Victory for care pathway families: Minister pledges new law so patients can’t be put on end-of-life regime without consulting relatives
Putting patients on the ‘death pathway’ without consulting their families will be outlawed next week.
Jeremy Hunt is to make it a legal requirement that doctors fully explain the end-of-life treatment in order to obtain consent.
The Health Secretary has acted after the Mail highlighted chilling cases in which patients were placed on the Liverpool Care Pathway – which involves withdrawal of fluids and food – without their relatives’ knowledge.
On Monday he will announce rule changes that will see end-of-life care included for the first time in the NHS Constitution. The document lays down principles that all doctors must follow.
Last night Mr Hunt said he would enshrine the ‘basic right’ of patients to be involved in decisions when they are mortally sick. He threatened ‘tough consequences’ for hospitals that fail to consult.
Patients and their families will be able to sue health trusts that break the rules and doctors who ignore their wishes face being struck off for misconduct.
The LCP, which leads to death in an average of 33 days, is designed to ease the pain and upheaval for patients who are terminally ill. Health trusts have however faced the charge that it has been overused to hasten the deaths of these patients.
Patients have had feeding tubes withdrawn while their relatives were unaware that they been placed on the pathway. In some cases, relatives have covertly fed their elderly relatives after discovering doctors have given up on them.
Hospitals have even been paid incentives of £30million to hit targets for the number of patients on the pathway.
Mr Hunt will launch a three-month public consultation on Monday on his plans to rewrite the NHS Constitution.
But he will make clear that doctors and NHS managers must start adhering to the new rules immediately. A source close to Mr Hunt said: ‘Jeremy expects them to consult patients and their families. NHS organisations should have to adhere to that principle.’
A Department of Health source said: ‘New changes to the NHS Constitution, to be unveiled on Monday will set out a new legal right for patients to be consulted on end-of-life care decisions. The right will also include family and carers.
‘NHS bodies, as well as private and voluntary providers supplying NHS services, are required by law to take account of it in their decisions and actions.
‘End-of-life care, like the Liverpool Care Pathway, can give patients dignity and respect in their last days, but recent reports have suggested that there is more the NHS can do to ensure that patients, their family and carers are fully involved in all discussions and decisions.
‘Thanks to new powers introduced by this Government, in the Health and Social Care Act, the new right will mean that if a patient is not involved in decisions about their end-of-life care, they can challenge the NHS and launch a civil action.’
Mr Hunt, who has previously condemned the ‘unforgivable failure’ of hospitals to consult patients, has ordered his civil servants to make healthcare for older people a policy priority.
His predecessor Andrew Lansley concentrated on reforming the structures of the NHS.
Mr Hunt told the Mail: ‘I want our country to be the best in Europe to grow old. ‘End-of-life care decisions affect older, and more vulnerable people. These patients and their families have a basic right to be involved in discussions and decisions affecting their end-of-life care.
‘This new consultation will help to raise awareness of these rights and ensure that there are tough consequences in any cases where standards fall short.
‘The NHS is one of this country’s greatest achievements. At the same time as we are protecting its budget, we are building an NHS able to meet patients’ needs and expectations now and in the future.’ Ministers have already announced four separate probes of the Liverpool Care Pathway.
Care minister Norman Lamb announced on Thursday a round table summit with doctors and patients’ groups following the Mail’s revelations about the systematic misuse of the pathway.
A Health Department organisation, the National End of Life Care Programme is also investigating complaints about such care, including the Liverpool method. A group called Dying Matters will also talk to families.
Lastly, medical professionals will be consulted about their views on the Liverpool pathway and other methods by the Association for Palliative Medicine, which represents 1,000 doctors. Their inquiry findings will go to the Department of Health.
It is not yet known what will happen if doctors and patients, or relatives, disagree over the best way to proceed with treatment.
Injured motorcyclist, 24, taken to hospital by his brother after 90 minutes because ambulances were diverted NINE times from crash scene
A motorcyclist badly injured in a crash had to be driven to hospital by his brother after ambulances sent to get him were diverted nine times.
David Pinion, 24, lay in agony for 90 minutes after suffering extensive internal bruising in the crash as a paramedic at the scene desperately tried to organise an ambulance.
But the paramedic was eventually told that the ambulances en route had to be diverted to ‘more serious’ incidents nine times and it would be best if the patient made his own way to the hospital. It is unclear how many ambulances had been dispatched.
Mr Pinion, whose waist had ballooned from 42in to 48in because of the swelling, was forced to ask the paramedic to call his brother to pick him up from the scene of the accident in Ely, Cambridge on October 14. The injured biker then had to be lifted off the road by his brother Robert and friend Chris Boon who drove him to Addenbrooke’s Hospital in Cambridge.
