Report reveals abuses in end of life care

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Too many vulnerable patients are being subjected to "inhumane treatment" and "premature and unnecessary death", according to a new cross-parliamentary report into the state of end of life care in Britain today.

The report, 'When end of life care goes wrong', has been prepared by the Lords and Commons Family and Child Protection Group (LCFCPG) and contains 17 medically assessed case studies of when care has fallen below expected standards.

The case studies are drawn from over 600 complaints about standards of end of life care submitted to the group as part of its investigation.

Standards were supposed to rise when the scandal-ridden, one-size-fits-all Liverpool Care Pathway was replaced by the National Institute for Health and Care Excellence (NICE) and individualised care packages, but the report states that recommendations are being "ignored" in many hospitals, hospices and care homes.

The LCFCPG said the hundreds of complaints ranged from clinical failures to "blatant abuse", and were "the tip of a very large iceberg".

According to the report, patients were put on end of life care plans despite being admitted to hospital for seemingly trivial conditions like constipation and knee replacement surgery.

Others known to be at the end of their life were admitted to hospices only to receive "undignified and callous treatment" that "paid no regard to their, or their families', wishes or concerns".

"As this report shows, misdiagnoses and mis-assessments as to quality of life are all too common," the report reads.

"This, together with a failure to appreciate the respect and care required for those approaching their last days is, in every sense, a fatal combination.

"Excessive and inappropriate use of midazolam and morphine, rendering a patient comatose, coupled with the withdrawal of food and hydration, have combined to impose a death sentence which, in the current climate, it is extremely hard to challenge."

Sam H Ahmedzai, emeritus professor of palliative medicine and chair of the 2015 NICE guideline committee, who reviewed the 17 case studies, said he was "shocked" by how badly patients and their families had been treated.

"When I compared the case studies with relevant NICE and General Medical Council (GMC) guidelines, I was dismayed how flagrantly these had been ignored," he said.

"Perhaps the most chilling case study concerned a young lady of 21 years with physical and learning disabilities, who entered a large teaching hospital for a planned minor operation and who died three weeks later, having been essentially starved to death, according to the coroner's inquest."

Lynda Rose, Anglican priest and convenor of the LCFCPG, said the findings were "horrifying".

"Our report shows all too clearly that misdiagnoses and mis-assessments as to quality of life and proximity to dying are disturbingly common," she said.

"Life matters, and every last moment of life matters for those bound together by love. We shall all one day have to cross that final bar – so for all our sakes, we need to end the abuse now and ensure that the vulnerable – whose voices are so often ignored – are respected and that they receive the best possible care society can offer."

The report makes a number of recommendations including the creation of a national inventory of local end of life care plans, policies and procedures currently being used in all healthcare settings, and a national rapid response service to advise and support people whose loved ones are experiencing a poor quality of care.

Carla Lockhart MP, Chair of LCFCPG, said that the report exposes the "horror" of some patients' experiences at the end of their life.

"These include interventions such as the withdrawal of oral hydration – even when the patient is sometimes begging for a drink – or the administration of strong sedatives, prescribed with the sole intention of rendering the patient unconscious, while hastening death.

"We believe this is unacceptable in British society and we urge the NHS, healthcare professional organisations and relevant charities to challenge these practices.

"We look to parliamentarians to enact the 'Call for remedial actions' as soon as possible."