The Pyrrhic villainy is proceeding
down a pathway of controversy, for it has yet to meet the challenge of the
Mental Capacity Act of 2005.
This Is Hampshire reports that the
This Is Hampshire also reports, unbeknowingly, upon the application of the CQUIN payments system in operation by the local Primary Care Trust -
Around 45 per cent of patients who die at Basingstoke hospital have been placed on the pathway – roughly 275 patients each year – compared with around 30 per cent of all patients who die in hospitals nationwide.
Hampshire Hospitals NHS Foundation Trust, which runs Basingstoke hospital, has been told by Hampshire Primary Care Trust, which holds the purse strings, that it should aim for 50 per cent of eligible patients who die per month in the hospital to be on the pathway.
Controversial care pathway used at Basingstoke hospital to be reviewed
7:30am Thursday 8th November 2012 in NewsBy Helen Morton
Basingstoke hospital
NEARLY half of all patients who die at Basingstoke hospital are on a controversial care pathway which can include the withdrawal of treatment, water and nourishment.
The Liverpool Care Pathway, dubbed the “death pathway” by critics, is now the subject of a national review by palliative care doctors after coming under fire in national media.
On Monday Government Health Secretary Jeremy Hunt outlined plans to make it a legal right for patients and their families to be informed of end-of-life care decisions, as part of changes to the NHS Constitution.
Around 45 per cent of patients who die at Basingstoke hospital have been placed on the pathway – roughly 275 patients each year – compared with around 30 per cent of all patients who die in hospitals nationwide.
Hospital chiefs at Basingstoke have defended their use of the Liverpool Care Pathway (LCP), which is used by about 85 per cent of trusts across the country and recommended by bodies including the Department of Health, The National Institute for Health and Clinical Excellence and The Royal College of Physicians.
They say LCP, which was introduced in Basingstoke in 2007, is a way off alleviating suffering when a patient is close to death.
Dr Lara Alloway, consultant in palliative medicine and clinical director in the cancer service at Basingstoke hospital, said the LCP is only used if it is the right choice for the patient.
She said that the withdrawal of water and nutrients was not automatic, adding: “In some cases when a patient is dying, intravenous fluids are not in their best interests and can cause more problems. Families are very much involved with the decision around aims of care.”
Dr Alloway said only senior doctors make the decision to put a patient on the pathway and only do so when they have “excluded any reversible causes and there is nothing we can do to change what is happening”.
Hampshire Hospitals NHS Foundation Trust, which runs Basingstoke hospital, has been told by Hampshire Primary Care Trust, which holds the purse strings, that it should aim for 50 per cent of eligible patients who die per month in the hospital to be on the pathway.
A review of the LCP was launched at the end of last month by The Association for Palliative Medicine, which represents 1,000 doctors who work in palliative care.
The group will “identify and explore concerns” about the LCP. The pathway was developed at the Royal Liverpool University Hospital and the city’s Marie Curie hospice, with the aim of easing suffering for the dying.
But not all medics agree it is the best way to treat patients. Consultant neurologist Professor Patrick Pullicino, who works for East Kent Hospitals, has been widely quoted as saying: “The lack of evidence for initiating the Liverpool Care Pathway makes it an assisted death pathway rather than a care pathway. Very likely many elderly patients who could live substantially longer are being killed by the LCP.”
He also claimed that it was impossible to predict a time of death within the timeframe used by pathway doctors. National media have reported that some patients were put on the pathway without relatives’ consent and that some have gone on to survive after being taken off the pathway.
Gazette reports that, under the reforms being
put out for consultation, Health Trusts that fail to involve patients and
families in decisions could be sued while doctors who ignore their wishes face
being struck off. It isn't as straight-forward as that, however.
Here is Gazette -
- Basingstoke Gazette »
- National News »
- National New
'Death pathway' consultation plans
11:35pm Friday 2nd November 2012 in National News© Press Association 2012
Health Secretary Jeremy Hunt said patients and families 'have a basic right to be involved in discussions and decisions affecting their end-of-life care'
Families are to get a legal right to be consulted before patients are put on the "death pathway", it has been revealed.
Health Secretary Jeremy Hunt will announce the new obligation on doctors next week as part of a raft of changes to the NHS constitution.
The move follows the emergence of cases where patients were placed on the Liverpool Care Pathway - which involves withdrawal of fluids and food - without relatives' knowledge.
Under the reforms, being put out for consultation on Monday, health trusts that fail to involve patients and families in decisions could be sued while doctors who ignore their wishes face being struck off.
Mr Hunt told the Daily Mail: "I want our country to be the best in Europe to grow old.
"End-of-life care decisions affect older, and more vulnerable, people. These patients and their families have a basic right to be involved in discussions and decisions affecting their end-of-life care.
"This new consultation will help to raise awareness of these rights and ensure that there are tough consequences in any cases where standards fall short.
"The NHS is one of this country's greatest achievements. At the same time as we are protecting its budget, we are building an NHS able to meet patients' needs and expectations now and in the future."
A Department of Health source added: "New changes to the NHS constitution, to be unveiled on Monday, will set out a new legal right for patients to be consulted on end-of-life care decisions. The right will also include family and carers. NHS bodies, as well as private and voluntary providers supplying NHS services, are required by law to take account of it in their decisions and actions.
"End-of-life care, like the Liverpool Care Pathway, can give patients dignity and respect in their last days, but recent reports have suggested that there is more the NHS can do to ensure that patients, their family and carers are fully involved in all discussions and decisions."
The Mental Capacity Act, 2005, sets
out very carefully the nature of patient capacity and their ability to consent.
Those patients possessing capacity are the only persons considered able to consent for themselves; those lacking capacity are treated in their own "best interests" by the medical team in charge of their care. Thus, in such cases, family or next of kin are informed only at the discretion of the medical team in charge.
Those patients possessing capacity are the only persons considered able to consent for themselves; those lacking capacity are treated in their own "best interests" by the medical team in charge of their care. Thus, in such cases, family or next of kin are informed only at the discretion of the medical team in charge.
Many doctors treat this Act as a Carte Blanche to act without any consideration to consult with family, next of kin, which is considered but a nuisance and impediment to their charge.
Furthermore, in particular consideration to 'patient confidentiality', the Data Protection Act and 'protocol', the medical team in charge may decide against sharing any information.
The arrogant have been made more arrogant...
But how does this sit with Mr. Hunt's proposals? Will they fall at the first post? Mr. Hunt says:
"The NHS is one of this country's greatest achievements. At the same time as we are protecting its budget, we are building an NHS able to meet patients' needs and expectations now and in the future."Are we witnessing the creation of the Communitarian Health Service?
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