In my last Blog entry I got angry about the Liverpool Care
pathway and just ranted on about it. That’s the way I go on in my more silly Blog;
This subject was perhaps too close to home, so I’ve calmed
down now and put together some real life facts which I’ve taken from a ‘Daily
Telegraph’ article by John Bingham, 31/10/12 based on sending out Freedom of
Information requests to Trusts.
Then I took a look at a more recent story by way of
illustrating what can go wrong down on the ward.
“According
to responses from a sample of 72 trusts, at least £12.4 million has been paid
out in the past two to three years to trusts which hit targets associated with
use of the care pathway. But the full figure could be more than £20 million.
Under a
system known as “Commissioning for Quality and Innovation” (CQUIN), local NHS commissioners
pay trusts for meeting targets to “reward excellence” in care.
These can
range from simply recruiting a set number of people to classes to help them
stop smoking to providing specialist end-of-life services on wards - such as
LCP.
As the
goals are set locally, they vary from area to area but in some cases trusts are
given specific targets to ensure that a set number of people who die in their
hospital are on the LCP.”
This is a breakdown;
“Overall 61
of those which responded said that they used the pathway, translating to 85 per
cent of the total.
Of those,
62 per cent disclosed that they had either received, or expect to receive, cash
rewards for meeting targets associated with the implementation of the pathway.
The remainder said they had adopted the LCP without receiving any payments.”
These are some specific figures which vary because these are
local incentives;
“Central
Manchester University Hospitals - which received £81,000 in 2010 for meeting
targets relating to the LCP - said the proportion of patients whose deaths were
expected and had been placed on the pathway more than doubled to 87.7 per cent
in the past year.
In
Berkshire the Heatherwood and Wexham Park Hospitals Trust received more than £1
million over two years for meeting its LCP goals. Its targets included carrying
out an audit of the number of deaths of patients on the LCP as well as having a
“meaningful conversation” with the patient themselves but did not set a
specific goal for the number of deaths.
Bradford
teaching Hospitals, which qualified for CQUIN payments of more than £490,000 in
the last two years, has seen the number of patients dying on the pathway more
than double to 51 per cent over the last three years.
In
Birmingham the Heart of England NHS Foundation Trust disclosed that 38 per cent
of patient deaths occurred on the LCP in 2010 and 27 per cent in 2011. It received
a CQUIN payment of £603,886 in the financial year 2010-11 alone.
This is why it’s a problem;
“A handful
of trusts openly spoke of either hitting or missing targets connected to the
LCP in their responses.
And this is the only proper response;
Dr Gillian
Craig, a consultant geriatrician who was among the first doctors to raise the
concerns over the possible flaws of the LCP, described the use of the incentives
as “absolutely shocking”.
“I think
there should be questions in Parliament as to who instigated this policy and I
think the cash payments should be stopped forthwith,” she said. “You can’t pay
people to use a certain protocol that everybody knows to be lethal.”
This is what the government said about it at the time;
“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.”
Now, a year later, the governments review has indicated the
LCP should be scrapped.
So I thought I would give you an example of the reality, down
on the wards. These are extracts from a recent hearing of the misconduct and
competence panel of the Nursing and Midwifery Council, dealing with Janice Harry
who worked as director of nursing, and later as clinical director and chief nurse
for Mid-Staffordshire NHS Foundation Trust.
The case hasn’t yet been decided, as far as I’m aware, so I
will only quote what she said in evidence rather than the other serious
allegations that have been made (but not yet considered) against her.
This is what she had to say about allegations that she went
from ward to ward to find out who was near to death;
“When asked
by the panel if she had inquired about the availability of a bed by asking
"whether anyone was going to go to heaven", Mrs Harry replied: “I am
not sure if those were the words I used but it was a question that was asked.”…..
"It does seem to be hard, but if we knew there was someone within a period
of time known to be dying ... at the end of the day the care people would
receive would be as it should be, but we needed to know if there was the
capacity or space of a bed."
This Chief Nurse faces allegations of bullying and rudeness
from colleagues and from the nurses under her charge as well as other
allegations. This is what she had to say;
Mrs Harry
admitted she had been abrupt in some dealings with staff, but added that she
had been given coaching to help her improve her manner. "Sometimes I can
be very straightforward. Sometimes it can be read as aggressive – but it is not
intentional," she said. "I can understand why some people may see it
that way."
So now we have financial inducements from the NHS to put
people on the Liverpool Care Pathway, a Chief Nurse storming from ward to ward
to find out ‘Whose going to heaven?”
Now, I wonder how the LVP consultations with patients and
relatives were conducted at that hospital Trust?
Neil Harris
(a don’t stop till you drop production)
Home: helpmesortoutthenhs.blogspot.com
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