Care homes 'put patients at risk' with feeding tube stance

CARE homes were accused today of putting elderly and infirm patients at risk by forcing them to be fitted with feeding tubes.

Many homes are said to be closing their doors to patients who do not have "nil by mouth" tubes inserted into their stomachs.

Although they claim to be acting in patients' interests, the motive may be to cut costs and save on staffing, say the authors of a Royal College of Physicians report.

The disclosure came as the college issued guidelines urging doctors and nurses to view artificial feeding as a "last resort".

An audit of 719 PEG procedures published in 2004 found 19 per cent were "futile" and did nothing to prolong life.

The finding suggests large numbers of patients are being fed "nil by mouth" inappropriately.

A 2008 survey showed in the previous year, 39,000 people in the UK were artificially fed outside hospital, either at home or in residential care.

Dr Rodney Burnham, who co-chaired the working party that produced the guidelines, said increasing numbers of care homes were refusing to take patients not fitted with feeding tubes.

"We come down very strongly on any blanket refusal on those grounds," he said. "They may cite patient safety but there could be a hidden agenda on grounds of staffing or costs."

He was unable to say what proportion of homes imposed the PEG rule, but added: "It is fairly widespread, because every hospital and every nutrition team you talk to will have had that experience."

PEG procedures were invasive and involved a significant element of risk, he said. Death rates of patients given PEG tubes were 6 per cent on average after 30 days and in some cases as high as 30 per cent. Nearly a third of patients suffered ill-effects.

Professor John Saunders, from Nevil Hall Hospital in Abergavenny, who co-chaired the working group, said: "I think if a patient is not in a position to make that decision and tube feeding is futile, it is unethical on a legal basis."

The professional guidance was issued against a background of 39 per cent of hospital in-patients in the UK being malnourished.

Feeding by mouth was recognised as essential to quality of life, and worth preserving even when a patient had difficulty swallowing.

"Nil by mouth should be a last resort," said the report.

A Department of Health spokesman said: "The use of intrusive interventions, is a clinical decision and should only be used when necessary, based on the circumstances of the person concerned, and with their or their representative's agreement."