Mr Pinion also suffered damage to his pelvis and ankle and was given morphine by hospital staff to ease his pain.
Mr Pinion, from Prickwillow, Cambridge,said: ‘The rapid response paramedic who got to me first was brilliant. ‘She couldn’t have done any more for me, but the people on the radio said they couldn’t get an ambulance to me. ‘They kept diverting them to more incidents because I was deemed not serious enough.
‘The paramedic was arguing with them and telling them I could have been bleeding internally but they just said they were sorry and there was nothing they could do. ‘Fortunately I didn’t suffer any broken bones but I was in so much pain that I really wouldn’t want to know what a broken bone feels like.’
But Mr Pinion’s angry family called for improvements to the ambulance service before lives are lost by delayed response times. Mr Pinion’s mother Vanessa said: ‘Does someone have to die before we have a decent, reliable ambulance service with a reasonable response time?’
An East of England Ambulance Service spokesman said: ‘This incident has already been raised by the Trust for investigation because the wait for transport to hospital was not acceptable.
‘The patient was assessed on-scene by a paramedic, who arrived within six minutes, as not being in a life-threatening condition and during this exceptionally busy time all ambulances which became available had to be diverted to life-threatening calls.’
An alternative ‘facts’ curriculum for Britain: Younger pupils ‘must focus on names, dates and places, not vague themes’
Children would go back to learning about landmark events and the great figures of history under an alternative national curriculum drawn up by campaigners.
In a move away from vague themes and topics, pupils would concentrate on names, dates, places and scientific concepts as well as classic art, music and literature.
The lessons, spelled out in a series of primers from the think-tank Civitas, are designed to put knowledge back at the heart of teaching and complement a curriculum expected to be launched by Michael Gove early next year.
A draft of the Education Secretary’s plan requires pupils to study a narrative of British history including key figures such as Winston Churchill, and in geography, show an understanding of the countries of the world.
The primers created by Civitas are designed to fit into Mr Gove’s framework and stretch primary age children.
While rejecting rote learning, the think-tank says a ‘significant body of enduring knowledge and skills’ should ‘form the foundation of a strong curriculum’.
David Green of Civitas said he wanted to help reverse a trend that has seen children taught broad topics such as ‘the seashore’. ‘You could count ships in maths,’ he said. ‘But there’s a limit to how far you can deploy the seashore effectively as a theme for all those lessons.’
He said low expectations of youngsters – especially those from disadvantaged backgrounds – had been a ‘terrible weakness’ in education for a generation.
He said the new curriculum would end the narrowing of education driven by a ‘corrupted’ regime of ‘teaching to the test’ – drilling to pass primary school tests.
Civitas has published two books in its series, covering what children in years one and two at primary school need to know. The next four are in development.
As well as a guide for teachers, the books are aimed at parents and grandparents to help them deepen children’s knowledge.
Schools, including the proposed West London Primary Free School, backed by journalist Toby Young, have expressed an interest in using the series of books.
However, the Civitas syllabus is likely to meet resistance from some teachers who claim that the rise of the internet and search engines such as Google are rendering the need to teach knowledge in schools increasingly obsolete.
The books are based on the ideas of E.D. Hirsch, an influential American educationalist who says the key duty of schooling is to give children access to the common knowledge that draws their society together. His theory is that the more knowledge a person has, the more sticks – like a snowball.
Mr Gove and former schools minister Nick Gibb, the architect of the Government’s curriculum review, have spoken of their admiration for Mr Hirsch’s work.
Under the Civitas scheme, pupils will leave primary school having studied a broad range of fiction, non-fiction, poetry, songs, music, great works of art and speeches by key historical figures.
In geography, children would begin by identifying the countries of the UK on a map and build up to in-depth studies of the continents.
Statins side effects warning when combined with other drugs: regulator
The statin craze seems to be slowly winding down at long last
Hundreds of thousands of people taking a common statin are to have their dose reduced due to fears over side effects, it has emerged.
Medicines regulators have warned that patients taking simvastatin at the same time as other drugs used to reduce high blood pressure are likely to suffer more aches and pains.
The MHRA has produced a patient leaflet for the first time to inform people of the changes being made.
Studies have shown that patients taking simvastatin, particularly the 40mg dose which is the most commonly prescribed in England, suffered more problems if they were also on amlodipine and diltiazem.
These are used to treat high blood pressure and chest pain associated with heart disease, and they are often prescribed with simvastatin.
