Thread by @pmdfoster

NEW/EXC: GPs and end-of-life carers calling for a relaxation of the "Shipman" rules over controlled drugs after some patients face unnecessarily distressing #coronavirus deaths at home because of delays in getting drugs - shocking situation 1/Thread

ft.com/content/aadf18…

Two cases relayed to me by Bill Hulme, medical director @hospiceuk in York illustrate the problem.

#COVID19 can attack very fast, with rapid onset of symptoms among vulnerable. It leads in final stages to extreme breathlessness, hyperventilation, panic and pain. Not nice. /2

@hospiceuk BUT there are drugs to address these issue - morphine for pain, and Midazolam, a muscle relaxant, which Mr Hulme says "work very well" in combination to keep patients in last hours of life comfortable.

Problem is, end-of-life carers cannot just go in to a home and administer /3

@hospiceuk Under the rules (which were tightened following Harold Shipman scandal were the GP was convicted of murdering 15 patients with 'controlled' drugs') these drugs need to be prescribed to each patient - your name has to be on the bottle. That takes time. /4

@hospiceuk Mr Hulme told of one case, a man, mid 60s with lung cancer and a six-month prognosis who was OK at breakfast, but in severe difficulty by lunchtime. Carers got to his home could see he had only hours to live. Then had to go through process of finding/filling scrip /5

@hospiceuk Because of local shortages and over-stretched pharmacies (they visited four or five, queuing at each) the carers had a much longer wait than they'd like. They got to the patient eventually, who died hour or two later. Harrowing stuff. /6

@hospiceuk NOW @MartinRCGP and some parts of the carer/pharmacist industry are lobbying Whitehall to relax these 'peacetime' rules on drugs to deal with the 'wartime' situation that #COVID19 presents /7

@hospiceuk @MartinRCGP Among the 'crazier' elements of the rules, as @MartinRCGP points out given supply issues noted above, is that any un-used or 'leftover' drug must be disposed of. Rules is rules, but surely that can be fixed? /8

@hospiceuk @MartinRCGP I spent half of yesterday trying to get a coherent response out of government, or what government plans to do, but really get anywhere. Beyond admission that law does present problems, but remedy isn't to change it. So what is the remedy then? /9

@hospiceuk @MartinRCGP The rules at present, as summarised by Mr Hulme, require named prescription, to a named person; all drugs need to be 'counted out, counted in' and unused drugs disposed of. See link for full list of 'post Shipman controls' /10

nhsbsa.nhs.uk/sites/default/…

@hospiceuk @MartinRCGP Given sheer *speed* #COVID19 attacks some people, wouldn't it possible, just for this outbreak, to have licensed carers like @hospiceuk staff to administer meds and get the paperwork filled retrospectively? Or something to speed up the chain? One for professionals to advise?/11

@hospiceuk @MartinRCGP The Home Secretary @patel4witham has written to statutory body covering drug misuse asking for some flexibility on presctiptions - but ONLY for those already with "ongoing treatment". That's no help if you're crashing with #COVID19 /12

gov.uk/government/pub…

@hospiceuk @MartinRCGP @patel4witham And if you read the response to @patel4witham letter from the Advisory Council on the Misuse of Drugs to even that fairly simple request, you can see how difficult this stuff is. /13

assets.publishing.service.gov.uk/government/upl…

@hospiceuk @MartinRCGP @patel4witham I am neither a lawyer or a doctor, so defer to those professions on what is possible.

But I was genuinely surprised to hear of these cases where patients at home are waiting unnecessarily to be made comfortable. /14

@hospiceuk @MartinRCGP @patel4witham There will, sadly, be lots more of these deaths. We know that.

Surely everything possible must be done to ensure they are as dignified as possible.

This is an emergency. Carers need reasonable powers to act reasonably in the circumstances. /15

@hospiceuk @MartinRCGP @patel4witham Lastly, the message from @hospiceuk and others is "HAVE the conversation".

In the case above, the patient had a 6-month prognosis, so hadn't rushed to make advance plan.

But #COVID19 can strike fast. Vulnerable groups particularly need make a plan. ENDS