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What age and degrees of infirmity and clinical appropriateness are the parameters under the "national guidelines" for seeking "do not resuscitate" instructions from patients; and[HL708]
In the case of elderly patients not considered fully mentally competent, what degree of consultation with patients' close families the "national guidelines" require before "do not resuscitate" instructions are implemented; and what requirements there are for the intervention of an independent social worker to safeguard patients having no close family support; and[HL709]
Who issued the "national guidelines" as used in the National Health Service hospitals on the solicitation of "do not resuscitate" instructions from elderly patients or their close families; and when; and[HL710]
When and where the "national guidelines" on the solicitation of "do not resuscitate" instructions were published; and[HL711]
What consultation took place before the "national guidelines" on the solicitation of "do not resuscitate" instructions were published and with whom; and when and where the guidelines were publicly debated, whether before or after publication.[HL712]
Lord Hunt of Kings Heath: Applicable guidelines on Decisions Relating to Cardiopulmonary Resuscitation were first published in 1993 in a joint statement issued by the British Medical Association, the Resuscitation Council (UK), and the Royal College of Nursing. A revised version was published in June 1999. The joint statement gives only general guidelines on the basic principles within which decisions regarding local policies on cardiopulmonary resuscitation may be formulated. It makes clear that all acute hospital trusts should establish local resuscitation policies. The wider ethical context on end of life decisions (of which cardiopulmonary resuscitation is an example) is contained in the BMA guidelines on Withholding and Withdrawing Life-prolonging Medical Treatment.
One of the basic principles of healthcare is that a competent patient has the right under common law to give or withhold consent to examination or treatment. The guidelines suggest that where competent patients are at risk of cardiac or respiratory failure, or have a terminal illness, there should be sensitive exploration of their wishes regarding resuscitation.
In the case of patients who are not capable of consenting to treatment, and in the absence of a valid advance refusal of treatment, it is a doctor's duty to act in the best interests of the patient concerned. The overall responsibility for "do not resuscitate" decisions rests with the doctor in charge of the patient's care. Before making a "do not resuscitate" decision, an assessment is made of the patient's best interests and the guidelines specify that this assessment should include consultation with other members of the health care team and, where appropriate, relatives or those close to the patient. However, the latter cannot determine a patient's best interest nor give consent to or refuse treatment on a patient's behalf. Although the guidelines suggest that resuscitation decisions should be subject to audit, the involvement of an independent party in individual decisions is not specifically required.
The guidelines recognise that the decision arrived at in the care of one patient may be inappropriate in a superficially similar case. "Do not resuscitate" decisions should therefore be reached on a case by case basis. Thus a blanket "do not resuscitate" policy based on a specific patient group (for example,
Lord Hunt of Kings Heath: Subject to paraliamentary approval of the necessary Supplementary Estimates for Class II, Votes 1 and 2 the Department of Health Departmental Expenditure Limit for 1999-2000 will be increased by £302,308,000 from £40,455,019,000 to £40,757,327,000. The increase is the net effect of changes to Class II, Vote 1 (Hospital, community health, family health and related services, England) of £261,646,000 made up of £113,671,000 in respect of the take-up of end year flexibility for NHS trusts, £134,000,000 from the reserve for the cost of generic drugs and clinical negligence claims and £14,000,000 from the capital modernisation fund. In addition, the following transfers will take place; £1,094,000 from Northern Ireland for out of area treatments; £177,000 from the National Assembly for Wales general practitioner drug costs and £155,000 from Class III, Vote 1 (Environment, Transport and the Regions: Housing, construction, regeneration, countryside and wildlife, England) for the Victoria Pilot Project. The overall increase is partially offset by transfers of £1,250,000 to Class XII, Vote 3 (Department of Social Security: administration) for the road traffic accident element of the Compensation Recovery Unit; £190,000 to Class XIII, Vote 1 (Scottish Executive) for student bursaries and £11,000 to Class XIV, Vote 1 (National Assembly for Wales) for the Dental Service Increment for Teaching.
The increase of £40,662,000 for Class II, Vote 2 (Department of Health, administration miscellaneous health and personal social services, England) is the net effect of transfers (detailed below) and £16,460,000 take-up of end year flexibility (as announced by the Chief Secretary to the Treasury on 27 July (Official Report col. 393) and £25,000,000 for claims in respect of asylum seekers grant; £580,000 (£60,000 running costs) from Class IV, Vote 1 (Home Office: administration, police, immigration and other services, England and Wales) for teenage pregnancy unit, publicity and drug project development work; £60,000 (running costs) from Class I, Vote 1 (Department for Education and Employment: programmes and central services), £60,000 (running costs) from Class III, Vote 5 (Department of the Environment, Transport and the Regions: administration) and £60,000 (running costs) from
The department's gross running cost limit will be decreased by £117,000 from £280,450,000 to £280,333,000, made up of an increase of £173,000 (detailed above) offset by and a transfer from DH DEL to programme expenditure of £290,000 for surveys and research.
All increases will either be offset by transfers to or from other departmental expenditure limits (detailed above) or charges to the DEL Reserve and will not therefore add to the planned total of public expenditure.
The Minister of State, Department of the Environment, Transport and the Regions (Lord Macdonald of Tradeston): Arthur D Little's report on regional Eurostar services is published today. We have placed copies in the Libraries of both Houses.
The report considers whether Eurostar services directly serving the English regions and Scotland would be financially viable, and what wider transport and social benefits they would bring. The consultants consulted widely with local and regional authorities and groups. The report provides an independent assessment of the costs and impacts of a range of options.
Under Section 40 of the Channel Tunnel Act 1987, the British Railways Board, now part of the Shadow Strategic Rail Authority, has a duty to prepare a plan for regional international rail services. The board is now reviewing its 1989 plan. It will no doubt wish to consider the Arthur D Little report in that review, which it expects to conclude in early summer. In the longer term, the Strategic Rail Authority will have a duty to produce a strategy for services in various parts of Great Britain for facilitating the carriage of passengers by way of the Channel Tunnel.
We are today giving the go-ahead for Eurostar UK Limited to lease some of the regional trains to GNER for a limited period for additional services on the East Coast Main Line. This will allow regional passengers to enjoy an immediate benefit from the investment made in these trains while leaving open future options for the use of the trains for regional Eurostar services. This arrangement accords with the recommendation of the Select Committee on Environment, Transport and Regional Affairs that leasing to a domestic rail operator should be considered while decisions on regional Eurostar services were under review.
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