Hospitals bribed to put patients on pathway to death: Cash incentive for NHS trusts that meet targets on Liverpool Care Pathway
Hospitals are paid millions to hit targets for the number of patients who die on the Liverpool Care Pathway, the Mail can reveal. The incentives have been paid to hospitals that ensure a set percentage of patients who die on their wards have been put on the controversial regime.
In some cases, hospitals have been set targets that between a third and two thirds of all the deaths should be on the LCP, which critics say is a way of hastening the deaths of terminally ill patients.
At least £30million in extra money from taxpayers is estimated to have been handed to hospitals over the past three years to achieve these goals.
Critics of the method warned last night that financial incentives for hospitals could influence the work of doctors.
The LCP involves withdrawal of life-saving treatment. Patients are sedated and most are denied nutrition and fluids by tube. On average a patient put on the Pathway dies within 29 hours.
One of the leading critics, hospital consultant Professor Patrick Pullicino, said: ‘Given the fact that the diagnosis of impending death is such a subjective one, putting a financial incentive into the mix is really not a good idea and it could sway the decision-making process.’
LCP is thought to be used in more than 100,000 cases a year.
Yesterday the Association for Palliative Medicine, which represents doctors working in hospices and on specialist hospital wards, announced it is organising an inquiry into the method.
The LCP is intended to ease the final hours of patients who are close to death and to spare them the suffering associated with invasive treatment.
Payments to hospitals to introduce it are made through a system called Commissioning for Quality and Innovation, or CQUIN, which channels money to hospital trusts through NHS ‘commissioners’.
The use of CQUIN payments to encourage the spread of the LCP through the wards and to persuade doctors to meet Pathway targets was revealed in answers to Freedom of Information requests.
Among trusts that confirmed the use of targets was Aintree University Hospitals NHS Foundation Trust, which said that in the financial year which ended in March the percentage of patients who died on the Pathway was ’43 per cent against a target of 35 per cent’.
Over the year the Trust received £308,000 for achieving ‘goals involving the Liverpool Care Pathway’. Salford Royal NHS Foundation Trust had CQUIN payments connected to the Liverpool Care Pathway almost halved after failing to reach targets.
Part of the scheme was a target for the number of patients discharged from hospital to die at home after being put on the Liverpool Care Pathway.
This would have paid £36,392 if a 47.6 per cent target had been reached. Its FOI statement said: ‘The Trust achieved 45.5 per cent so funding for the LCP element was reduced to £18,600.’
FOI replies so far received by the Mail suggest that if the money paid by NHS commissioners were spread equally around all NHS acute hospitals, it would mean £30million has been sunk into the campaign to put the Pathway into universal use since 2009.
The Department of Health defended LCP payments by target last night. A spokesman said: ‘It is right local areas try to improve the care and support offered to dying people as it means patients are more comfortable and treated with dignity in their final days and hours.
‘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.’
But Dr Tony Cole, chairman of the Medical Ethics Alliance pressure group said: ‘If death is accelerated by a single day that will save the NHS nearly £200 – that is the estimated cost of a patient per day in hospital. ‘My position on the LCP is that it is inherently dangerous and unnecessary.’
Child has to act as midwife after NHS sends expectant mother home
This is being portrayed in a feelgood light because the outcome was much better than could be expected but it is still a clear failure of care. Relying on a child to provide critical medical care is appalling
A six-year-old girl delivered her own sister when she was woken up by her mother who had gone labour on the bathroom floor at home – thanks to watching an episode of BBC drama Casualty.
Francesca Goodby calmly talked her mother Kay, 28, through the sudden birth after her waters broke in Bearwood, West Midlands – while her father Michael, 33, was calling 999.
She helped her panicking mother with her breathing, encouraging her to push, fetched her clean towels and even made sure the umbilical cord was not wrapped around the baby’s head.
Francesca leapt into action in July after recalling an episode of Casualty when a woman suddenly went into labour. After 12 minutes of pushing, 6lbs 8oz baby Roisin had been delivered.
The schoolgirl said: ‘I had to keep mummy calm. I didn’t want the cord to be wrapped around her neck because she might have died and I held her when she was born to keep her safe.
‘I don’t know how I knew about it but I do watch Casualty and like it a lot. My friends at school all said “wow” and my teacher was really impressed with me.’
When two ambulances arrived, paramedics were stunned to find Francesca – who wants to be a doctor when she is older – holding her newborn sister after carefully wrapping her in a towel.
Shop assistant Mrs Goodby said yesterday: ‘I was so impressed with Francesca. She was remarkably cool and collected for a six-year-old.
