EVERYONE should be allowed to die with as little pain as possible and as much dignity. That is the logic behind the Liverpool Care Pathway (LCP), a controversial palliative care programme for terminally ill patients deemed to be near to death.

However, the programme, or perhaps the way it is interpreted by medical staff, is causing an increasing amount of unease nationally and is an issue which has raced to the top of the agenda for West Worcestershire MP Harriett Baldwin.

The LCP, originally designed by the cancer charity Marie Curie in the late 90s at a Liverpool hospice, was approved by the National Institute for Health and Clinical Excellence (Nice) in 2004 before it was rolled out across hospitals, care homes and hospices.

Part of the LCP is the withdrawal of assisted hydration and nutrition and the removal of intravenous drips and medications.

The controversy has recently been the focus of articles in the Daily Telegraph when a group of doctors wrote to the newspaper claiming the LCP was the cause of elderly patients dying prematurely.

Rather than food and fluid being withdrawn because people were dying, it was seen as accelerating or even causing their deaths.

Another issue is the decision to put people on this pathway by a third party without proper consultation with the patient or their families or carers.

This issue is relevant everywhere but may be seen as particularly pertinent to Worcestershire, given the damning report by the Care Quality Commission (CQC), the national health and social care watchdog, published in May.

Inspectors had “major” concerns about the nutrition and hydration of patients in wards five and 11 of the Alexandra Hospital in Redditch. There were examples of some vulnerable patients having to be prescribed water to make sure they had enough to drink and having to eat with their hands because no one had helped them cut up their food.

THE POLITICIAN

A county MP is determined that a care pathway for the dying does not become “euthanasia by the back door”.

West Worcestershire MP Harriett Baldwin has welcomed new guidance in the county’s NHS acute team to improve a care programme for terminally ill patients.

She first learned about the pathway three years ago when it was mentioned in the medical notes of a woman who had died at Worcestershire Royal Hospital in Worcester with dehydration.

Mrs Baldwin was in contact with the woman’s niece and contacted the hospital trust for answers.

When the damning report into care at two wards at the Alex by the CQC was published, Mrs Baldwin was concerned that this was linked to interpretations of the Liverpool Care Pathway.

She said: “It’s important the hospital has the right training process and safeguards because I would hate to see any suspicion that it was euthanasia by the back door.”

Mrs Baldwin requested the Liverpool Care Pathway be considered as part of the acute trust’s review of the failings identified by the CQC report.

Mrs Baldwin has raised concerns with trust management on several occasions about the use of the LCP after hearing from constituents.

She said: “I have been urging the acute trust to take another look at the way it uses the Liverpool Care Pathway for some time and I am pleased that these steps have been taken.

“It can of course be difficult to define the moment when a patient becomes terminally ill and it can be upsetting if all relatives see is that nutrition and hydration are no longer being given.”

THE PALLIATIVE CARE EXPERT

A palliative care expert says guidance is now much clearer on the best way to look after people when they are at the end of their lives.

Jenny Garside, end-of-life care facilitator for Worcestershire Acute Hospitals NHS Trust, said the trust had been participating in the Liverpool Care Pathway for a number of years and the latest – version 12 – was now being used in the county’s three acute hospitals.

She said: “The updated pathway contains a detachable leaflet for relatives and friends about the use of the LCP and issues such as hydration and nutrition that are often a major concern during the end-of-life phase for patients.

“The new pathway also gives clearer guidance to medical and nursing teams about identifying and placing a patient on the LCP, multi-disciplinary team (MDT) review and issues such as hydration and nutrition.

“The trust has two end-of-life care facilitators – one based at Worcestershire Royal Hospital and the other at the Alexandra Hospital, Redditch.

“They visit all ward areas to arrange training on the new document and offer advice and support. Staff can also access an online e-learning package.

The trust takes part in the Marie Curie National Care of the Dying Audit to benchmark the use of the document in the trust against a national standard. The training in the trust is then tailored to identified areas of need.

“We are also seeking feedback from families and relatives about the care their dying relative has received using the local ‘Voices’ questionnaire, which has been adapted for use by the trust.”

For more information, visit liv.ac.uk/mcpcil/liverpool-carepathway/ documentation-lcp.htm.

THE CARER

A carer whose blind and bedridden mum was sent home with a letter to say she should not be revived if she was dying said more needed to be done to improve care.

Ron Grainger, aged 58, of Cherry Ochard, Holt Health, near Worcester, said he believed his mum was dying because she was not being given enough to eat and drink in Worcestershire Royal Hospital rather than because of any illness.

Although he says his mother was never placed on the LCP to his knowledge, he remains concerned about attitudes to the elderly and vulnerable in hospital.

Lilian Grainger, who is 90 and suffers from a lung condition, was sent home on March 29 last year with a form saying “do not resuscitate”.

He said: “In my view she was only ever dying because they never gave her drink and food. They are supposed to be protecting vulnerable people. They should be ashamed of themselves.”

Mr Grainger is also concerned about what he sees as the lack of discharge meetings and other communication between the hospital and a patient, their families and carers.

He said: “My mum was discharged one year and one month ago with end-of-life care. They discharged her without a planning meeting. They should have had a discharge meeting, especially if there are carers involved like me.

They didn’t do any of that.”

One of his issues is the refusal of NHS Worcestershire to fund continuing healthcare – which pays for nursing home costs – which was withdrawn in February this year after payments began in March 2010.

He said: “They had already made up their minds. I said, ‘You can’t do that, it’s unlawful’. My mother’s needs haven’t changed.”

John Rostill, then chief executive of Worcestershire Acute Hospitals NHS Trust, wrote to Mr Grainger offering his family an “unreserved apology” while Hilary Green, continuing healthcare manager for NHS Worcestershire, acknowledged that Mr Grainger was not involved in all assessments of his mother’s eligibility, “contrary to our standard practices and procedures”.