Thursday, November 1, 2012
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.
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 dying patients.
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.
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.
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.
The LCP was originally developed at the Royal Liverpool University Hospital and the city’s 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.
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.
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.
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.
Elsewhere the targets relate to how the pathway is operated or monitored.
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.
Overall 61 of those which responded said that they used the pathway, translating to 85 per cent of the total.
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 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.
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 can’t 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.
“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.”