Liverpool Care Pathway Cash Incentives

Topics covered: Ridouts professional advice

Hospitals have been offered cash incentives to put patients on the Liverpool Care Pathway in order to meet targets.  They are paid millions to hit targets for the number of patients who die on the Liverpool Care Pathway.

Hospital consultant Professor Patrick Pullicino warned financial incentives for hospitals to put patients on the Liverpool Care Pathway could influence the work of doctors. He said ‘given the fact that the diagnosis of impending death is such a subjective one, putting a financial incentive into the mix is really not a good idea and it could sway the decision-making process’.

In some cases, hospitals have been set targets that between a third and two thirds of all the deaths should be on the LCP, which critics say is a way of hastening the deaths of terminally ill patients. Over the last three years, an estimated £30million in taxpayers’ money has been paid to hospitals to achieve these goals. The Association for Palliative Medicine, which represents doctors working in hospices and on specialist hospital wards, announced it is organising an inquiry into the method.

Payments to hospitals to introduce LCP are made through a system called Commissioning for Quality and Innovation, or CQUIN, which channels money to hospital trusts through NHS ‘commissioners’. The use of CQUIN payments to encourage the use of the LCP was revealed in answers to Freedom of Information requests.

Among trusts that confirmed the use of targets was Aintree University Hospitals NHS Foundation Trust, which said that in the financial year which ended in March the percentage of patients who died on the Pathway was 43 per cent against a target of 35 per cent. Over the year the Trust received £308,000 for meeting targets.

Salford Royal NHS Foundation Trust had CQUIN payments connected to the Liverpool Care Pathway almost halved after failing to reach targets. The Trust was offered £73,385 for increasing numbers of patients who die at home rather than in hospital. Part of the scheme was a target for the number of patients discharged from hospital to die at home after being put on the Liverpool Care Pathway.

The Department of Health defended LCP payments saying ‘it is right local areas try to improve the care and support offered to dying people as it means patients are more comfortable and treated with dignity in their final days and hours. 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.’

However, Dr Tony Cole, chairman of the Medical Ethics Alliance pressure group said ‘if death is accelerated by a single day that will save the NHS nearly £200 – that is the estimated cost of a patient per day in hospital. My position on the LCP is that it is inherently dangerous and unnecessary‘.

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