healthmedicinet

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 asssessed 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 protocals 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.