The incentives are paid to hospitals for ensuring that a set percentage of those who die on their wards have been put on the Liverpool Care Pathway, figures disclosed to a newspaper have revealed.
The LCP is intended to ease the last hours of dying patients to save them the suffering caused by invasive treatment but is controversial because critics say it is a way of hastening their deaths.
Figures disclosed to a newspaper shows that in some cases, hospitals have been set targets that between a third and two thirds of all the deaths should be on the pathway.
And perhaps this is one of them.
I know, I know. But there\’s one hell of a difference to my mind between operating a DNR policy and refusing a sip of water to a dying person.
Well we currently have a monetary incentive to throw desperate and expensive measures at those who are inevitably going to shuffle off into the hereinafter in a short space of time because the hospitals get paid to do it.
What about choice? On average 50% of your lifetime healthcare costs fall in your last 6 months of life. On top of that we have (in DE) expensive and mandatory “old age care insurance”. You know what I’d like? Half my health insurance back please. I’d prefer to enjoy that money while I am young and once I am within 6 months of death feel free to make me pay for all the remaining treatment I wish to.
And if it ever gets to the stage that someone else is wiping my shitty arse, my care requirements are one 9mm round and repainting the wall behind me. Which I can get rather cheaper than the government-mandated “care insurance” scheme.
It seems you are no longer allowed to opt out of life once it has become futile.
The pathway is voluntary and requires family consent.
It’s also, unless you have strong moral objections (of a sort that I have no real comprehension, but which religious types seem to be serious about), something which you’d be crazy not to volunteer for. You die slightly earlier but in much less suffering. And the fact that it saves money *is* important – budgets *are* fixed and money that is saved here *can* be used to save other people’s lives.
So incentivising doctors to raise it with the family – at which point the family can still tell the doctor to get stuffed, and s/he must obey their wishes if they do – is an unequivocally good thing, compared to the alternative where there’s no direct reason for the doctor to have that awkward conversation.
Well, I’ve read that story through twice now because the first time I thought I’d misunderstood something.
I’m told there are archives of files relating to the extermination programs in Germany in the late 30s/40s. There you can find a myriad of the bureaucratic paperwork that enabled it. The movement requests for trains. The purchase orders for gas. The requirements for the selling off of clothing & personal effects.
That paperwork must have been authored & rubber stamped by the same sort of people, came up with this idea. If it’s true, there’s something downright ugly & evil lurking at the heart of the NHS.
Oh, bloody hell. Killing healthy people because you hate their race/sexuality/religion is about as different from painlessly and cost-effectively managing terminal illness as you can get.
There is nothing at all in the Liverpool Care Pathway about “refusing a sip of water”. The only question is whether it’s appropriate to use artificial hydration when the patient is no longer capable of drinking, on which it says “The LCP does not preclude the use of clinically assisted … hydration … All clinical decisions must be made in the patient’s best interest.”
johnb. Do you not understand what ‘incentivise’ means? If it was double glazing they’d be under pressure to make a sale. So you’ve a doctor, who pretends to be an expert, asking a distraught family to authorise a course of action, on which they have no expertise whatsoever. And the doctor is doing so, not necessarily because this is the correct choice but because there’s financial incentives to do so.
You don’t find anything wrong in that?
And often the patient’s best interests are indeed served by letting them die sooner rather than a little bit later.
You know, to receive medical treatment you do have to give your consent to such. You don’t actually have to give your consent to not be treated. Yet now the assumption seems to be that Nanny State knows best and we’ll kick up a media shitstorm when it is pointed out that you are (and always have been) entitled to withdraw consent to treatment.
@bis, currently the hospitals have an incentive to “sell” as much futile treatment as possible because that gets paid for.
Incidentally, I’m very much a believer in the right to die & assisted suicide. But it’s things like this, make the argument against it so much stronger.
“The pathway is voluntary and requires family consent.”
