You read it here first...
At last, CQUIN-gate has broken. The CQUIN payments have been
reported in these pages for a long time -
WEDNESDAY, 13 JULY 2011
Liverpool Care Pathway - A Grave And Perilous Pathway
The Department of Health (DOH) uses a Commissioning for Quality and Innovation (CQUIN) payment framework which enables commissioners to reward excellence by linking a proportion of providers’ income to the achievement of local quality improvement goals:"It makes a small proportion of provider income (0.5% of contract value in 2009/10) conditional on achievement of locally agreed goals around quality improvement and innovation. It is intended that goals should be stretching but realistic."CQUIN has set targets for 2011/2012 with regard to the End of Life program.
The forward plan is to increase the number of patients identified to be on the end of life care pathway and from a baseline of 0% to 20%; it is further planned to have 30% of all patients who die in hospital dying on the Liverpool Care Pathway.
To ensure they receive their provider income in fulll, Trusts have to comply with or exceed these goals. Some, like Royal Brompton, have upped the plan expectations:
1) 95% of patients identified as end of life (last 48 hours of life for expected deaths) are offered an EOL care planning discussionIt is the DOH which is the driving force behind rolling out LCP across the NHS!
2) 80% of patients offered a discussion should have an advanced care plan
3) 98% of patients who have an advanced care plan should have a record of the decision to resuscitate stated clearly in the notes
4) 50% of patients who die in hospital (expected deaths) should die on a Liverpool care pathway
FRIDAY, 26 AUGUST 2011
Liverpool Care Pathway – What Are Its Aims And Purposes?
Once the patient has been diagnosed as ‘dying’, the LCP-trained nurses feel it makes documentation more accurate and less time consuming. LCP-trained nurses actually favour this and find it rewarding. The dying process becomes a controlled and predetermined procedure.
In fact, it is flawed at the outset for, once enacted, the LCP replaces all other forms of documentation.
In fact, it excludes all other possibilities but that of the predicted scenario.
In fact, it makes ‘dying’ a tidy matter, much as induction makes birthing a tidy matter, less fraught with nuisance and the unexpected.
In fact, the LCP is no more than that - death by induction.
In fact, NHS funding is actually tied to implementation of the LCP via the CQUIN payment framework of the Department of Health. Thus, cash-strapped Business Managers will make a determined effort to inflict the LCP across the wards and ensure that its processes and procedures are adhered to without fail and without question.
FRIDAY, 2 SEPTEMBER 2011
Liverpool care Pathway - A Death Road
The Department of Health
The DOH committed to investing 286 million pounds over the two years to 2011 to support implementation of this End-of-Life Care Strategy. That is 286 million pounds spent to assist people on their path to the next world while denying the necessary funding to keep them alive and well in this.
Whilst, as reports over many years confirm to be the case, the old and frail are neglected, starved and forced to suffer all manner of degrading abuse in their final years. If not a quality life, the DOH is determined, at least, to give them a ‘quality’ death!
Commissioning for Quality and Innovation (CQUIN)
The CQUIN payment framework enables commissioners to reward excellence by linking a proportion of healthcare providers' income to the achievement of local quality improvement goals. More radical implementation of LCP is one of these goals.
The pressure is on local-level Business Managers to meet expected performance levels in order to maintain central funding. In the case of living wills, there is the twofold pressure to satisfy the demand of organ donation.
Death Road
If corners may be cut, they will be cut. With the processes and procedures of BMP, the Pathway protocols are becoming an all-purpose conveyer belt to the morgue.
SUNDAY, 4 SEPTEMBER 2011
Liverpool Care Pathway - Into That Darkness?
A culture of death is pervading the NHS in the
The DOH, through its CQUIN policy, is determined to push through this Death Pathway policy.
It used to be that you would go into hospital and they would fight to keep you alive and get you well; now, that is all thrown out the window.
Now, they will look for signs of death to place you on Death Road. Death by induction will proceed whether or not you wish it or desire it.
