Liverpool Care Pathway - In Practice

This is Northern Echo -

Hospitals paid incentives for controversial end of life care

5:20am Monday 4th February 2013 in NewsExclusive By Julia Breen

DENIED FLUIDS: Audrey Cummings

HOSPITALS in the region have received more than £2m for using a controversial "end-of-life" programe which allows doctors to withdraw treatment and fluids.

Officials say the plan - called the Liverpool Care Pathway (LCP) after the Royal Liverpool University Hospital where it was developed - is a compassionate method of treating dying patients.

But the Government has ordered a review of its use after claims some families had no idea their relatives were on it.

Eighty-year-old Andrew Cummings, of Darlington, said he was completely unaware that his wife’s care in her dying days involved withholding fluids.

“It was like the secret service,” he said. “You are the relative but no-one tells you anything. The Liverpool Care Pathway wasn’t mentioned because the first time I heard of it was after she died and realised that was what had happened to her.”

However, the Department of Health says staff must discuss the treatment with patients (where possible) and their families. Any failure to do so is "unacceptable".

Nationally, 130,000 dying patients are put on the programme every year. Hospitals that adopt the LCP receive financial rewards.

South Tees Hospitals NHS Foundation Trust, which runs the James Cook University Hospital in Middlesbrough and the Friarage Hospital in Northallerton, was given £1.4m in 2010 and 2011-12.

County Durham and Darlington received £641,000 and North Tees and Hartepool was given £395,000.

The LCP was developed to give patients a peaceful death by withdrawing unnecessary medications and tests, and not giving fluids when a patient has stopped being able to eat or drink.

Mr Cummings wife, Audrey, was admitted to Darlington Memorial Hospital with a urine infection on Saturday September 15 last year before being diagnosed with severe heart problems.

He said: “We got called into this little room and a doctor just reeled it off parrot fashion that there was nothing more they could do for her and she was going on palliative care.

“My son and daughter came down and realised that Audrey wasn’t getting anything to eat or drink.”

Mr Cummings praised nurses who cared for his wife but he said he had to insist on seeing a doctor after nurses said they were unable to provide any more medication when she started having spasms.

Mike Wright, Executive Director of Nursing at County Durham and Darlington NHS Foundation Trust, said: “We would like to offer our condolences to Mr Cummings for the loss of his wife. We acknowledge that we could have communicated better but are pleased that he was satisfied with the care his wife received."

Mr Wright said the LCP was a "national model of best practice" and denied the Trust was paid to put patients on it. The incentive payments related to staff training on LCP and improving care for dying patients.

However, critics say introducing a financial incentive to end-of-life care is not appropriate. They fear it could sway the decision-making process.

Some Roman Catholic doctors have voiced concerns that the programme speeds up dying. Alert, an anti-euthenasia pressure group, claimed it was designed to "finish people off".

Professor Edwin Pugh, head of palliative care at the North Tees andHartlepool NHS Foundation Trust, said: “I am very aware of the national debate. Dying is a normal event. We don’t want to medicalise it. The LCP is for patients in the last day or two of life who are more or less unconscious."