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Controversial care pathway used at Basingstoke hospital to be reviewed
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.