TUESDAY, 27 SEPTEMBER 2011
Liverpool Care Pathway - A Forward-Planning Document For Dying As An Accepted And Acceptable Policy For Incorporation Into A Strategy And Stratagem Of Planned Financial Constraint In the Non-Hospice Setting
With the introduction of LCP, killing has become a ‘legal’ therapy!
LCP provides a ‘controlled’ dying environment; it is ‘death by induction’ at the end of life, much as the controlled environment provided by induction at the beginning.
Clinicians, practitioners are being encouraged to proactively look for ‘signs’ of death. It will become not merely the policy of choice but, with implementation being proactively encouraged by the DOH funding policies, one of necessity, an obligatory requirement placed upon clinicians to adopt.
CQUIN is the DOH funding policy. CQUIN has set targets for 2011/2012 with regard to the End of Life LCP program. The forward plan is to increase the number of patients identified to be on the end of life care pathway from a baseline of 0% to 20%; it is further planned to have 30% of all patients who die in hospital dying on the Liverpool Care Pathway.
To ensure they receive their provider income in full, Trusts have to comply with or exceed these goals. Some, like Royal Brompton, have upped the plan expectations:
1) 95% of patients identified as end of life (last 48 hours of life for expected deaths) are offered an EOL care planning discussion
2) 80% of patients offered a discussion should have an advanced care plan
3) 98% of patients who have an advanced care plan should have a record of the decision to resuscitate stated clearly in the notes
4) 50% of patients who die in hospital (expected deaths) should die on aLiverpool care pathway
It is the DOH which is the driving force behind rolling out LCP across the NHS!
From 'cradle to grave' was the promise. Cradle to grave has become a bit of a stretch, especially now with the pressure of financial constraints being imposed. Putting pressure on clinicians to identify patients as 'dying' to place them on LCP simply to achieve these DOH targets is fraught with peril! Clinicians will be hounded, against their better judgement, by cash-strapped Trust's business and finance managers to meet targets in order to sustain funding.
The Pathway is established as a legal "therapy" and, through DOH CQUIN payments, has been made the subject of cost/benefit assessment by health managers and economists. And in a cost conscious health service £5 for a lethal injection will be a tempting therapeutic option to £500 per week for effective palliative care.
The ‘legalised’ killing provided by LCP puts vulnerable people - the elderly, chronically sick, disabled - at risk. These people are already a financial or emotional burden on relatives, carers or society and this is why they need strong legal protection. This sinister about-turn that has taken place makes the unthinkable thinkable and possible.
The "right" to die a dignified death has replaced the right to live a dignified life and can so easily become a coercive offer, a duty to die. Vulnerable people are being placed at risk.
Rogue doctors such as Dr Harold Shipman are going to have a field day!
Rogue doctors such as Dr Harold Shipman are going to have a field day!
A Death Pathway is not needed in this country. Instead, we need the excellent palliative care already available to be made much more widely accessible. What is needed is a protocol for life to provide life with dignity up to the last moment of life.
The lingering question is pursed upon all our lips:
Can the NHS afford to keep you alive?
FRIDAY, 14 OCTOBER 2011
Liverpool Care Pathway – Evidence Based
Almost 50 NHS trusts are in severe financial trouble, including 20 which are ‘non-viable’, a report says.
In some cases, costly Private Finance Initiative deals have landed hospitals with huge debt repayments they can no longer afford.
The analysis by the National Audit Office says deep-seated problems could lead to the break-up of local hospital services.
The analysis by the National Audit Office says deep-seated problems could lead to the break-up of local hospital services.
NHS managers said time was running out before some services went bust, and predicted more care would have to be moved out of general hospitals into specialist centres and patients’ homes.
Under PFI deals, a private contractor builds a hospital and retains ownership for up to 35 years. During this period, the public sector must pay interest and repay the cost of construction, as well as paying the contractor to maintain the building.
