Friday 29 June 2012

Liverpool Care Pathway – Working With Finite Budgets

This is the report that appeared in The Express. Charlotte Meredith's Express article on the subject is linked with reports elsewhere of financial perils that threaten the NHS and a warning that  the health service "looks like a supertanker heading for an iceberg.”

NHS DOCTORS “ENDING THE LIVES OF THOUSANDS OF ELDERLY PATIENTS TO FREE BEDS"


Thousands of elderly patients are being 'helped to die' according to a top doctor
Thousands of elderly patients are being "helped to die" according to a top doctor
Wednesday June 20,2012

By Charlotte Meredith for express.co.uk


ILL elderly patients are prematurely being “helped to die” because their care is too time consuming and there are not enough beds, claimed a senior health consultant yesterday.

The chilling news came to light after Professor Patrick Pullicino revealed NHS doctors are using the controversial ‘death pathway’ as a form of euthanasia for the elderly.

The Liverpool Care Pathway (LCP) is more commonly used in hospitals for the severely ill, when doctors consider it impossible for a patient to recover and death is imminent.

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Predicting death in a time frame of three to four days, is not possible scientifically
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Professor Pullicino
Under the pathway, doctors can withdraw treatment, food and water while patients are heavily sedated in an attempt to make their final days pass quickly and comfortably– normally resulting in a patients death within 33 hours.

Professor Pullicino said that in many cases LCP was being initiated without clear evidence of it being required.

Speaking to the Daily Mail, he claimed that the “pressure on beds and difficulty with nursing confused or difficult-to-manage elderly patients” resulted in an increase of the radical treatment,

Of the estimated 450,000 NHS care and hospital deaths in Britain each year, around 29 per cent – 130,000 – are of patients who were on the LCP.

Professor Pullicino, who revealed one patient he took off the LCP went on to be successfully treated, claimed that elderly patients who could live longer are being put on an “assisted death pathway rather than a care pathway.”

The consultant neurologist for East Kent Hospitals said that often claims that a patient required LCP because they had hours or days left are “palpably false”. 

He said: “Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically.” 

A Department of Health spokesman said: “The Liverpool Care Pathway is not euthanasia and we do not recognise these figures. The pathway is recommended by NICE and has overwhelming support from clinicians – at home and abroad – including the Royal College of Physicians.” 

“A patient’s condition is monitored at least every four hours and, if a patient improves, they are taken off the Liverpool Care Pathway and given whatever treatments best suit their new needs,” he added.

Meanwhile, the publication of reforms to social care for the elderly has been postponed yet again, forcing a Labour peer to warn that the system is in danger of collapse.

The Government is “drifting” towards perilous social care reform and those in nursing and residential care homes are most at risk of receiving sub-standard care, despite huge costs, according to Lord Warner.

He said: “We have actually got a situation where relatively poor people are spending all their assets to pay for their care.”

The head of the NHS confederation warned today that the health service "looks like a supertanker heading for an iceberg.”

Speaking at an annual conference in Manchester Mike Farrar, chief executive of the confederation which represents organisations providing NHS services, said: "Despite huge efforts to maintain standards of patient care in the current financial year, healthcare leaders are deeply concerned about the storm clouds that are gathering around the NHS.

"Many NHS leaders see finances getting worse and that this is already having a growing impact on their patients," he added.

The comments come as a survey revealed almost half of NHS officials think patients will be given a dramatically reduced quality of care over the next year because of cuts to costs.

Some 47 per cent of the NHS leaders present at the conference said that they fear growing financial pressures on the nation’s health service will damage patients' quality of care, saying that the economic burden on the health service is "very serious."

Mr Farrar added: "Frankly, without action on the way we provide health and social care, the NHS looks like a supertanker heading for an iceberg. The danger is clearly in view and looming ever-larger.”
A senior economist waded in on the NHS debacle this morning saying that proposed efficiency savings are simply not realistic.

John Appleby, chief economist at the King's Fund, said asking the NHS to find nearly £50 billion in efficiency savings by 2019 to 2020 would be "frankly undoable," in an article published on bmj.com.

Mr Appleby warned that the NHS is destined for failure, stretching it’s already "barely achievable" productivity challenge another four years.

He said: "To be inefficient is not just to waste money, it's to waste lives. So, there should be no let-up in finding new and better ways of using finite budgets to do good things for people who use the NHS. But maybe it's time for some realism."

“New and better ways of using finite budgets.” What does that mean?

The DOH sponsored Commissioning for Quality and Innovation (CQUIN) payments made to Trusts for setting in place LCP protocols are still the cheaper option compared with access to appropriate and adequate palliative care.

The elderly are more likely to be placed on the LCP death pathway. A cash-strapped NHS can ill afford recuperative care for someone already on the downhill slope of terminal old age!

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