Just google it. There are loads of stories of people being put on the LCP without family consent, or even the doctor’s consent in some cases. Loads of them.
http://www.dailymail.co.uk/news/article-2217061/Liverpool-Care-Pathway-Family-revive-man-doctors-wasnt-worth-saving.html
http://www.telegraph.co.uk/health/healthnews/9612091/Family-not-told-grandmother-was-put-on-Liverpool-Care-Pathway.html
http://www.dailymail.co.uk/news/article-2217747/A-lonely-death-care-pathway-MPs-demand-action-patient-chosen-die-doctors-telling-
family.html
Perhaps it has something to do with the above-mentioned incentives.
“There is nothing at all in the Liverpool Care Pathway about ‘refusing a sip of water’. The only question is whether it’s appropriate to use artificial hydration when the patient is no longer capable of drinking, on which it says ‘The LCP does not preclude the use of clinically assisted … hydration … All clinical decisions must be made in the patient’s best interest.'”
This is dishonest. As practiced, the LCP involves giving someone increasing amounts of morphine and not giving them any water. This kills someone within a couple of days. That’s why there are cases of people recovering quickly when their families find out and have them taken off it.
The LCP would be fine if it was voluntary. But in practice it often isn’t.
The fact is that there are people who are going to die anyway within six months, so the attitude of the NHS is kill them now instead of wasting vast amounts of money just to extend their life a bit. Makes sense from the point of view of the NHS. It’s inherent in the logic of a welfare state.
Just like incentives were given in the USSR to produce X many tractors each week.
Socialist State monopolies need and work on targets because that is how they work.
In any organisation with imposed targets, those in it learn how to play the system. Their primary aim is to meet the targets not deliver the supposed benefits, because the former is quantitative and thus easily measured and reported, the latter qualitative and cannot have a number placed on it.
Example: one hospital I know with a long waiting list for a particular procedure reduced its waiting list overnight.
It stopped doing the procedure.
The NHS is a Socialist State monopoly.
There is little point about complaining about a particular target when it is the whole edifice which needs blowing up and replacing.
As long as the British people fail to understand this and do nothing about it, they get only what they deserve.
Makes Sarah Palin’s comments about ‘death panels’ a bit closer to home eh?
Go into hospital for something fairly routine, have complications, end up on the LCP (if ever there was a evil use of words to hide the true meaning of an action, those three qualify) because some doctor needs to meet his quota for the month. NHS, the wonder of the world.
I wouldn’t piss on the NHS if it was on fire. It has become a downright evil organisation, and none of my family will ever be left in its ‘care’ if I can help it.
The fact is that there are people who are going to die anyway within six months, so the attitude of the NHS is kill them now instead of wasting vast amounts of money just to extend their life a bit. Makes sense from the point of view of the NHS. It’s inherent in the logic of a welfare state.
Well, yes. Unless the people are actually millionaires able to bear the cost of their own treatment, then it makes sense from the point of view of *everybody*.
The UK system where everyone gets basic healthcare at the government’s expense, and people who want to pay lunatic sums for life-prolonging when nearly dead (whether that’s in the form of questionably effective oncology drugs or intensive care in general) can do so, seems far more sensible than e.g. the US system where healthcare insurance is insanely expensive because everyone down the line is incentivised to prolong life as long as possible, irrespective of cost or levels of suffering.
As right-wingers are fond of pointing out in most other situations, there isn’t a magic money tree.
James: I’m not sure what you think your links prove. In order, 1) a man had an extra month of uncomprehending suffering, and his daft relatives think this is a good thing. 2) an understandably stressed grieving husband forgot the conversation he’d had with medical staff 3) there was a colossal communications screw-up, as occasionally happens in all organisations. None of these in any sense invalidate the LCP.
johnb
You really don’t get this do you. No-one so far has advocated prolonging life unnecessarily. We’re all aware that resources aren’t unlimited & require difficult choices. I might have been in the position of having to make one a few months ago. Very likely may have to make one in the near future. Now I’m wondering if Mum would have gone to some bureaucrats convenience. Dad will be at some other’s. They’re choices I want to make with all the facts. Not in accordance with targets that are cooked up in offices in secret with little cash sweeteners attached to them.
