The Government has revealed that it will legislate to ensure that patient's families are consulted before doctors decide to place them on an 'end-of-life' care pathway.
The reforms, which were put to consultation yesterday, will allow hospitals and doctors to be sued if they fail in their obligation to consult families.
The Liverpool Care Pathway is the controversial NHS scheme that has caused considerable uproar in recent weeks, after it emerged that doctors were placing patients on the pathway without informing their relatives.
The controversy has been further fuelled by accusations that NHS managers may be using the care pathway to clear the beds of the terminally ill and may even be receiving financial incentives in order to do so.
Liverpool Care Pathway
The Liverpool Care Pathway was developed in the late 1990s in a collaboration between the Marie Curie Hospice in Liverpool and the Royal Liverpool University Hospital. The care pathway represents the 'best practice' guidelines for the palliative care of dying patients and was designed to take the practices that were used to great effect in the hospice setting and to translate them into use in hospitals and other care settings.
It has long been considered that end-of-life care was best in hospices, but with spaces limited to allow only 15% of terminally ill patients to die in one, it was thought necessary to bring hospice practice into wider NHS use.
The Liverpool Care Pathway involves a series of steps which clinicians should take when dealing with a terminally ill patient. At the beginning, a team of doctors representing all the various aspects of care must agree that all reversible causes for the patient's condition have been considered and the patient is dying. The meeting then considers what care should be offered and whether non-essential treatment should be discontinued. In the final hours of life, artificial nutrition and hydration may be removed, to speed up the end-of-life process for the ill patient.
Controversy
Controversy has always followed the care pathway, despite several studies that have supported its use in the palliative care setting and have hailed the pathway as offering dignity in death for the terminally ill.
Last month The Daily Mail reported how a Norfolk man was taken home and revived by his family after being placed on the Liverpool Care Pathway without their knowledge. Mr Flanaghan had suffered a massive heart attack, which doctors believed he would not recover from.
However, his family revived him with sips of water, before doctors agreed to replace his drip. He recovered and was able to return home, where he lived for a further four weeks before passing away peacefully among his family.
The outcry over Mr Flanaghan's case was increased when it was revealed that the number of patients placed on the pathway had doubled in the past two years and that a report by the Royal College of Physicians revealed that as many as half of the families of those patients involved may not have been informed of the decision to place their relative on the care pathway.
Last week, The Daily Telegraph revealed that three-quarters of the NHS Trusts that use the Liverpool Care Pathway were being paid financial rewards under the 'Commissioning for Quality and Innovation' scheme, which rewards NHS trusts for meeting targets relating to excellence in care.
New laws
The Government has responded to the controversy by announcing that changes to the NHS constitution will include a new legal right for patients and their families and carers to be consulted on end-of-life care decisions.
"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," said a Department of Health spokesman.
Sources:
End-Of-Life Care: Plan For New Legal Rights (Sky)
NHS millions for controversial care pathway (The Telegraph)
A pathway to euthanasia? Family revive father doctors ruled wasn't worth saving (Daily Mail)
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