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Government sets Euthanasia targets

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PostPosted: Sun May 07, 2017 8:04 am    Post subject: Government sets Euthanasia targets Reply with quote

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

http://www.telegraph.co.uk/news/health/news/9644287/NHS-millions-for-c ontroversial-care-pathway.html

NHS millions for controversial care pathway

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.
Almost two thirds of NHS trusts using the Liverpool Care Pathway have received payouts totally 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 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.”
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PostPosted: Sat May 20, 2017 1:42 am    Post subject: New NHS death guidelines 'worse than Liverpool Care Pathway' Reply with quote

New NHS death guidelines 'worse than Liverpool Care Pathway'

http://www.telegraph.co.uk/news/health/news/11779213/New-death-guideli nes-worse-than-Liverpool-Care-Pathway.html

One of the first medics to raise concerns about the now discredited Liverpool Care Pathway says new protocols to replace it are more dangerous, and could hasten patients' deaths
New NHS guidelines on “end of life” care are worse than the Liverpool Care Pathway and could push more patients to an early grave, a leading doctor has warned.
Prof Patrick Pullicino, one of the first medics to raise concerns over the pathway, said the national proposals would encourage hospital staff to guess who was dying, in the absence of any clear evidence, and to take steps which could hasten patients’ death.
The Liverpool Care Pathway - which meant fluids and treatment could be withdrawn, and sedation given to the dying - was officially phased out last year, on the orders of ministers.
It followed concern that under the protocols, thirsty patients had been denied water and left desperately sucking at sponges.
Last week the National Institute of Health and Care Excellence (Nice) published new 32-page guidance for hospital staff on end-of-life care.
Writing for the Daily Telegraph, Prof Pullicino said the plans repeat features of the pathway which made it so dangerous, compounding them with even more lethal errors.
The Nice proposals call on hospital staff to identify a list of “signs” and “changes” – such as agitation or fatigue which could suggest a person is entering the last days of their life, before drawing up a plan for their care, which could see fluids withdrawn.
Prof Pullicino, professor of clinical neuroscience at the University of Kent, said such signals were not reliable evidence on which to forecast imminent death, and that it was dangerous to base treatment decisions on a turn for the worse.
“Diagnosis of who was imminently dying was the core problem of the Liverpool Care Pathway and is no better in the Nice document,” he said. “It includes a cookbook list of features that may suggest someone is dying but is totally inadequate to make a diagnosis and is not evidence-based. So we are back at the LCP in terms of the risk of putting patients who are not dying onto inappropriate and potentially lethal treatment.”
The neurologist said patients should be given “good quality compassionate care” not a set of protocols based on poor evidence.
The pathway was axed following a review led by Baroness Neuberger, which said patients “should be supported with hydration and nutrition unless there is a strong reason not to do so”.

The new guidance says dying patients who are able to drink should be given water if they seek it.
But it also says patients should also be told “death is unlikely to be hastened by not having clinically assisted hydration” - such as a drip.
Prof Pullicino said the claim was “completely untrue,” stating that lack of hydration would kill anyone who cannot drink.
He accused Nice of a “disaster of misinformation, distortion and ambiguity” in its advice.
The neurologist - who had a patient survive 14 months after being taken off the care pathway – said all patients should be given adequate nutrition and hydration regardless of their prognosis.
“Dehydration was a central mechanism of the deaths on the LCP. Despite the removal of the LCP, I still frequently witness severely dehydrated elderly patients on hospital wards.
“Unless it becomes standard, and monitored by the Care Quality Commission, that hospitals are obliged to give nutrition and hydration adequate for patients’ physiological needs at all times and regardless of prognosis, end-of-life care is going to remain lethal,” he writes.
The guidelines, which are now out to public consultation, also encourage the use “anticipatory prescribing” as early as possible, giving hospital staff access to pain relief and sedatives without having to call for a doctor.
The neurologist said the practice was one of the most dangerous aspects of the previous pathway, allowing nurses to increase the dose of medication and hasten death.
Although the LCP was officially withdrawn last year, the neurologist said he regularly received reports from relatives desperately trying to obtain “active” care for patients who were denied it because they were deemed to be dying.
Earlier this year the Royal College of Nursing and charity Macmillan Cancer support said some hospitals had not changed their practices since the pathway was officially axed.
A NICE spokesman said: “Recognising when someone is approaching their last few days of life and making sure they are as comfortable as possible can be difficult for families and healthcare professionals alike. The NICE guidance, which is being developed by an independent group of experts through a rigorous process of evidence analysis and public consultation, will support the NHS to provide high-quality and compassionate care.
“The draft guideline is open for public consultation and we welcome any comments from healthcare professionals and stakeholders, as well members of the public, as they help inform the final guidance. Draft recommendations include the use of multiprofessional teams to provide care; creating individualised care plans; involving the person and their loved ones in decisions about their care, including the use of medicines; and supports the use of fluids.”
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