It’s very deeply sick.
OK, so you’re saying medicine is the one area where cash incentives to allocate resources effectively are an inappropriate way of ensuring the effective allocation of resources?
I think Tim has got a point about monetary incentives. But if you get your information about the LCP from stories in the Telegraph and the Mail then your information will be wrong.
James James is mistaken to think that the LCP “kills someone within a couple of days”. Which is not to say that no one dies on it that quickly, because it’s used for people who are dying.
No, I’m saying if the NHS wants to offer me a grand in used readies to top Dad, I’ll consider it. What I don’t want is his doctor or the hospital being offered the same deal behind my back.
Plain enough for you?
” But if you get your information about the LCP from stories in the Telegraph and the Mail then your information will be wrong.”
Personally, I wouldn’t believe information from the NHS if it was tattooed across the Health Minister’s buttocks. They’re liars. They’ve form for it. Torygraph & the Fail are a better bet.
@john b et al. Your view of the efficient allocation of resources despends on your perspective. If you have lots of money and not much time to live and value extending that time to live you will spend a lot of money on it.
The question here is, how much of other people’s money you get to spend on it. And just about everyone (myself notably excluded) would say they get to spend all of other people’s money on a few extra days.
So there is a conflict between the efficiency with which you might allocate your own resources (if they’re yours you’re entitled to be economically irrational with them) and the efficiency with which everyone’s resources should be allocated (where you are less entitled to be economically rational – although granted in healthcare and some other things economic rationality is not the sole driver of decision to allocate resources).
“As right-wingers are fond of pointing out in most other situations, there isn’t a magic money tree.”
Agreed. So let’s look at all the other fat we can trim out of the budget before we start offing taxpayers, eh?
D’y’know, JuliaM, that’s what pisses most. They’ll pare x millions off the budget with this cynical rerun of the Final Solution then fritter the same x millions on upgrading office furniture or apparently, buying a bloody yacht.
http://www.telegraph.co.uk/health/3195750/NHS-trust-to-buy-400000-yacht.html
I’ve no great love for the NHS considering the mistakes and lack of help they are capable of doing to my family. They are however for most of us the only option available. Lack of choice, lack of affordability of another choice, lack of options – can see the same consultant privately I see on the NHS with still no confidence in his abilities.
Wife and I are both subject to hospitalisation and we’ve discussed in advance what we want if xxx happens. Including going fighting to the end. May not matter if the stories I hear from others whose relatives have been on this care plan are anything to go by – not media stories, real experiences where the state seeks to end life early.
The yacht is almost certainly a better use of half a million quid than a six-month dose of DOESNTWORKAVIR, or whatever the next cancer megadrug is. Encouraging fat kids to be less fat will lead to far more healthy-life-years and reduced medical bills than postponing nearly-dead people from being dead.
From the article:
“It said the 400,000 pounds involved was part of a 40 million levy returned to NHS Hull, had to be spent within 18 months and cannot be used to support services that would require ongoing funding.”
So they got some money, and rather than hand it back because they didn’t have a sensible use for it, decided to spunk it up the wall buying a yacht.
Which sums up the bureaucratic mentality to a T. Better to keep the money in your own budget and waste it, than return it to the Treasury so it could be used elsewhere. Bravo. C.Northcote Parkinson would be proud.
@johnb #25
Let’s put 2+2 & see what we come up with, eh?
Googling for the NHS yacht story, this little gem:
http://www.iow.nhs.uk/index.asp?record=1773
Very popular yachting is, with our NHS colleagues……..
