Liverpool Care Pathway – The Judas Lamb, A Wolf In Sheep's Clothing

Is Mr Lamb the Judas Goat leading us all to the slaughter?

He is reported as saying - 

"Payments have been made to encourage and ensure that patients and their loved ones are involved in the critical discussions that take place at the end of life. If that is the result of the system, then that seems to me to be a good outcome." -BBC News

Not quite true, actually, and the outcome not quite so good. This is -

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 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 a Liverpool care pathway 

It is the DOH which is the driving force behind rolling out LCP across the NHS!

Mr Lamb must know all this, so why is everyone expressing such surprise...?

The Lib Dem minister, responsible for social care, said his "sole interest" was making the final days of someone's life as comfortable and dignified as possible whether they chose to be in hospital, a hospice or at home.

"This (the pathway) is an approach improving the experience at the end of life. This is an approach supported by Macmillan and Marie Curie. Would those organisations really advocate a programme that denied dignity to people at the end of life."

'Right to complain'

Mr Lamb said he wanted to hear about cases where patients or their families had not been properly involved in, or informed about, how they were being treated and had convened a "roundtable" of clinicians and patients groups later this month to discuss the issue.

"Families are right to complain when that happens and it is that sort of approach which has to be challenged," he added. "I am absolutely determined myself to ensure we do challenge that." 

"I want to hear where things have gone wrong. I want to ensure we address that absolutely, but a lot of good things have happened in recent years to improve the experience at the end of life." 

Report from  BBC News

Mr Lamb appears still to be under the mistaken impression that the fault lies in the application of the Pathway rather than that it is the Pathway itself which is at fault.

Mr. Lamb, people have been placed on the pathway who are not even terminally ill. Let us face it, Mr. Lamb, people are being placed on the Pathway because their 'terminal illness' is Terminal Old Age!

FOOTNOTE:

A new national CQUIN goal has been introduced for use in 2012-13.

Dementia Goal

An estimated 25% of acute beds are occupied by people with dementia. Their length of stay is longer than other people and they are often subject to delays on leaving hospital.

This particular goal is to help identify patients with dementia and other causes of cognitive impairment, alongside their other medical conditions and to prompt appropriate referral and follow up after they leave hospital.

There are more bed-blockers to shift. And where will this lead...?