CQUIN is the DOH funding policy. CQUIN has set targets for 2011/2012 with regard to the End of Life LCP program. The forward plan is to increase the number of patients identified to be on the end of life care pathway from a baseline of 0% to 20%; it is further planned to have 30% of all patients who die in hospital dying on the Liverpool Care Pathway.
To ensure they receive their provider income in full, Trusts have to comply with or exceed these goals.
TUESDAY, 25 OCTOBER 2011
Liverpool Care Pathway - Dutch Style
With the introduction of LCP, killing has become a ‘legal’ therapy!
The Liverpool Care Pathway is established as a legal "therapy". Through the Department of Health CQUIN incentives, it has been made the subject of cost/benefit assessment by health managers and economists. In a cost conscious health service, a short sharp end will be a tempting therapeutic option to £500 per week and more for ‘continuing care’.
CQUIN is the DOH funding policy. CQUIN has set targets for 2011/2012 with regard to the End of Life LCP program. The forward plan is to increase the number of patients identified to be on the end of life care pathway from a baseline of 0% to 20%; it is further planned to have 30% of all patients who die in hospital dying on the Liverpool Care Pathway.
To ensure they receive their provider income in full, Trusts have to comply with or exceed these goals.
The protocol of the LCP is to look for signs of ‘dying’ in order that life might be placed on that downward cycle toward a controlled and predictable and predicted final termination. While the protocol of the Hippocratic Oath is to look for signs of life in order that life might be saved and secured and preserved.
FRIDAY, 28 OCTOBER 2011
Liverpool Care Pathway – Not Anecdote Nor Chestnut Of Barker Or Raconteur
The concern to respect the wishes of the living and of those who wish to live has become second to that of the dying and those who wish to die.
The right to life and the desire to preserve life has been overtaken by the right to death and the desire to promote death as a preferable outcome.
Medical standards must be met and maintained but financial constraint must not be breached.
This is a fine line which cannot be crossed; it is a medical and financial tightrope that enforces a precarious balancing act of resources.
There is an insistent pressure that advance directives to decline treatment be observed -
While the expectation to receive prompt and sympathetic treatment is given scant regard.
Bad and mad financial decisions in capital provision in recent years have put the NHS in financial jeopardy.
Instituting a protocol that promotes death as a positive outcome and making establishment of that protocol a condition of DOH funding under the CQUIN payments system must seem like a financial lifeboat to DOH and NHS Managers, therefore.
That protocol is The Liverpool Care Pathway.
THURSDAY, 10 NOVEMBER 2011
Liverpool Care Pathway – Doctors Are Not Always Right
What is the alternative to offering expensive drugs which do not prevent but only delay the onset of deterioration and the more controversial route of actual euthanasia?
The third option is and always was – or should have been and should be – adequate and sufficient and effective palliative care. Adequate and sufficient effective palliative care should always include the delivery of all and any such means as may alleviate or forestall a condition or affliction.
Those who pull the financial purse-strings in the NHS (National-socialist Health Service) have other considerations, however. They are particularly persuaded in their decision-making by the DOH CQUIN financial inducements to favour introduction and implementation of LCP and get patients onto the Pathway.
The prospect of an organ harvest through Living Will directives must not be far from mind, also.
Doctors are not always right. Miracles can and do happen. Professor Stephen Hawking was diagnosed with Motor Neurone Disease in his 20s; was told he would not live to see 30! He is considered one of the most prominent and brilliant scientists of this era. Should Hawking have accepted the death-induction options of LCP or euthanasia had they been made available to him at the time? The man was more determined, more resilient; he is an inspiration to us all.
There are many such people, possessing the support and encouragement of their loved ones.
TUESDAY, 15 NOVEMBER 2011
Presumed consent organ donation to be Welsh law by 2015
The Welsh government says it plans to have a new law in place for presumed consent of organ donation by 2015.
A superior quality organ harvest
There are many ’ethical’ problems related in the article above. These pertain to the suicidal and those executed under law. One thing is clear and that is a life terminated rather than being permitted to pass naturally permits a harvest of superior quality organs.
