Liverpool Care Pathway – Dear Secretary Of State: A Cost Evaluation

The Pathway does not just free up beds and ease stretched NHS resources.

Full basic state pension for 2012-13 for a single person is £107.45 per week. Full basic state pension for a married couple (or civil partners) for £2012-13 is £171.85.

(Liverpool Care Pathway – The Economics Of A Pathway)

Seven weeks or seven hours, every last moment of life is precious - and costing the State a small fortune.

The Pathway is an all-round no-brainer to save the State a fortune and dig the Exchequer out of the pension black hole it finds itself in.

It truly is amazing what a face-lift like a name change can do for your popularity. The Voluntary Euthanasia Society has been around since the 1930's but it has never enjoyed such levels of popularity and influence amongst public and political figures as it enjoys at present. The Voluntary Euthanasia Society is now Dignity in Dying.

There is a growing and widespread respect for those who demand the choice to die but a casual and dismissive disdain for those who  plead for the chance to live.

Baroness Greengross OBE, vice-chair of the All-Party Parliamentary Group on Choice at the End of Life, says:

‘Palliative care and assisted dying legislation share many common values: the alleviation of suffering, patient choice and a patient focused process. They should not be seen in isolation.’

The linkage is established. Euthanasia is but one step further along the Pathway, not at all the one step beyond it. The culling of infants further establishes this link.

"Last month the chairman of the Royal College of General Practitioners expressed himself "horrified" by the discovery that many of the 114 British "clients" of Dignitas had not been suffering from terminal illnesses at all."

(Dominic Lawson: Death, dignity and the darker side of family dynamics - The Independent)

Would the chairman of the Royal College of General Practitioners express himself equally "horrified" by the discovery that many of those placed on the Liverpool Care Pathway had not been suffering from terminal illnesses at all?

The linkage is established. Euthanasia is but one step further along the Pathway, not at all the one step beyond it. The culling of the vulnerable, the elderly, those assessed living a life not worth living further establishes this link.

The DOH End of Life Care Strategy Third Annual Report is freely available -

Page 8 begins –

"Dear Secretary of State..."

On page 57, this can be found -

"Liverpool Care Pathway - CQUIN 

A CQUIN for the Liverpool Care Pathway (LCP) was introduced into acute contracts within NHS South Central for 2009/10. This has led to an increase in the number of people dying on the pathway and in the education of staff on the LCP."

This clearly states: CQUIN payments have resulted in an increase in the number of people dying on the pathway...

Dear Secretary of State, how could you not know?

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!

Peopled and chaired by those who support the cause, the outcome of the Commission on Assisted Dying was not at all surprising. The Commission was funded by Bernard Lewis and Sir Terry Pratchett, both supporters of Dignity in Dying, specifically for that outcome. It was also chaired by Lord Falconer, who also supports changing the law to make assisted suicide easier. The Commission wants the law changed so that if patients have less than a year to live, doctors can prescribe drugs to hasten their end.

Hmmm. "if patients have less than a year to live, doctors can prescribe drugs to hasten their end." 

That nicely fits the GPs 1%...

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? And where will this end...?

The Mail has drawn attention to the CQUIN payments system in the hospital setting but, as has been reported in these pages, this now extends into District Nursing and General Practice. CQUIN is, no doubt, also involved in the spread of the GP death lists and the use of LCP, for instance, in St. Mungo's and elsewhere. It is involved in, not merely innovating Death Pathways but, now, is to clear the wards of patients deemed suffering from dementia.

Pecuniary Gain obtained for instituting proposals and protocols is bribery. Bribery is corruption.

Lord Howe did not mince his words. Let us not do so.

Society's shift toward euthanasia has been like a sponge soaking up the drips of diatribe emanating from such worthies as Mr. Pratchett. 

The NHS has been made to empty its coffers into that other black hole of government instigated PFIs. Funding is under pressure. GPs have received ridiculous increases for providing less and less service. GP surgeries are now run like private businesses, but with the security of remaining within the net of the State-run NHS.

The CQUINs paid out for meeting goals may appear a foolhardy expense and further drain on an ever-diminishing pot, but when those goals produce savings in the long term, that paints an entirely different picture.

When the State intervenes and starts throwing public money around, lucrative gain calls, the corruptible are corrupted.

The linkage is established. Euthanasia is but one step further along the Pathway, not at all the one step beyond it.

Can we continue to excuse and to accept? We are taking that one step further along the Pathway. Will we, soon, take that one step beyond it?

Heaven forbid!