‘She had gone to bed but woke up when I started screaming.
‘She came in and was like “mummy are you okay?” and said “I can see the head”. She was keeping me calm and telling me where to put my hands and telling me to keep breathing.
Sisters: The schoolgirl helped her panicking mother with her breathing, encouraging her to push, fetched her clean towels and even made sure the umbilical cord was not wrapped round the baby’s head
Sisters: The schoolgirl helped her panicking mother with her breathing, encouraging her to push, fetched her clean towels and even made sure the umbilical cord was not wrapped round the baby’s head
‘As soon as she was born she got a towel and it was like she knew what to do – I didn’t say anything to her. Francesca had her wrapped up and made sure the cord wasn’t wrapped around her neck.
‘My husband was downstairs on the phone for 12 minutes and a few minutes after she was born two ambulances turned up. They were shocked that Francesca was holding her in towels.’
She added that her daughter must have learned how to deliver a baby by watching Casualty – and when they saw a recent episode where a lady gave birth, Francesca said: ‘That’s your story, mummy.’
Mrs Goodby started having contractions every 20 minutes on July 16. The next day she went to her chosen birthing centre but was discharged because she was only in the early stages of labour.
Once at home, she said she called her midwife 10 times to say her contractions were stronger and lasting longer – but was told her labour wasn’t advanced because she could speak normally.
However at around 9.30pm, Mrs Goodby noticed she was bleeding – but she said the birthing centre told her they would probably discharge her if she came in again.
Finally, just before 10pm on July 17, her waters broke after she went to the toilet. Her screaming woke up Francesca – who came to her mother’s aide as her father went downstairs to call 999.
The delivery was quick after her waters broke and following an overnight stay in hospital, mother and baby were discharged.
She is now looking forward to one day telling Roisin how her older sister helped bring her into the world. Mr Goodby, also a shop assistant, missed Francesca’s birth too thanks to work obligations.
Mrs Goodby said: ‘I had just gave birth to Francesca and he turned up, he just missed it. I don’t think it really matters to him – he probably would have fainted, like you see men do on the telly.’
Labour Party increase in welfare payments ‘cost families £3,000 a year’ and promoted ‘destructive’ behaviour
Labour’s increase in welfare spending cost every household an extra £3,000 a year in tax and promoted ‘destructive’ behaviour, Iain Duncan Smith will say today.
The Work and Pensions Secretary will claim his radical reforms of the benefits system are inspired by its founder William Beveridge, who warned in the 1940s that even those in need should never feel income from the state can ‘come from a bottomless purse’.
In a keynote lecture in Cambridge, Mr Duncan Smith will insist that although the Coalition has already trimmed £18billion from the vast welfare bill, further changes are needed to drive out ‘perverse incentives’.
He will insist it is unfair, for instance, that the pension credit system means hard-working people who try to save can find themselves retiring on the same income as their neighbour – someone who has not saved a penny but is eligible to claim.
‘What kind of a message does that send out?’ Mr Duncan Smith will ask. ‘It tells people on low incomes that it’s not worth saving – it’s not even worth working. Just sit back and wait for the government to pay out when you retire.’
He will also suggest workless families can no longer expect ‘never-ending amounts of money for every child’ and confirm the Government intends to restrict housing benefit to the under-25s.
Under Labour, he will say, spending on benefits and tax credits rose by over 60 per cent – spiralling even before the recession, when growth was booming, jobs were being created, and welfare bills should have been falling.
By 2010 the extra spending was costing every household in the country an extra £3,000 a year in tax, helping to increase the budget deficit.
‘We were unable to pay our way, with an economy built on debt and consumption,’ Mr Duncan Smith will say.
‘Some 4.6 million people – 12 per cent of the working age population – on out of work benefits. One in every five households with no one working, and two million children living in workless families – a higher proportion than almost any country in Europe.
‘This culture of entrenched worklessness and dependency was not just a product of the recession. There were over four million people on out of work benefits throughout the years of growth.
‘Under the previous Government whilst employment rose by 2.4 million, more than half of that was accounted for by foreign nationals.’
The welfare system became one of ‘Byzantine complexity’, with more than 30 different benefits, Mr Duncan Smith will say. Disabled people alone were entitled to a ‘complicated muddle’ of seven additional payments, three different premiums and four components of the main out of work benefits and tax credits.
The incentives in the system are being changed so that ‘it acts as a springboard rather than a trap, rewarding those who move into work’.
