Photo courtesy of British National Health Service Web site.
(CNSNews.com) As Britains government-run National Health Service continues to draw flak over the treatment of elderly and dying hospital patients, some NHS doctors are fighting back, disputing claims that have been raised as part of the U.S. debate over health-care reform.

More than 100 NHS health professionals and patients signed their names to an open letter published in the British Medical Journal this week, defending the U.K. health care system against criticism that has arisen in the U.S.

Survey after survey shows that British patients express a high degree of satisfaction with the care they personally receive from the NHS, they asserted. On average, British users of the NHS live longer and have a lower infant mortality rate than people in the U.S.

Elderly patients, they argued, receive the same treatment as younger ones, and get free flu vaccinations, free medication, free operations as needed, nursing care visits, and help and adaptations for the home.

The initiative comes amid a steady stream of complaints about the 61-year-old NHS, which has long faced accusations of rationing health care for reasons of cost-efficiency.

Over the past month it has been confronted by two especially damaging scandals.

The first came in the form of a report by an independent charity documenting a consistent pattern of shocking standards of care experienced by some NHS hospital patients. The report included gruesome personal accounts by family members of finding loved ones lying in blood, vomit or excrement.

The Patients Association, which operates a telephone helpline, said it had been receiving complaints for years about dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment.

These accounts reveal patients being denied basic dignity in their care often left in soiled bed clothes, being given inadequate food and drink, having repeated falls, suffering from late diagnosis, cancelled operations, bungled referrals and misplaced notes, said the charitys director, Katherine Murphy.

There are also worrying instances of cruel and callous attitudes from staff towards vulnerable and sometimes terminally ill patients.

After the report was released, the association said it was overwhelmed by responses, including hundreds of emails and calls from others across the country with their own stories to tell.

We feel the immense response we have had from the public is the best answer to continual rebuttals by NHS leaders and the Department of Health as they insist on ignoring the scale of the problem, it said in a statement.

Final pathway

The second recent blow to the NHSs reputation involved claims by experts that guidelines for care of the dying, which are being rolled out across the country, may be ending the lives of some patients prematurely because they are assessed as being closer to death than they actually are.

In a letter published in The Daily Telegraph, six experts raised concerns about the Liverpool Care Pathway for the Dying Patient (LCP), described by health authorities as a template to guide the delivery of care for the dying.

Implemented in 2004 and now used in hundreds of hospitals and care homes, the LCP advises senior staff to assess whether a patient is near death, based on signs such as difficulty swallowing or moving in and out of consciousness.

If deemed to be close to death, patients are put on the pathway and doctors can withdraw food and fluids and halt any intervention judged to be of no further benefit. They may also be sedated until they die.

The LCP recommends that the situation should be discussed with relatives. Staffers also are expected to regularly assess the patients condition, and to respond to any improvement by resuming treatment.

The withdrawal of food and fluids is already controversial pro-lifers call it backdoor euthanasia but some health professionals have raised additional concerns.

They warn that some symptoms used in the assessment could be the result of factors other than a condition of near-death for instance, a state of semi-consciousness could be related to the administration of morphine.

Forecasting death is an inexact science, the six experts, who included an emeritus professor of geriatrics at the University of London, Peter Millard, wrote in their letter.

If you tick all the right boxes in the Liverpool Care Pathway, the inevitable outcome of the consequent treatment is death. As a result, a nationwide wave of discontent is building up, as family and friends witness the denial of fluids and food to patients.

The writer said syringe drivers equipment used to administer a steady flow of fluid and/or medication to a patient over a sustained period of time are being used to give continuous terminal sedation, without regard to the fact that the diagnosis could be wrong.

The LCP was originally developed for cancer patients at a Liverpool hospice. Adopted in 2004 on the recommendation of an NHS agency called the National Institute for Health and Clinical Excellence (NICE), it is now used for terminally-ill patients irrespective of diagnosis.

A national audit of 3,893 patients put onto the LCP last year found that 39 percent of them had cancer while the rest had conditions including pneumonia, stroke and heart failure.

The audit, released this week, found the average age of affected patients to be 81. For cancer patients the median length of time spent on the pathway was 30 hours, while for those with other diagnoses it was 35 hours.

The audit also found that in only 72 percent of cases was the pathway that is, the withdrawal of life-supporting treatment explained to carers and relatives. In only 68 percent of cases did relatives express an understanding of what was about to be done.

The audit acknowledged that there was room for improvement when it came to communicating with relatives and carers about the LCP.

Choices have to be made

An annual social attitudes report compiled by Britains National Center for Social Research and released in January found that satisfaction with the NHS was higher than it had been at any time since 1984.

However, a breakdown shows that while satisfaction with NHS GPs was high, at 76 percent, satisfaction with inpatient services had dropped, from 74 percent in 1983 to 49 percent now.

The survey authors said the result seems to reflect concerns about the quality of medical treatment and nursing care in hospitals.

Ensuring cost-efficiency in the NHS is the function of NICE. The agency came under fire in 2006 for guidance saying that drugs for Alzheimers should only be prescribed on the NHS to patients with moderate-stages disease, and not those in the early stages.

NICE argued that the drugs, which cost a little over $4 a day, did not make enough of a difference for them to be recommended for all patients.

Opponents of the move took legal action, but the High Court in London upheld NICEs position in a ruling that the Alzheimer's Society described as insulting and devastating news.

Last week an osteoporosis expert told a British Science Association festival that thousands of British women suffering from the brittle bone condition were being denied better, but more expensive treatment. NICE is not due to appraise the new treatment for another three years.

So much for the promise at the inception of the NHS that all medicines and care would be given from cradle to grave, said Dr. Helen Evans, director of Nurses for Reform, in response to the news.

As far as I can see the NHS and other government agencies such as NICE seem now to be there for the sole purpose of making sure that very little is available and that the journey to the grave is very uncomfortable and much quicker than necessary, she said. Nurses for Reform is a network of nurses dedicated to consumer-led reform of health-care systems.

On its Web site, NICE explains how it decides whether or not a treatment is cost-effective, through use of a measure called a quality-adjusted life year (QALY).

QALY aims to calculate how many extra months or years of life of a reasonable quality a patient may gain as a result of treatment. Quality of life is gauged taking into account factors like the level of pain, mobility and general mood.

NICE then calculates how much the drug or treatment costs per QALY gained. If the treatment costs 20,000-30,000 pounds sterling (approximately $33,000-$49,400) per QALY gained, the agency considers it cost-effective.

If a treatment costs more than £30,000 per QALY gained, it is not normally recommended for use in the NHS.

With the rapid advances in modern medicine, most people accept that no publicly funded healthcare system, including the NHS, can possibly pay for every new medical treatment which becomes available, NICE says.

The enormous costs involved mean that choices have to be made.