Hospital staff are taking a dismissive attitude towards patients who have alcohol-related liver disease and lives could be needlessly lost, a review of patient deaths has reported.
The review, the National Confidential Enquiry Into Patient Outcome and Death (NCEPOD), warns of unacceptable levels of care in the health service, a shortage of specialist doctors, and failures to properly screen and act upon drinking habits and manage acutely ill patients.
In some cases, the deaths might have been avoided, according to the review. Even when doctors were uncertain of cause of death they sometimes did not recommend an autopsy or report deaths to coroners, according to the analysis of hundreds of NHS cases.
Bertie Leigh, chairman of NCEPOD, a charitable body to improve professional standards, which is funded largely by the government, said: “We all know this is a group of people who are difficult to help. But they are still entitled to be treated on their clinical merits and the care that would bring benefit.
“I fear there is a more than a hint of dismissive attitudes in many of these cases ”¦ no decent healthcare system should write people off or deem them less worthy of the best care available to them.”
Leigh, who is a medical lawyer and the first person to chair the organisation who is not a doctor, expressed surprise that “such extremely ill people were admitted under doctors who claimed no specialist knowledge of their disease, and [were] not transferred to doctors who did”.
He added: “There cannot be any other area of medicine where our hospitals would make such a candid admission. It is hard to avoid a feeling that these people are failed all the way through their care pathway, and that there were too many missed opportunities where the NHS could have intervened.”
Leigh said most of the deaths studied were of people under 60.
“Since it is reasonable to anticipate that the survivors will continue to drink excessively and carry an increasing burden of physical harm, there may be some truth in the suggestion that a vulnerability to cirrhosis is in part genetic, because the rate of death does not continue to increase with age.”
The review, carried out by doctors and entitled Measuring the Units, was established to see how a national liver plan published by the British Society of Gastroenterology in 2009 was being followed. Although there were “green shoots here and there”, there were “few positive buds”, said Leigh.
The criticism has come a fortnight after NHS figures showed that, in 2011-12, an estimated 1.22m hospital admissions in England were linked to drinking too much alcohol, more than 40% up on 2002-03.
NHS investigators and advisers studied hundreds of the 8,748 alcohol-related deaths recorded in the UK in 2011.
The organisation recommends better screening for alcohol misuse of all patients using hospital services, even for those not admitted, so that people with harmful drinking habits can be referred quickly to alcohol support services.
Each hospital should have a seven-day specialist nurse service to ensure access to such help within 24 hours of admission; every acute hospital should also have a multidisciplinary alcohol care team led by a consultant, it says.
All patients with acute alcohol-related liver disease should see a gastroenterologist or hepatologist soon after admission, adds the review.
The review, covering NHS hospitals in England, Wales and Northern Ireland, as well as public hospitals in the Isle of Man, Guernsey and Jersey, looked at the clinical care of 512 patients but focused in detail on 385 of those.
Of these, 32 deaths might have been avoided with better care, and the care of less than half the patients reviewed was considered good.
A quarter of patients were not seen by a gastroenterologist or hepatologist during their admission. Consultant hepatologists were only present in 28% of hospitals.
Mark Juniper, NCEPOD’s clinical co-ordinator for medicine and an author of the report, said: “Many people with alcohol-related liver disease have multiple admissions with this condition. This gives clinicians an ideal opportunity to offer appropriate treatment and advice to patients to help them stop drinking and improve their future health.
“Unfortunately, this isn’t happening, and in over a third of patients reviewed in this study, referral for support to stop drinking was not made, despite most hospitals reporting to have alcohol liaison services. This is partly because the services are not available at all times that they are needed.”
Juniper, who is a consultant physician, working at the Great Western hospitals NHS foundation trust, Swindon, added: “Similarly, patients were not always seen by a specialist in liver disease, and when they [were] this was often not for several days after admission.
“We know that abstinence works, and that when simple advice is offered to patients, one in eight will reduce their harmful drinking levels – that’s better than the results from ‘stop smoking’ support services.”
He said of medical attitudes to such patients: “There are misunderstandings. It is quite difficult to predict the patients who will do well and who will do badly once they get into hospital and are very sick ”¦ there are patients who are being denied intensive care and aggressive treatment who do have the potential to survive.”
