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Halt called to controversial end-of-life patients regime

THE controversial end-of-life regime that allows patients' deaths to be hastened through withdrawal of medication, food and water is to be withdrawn in Scotland.

Liverpool Care Pathway [LCP] was subject to a critical review south of the Border by the Neuberger Inquiry, which found poor training meant it had been "misused" in recent years.

Created 15 years ago by the Royal Liverpool University Hospital and the city's Marie Curie Hospice, the scheme was seen as a humane approach to the care of terminally ill cancer patients.

It became discredited after its use spread and it became associated with financial targets by health boards.

In Scotland, an expert group, The Living and Dying Well National Advisory Group, has made a series of recommendations that will see LCP phased out and replaced by a more ­flexible, personalised system to be drawn up in coming months.

Some families north of the Border have been bitterly critical of the way their loved ones have been allowed to die under the LCP without them being fully consulted. They include the family of Jean Tulloch, who died in Edinburgh's Western General Hospital in March last year without them being informed she was on the regime.

Health Secretary Alex Neil said: "When the LCP was introduced, the aim was to support the delivery of high- quality care by all clinical teams providing care in the final days and hours of life. This aim is as relevant today as it ever was."

However, he added: "The expert group has recommended phasing out the LCP and setting up a new group to develop an alternative. In the meantime, strong interim guidance will be put in place to ensure care for those at the end of their lives meets the high standards we demand."

Amid fears some boards were using the system to clear beds and save money without consulting relatives, Baroness Julia Neuberger was asked to investigate the situation in England. The Liverpool regime was also used in Scotland and Northern Ireland, but not in Wales.

Her review took evidence from patients and health staff as well as reviewing literature, and said a "deeply distressing" picture had emerged.

It described patients being left without adequate nutrition and hydration, with reports of some people desperately trying to suck sponges used by staff to dab their faces.

One of the major criticisms of the review was that the LCP had become a "tick box" exercise, which did not take the individual patient's circumstances into account and did not always involve proper consultation of relatives.

Mr Neill added: "This will include work to support staff to speak to patients and their families openly and honestly to avoid misunderstandings and distress. Families need to know there is a clear accountability for care and this must be communicated."

The Scottish Government expects new, comprehensive guidance to be in place within a year.

Sir Graeme Catto, chairman of Dignity in Dying said: "We welcome this new focus on patient-centred, individualised care, and ensuring everyone has as dignified a death as possible. We hope this new guidance for healthcare professionals will ensure that dying people have what they consider to be the best possible death, within the constraints of the existing law.

"However, we must remember that the reported problem with the Liverpool Care Pathway was not the guidance itself, but rather poor implementation or inappropriate use."

Anti-euthanasia campaigner Aidan Cook said: "Care Not Killing has ­previously raised concerns about how the Liverpool Care Pathway was being used. Our prime concern is that all patients receive the best of care and that protocols for end-of-life care are properly understood and implemented by medical personnel."

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