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HOME NEWS HEALTH HEALTH NEWS

NHS millions for controversial care pathway

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The majority of NHS hospitals in England are being given financial rewards for placing
terminally-ill patients on a controversial pathway to death, it can be disclosed.

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Almost two thirds of NHS trusts using the Liverpool Care Pathway have
received payouts totalling millions of pounds for hitting targets related to
its use, research for The Daily Telegraph shows.

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The figures, obtained under the Freedom of Information Act, reveal the
full scale of financial inducements for the first time.
They suggest that about 85 per cent of trusts have now adopted the
regime, which can involve the removal of hydration and nutrition from
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More than six out of 10 of those trusts - just over half of the total - have
received or are due to receive financial rewards for doing so amounting
to at least 12million.

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At many hospitals more than 50 per cent of all patients who died had
been placed on the pathway and in one case the proportion of
forseeable deaths on the pathway was almost nine out of 10.

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Last night the Department of Health insisted that the payments could
help ensure that people were treated with dignity in their final days and
hours.
But opponents described it as absolutely shocking that hospitals could
be paid to employ potentially lethal treatments.

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The LCP was originally developed at the Royal Liverpool University

Hospital and the citys Marie Curie hospice to ease suffering in dying
patients, setting out principles for how they to be treated.
It involves the withdrawal of treatments or tests from patients which
doctors believe could cause distress and do more harm than good.
Protocols say that doctors should consult the patient, if possible, and
their families.
But the system has been mired in controversy amid claims that it can
actively hasten death.
A series of cases have also come to light in which family members said
they were not consulted or even informed when food and fluids were
withheld from their loved-ones.
In some instances patients placed on the pathway because doctors
judged that they were nearing the end of their life went on to recover.

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According to responses from a sample of 72 trusts, at least 12.4 million

has been paid out in the past two to three years to trusts which hit
targets associated with use of the care pathway. But the full figure could
be more than 20 million.

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Under a system known as Commissioning for Quality and Innovation

(CQUIN), local NHS commissioners pay trusts for meeting targets to
reward excellence in care.
These can range from simply recruiting a set number of people to
classes to help them stop smoking to providing specialist end-of-life
services on wards - such as LCP.

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Of those, 62 per cent disclosed that they had either received, or expect
to receive, cash rewards for meeting targets associated with the
implementation of the pathway. The remainder said they had adopted
the LCP without receiving any payments.
Central Manchester University Hospitals - which received 81,000 in
2010 for meeting targets relating to the LCP - said the proportion of
patients whose deaths were expected and had been placed on the

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Elsewhere the targets relate to how the pathway is operated or

monitored.

Overall 61 of those which responded said that they used the pathway,
translating to 85 per cent of the total.

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As the goals are set locally, they vary from area to area but in some
cases trusts are given specific targets to ensure that a set number of
people who die in their hospital are on the LCP.

Each Trust was asked how many people had died on the LCP over the
past three years and how much money received in that period was
attached to goals involving it.

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patients whose deaths were expected and had been placed on the
pathway more than doubled to 87.7 per cent in the past year.
In Berkshire the Heatherwood and Wexham Park Hospitals Trust
received more than 1 million over two years for meeting its LCP goals.
Its targets included carrying out an audit of the number of deaths of
patients on the LCP as well as having a meaningful conversation with
the patient themselves but did not set a specific goal for the number of
deaths.

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Bradford teaching Hospitals, which qualified for CQUIN payments of

more than 490,000 in the last two years, has seen the number of
patients dying on the pathway more than double to 51 per cent over the
last three years.
In Birmingham the Heart of England NHS Foundation Trust disclosed
that 38 per cent of patient deaths occurred on the LCP in 2010 and 27
per cent in 2011. It received a CQUIN payment of 603,886 in the
financial year 2010-11 alone.
A handful of trusts openly spoke of either hitting or missing targets
connected to the LCP in their responses.
Dr Gillian Craig, a consultant geriatrician who was among the first
doctors to raise the concerns over the possible flaws of the LCP,
described the use of the incentives as absolutely shocking.
I think there should be questions in Parliament as to who instigated this
policy and I think the cash payments should be stopped forthwith, she
said.
You cant pay people to use a certain protocol that everybody knows to
be lethal.
Dr Phillip Lee, the Tory MP for Bracknell and a former GP, insisted that
the pathway did not amount to euthanasia by the back door.
This is about trying to provide appropriate care to someone who is
dying, he said.
Palliative care specialists are some of the best doctors that this country
has.
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Sometimes there are conflicts between doctors and patients families

but I just cannot believe that there is anybody in the palliative care arena
who is trying to anything other than provide the best care for patients.
Earlier this week the NHS disclosed that it was beginning a review of the
operation of the LCP following concerns highlighted in the media. Dying
Matters, a coalition of organisations including hospices, has been asked
to speak to relatives about their experiences as part of the inquiry.
The Department of Health has consistently stood by the LCP.
Last night a spokesman said: The Department of Health does not
centrally fund any payments for the use of the Liverpool Care Pathway,
but local areas may choose to do so in order to improve the care and
support given to people in their last days.
This means patients can be more comfortable and treated with dignity
in their final days and hours.
The Liverpool Care Pathway is supported by more than 20 leading
organisations, including Marie Curie Cancer Care and Age UK, as a way
to help meet the care and dignity needs for those who are at the end of
their life.
We are clear the Liverpool Care Pathway can only work if each patient
is fully consulted, where this is feasible, and their family involved in all
aspects of decision-making. Staff must properly communicate with the
patient and their family - any failure to do so is unacceptable.

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