Ministers order an inquiry into the care pathway payments that saw hospitals receive millions to implement controversial system


Ministers order an inquiry into the care pathway payments that saw hospitals receive millions to implement controversial systemSeveral cases have been reported where patients have been put on Liverpool Care Pathway without their family's knowledge
Care minister Norman Lamb called the number of cases 'unacceptable'Liverpool Care Pathway through to be a part in 130,000 deaths of hospital patients every year

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UPDATED:

22:59 GMT, 26 November 2012

Inquiry: Care minister Normal Lamb said the number of cases was 'unacceptable'

Inquiry: Care minister Normal Lamb said the number of cases was 'unacceptable'

Ministers yesterday ordered an
independent inquiry into why hospitals have been paid to hit targets for
numbers of patients dying on the Liverpool Care Pathway.

The new investigation will examine how
hospitals have received tens of millions of pounds to implement the
controversial system for care of the dying.

Care and support minister Norman Lamb
said there had been too many cases of patients dying on the pathway
while their families were told nothing about the withdrawal of
life-saving treatment.

‘This is simply unacceptable,’ he added.

Mr Lamb said the inquiry would
‘consider the value of locally set incentives, and whether they are
leading to bad decisions or practice’.

The decision to order an independent
investigation follows deepening concern over the LCP, which is thought
to be used in the deaths of 130,000 hospital patients each year.

The method, first developed in a
Liverpool hospital and widely in use across the NHS for the past four
years, aims to ease the suffering of dying patients.

It commonly
involves heavy sedation with morphine or similar drugs, and the removal
of tubes providing nutrition and fluids.

But in the past few weeks, a string of
relatives have contacted the Mail expressing concern about the LCP,
saying patients have been put on it without their knowledge. Many have
recovered fully after being taken off the pathway.

Medical critics have said there is no
scientific method of predicting when death will come, arguing that the
pathway amounts to a self-fulfilling prophecy, that many patients die
before they should, and that the system is used to free beds and get rid
of difficult patients.

Ministers have made a series of
concessions to critics over the past month, including the establishment
of an inquiry led by the same palliative care doctors who have been
instrumental in promoting the use of the Liverpool Care Pathway.

They
have also changed NHS rules to put a legal obligation on hospitals to
tell families when a relative is put on the pathway.

One of too many: Cancer patient Thomas James, 90, pictured with his daughter Debbie Croston, was put the Liverpool Care Pathway at his home without any consultation with his family

One of too many: Cancer patient Thomas James, 90, pictured with his daughter Debbie Croston, was put the Liverpool Care Pathway at his home without any consultation with his family

Yesterday’s decision to launch a full
independent inquiry followed a summit between ministers, doctors in
favour of the LCP, and their critics, at the Department of Health in
Whitehall.

The internal medical inquiry into the
LCP will now be taken over by the independent chairman, who is yet to be
picked. Critics of the LCP said the review should be overseen by a High
Court judge.

The decision to call an independent
investigation is understood to have been heavily influenced by the Tory
MP for Congleton, Fiona Bruce, who was at the meeting. Mrs Bruce, a
mother of two who is an evangelical Christian, said both her parents had
died on the pathway and she believed something was wrong with the
process.

After the meeting, Mr Lamb said the independent inquiry would report back to him in the New Year.

On ‘bribe’ payments, first revealed by
the Daily Mail, which have seen at least 30million given to hospitals
that hit targets for numbers of patients who die on the pathway, Mr Lamb
said: ‘We are doing an analysis to focus on the circumstances under
which these payments have been made.

How the mail led the way

‘I don’t want any payments to be made for anything other than to improve the experience of death.

‘Payments must not be made unless it
is absolutely clear that it’s genuinely improving the end of life and is
not just a payment for putting people on a list or a register.’ One of
the leading medical figures at the summit was Professor Patrick
Pullicino, consultant neurologist at East Kent Hospitals University NHS
Foundation Trust, who rang alarm bells over the LCP in the summer in a
speech arguing that it had become a euthanasia pathway.

Prof Pullicino said: ‘It was a
positive meeting. We thought we were the only people in a whole group of
wolves, but we were surprised to find there were a number of people who
sympathised with us.’

He said the independence of the
inquiry would depend on who was in charge of it. ‘If it is a palliative
care doctor, it means zero, but if it is a member of the judiciary it
will be very good,’ he added.

Among those at the summit who defended
the Liverpool Care Pathway was John Ellershaw, professor of palliative
medicine at the University of Liverpool and one of the leading figures behind its design.