The DOH CQUIN payment framework program of promoting universal implementation of LCP protocols throughout the NHS (National-socialist Health Service) and their rolling out across the entire health sector accompanied by and in combination with a policy of ‘presumed consent’ would also result in a harvest of superior quality organs. That is a bounty not to be easily discounted or overlooked!
FRIDAY, 2 DECEMBER 2011
Liverpool Care Pathway – Doctors Continue To Play God
Tens of thousands of patients with terminal illnesses are being placed on a “death pathway”, almost double the number just two years ago, the Royal College of Physicians has found.
It is not at all the case that these 'tens of thousands' of patients placed on theLiverpool Care Pathway are necessarily patients diagnosed with terminal illness. That may be the case within the Hospice setting, but not so outside. There is also good reason that the number placed on this Death Pathway has doubled in just two years.
That is plainly a result of DOH funding via the CQUIN payments being conditional upon full implementation of LCP.
FRIDAY, 2 DECEMBER 2011
Liverpool Care Pathway – Again, On The Telegraph Road
With the introduction of LCP, killing has become a ‘legal’ therapy!LCP means withdrawal of treatment. Liverpool care has become a viable, cost-effective alternative option to cost-intensive, real palliative care!
The Liverpool Care Pathway is a legal document established as a legal "therapy". Through the Department of Health CQUIN incentives, it has been made the subject of cost/benefit assessment by health managers and economists. In a cost conscious health service, a short sharp end will be a tempting therapeutic option to £500 per week and more for ‘continuing care’.
CQUIN is the DOH funding policy. CQUIN has set targets for 2011/2012 with regard to the End of Life LCP program. The forward plan is to increase the number of patients identified to be on the end of life care pathway from a baseline of 0% to 20%; it is further planned to have 30% of all patients who die in hospital dying on the Liverpool Care Pathway.
To ensure they receive their provider income in full, Trusts have to comply with or exceed these goals.
WEDNESDAY, 28 DECEMBER 2011
Liverpool Care Pathway - A Complicity Of Involvement
The Liverpool Care Pathway is a legal document established as a legal "therapy". Through the Department of Health CQUIN incentives, it has been made the subject of cost/benefit assessment by health managers and economists. In a cost conscious health service, a short sharp end will be a tempting therapeutic option to £500 per week and more for ‘continuing care’.
CQUIN is the DOH funding policy. CQUIN has set targets for 2011/2012 with regard to the End of Life LCP program. The forward plan is to increase the number of patients identified to be on the end of life care pathway from a baseline of 0% to 20%; it is further planned to have 30% of all patients who die in hospital dying on the Liverpool Care Pathway.
To ensure they receive their provider income in full, Trusts have to comply with or exceed these goals.
SUNDAY, 1 JANUARY 2012
Liverpool care Pathway – Going Counter To The Principle Of Law
It has been upheld in a court of law that preservation of life is a fundamental principle of law.
In a supporting article in the Telegraph, Counsel is quoted as saying,
"If it is not in M's best interests to withdraw or withhold life-sustaining treatment, including artificial nutrition and hydration, were such treatment withheld or withdrawn, this would amount to the actus reus
How, then, are these arbitrary judgements viewed, that a person has reached the end of their life and is to be placed on the “care pathway of the dying” and is to be starved of food and fluids and dosed with morphine until they are dead? Is that not, also, murder?
(Liverpool CarePathway - More From The Frontline)
Those complicit in this, through requiring implementation of this “Pathway of the Dying” via the blackmail of the DOH CQUIN payments, are they not guilty, if not of murder, of manslaughter?
It does seem that the Liverpool Care Pathway stands alone, above criticism and outside the law – above the law.
SUNDAY, 24 JUNE 2012
Liverpool Care Pathway – The Truth Will Find A Way
The elderly have "less access to palliative care" the King's Fund has stated. It would appear that Ministers now recognise these discriminatory practices.