Speaking to Cambridge Public Policy, a think-tank linked to the city’s university, Mr Duncan Smith will say he takes his ‘lead from Beveridge’. ‘As Beveridge said: “The insured persons should not feel that income [from the state] can come from a bottomless purse”,’ he said. ‘Especially so, when the economy isn’t growing as we had hoped, the public finances remain under pressure and the social outcomes have been so poor.’
British PM insists prisoners will not be given the vote
David Cameron was at war with his own senior law officer last night after insisting that prisoners would not be given the vote.
Attorney General Dominic Grieve was said to be ‘furious’ with the Prime Minister’s stance. Last night there was speculation that Mr Grieve could even resign his Government role if the Prime Minister fails to respect the ‘rule of law’ and do as he wishes.
The Prime Minister told MPs that Britain would not capitulate to demands by the European Court of Human Rights for inmates to be enfranchised. He told MPs: ‘No one should be in any doubt – prisoners are not getting the vote under this Government.’
His comments were seen as a swift slap-down for Mr Grieve, the Cabinet’s most senior legal adviser.
Only minutes earlier Mr Grieve had claimed that Britain’s reputation would be damaged if it did not adhere to the ruling by Strasbourg, which dates back to 2005.
Mr Grieve, who claimed it was technically possible for Britain to be booted out of the Council of Europe, said: ‘The United Kingdom has an enviable reputation in relation to human rights standards and adherence. ‘I have no doubt that it would be seen by other countries as a move away from our strict adherence to human rights laws.’
Mr Grieve argued that refusing inmates the vote ‘would be costly to the United Kingdom’ as Strasbourg would almost certainly award them compensation worth tens of millions of pounds.
Mr Grieve added that, while the Government could choose not to pay, that ‘would be a further breach of the obligations’. He added: ‘The issue is whether the United Kingdom wishes to be in breach of its international obligations and what that does to the reputation of the United Kingdom.’
The remarks by Mr Grieve infuriated backbench Tory MPs. They insist it is nonsense to suggest Britain could be thrown out of the Council of Europe, which has failed to suspend the membership of countries such as Russia and Turkey which are guilty of flagrant abuses of human rights.
MPs also point out that the overwhelming majority of MPs voted last year to maintain the UK’s historic ban on prisoner voting and say Strasbourg must respect the sovereignty of Parliament.
So what will happen next?
The latest day of drama over prisoner voting was prompted by claims that the Government was prepared finally to reach a settlement with Strasbourg.
To the anger of Tory MPs, it was reported that Mr Grieve had persuaded Mr Cameron of the need to introduce a Bill giving at least a limited number of convicts the vote. But the claims were immediately rejected by Number Ten and insiders at the Ministry of Justice.
Later, at Prime Minister’s Questions in the Commons, Mr Cameron said: ‘I don’t want prisoners to have the vote, and they should not have the vote. ‘If it helps by having another vote in Parliament on another resolution to make absolutely clear, to help put the legal position beyond doubt, I am very happy to do that.’
A Tory source said Mr Grieve had gone public with his concerns after becoming frustrated with Mr Cameron’s refusal to accept his advice on prisoner voting. He is backed in the Cabinet by former Justice Secretary Kenneth Clarke.
The source said: ‘For Dominic the rule of law is the key issue. The legal advice is very clear that the UK has to abide by the court’s ruling. There are different ways of doing it, but we cannot just say no – it may be popular politically in the short term, but legally it is madness and even the popularity of it may fade when we start having to pay compensation to murderers.’
A senior Government source insisted that Mr Cameron’s stance did not conflict with the Government’s legal advice. The source said: ‘The Attorney General’s arguments are slightly difficult to penetrate – he says lots of different things. ‘The focus has been on his concerns, but he does point out that parliament is sovereign and that there is flexibility in this.’
The agony of knowing your son’s being bullied – and the school is too politically correct to punish his tormentors
Foolish woman failed to check the school first before moving. Most middle-class British parents know to do that
Each day at 3.15pm, the school gates open and hordes of boisterous children spill happily out on to the Tarmac. My son, however, is not one of them. He makes his way across the playground, shoulders hunched, head down, dragging his bag. He exudes a weariness that singles him out from his peers.
I can see, from ten yards away, how bad his day has been. I take in the frown, the nervous gesture he makes with his hand across his brow and the way he glances warily about him. I know — my heart lurching — that he is summoning all his energy not to cry.
‘You OK?’ I ask, as casually as I dare. He nods, desperate to hold it together until we get to the car. But I know, and he knows, that all is not ok. We’re into the fourth week at a new school and — I’m going to use a word now that I have discovered is a little like throwing a bomb into a room — he is being bullied.
