Are they playing God?

Cllr. Ted Eden

A HIGHLY controversial health practice which opponents say "plays God" with dying patients could soon be rolled out to all wards at Queen's Hospital. The Liverpool Care Pathway (LCP) encourages medics to remove treatment - including fluids, food and medication - from patients deemed close to death. Patient may also be placed on continuous deep sedation until they pass away. The scheme is currently in play in 40 per-cent of adult wards in the Rom Valley Way hospital, with 17-per-cent of patients dying under the scheme, Havering Council's health overview and scrutiny committee heard on Tuesday evening.

New proposals could see it introduced to all adult wards - but there are widespread fears the scheme is open to abuse."Reports of the use of this pathway and its effects, including firsthand testimony I've heard, have been quite appalling," said concerned committee chairman Cllr Ted Eden, who called the scheme in for scrutiny. "At precisely the moment they [patients] need care, they are too often placed on what seems little more than a pathway to oblivion."In my view, this could easily be seen as playing God or even killing people off." Sue Connelly, Romford MP Andrew Rosindell's chief of staff, expressed similar fears: "The people of the borough of have no confidence in [Queen's] hospital; this is why everyone is so suspicious. Need a few beds? Do away with that one and that one and that one," she said. However LCP advocate Judith Douglas, divisional nurse for clinical support services at Barking, Havering and Redbridge (BHR) Hospitals Trust, said it was the best possible course of action for patients in terminal "pain and agitation""There is no hidden agenda," Ms Douglas said. "On the LCP patients die with dignity and with the best quality of life they have left.

" Dr Ian Grant, divisional director of the scheme, and haematology specialist, also moved to placate fears: "There is nothing sinister about this - the LCP is not about shortening life," he said. "We do not believe in euthanasia, either passive or active, it's about excellence of care." The scheme, devised by a Marie Curie hospice in Liverpool in 2004, is now a NHS model, used in around 900 hospitals, hospices and care homes in the country. It has come under fire recently from some doctors and campaigners who believe patients were being wrongly judged as close to death. Ms Douglas conceded that patients sometimes improved and were taken off the LCP, but said this was "very rare". Patients are constantly monitored by a multi-disciplinary team, she said. Cllr Pam Light, the borough's over-50s representative, said the scheme was worrying in light of the Trust being rated worst in the country last month by a health watchdog:

"It sounds good in theory - in a perfect society and in a well-run hospital - but not in practice," she said. An essential tenet of the LCP is that family members or carers - and where possible the patients themselves - is informed before the programme is begun, and "fully understand" why the decision has been made. Ms Douglas said: "We have discussion with the family on a one-to-one basis. The family is involved or uninvolved as they want." But according to a 2009 Marie Curie-led national care of the dying hospitals audit, including of Queen's and King George in Goodmayes, only 72 per-cent of families were told their loved ones were being put on the pathway, while a mere 68 per-cent understood the nature of the scheme - both down from the previous 2008 audit. The LCP was first introduced at BHR in 2005. All staff involved in the care provided are trained to use the LCP and are supported by the specialist palliative care team. Consultation is not required for further roll-out as it is agreed national strategy A Department of Health spokesman said: "People coming to the end of their lives should have a right to high quality, compassionate and dignified care.

"The LCP is an established and recommended tool that provides clinicians with an evidence-based framework to help delivery of high quality care for people at the end of their lives."It has been recommended in the Supportive and Palliative Care Guidance issued by the National Institute for Health and Clinical Excellence (NICE)."Many people receive excellent care at the end of their lives. We are investing £286 million over the two years to 2011 to support implementation of the End of Life Care Strategy to help improve end of life care for all adults, regardless of where they live.