Liverpool Care Pathway – And The Rationing Of Resources

Dr. Ezekiel Emanuel has discussed in his philosophical treatise, "Where Civic Republicanism and Deliberative Democracy Meet", how best to apportion care in the circumstance of a scarcity of care provision with 'both procedural and substantive insights for developing a just allocation of health care resources' and the allocation of those scarce resources considered or not considered as basic.

Vile ideas have been and are being everywhere ‘floated’ and to what purpose and for what agenda, we care not to think – or dare not to imagine.

Imagine not -

The NHS is in dire financial straits. Both those of this and those of that political ilk each lay the blame at each other's door. Much of this 'blame' must be laid at the door of the PFI's (Private Finance Initiatives) indulged in frivolously and thoughtlessly by the last Labour government.

The Private Finance Initiative (PFI)

The Private Finance Initiative (PFI) was announced in the 1992 Autumn Statement with the aim of achieving closer partnerships between the public and private sectors. It was one of a range of policies introduced by the Conservative Government to increase the involvement of the private sector in the provision of public services. Following two reviews of the PFI by Sir Malcolm Bates, the present Government has continued to pursue the delivery of some public services through this means.

As at 1 September 2001 there had been almost 450 PFI deals signed with a total capital value of £20 billion. The increased level of activity must be paid for by higher public expenditure in the future, as the stream of payments to the private sector grows. PFI projects signed to date have committed the Government to a stream of revenue payments to private sector contractors between 2000/01 and 2025/26 of almost £100 billion.

Here is The Telegraph reporting just last week -

Hospitals 'can't cope' with rise in elderly patients

Hospital wards are “on the brink of collapse” due to ever-increasing numbers of elderly patients and weekend staff shortages that are seriously compromising safety, according to a hard-hitting report by the Royal College of Physicians.

THE LIVERPOOL CARE PATHWAY - AN 'UNLAWFUL' PRACTICE

An unlawful practice? That reasoning appears perfectly valid.

This is the act of taking life, however, and if that taking of life is 'unlawful' then that is murder and that is a sobering thought.

That this taking of life is State-sponsored is not merely frightening, it is scandalous.

This State-sponsorship goes further than merely promoting the LCP protocols, however; it extends to the DOH-sponsored Commissioning for Quality and Innovation (CQUIN) payments made to Trusts to bribe them into setting in place LCP protocols.

Just last October, the MailOnline asked –

Is this what we get for spending MORE on the NHS than ever before?

and replied -

Shameful neglect of the elderly in ONE FIFTH of our hospitals breaks the law, says watchdog.

 TheTelegraph Medical Correspondent, Stephen Adams, reported today -

NHS under pressure with more trusts in the red

Number of NHS trusts in financial difficulty has more than doubled in a year, an Audit Commission report warns.

Under such pressures of shortages and scarcity, it is clear where and how the choices and decisions are being taken.

As managers squeeze doctors to squeeze "more value from every £1 they spend", communitarianism is coming into its own.

 

Hospital closures inevitable and NHS operation rationing will continue, warns think-tank

NHS patients should expect continued rationing of common operations for years to come, while hospital closures are “inevitable”, according to an influential think-tank.

Prof Appleby questioned how much impact limiting access to such procedures actually had on improving
the finances of primary care trusts (PCTs), which pay for treatments in hospitals Photo: ALAMY

By Stephen Adams, Medical Correspondent

10:00PM BST 29 Jun 2012

John Appleby, chief economist at The King’s Fund, also warned services in some hospitals could seriously deteriorate due to the impact of the economic crisis.

He said it was highly unlikely the NHS budget would be significantly increased in the foreseeable future.

Against this grim financial background managers are being asked to get 5p more value from every £1 they spend, every year, partially to keep up with the increasing demands of an ageing population.

Patients have already experienced the effect of this. For example, nine in 10 trusts have introduced tighter criteria to qualify for a range of procedures deemed to be of ‘low clinical value’ - including hip and knee replacements, cataract removals and weight-loss surgery.

Doctors and patient groups have argued that these are unfair and will be more expensive in the long run.

But Prof Appleby said the “financial imperative” was so pressing that such restrictions were likely to continue well beyond 2015.

He said: “In terms of disinvesting from comparatively low value treatments, I would expect that to go on, even though it’s extremely difficult if it’s a case of withdrawing a service.”

However, he questioned how much impact limiting access to such procedures actually had on improving the finances of primary care trusts (PCTs), which pay for treatments in hospitals.

And he said the NHS needed to make “a quantum leap” to keep raising productivity year after year, to save a cumulative total of £50 billion by 2020.

Restricting some operations, plus “shaving a bit off the length of stay in hospitals and changing to low energy lightbulbs isn’t going to do it”.

Politicians had to grasp the nettle and tackle more fundamental questions, he said, such as the fact that there were “too many hospitals in the wrong places”.

“The system of care is not as good as it could be if we reorganised it,” he said.

Earlier this week, The Daily Telegraph disclosed that South London Healthcare NHS Trust, which runs three hospitals, was on the brink of bankruptcy and could soon be run by a management team appointed by ministers. Exactly what will then happen to it is unclear.

But senior figures say this is not an isolated example, and there are many other hospital trusts in dire financial problems, particularly in outer London and the south east, that could go the same way.

Asked if closures were inevitable, Prof Appleby said: “In a word, yes.”

Whole hospitals could close, he said, “or relatively small district general hospitals could attempt to withdraw from providing the full range of services and become more specialist”.

In the meantime there was the danger of a poorer and poorer service in underperforming hospitals, he warned.

“I think the worry with that is that there will be certain areas that would start to see deterioration of services to such a degree that the Care Quality Commission has to step in.”

The CQC has the power to close down wards or services until the provider meets safety standards, and can even close them down permanently.

Prof Appleby said: “That’s really serious: it’s patients having to be ferried to other areas.

“If the NHS got to that stage it would be really appalling.”

Earlier this month Mike Farrar, chief executive of the NHS Confederation, warned that without “assertive action”, “the NHS looks like a supertanker heading for an iceberg”.

A Department of Health spokesperson said: "We know the NHS can, and must be, more efficient to meet future challenges. Where the NHS can do things better and save money to reinvest in high quality patient care, it must do so. We have always been absolutely clear that being efficient does not mean cutting services — it means getting the best services to meet patients' needs and the best value for every pound the NHS spends."