The NHS is having to remind doctors and nurses to give dying patients water to ease their suffering, it has emerged. The need to issue a reminder comes amid concern that the Liverpool Care Pathway – which denies people food and drink to hasten their deaths – is still being used in parts of the country despite being banned a year ago.
The Liverpool Care Pathway was developed in hospices in the 1990s as a way of ensuring that dying people were treated with care and dignity in their last days and hours. But once rolled out across the NHS, it became a box ticking exercise in which all food and drink was routinely removed from people deemed to be close to death, sometimes as a way of hastening their deaths, ostensibly to ease suffering.
The clamour from carers and relatives, some of whom had to resort to sneaking wet sponges to their loved ones to ease their suffering, eventually resulted in an independent review which recommended the abolition of the Pathway.
But a year on, clinical staff who are used to removing food and drink from dying patients are routinely waiting three days to put patients on drips or feeding tubes to see whether doing so is in their best interests, the Daily Mail has reported.
Professor Patrick Pullicino of the University of Kent, who was one of the first doctors to raise concerns about the way the Pathway was being used, has said that he still regularly sees dehydrated patients on wards. ‘I’m sure it’s a hang-over from the Liverpool Care Pathway,” he said.
‘People are paying less attention to ensuring elderly patients are hydrated. It’s not malicious, but the climate has come in.’
He added that staff are more concerned about potential legal action if they insert a drip into a frail elderly patient. Consequently, staff hold meetings to discuss what to do, which can lead to delays lasting “days and days”.
Rob George, professor of palliative care at Kings College London and president of the Association of Palliative Medicine has also spoken out against a box-ticking culture in the NHS, saying that the Liverpool Care Pathway had been “a wake-up call.” He has urged a more patient-centred approach.
“The problem is in a sense with an industrialised approach to managing dying people is everyone gets pre-occupied with ticking the boxes and not looking at the person in front of them,’ he told Radio 4’s Today program.
“Let’s not forget we are dealing with people who are dying and people who are distressed. It’s not about diagnosis and pathology it’s about distress and people. Bed side assessment and communication, the milk of human kindness, all those things are what matters.”
However, he added: “It’s very difficult in the modern health service, often, with the pressures on staff and all of the almost compassion fatigue sometimes that people have engaging with those individual needs.”
The results of the independent review have prompted the NHS’s watchdog, Nice, to review its guidelines for the care of dying adults. New draft guidelines, currently out for consultation, recommend that doctors “Support the dying person to drink if they wish to and are able to.”
Following concern expressed in the review that elderly people were becoming dehydrated thanks to the Pathway, and that the symptoms of dehydration were being used to reason that the patient was dying with no hope of recovery, the guidelines also recommend essentially giving patients fluids and monitoring them to see whether they recover.
Tory MP Andrew Percy, a member of the Commons health select committee, said the very fact that Nice had had to issue guidance was itself “concerning”.
“It’s been made very clear that the Liverpool Care Pathway is not acceptable and is not an appropriate pathway for people at the end of their life,” he said. “We heard some terrible examples of people being denied fluids at the end of life and it’s concerning that Nice have felt the need to issue this guidance.”
The head of Nice, Sir Andrew Dillon, has said: “Recognising when we are close to death and helping us to remain comfortable is difficult for everyone involved.
“The Liverpool Care Pathway was originally devised to help doctors and nurses provide quality end-of-life care. While it helped many to pass away with dignity, it became clear that it wasn’t always used in the way it was intended. Some families, for example, felt that elderly relatives were placed onto the pathway without their knowledge or consent.
“The guidelines we are developing will ensure that people who are nearing the end of their lives are treated with respect and receive excellent care.”
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