Just a mo. Let’s go back to Jim’s post a sec:
“… part of a 40 million levy returned to NHS Hull, had to be spent within 18 months and cannot be used to support services that would require ongoing funding.”
Ongoing funding?
It’s not without reason yachting’s regarding as standing under a shower tearing up banknotes. How the hell they going to avoid ongoing funding of a yacht FFS? Concrete it into the hospital car park?
This article attempts to justify the yacht.
Back to the LCP. There are two issues: first, how to care for patients dying prematurely of disease (often cancer), on which question it’s worth reading this, from the USA. Doctors should agree a plan with the patient.
Second, how to care for elderly, confused patients in very poor health. The procedure should include an unambiguous conversation with the closest available relatives.
However, the evidence of relatives after the death is not always reliable. Anecdotally, there is rather little correlation between mistakes made and complaints received.
BiS: if you read further up the article it says that another publicly funded body in Hull (‘One Hull’) had agreed to allocate £1.3m per annum to fund the yacht, up til March 2011. I didn’t realise that this was such an old issue. I guess that this yacht is now moored up somewhere because they’ve run out of money to use it, just 3 years later.
The whole thing is proof (if ever proof were needed) that Gordon Brown firehosing cash all over the NHS didn’t actually make things much better for the patients.
Got few NHS senior management a nice day out at Cowes though, obviously.
Regardless of whether (back to the yacht)
60% of people who went on a 12-week, £3000, course being in something approaching a future 1 year later, isn’t a bad spend – it’s much better than a lot of the DWP schemes. I presume the £3000 doesn’t include the depreciation for the yacht, though.
James V,
“On average 50% of your lifetime healthcare costs fall in your last 6 months of life. On top of that we have (in DE) expensive and mandatory “old age care insurance”. You know what I’d like? Half my health insurance back please. I’d prefer to enjoy that money while I am young and once I am within 6 months of death feel free to make me pay for all the remaining treatment I wish to.”
Even assuming your figures are true, we don’t live in a 70’s sci-fi movie, with Jenny Agutter around for on-tap sex.
No one actually knows when they are six months from death!
My Dad has been in hospital a dozen times this year. In the Spring he looked like he was waiting for death, yet I saw him last week and he was alert, cheery and swearing. Maybe my Mum will call me tomorrow and tell me he’s dead. Maybe he’ll be sitting on my deck in 2015, drinking gin. How can anyone know?
There is also the fact that your figures are an average. For all those whose costs in the last six months equal all those before, there are others who cost more in the last six months, and others who cost less.
It’s like the old line, “Whenever I lose for my keys they’re always in the last place I look. So why don’t you look there first?”
The pathway kills by dehydrating the patient which I think is cruel. The amounts of analgesia often do not keep the patient comfortable between doses. When I decide that further medical intervention is futile I want to go out on a cloud of pethidine, no dry throat and how about a bonus of those recreational drugs I have been too prim to indulge in thus far. Addiction is not going to be a problem.
PaulB
The procedure should include an unambiguous conversation with the closest available relatives.
However, the evidence of relatives after the death is not always reliable.
How may have you killed? Or are you just making this up?
TG: You may find your reading comprehension improves if you read whole paragraphs, rather than one sentence from each. I suppose your lips got tired.
john b – “Unless the people are actually millionaires able to bear the cost of their own treatment, then it makes sense from the point of view of *everybody*.”
Sorry but no it doesn’t. This is the argument that says we are better off not paying tax to have a welfare state. Normally you would be the first to leap up and say the *risk* of poor health or unemployment means *most* people, even the relatively wealthy middle class are happy to pay. Which they often are. There is a real risk for everyone that they or their loved one will be killed by a doctor without asking permission. That is not in anyone’s interest.
“The UK system where everyone gets basic healthcare at the government’s expense, and people who want to pay lunatic sums for life-prolonging when nearly dead (whether that’s in the form of questionably effective oncology drugs or intensive care in general) can do so”
How can they do so? Doesn’t the NHS threaten to cut off all treatment if you buy so much as an aspirin privately?