This is clearly at odds with the DOH sponsored Commissioning for Quality and Innovation (CQUIN) payments made to Trusts for setting in place LCP protocols. Instead of access to appropriate and adequate palliative care, the elderly are more likely to be placed on the LCP death pathway.
FRIDAY, 29 JUNE 2012
Liverpool Care Pathway – Working With Finite Budgets
“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!
SATURDAY, 30 JUNE 2012
Liverpool Care Pathway – A Sobering Thought
THEThat 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.
Forking out these payments is still the cheaper option compared with providing access to appropriate and adequate palliative care. Thus, 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.
TUESDAY, 4 SEPTEMBER 2012
Liverpool Care Pathway – Intrusion By Stealth
In other words, District Nursing, as a profession, must demonstrate that it is implementing the end-of-life care pathways (such as LCP) required by the DOH in order to take advantage of the CQUIN payment incentives which will pay for the resources district nursing services so desperately need.
THURSDAY, 20 SEPTEMBER 2012
Liverpool Care Pathway – And The Rationing Of Resources
THE
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.
THURSDAY, 25 OCTOBER 2012
Liverpool Care Pathway – The Economics Of A Pathway
The Death Programme goes marching on.
DOH CQUIN payments are financial incentives made to encourage implementation of required objectives and meet targets, "to reward excellence by linking a proportion of providers’ income to the achievement of local quality improvement goals".
Are DOH CQUIN payments also being made to GP Hitmen to implement the Death Lists?
__________________
At last, a national newspaper gives
these payments the attention of their front page.
The Daily Mail has done meritorious work in bringing
the Liverpool Care Pathway to the
fore. The Daily Mail has done meritorious work in giving a voice
to be heard to those who had no voice.
At last, a national newspaper has taken it upon itself to
'publish and be damned!' -
Here is the MailOnline –
Hospitals bribed to put patients on pathway to death: Cash incentive for NHS trusts that meet targets on Liverpool Care Pathway
- Some hospitals set target of two thirds of all deaths should be on LCP
- At least £30m in extra money handed to hospitals to achieve these goals
- Critics warn financial incentives could influence the work of doctors
|
Hospital consultant Professor Patrick Pullicino warned financial incentives for hospitals to put patients on the Liverpool Care Pathway could influence the work of doctors
Hospitals are paid millions to hit targets for the number of patients who die on the Liverpool Care Pathway, the Mail can reveal.
The incentives have been paid to hospitals that ensure a set percentage of patients who die on their wards have been put on the controversial regime.
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.
At least £30million in extra money from taxpayers is estimated to have been handed to hospitals over the past three years to achieve these goals.
Critics of the method warned last night that financial incentives for hospitals could influence the work of doctors.
The LCP involves withdrawal of life-saving treatment. Patients are sedated and most are denied nutrition and fluids by tube. On average a patient put on the Pathway dies within 29 hours.
One of the leading critics, hospital consultant Professor Patrick Pullicino, 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.'
LCP is thought to be used in more than 100,000 cases a year.
Yesterday 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.
The LCP is intended to ease the final hours of patients who are close to death and to spare them the suffering associated with invasive treatment.
Payments to hospitals to introduce it 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 spread of the LCP through the wards and to persuade doctors to meet Pathway targets 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 achieving 'goals involving the Liverpool Care Pathway'. Salford Royal NHS Foundation Trust had CQUIN payments connected to the Liverpool Care Pathway almost halved after failing to reach targets.
Controversial: The LCP is intended to ease the final hours of patients who are close to
death and to spare them the suffering associated with invasive treatment
Figures show 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.
This would have paid £36,392 if a 47.6 per cent target had been reached. Its FOI statement said: 'The Trust achieved 45.5 per cent so funding for the LCP element was reduced to £18,600.'
'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.'
Professor Patrick Pullicino
FOI replies so far received by the Mail suggest that if the money paid by NHS commissioners were spread equally around all NHS acute hospitals, it would mean £30million has been sunk into the campaign to put the Pathway into universal use since 2009.
The Department of Health defended LCP payments by target last night. A spokesman said: '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.'
But 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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