The side effects are those usually associated with statins, including muscle problems such as pain, tenderness, weakness and cramps and more rarely muscle breakdown leading to kidney damage. These occurred more frequently when patient were on both drugs at the same time.
Regulators have said patients taking the combination should not stop them and talk to their doctor at their next routine appointment.
Doctors may lower the simvastatin dose as the side effects were less common when patients were on a 20mg dose, or switch them to another statin.
An MHRA spokesman said: “The MHRA is committed to public health and continuously monitors the safety of all medicines.
“We have recently published information on dosing recommendations for simvastatin which were updated due to a small risk of an increase in side effects when it is used at higher doses in conjunction with amlodipine or diltiazem.
“This advice is intended to optimise the proven beneficial effects of statins while minimising any adverse effects and should not be a reason for stopping statin treatment. We have advised that patients continue their treatment and discuss this with their doctor at their next routine appointment.
“The updated information has been highlighted in our first Drug Safety Update article designed exclusively for patients, with the aim that people taking these medicines can understand why their statin treatment may have changed.”
The global war on free speech
It’s not just China and Russia: editors in Greece and Hungary are being harassed, while Britain’s straitened press is in danger of being cowed by powerful interests and excessive regulation
By John Kampfner (Kampfner is a former editor of ‘The New Statesman’, a British Leftist organ. A recent article there was headed: “The world cannot afford a defeat for Barack Obama”. Rather says it all. Still, he is pretty right below
Look back at the big events of the past decade and ask yourself: did we find out too much or too little of what the powerful did in our name? Did we know too much or too little about weapons of mass destruction in Iraq? Did we enquire too much or too little about the cheating of the bankers?
When I posed this question during my testimony to the Leveson Inquiry back in January, I swear I saw the judge’s eyes roll. I fear Lord Justice Leveson had been persuaded long before that journalism was a problem for society, not part of the solution to its ills. He could have been forgiven for coming to this instant conclusion, having listened to the heart-rending testimony of Milly Dowler’s parents, or Kate and Gerry McCann, or of other victims of hounding and despicable behaviour.
Even though I have worked in the profession, or trade, for more than two decades, I hold no candle for the press as an institution. My concern is broader. Freedom of expression – the bedrock of democracy – is under threat in Britain, as it is around the globe.
Wherever you look, someone with power, somewhere in the world, is trying to prevent the truth from getting out. In dictatorships they often resort to violence. But usually those with power hide behind laws that, while technically legitimate, are designed to chill free speech.
We think such measures are the preserve of places like China and Russia. And they are. In China the media are severely censored. Dissidents are routinely jailed. Western media are blocked online when they become inconvenient, as the New York Times was recently after revealing details of premier Wen Jiabao’s family wealth.
In Russia, investigative journalists are killed when they find out too much. The internet is now severely restricted. Members of the punk band Pussy Riot languish in penal colonies for protesting in church.
But dangers also lurk in so-called democracies. In Greece, a magazine editor yesterday went on trial for having the temerity to publish details of the tax avoidance schemes of the super-rich, as ordinary people suffer greatly from austerity. If normal ethical standards were applied, Costas Vaxevanis would have been celebrated for his intrepid reporting. But shooting the messenger has become the norm for politicians and business leaders, as a means of diverting attention from their crimes and misdemeanours – and frightening whistleblowers and journalists. In France, presidents and ministers have for years hidden behind privacy clauses to keep their dodgy financial affairs secret. Hungary’s recent press law, requiring media outlets to be licensed, has led to a spate of overly critical editors being sacked and radio stations taken off air.
What is so dispiriting is that we in Britain appear now to be leaning in this direction. We increasingly regard free speech as a danger.
There are a number of reasons: some of it is the result of bad law; some of it is economic. Politicians, lawyers and the public are struggling to come to terms with rapid technological changes. The internet was supposed to be the vehicle that broke down old rules and hierarchies. We suddenly acquired a voice through emails, blogs and social networking. We could bear witness to events through sound recording and cameras on our mobile phones.
The power relationship shifted. Gone were the days when a mere citizen would have to send a letter to their MP, who would occasionally deign to reply. Mostly they didn’t, seeing engagement or accountability as an intrusion on their valuable time.
That has changed, thank goodness, and cannot be reversed. The moment George Osborne’s assistant queried, possibly innocently, his standard-class train ticket, that episode was in the public domain.
Yet at the same time we struggle with Twitter and Facebook and the freedoms they afford. Online, the extremely poor joke and the offensive remark have now become matters not for peer groups to sort out, but for the authorities. So the hapless young man who tweets in frustration about blowing up an airport is arrested; a stupid boy who insults the Olympic diver Tom Daley is visited by the police; and the equally pathetic young man who makes an ill-judged “joke” about the disappeared Welsh schoolgirl April Jones is taken in, too.