That’s right. Bullied. Not picked on, teased, or made the butt of some playground pranking. But bullied. I know it’s an emotive word — a word that is often over-used and bandied about unnecessarily (I know this because the school in question keeps telling me this repeatedly).
But when you have a ten-year-old who was previously confident but now shakes on the school run; who loved school but now spends the majority of his evening begging to be allowed to stay at home the next day — then, excuse me, I’ll use any word I damn well please.
Trust me, I’m not a precious mother. Nor am I one of those who feels the need to endlessly enter the school to put my maternal oar in. My approach — until now — has always been one of: ‘Get out of the car — see you in six hours.’
When we decided to move Monty to a new school at the beginning of Year 5, just shy of his tenth birthday, I wasn’t unduly worried.
He had been happily attending the same small, idyllic village primary since 2007. But two years ago we moved to a house ten miles away, out of the area, and since then I’ve been spending an hour in the car each day doing a 40-mile round trip to get him there and back.
I decided to send him to the local primary at the end of our road. It’s much bigger, with a more mixed social intake. I reasoned that this was surely a good thing. I want my children to learn with children from a variety of backgrounds. It opens their eyes to the wider context that it takes all sorts to make the world go round.
Well, that’s how I felt before. Now I snort at my naivety. Because, from bitter experience, I know that this ideal only works if those other children have a similar code of behaviour and manners — one that is reinforced by school and parents alike.
And before you accuse me of being a judgemental snob let me put this to you. Is it acceptable to kick another child relentlessly in the small of their back during a lesson?
Or to tip them out of their chair? Or to erase the work they have spent the last 30 minutes doing from the whiteboard? And that’s the stuff that went on when there was a teacher in the room.
Bear in mind we are talking here about a village school in the leafy Home Counties — not an inner-city primary on special measures. So when Monty initially admitted to me, in floods of tears, what was going on, I had every faith the problem would be nipped in the bud, swiftly and effectively.
How wrong I was. To begin with, the head teacher acknowledged there was an issue with two of the boys in that year group who were feeling ‘a little insecure’ about Monty’s arrival. I ventured that Monty was feeling a little insecure about being chased up a tree and having his trainers ripped off his feet and thrown over the hedge.
But, hey ho, it was early days and I still felt confident that things would be dealt with.
Monty’s first week was dreadful. I watched as he put a brave face on the business of being the new boy, while sinking further into dismay because these bullies didn’t ‘like’ him.
I could see part of the problem was that — with three sisters — Monty is probably a bit more in touch with his feminine side than his peers. By nature, he is communicative, a little quirky, and more likely to break into song in the playground than kick a football.
He does ballet, musical theatre and talks about his emotions, which, admittedly, might make another type of boy conclude that he’s a weirdo, or a geek — two of the names he was repeatedly called during his first week.
All this is, of course, par for the course. My husband Keith and I explained to him that there will always be people who don’t like you and one of life’s lessons is to toughen up and deal with it.
Then we went to the school to ask what the hell was going on. The head teacher reiterated that the situation was ‘being handled’. These two boys had behavioural issues that they were working on.
Things got worse. In his second week, Monty was repeatedly followed into the toilets (where I suspect he was going to have a quick cry) and relentlessly pursued at every turn.
Any mother will identify with the angst of seeing your child unhappy but having no power to deal with it. I was sorely tempted to speak to the boys’ parents but the look of horror on the head’s face when I suggested it stopped me in my tracks.
Another of my bright ideas was to invite the bullies to tea — but this time it was the look on Monty’s face that made me realise I was clutching at straws.
By now, we were speaking to the school every day. Or rather, they were repeating the same thing to us over and over again: ‘We have a zero-tolerance approach to bullying.’
This was beginning to sound like point number one on some Department of Education guideline sheet for schools: ‘Buy time by telling the parents what they want to hear. Eventually they’ll believe you.’
But I didn’t. I was fast losing faith. The school might, indeed, have zero tolerance. I have zero tolerance about crisp packets being shoved down the back of the sofa but that doesn’t mean it doesn’t happen.
The tricky bit is implementing a consequence. So, I put it to the head teacher: what punishment are you giving these boys for making my son’s life a misery? ‘Oh, none,’ she replied. ‘We’re going to set up a drama group to help the three of them (including Monty) deal with their social responses.’
Social responses? What on earth was she talking about? I felt like she had swallowed a whole political correctness dictionary!
