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Overhaul order for end-of-life care

Health officials have ordered a complete overhaul of care for terminally ill patients after an independent review concluded that doctors have used a controversial end-of-life care regime "as an excuse for poor-quality care".

The Liverpool Care Pathway (LCP) - which recommends that in some circumstances doctors withdraw treatment, food and water from sedated patients in their final hours or days - will be axed in coming months and will be replaced with a personalised end-of-life care plan for each individual patient.

The independent review highlighted "distressing" implementation of the regime.

The review panel, chaired by crossbench peer Baroness Julia Neuberger, said they were "shocked" and "upset" at some of the cases of appalling care. Patients were left on the pathway for weeks without any review and some patients' families were even shouted at by nurses for giving them water, she said.

Baroness Neuberger said that hydration problems were the "biggest issue" raised by people who gave evidence to the review. She said: "The same stories keep emerging of poor care, appalling communications and of a lack of attention or compassion. Among the worst stories were of people on the Liverpool Care Pathway for days going into weeks without communication or review or discussion.

"And also desperate stories of desperate people who are longing for a drink of water who were, through misunderstanding of the Liverpool Care Pathway and poor care, denied a drink. Stories of nurses shouting at families who give a patient a drink were frequent as were stories of people who were just left to get on with it with no regular observations or review."

Chair of the clinical sub group of the review panel, GP Dr Dennis Cox, added: "When we started to meet the families to discuss their stories, we were genuinely shocked to hear what had been happening. The main and recurrent concern was the withdrawal of oral fluids from a patient still able to drink. We heard stories about relatives being forbidden to give dying patients a drink even if they were thirsty. And there were heartbreaking accounts of people desperately sucking at sponges used to moisture their mouths."

Care and support minister Norman Lamb confirmed that the pathway would be phased out in coming months. He also ordered all NHS hospitals to undertake reviews of care given to dying patients. He also ordered hospital bosses to ensure that in the future every patient has a named senior clinician responsible for their care in their final hours and days of life.

Financial incentives to put people on the regime will also be scrapped, he added.

He said: "People's final days should be as comfortable and dignified as possible. That is why there is a place for thoughtful and careful end of life care that involves patients and their families, but it is clear what we have now needs to be replaced so we can create a better way of doing this."


From Belfast Telegraph