I am as angered by these remarks as anyone, but is it the state’s job to arbitrate matters of taste and decency? When Nick Griffin, the BNP leader, was invited on to the BBC’s Question Time a couple of years ago, to howls of outrage, I saw it as important to defend his right to appear – and to make a fool of himself, which he duly did. To misquote Voltaire, the only free speech worth defending is that of the person whose views you find most obnoxious.
Everywhere around the world, it seems, the right to take offence has been elevated into a human right. Usually, but not always, this “right” is exercised through religious belief. Most cases are seen through the prism of “insults” to Islam. But this “right” now seems to be exercised by whoever wants it.
What does all this have to do with our press? The best word I can find is “raucous”. A raucous, argumentative society is a healthy society. Of course we need laws to protect people – from child pornography to incitement to violence. We need state secrets. But the Official Secrets Act has often been used for the wrongful purpose of protecting the reputations of ministers and officials. We need anti-terrorism measures, but not the outrageous Communications Data Bill currently being discussed in Parliament, that would give not just the security services but dozens of lesser public bodies the right to demand emails and social media traffic from any citizen in the land. These plans are dangerous; they are also manna from heaven for the Russians and Chinese, who love to point to the West’s double standards when their records are held up to scrutiny.
We need libel laws, but not those that for years have indulged sheikhs, oligarchs and other super-rich figures, preventing anyone from writing about them. These laws are being changed, but I fear the end result will fall far short of the improvements the libel reform campaign I helped to lead has sought.
Throw in the economics: many newspapers have closed or been pared to the bone, particularly in the regions. Whose interests are served when local councils know that planning decisions and other dodgy dealings will go unreported? The same goes on a national scale, not just about politicians, but sports stars and their agents and businesses on the take. Investigative journalism takes time, requires patience and indulgence from editors, and costs money. That is the area that is being cut back most of all – to everyone’s detriment.
So how come a general view has been allowed to take hold that our press is out of control? The terrible acts of a few, hacking the phones of the vulnerable with no possible public interest, have handed the moral ground and political power to those who want journalists to be more “respectful”.
I have attended a number of press conferences over the years involving prime ministers and US presidents. When the two leaders marched into the room, the Americans would stand to attention; the Brits would sit sullenly. I know which I prefer.
Nobody sensible will defend the old-style boys’-club regulation of newspapers. Of course, something more vigorous must emerge from the Leveson Inquiry. But I have worked in many countries – not just under authoritarian regimes – where journalists are seduced by the offer of a seat at the top table, or are persuaded not to ask that extra question. “Go easy, we don’t want trouble” could all too easily become the mantra here. Would, I ask myself, this newspaper have had the courage to break the story about MPs’ expenses in the post-Leveson world? I would like to think so, but I’m not sure.
We all want to strike the right balance. But perfection is elusive. Forced to choose, I would rather have a public space that goes too far than one that – like so many countries around the world – is pliant in the face of power.
Litter-picking enthusiast prosecuted by nasty British bureaucracy
A litter-picking enthusiast who is so devoted to keeping the streets clean that he spends an hour every day tidying up rubbish himself was stunned to find himself fined £75 for putting refuse in a bin.
Council officials accused David Baker, 39, of fly-tipping because they said he had used a public street bin to deposit a pizza box and junk mail – considered illegal as this is classed as “domestic waste”.
The former geologist has gathered tonnes of rubbish dropped by strangers over the last six years, winning awards for his efforts, after becoming fed up with litter piling up near his town centre flat.
He described his fine as “bureaucracy gone mad” and said the council seemed so “desperate for money” it would fine anybody.
Mr Baker said: “I think that it is completely outrageous that I should be fined for actually cleaning rubbish off the streets.
“How can people who actually want to put rubbish in the bin be fined? To claim that what I put in the bin amounts to fly-tipping is crazy.
“I moved to a town centre flat six years ago and got fed up with all the rubbish in the street. “I look after all the plants and dead head them daily and I go around picking up rubbish. “I fill a carrier bag or two a day and I go out most days of the year – unless I’m on holiday.
“I am out at least an hour every day and do it all for free. I just think the council are desperate for money and have a mentality of fining people for anything at the moment.”
Councillor Tracy Wood said: “Our enforcement officers issued a fixed penalty fine to Mr Baker in Stourbridge, after they found his domestic waste and letters in the litter bin on a number of occasions. “However, we will be reviewing the fine and speaking to Mr Baker directly to discuss it.”