What happens when medicine is nationalised and deprofessionalised

Loved ones not always told their relative is on controversial ‘death pathway’
NHS doctors are failing to inform up to half of families that their
loved ones have been put on a scheme to help end their lives, the
Royal College of Physicians has found.
Loved ones not always told their relative is on controversial ‘death pathway’
In a quarter of hospitals trusts, discussions were not held with one
in three families

By Rebecca Smith, Medical Editor


Tens of thousands of patients with terminal illnesses are being placed
on a “death pathway”, almost double the number just two years ago, a
study published today shows.

Health service guidance states that doctors should discuss with
relations whether or not their loved one is placed on the scheme which
allows medical staff to withdraw fluid and drugs in a patient’s final
days. In many cases this is not happening, an audit has found. As many
as 2,500 families were not told that their loved ones had been put on
the so-called Liverpool Care Pathway, the study disclosed.

In one hospital trust, doctors had conversations with fewer than half
of families about the care of their loved one. In a quarter of
hospital trusts, discussions were not held with one in three families.

Overall, doctors discussed plans with relations in 94 per cent of
cases, which is an improvement since the last audit but still means
thousands of families were not informed. Under the guidance, patients
who are close to death can be placed on the Liverpool Care Pathway, so
called because it was developed at the Royal Liverpool Hospital in the
1990s. It aims to ensure they die without being subjected to
unnecessary interference by staff.

In addition to the withdrawal of fluid and medication, patients can be
placed on sedation until they pass away. This can mean they are not
fed and provided with water and has led to accusations that it hastens

The study looked at a snapshot of data from 7,000 patients who were on
the Liverpool Care Pathway in 127 hospital trusts between April and
the end of June. The audit was last conducted in 2008-09, when 4,000
patients were found to be on it.

The audit was led by the Marie Curie Palliative Care Institute
Liverpool in collaboration with the Royal College of Physicians. It
showed palliative care services are improving. When the audit was last
carried out in 2008-09, one in four families were not told when their
loved one was placed on the care pathway.

But it said that a discussion should “always” be held with relations
and carers and that the condition of the patient should be reviewed
every four hours.

Kevin Fitzpatrick, spokesman for the campaign group Not Dead Yet,
said: “It is very worrying that in any situation less than 100 per
cent of families are being consulted before patients are being put on
the Liverpool Care Pathway. It is a shock for families to find that

“In some situations doctors are prepared to do it without consulting
families because they think they know what is best and questions arise
as to why they think it is OK to do that. Families have the right to
know why a loved one is being put on the LCP.”

Sarah Wootton, chief executive of the campaign group Dignity in Dying,
said: “The NHS is clearly moving in the right direction. However, the
report highlights there is a need for further training and education
on end-of-life communication. As a society we need to appreciate that
dying is not a failure of medical care and treatment, but dying badly

Simon Chapman, director of policy and parliamentary affairs at the
National Council for Palliative Care, said: “If some hospitals can
improve, all can, and performance is still too patchy. There is
absolutely no reason for dying and end-of-life issues not being
discussed more openly.”

A Department of Health spokesperson said: “Patients and their families
should always be involved in any decision about end-of-life care.

“The audit rightly highlights the continuing importance of training
for staff, and the critical role they have in involving patients and
families closely when the Liverpool Care Pathway is used.”

The Liverpool Care Pathway was intended for use in hospices but was
given approval by the Department of Health in 2006 leading to
widespread use in hospitals. Concerns about the pathway were raised
first in The Daily Telegraph in 2009 when experts warned that in some
cases patients have been put on the pathway only to recover when their
families intervened, leading to questions over how people are judged
to be in their “last hours and days”.