I rushed from the room, went straight home and told Monty that if either of those boys came anywhere near him again he had my permission to punch them — a social response I felt was quite appropriate under the circumstances.
But I knew he wouldn’t. He’s no angel, but punching is not his style. Then the school suddenly changed tack. ‘This isn’t actually a bullying matter,’ the head teacher informed me at the beginning of week three.
‘Bullying is the relentless targeting of one individual, and these two boys behave like this towards every child in the class.’ She then suggested — with Monty present — that it might be best to just ‘put up with it, and stop taking their behaviour so personally’.
I couldn’t believe what I was hearing. By shifting the focus from ‘bullying’ to ‘general bad behaviour’ it seemed as though she had cleverly placed the onus of the problem on Monty — deflecting it away from a word she appeared desperate not to have the school associated with.
According to ChildLine, there has been a rise in bullying in schools and there is much evidence to show there is often a discrepancy between what teachers consider to be bullying behaviour and what their pupils report is actually happening.
Indeed, bullying remains the second most common reason for children to contact ChildLine, with 31,599 counselling sessions being carried out last year — approximately 87 per day.
To this end, the charity are launching a ChildLine schools service next month — run by trained volunteers — who will go into schools across the UK and hold workshops for children, in particular those aged nine to 11 years old, about bullying and how they can be supported.
Of course, it will be too late for Monty. But that’s OK because I have taken matters into my own hands in the best way I know how. I have moved him somewhere else.
Call it running away if you like, but when you have lost all trust in your child’s school to nurture and protect them with common sense and no other agenda, then what other option do you honestly have?
I know my decision was a good one because now, at the end of the day, Monty has a bounce in his step and is bursting with enthusiasm. He’s still dragging his bag along the ground, mind you. But perhaps you’ll understand when I say I honestly couldn’t care less…
British energy policy in a muddle
Next month, the coalition government in Britain intends to publish its new energy bill. The coalition partners, however, are increasingly at odds over the direction of the United Kingdom’s energy policy. In view of growing antagonism, it remains unclear whether the bill can be salvaged or whether the increasing friction will lead to its delay.
Last week, British Prime Minister David Cameron bewildered MPs when he announced that energy suppliers would be forced by law to put customers on their cheapest energy tariffs. Ed Davey, the Energy Secretary, contradicted the PM declaring that the government’s new energy legislation would actually introduce something quite different to bring down energy costs – increased market competition. No wonder that the government’s approach to energy legislation appears increasingly confused and frenzied.
Energy policy is one of the main economic battle grounds between the government’s coalition partners. On energy policy, the Treasury has been increasingly at odds with the Department of Energy and Climate Change. This conflict has been growing between the Treasury and DECC ever since Chancellor George Osborne promised an end to Britain’s unilateral decarbonisation targets.
The Chancellor has sent a clear signal that the government’s ambition to restore the UK economy to health is overriding its desire to be the greenest government. He is adamant that the UK should no longer place too much emphasis on renewable energy and should adopt a new dash for gas. Cameron’s recent reshuffle has certainly helped to pave the way for a new gas policy while Owen Paterson, the new Environment Secretary, has been widely reported to favour the rapid exploitation of shale gas. Yet, Davey is trying hard to safeguard the future of renewable energy subsidies.
In July, Osborne wrote to Ed Davey warning him that renewable energy was too expensive and that Britain should advance gas-fired electricity generation instead. Osborne stressed that the government “need to set out an approach which puts costs to consumers at the heart – we should be limiting support for low-carbon generation to a level the country can afford”.
The DECC, on the other hand, has based the case for expanding green – and more expensive – energy in large part on their assumption that gas prices will inescapably rise in the future. This argument is no longer credible in the light of the growing international abundance of shale gas, not to mention the likely shale gas potential in Britain itself.
It will be interesting to see whether the coalition government will be able to overcome these conflicting and contradictory policy approaches in coming weeks. Davey claims the ultimate intention of the energy bill, expected to be published in November, was to “move from price setting by ministers to price discover by market”. However, the draft energy bill – released earlier this year – was just as confused and inconsistent as Cameron’s latest intervention. Unless these incongruities are disentangled and resolved, the energy bill will not provide investors with the certainty they require to make substantial investments.
This lack of clarity would inevitably lead to constant government amendments and continual intervention, further bewildering the energy sector. It is doubtful that an energy bill fudge would actually be workable, let alone economically viable. There is a growing risk that it will prove to be highly unpopular as the costs of these measures are likely to further inflate energy bills artificially. In this case, the crisis of energy policy making could quickly turn into a veritable government fiasco.