoid the mistakes of the LCP but would not say whether any research would be undertaken to provide a science base for the new replacement.

“Ultimately it will be the experience of patients and their families that provide the real quality assurance,” she said.

Defending the use of sedatives, she said that “if used in the right way and in the right circumstances” they could help to “alleviate distress and allow someone to die in a more comfortable way”.

“Therefore they will be part of the alliance’s way forward regarding high quality care for people in the last days to hours of life and the alliance will be making sure that they are used appropriately and avoid problems of the LCP,” she said.

The alliance includes the Department of Health, the Care Quality Alliance, the Nursing and Midwifery Council, NICE, the Royal College of GPs, the Royal College of Nursing and the Royal College of Physicians, as well as NHS England, the General Medical Council, the General Pharmaceutical Council and the cancer charities Macmillan Cancer Support and and Marie Curie Cancer Care.

Many of the groups were signatories to a “consensus statement” of uncritical support for the LCP last year as good medical practice at a time when hundreds of families were complaining of their bad experiences of the pathway.
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Hospitals are paid millions to hit targets for the number of patients who die on the Liverpool Care Pathway, the Mail can reveal.

The incentives have been paid to hospitals that ensure a set percentage of patients who die on their wards have been put on the controversial regime.

In some cases, hospitals have been set targets that between a third and two thirds of all the deaths should be on the LCP, which critics say is a way of hastening the deaths of terminally ill patients.

At least £30million in extra money from taxpayers is estimated to have been handed to hospitals over the past three years to achieve these goals.

Critics of the method warned last night that financial incentives for hospitals could influence the work of doctors.

The LCP involves withdrawal of life-saving treatment. Patients are sedated and most are denied nutrition and fluids by tube. On average a patient put on the Pathway dies within 29 hours.

One of the leading critics, hospital consultant Professor Patrick Pullicino, said: 'Given the fact that the diagnosis of impending death is such a subjective one, putting a financial incentive into the mix is really not a good idea and it could sway the decision-making process.'

LCP is thought to be used in more than 100,000 cases a year.

Yesterday the Association for Palliative Medicine, which represents doctors working in hospices and on specialist hospital wards, announced it is organising an inquiry into the method.

The LCP is intended to ease the final hours of patients who are close to death and to spare them the suffering associated with invasive treatment.

Payments to hospitals to introduce it are made through a system called Commissioning for Quality and Innovation, or CQUIN, which channels money to hospital trusts through NHS 'commissioners'.


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