“seems far more sensible than e.g. the US system where healthcare insurance is insanely expensive because everyone down the line is incentivised to prolong life as long as possible, irrespective of cost or levels of suffering.”
Sensible is an interesting word. We want our doctors to have incentives. I would like to think those were oriented towards providing a good service for patients informed by their medical ethics. Not reducing costs to the tax payer as such. I am sure killing the old sounds sensible. If you only look at killing the old and not the wider implications.
“As right-wingers are fond of pointing out in most other situations, there isn’t a magic money tree.”
Indeed. But let’s face it, the medical profession wants euthanasia. This is just a fig leaf to let them do it. It is not about money as such.
MrPotarto – “Even assuming your figures are true, we don’t live in a 70?s sci-fi movie, with Jenny Agutter around for on-tap sex.”
In fairness to Ms Agutter, she declined the sex so she wasn’t actually on tap. But otherwise, I am totally with you. There can be no techno-utopia that does not have Ms Agutter or a reasonable likeness around for on-tap sex.
And flying cars. Peter Ustinov we can do without.
I think most people are missing the point. The value of dying people is mostly to the relatives. It is hard for the NHS to measure how important someone’s father’s last days were or how annoying, to put it no stronger, that the NHS did not save someone else’s Grandmother until they could be there. These moments are literally priceless. As it happens I do think some doctors get a thrill out of making life and death decisions. Even if they don’t, we should not encourage them.
LJH: “When I decide that further medical intervention is futile I want to go out on a cloud of pethidine, no dry throat and how about a bonus of those recreational drugs I have been too prim to indulge in thus far” – yes, this, to a squillion. The UK is closer to this than nearly every other healthcare system (in Australia, diamorphine is illegal to prescribe).
SMFS: “The value of dying people is mostly to the relatives. It is hard for the NHS to measure how important someone’s father’s last days were or how annoying, to put it no stronger, that the NHS did not save someone else’s Grandmother until they could be there.” – yes, this, too. The final LCP story linked upthread is a terrible thing, because of this. Ditto any brain-dead chap being switched off without kid/wife/mum getting to hold his hand. But *once we’re there to hold their hands*, assuming we’re 24 hours away rather than exploring the Antarctic or missionaries in the Cook Islands, that no longer applies. No sense in keeping someone suffering just so we can spend a week waiting to hold his hand while he dies, rather than a day.
john b – “(in Australia, diamorphine is illegal to prescribe).”
I find that hard to believe. It was not that long ago, ie well within my lifetime, that heroin was routinely used in Australian hospitals.
“No sense in keeping someone suffering just so we can spend a week waiting to hold his hand while he dies, rather than a day.”
Well no one is suffering as they will be drugged up but you still miss the point. Medicine is not an exact science. They cannot be sure if some patient will live or die. They can make guesses. Informed guesses even. But they do not know in the vast majority of cases. So the issue is not whether someone hangs around for no good purpose but whether doctors should routinely decide that some patient is blocking a bed and so should be put down. Mistakes will be made. People who might have lived will be killed. But, hey, they were old and so would have died in a year or two anyway, right?
In Australia heroin is an S9 (only with Federal government permission as a trial) drug, while cocaine and pethidine are S8 (prescription and punishable if held without one) drugs.
On 39, yes, indeed, I can’t work out why you’re so outraged. Factory and aviation safety work on the same principle. Informed guesses.
johnb @25, is 400K spent on a yacht for a few dozen fatties really cost effective?
Preventative medicine is generally cheaper than spending on fixing the problems afterwards. But sometimes it goes too far in stopping people having a life. Especially when the prevantative process employs too many people who do nothing but increase their empires. The whole preventative ideology goes too far when it doesn’t take into account the risks, just the potential harm. And because it doesn’t everything is banned leaving people to not actually have a life because they can’t do anything.