an indefensible defence of the
Care Pathway, The Guardian has
accused Jeremy Hunt of playing politics. Actually, The Guardian is right in this respect - that there
is, surely, a conflict of legislation involved... Liverpool
Here is the MailOnline -
Victory for care pathway families: Minister pledges new law so patients can't be put on end-of-life regime without consulting relatives
- Doctors will be legally obliged to seek patients' consent before placing them on end-of-life pathway under new law
- Mortally ill cannot have fluids and food withdrawn without relatives' knowledge
By TIM SHIPMAN
Legal pledge: Health Secretary Jeremy Hunt will vow to make doctors explain end-of-life care to patients' relative
Putting patients on the ‘death pathway’ without consulting their families will be outlawed next week.
Jeremy Hunt is to make it a legal requirement that doctors fully explain the end-of-life treatment in order to obtain consent.
The Health Secretary has acted after the Mail highlighted chilling cases in which patients were placed on the Liverpool Care Pathway – which involves withdrawal of fluids and food – without their relatives’ knowledge.
On Monday he will announce rule changes that will see end-of-life care included for the first time in the NHS Constitution.
The document lays down principles that all doctors must follow.
Last night Mr Hunt said he would enshrine the ‘basic right’ of patients to be involved in decisions when they are mortally sick.
He threatened ‘tough consequences’ for hospitals that fail to consult.
Patients and their families will be able to sue health trusts that break the rules and doctors who ignore their wishes face being struck off for misconduct.
The LCP, which leads to death in an average of 33 days, is designed to ease the pain and upheaval for patients who are terminally ill. Health trusts have however faced the charge that it has been overused to hasten the deaths of these patients.
Patients have had feeding tubes withdrawn while their relatives were unaware that they been placed on the pathway.
In some cases, relatives have covertly fed their elderly relatives after discovering doctors have given up on them.
Hospitals have even been paid incentives of £30million to hit targets for the number of patients on the pathway.
Mr Hunt will launch a three-month public consultation on Monday on his plans to rewrite the NHS Constitution.
But he will make clear that doctors and NHS managers must start adhering to the new rules immediately.
Saved: Rustie Lee, left claims her mother Eugenie Edwards, 87, was put on a pathway to
death at Birmingham's City Hospital after wrongly being told she had just 48 hours to live
'Basic right': Patients will be put at the centre of decision making over their care when
they are terminally ill under a shake up of treatment
A source close to Mr Hunt said: ‘Jeremy expects them to consult patients and their families. NHS organisations should have to adhere to that principle.’
A Department of Health source said: ‘New changes to the NHS Constitution, to be unveiled on Monday will set out a new legal right for patients to be consulted on end-of-life care decisions. The right will also include family and carers.
‘NHS bodies, as well as private and voluntary providers supplying NHS services, are required by law to take account of it in their decisions and actions.
‘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.
How the Mail previously covered the story
‘Thanks to new powers introduced by this Government, in the Health and Social Care Act, the new right will mean that if a patient is not involved in decisions about their end-of-life care, they can challenge the NHS and launch a civil action.’
Mr Hunt, who has previously condemned the ‘unforgivable failure’ of hospitals to consult patients, has ordered his civil servants to make healthcare for older people a policy priority.
His predecessor Andrew Lansley concentrated on reforming the structures of the NHS.
Mr Hunt told the Mail: ‘I want our country to be the best in Europe to grow old.
‘End-of-life care decisions affect older, and more vulnerable people. These patients and their families have a basic right to be involved in discussions and decisions affecting their end-of-life care.
‘This new consultation will help to raise awareness of these rights and ensure that there are tough consequences in any cases where standards fall short.
Legal challenge: Patients not consulted on end-of-life care will be able to challenge their
treatment in the courts under the new powers introduced in the Health and Social Care Act
‘The NHS is one of this country’s greatest achievements. At the same time as we are protecting its budget, we are building an NHS able to meet patients’ needs and expectations now and in the future.’ Ministers have already announced four separate probes of the Liverpool Care Pathway.
Care minister Norman Lamb announced on Thursday a round table summit with doctors and patients’ groups following the Mail’s revelations about the systematic misuse of the pathway.
A Health Department organisation, the National End of Life Care Programme is also investigating complaints about such care, including the Liverpool method. A group called Dying Matters will also talk to families.
Lastly, medical professionals will be consulted about their views on the Liverpool pathway and other methods by the Association for Palliative Medicine, which represents 1,000 doctors. Their inquiry findings will go to the Department of Health.
It is not yet known what will happen if doctors and patients, or relatives, disagree over the best way to proceed with treatment.
A conflict of legislation...
This family discovered, to our alarm, that next of kin have no input in the direction of treatment (and withdrawal of treatment?) in such cases covered by the Mental Capacity Act 2005.
The Mental Capacity Act, 2005 sets out very carefully the nature of patient capacity and their ability to consent.
Those patients possessing capacity are the only persons considered able to consent for themselves; those lacking capacity are treated in their own "best interests" by the medical team in charge of their care. Thus, in such cases, family or next of kin are informed only at the discretion of the medical team in charge.
Many doctors treat this Act as a Carte Blanche to act without any consideration to consult with family, next of kin, which is considered but a nuisance and impediment to their charge.
Furthermore, in particular consideration to 'patient confidentiality', the Data Protection Act and 'protocol', the medical team in charge may decide against sharing any information.
This family discovered this to be the case with a family member at
Under the Mental Capacity Act 2005, a consideration of the family's views (or that of an independent mental capacity advocate) may be permitted, but that does not extend to the granting of consent.
Now, how does this sit with Mr. Hunt's proposals? There is a double whammy conflict here of laws, professional guidelines, protocols of confidentiality...
Doctors are not required to inform parents out of respect of confidentiality of the child, so do not think, for one minute, that doctors have to tell you that a death sentence has been applied to your loved one via the LCP (Liverpool care Pathway) if they are deemed to lack mental capacity under the Mental Capacity Act 2005.
This is a political game Mr. Hunt is playing that will come home to roost. He wants to take the driver to task whilst leaving the gleaming 'gold standard' vehicle intact and up and running. Mr. Hunt is skating on thin ice!