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Bishop Egan welcomes Government move on Liverpool Care Pathway

By on Friday, 5 April 2013

Bishop Egan, centre (Photo: Mazur/

Bishop Egan, centre (Photo: Mazur/

Bishop Philip Egan of Portsmouth has welcomed reports that the Government will abolish cash incentives rewarding NHS Trusts for placing seriously ill or elderly patients on the Liverpool Care Pathway.

The bishop spoke after Care Services Minister Norman Lamb told bereaved families at a meeting in Leeds that he intended to halt the controversial system of paying hospitals for hitting targets of patient deaths on the pathway.

Mr Lamb was reported as saying that he did not believe any hospital should gain financially from the deaths of patients through the Commissioning for Quality and Innovation (CQUIN) schemes.

He revealed his intentions to stop the payments during the first of a series of meetings with families under the independent review of the LCP chaired by Baroness Neuberger.

“It is important that I respect the independence of this review but I have already made clear that I have serious concerns about the use of financial incentives and that they should only ever be used if they demonstrably improve patient care,” he said in a statement afterwards.

After Mr Lamb’s comments were reported Bishop Egan issued his own statement welcoming the decision.

“I am very grateful that the Government has now set up a review in order to fine-tune and improve the LCP,” said the bishop, who in December announced in a pastoral message to his diocese that he had “unresolved reservations” about the LCP.

“One of my reservations was the payment of financial incentives to hospitals to put patients on the LCP. I worry that this could easily blur motives,” he said.

“I am delighted therefore that the Government is going to stop these payments and thus to avoid any potential confusion.”

The system of incentives has seen six-figure payments made to NHS Trusts that succeed in achieving a set percentage of patient deaths on the end-of-life framework.

Figures released under the 2000 Freedom of Information Act have shown that about two thirds of all NHS hospitals operating the LCP have received payments for hitting targets associated with its implementation.

An estimated £30 million has been paid out over the last three years, with some 130,000 patients now dying annually on a framework designed to make the final hours of life as pain-free and peaceful as possible.

The terms of reference of the Neuberger review state that investigations will be carried out to see if the payments were resulting in “bad practice”.

The LCP has become controversial because some senior doctors say it is not scientifically possible to predict when a patient is dying and that prognoses of death are little better than “guesswork”.

This, they argue, means that a high rate of misdiagnosis is inevitable on a pathway which is lethal, with most patients dying within 29 hours.

Hundreds of families are complaining that relatives were wrongly placed on the LCP or that neither they nor the patient were informed of the decision.

One of the critics of the LCP, Professor Patrick Pullicino, a consultant neurologist with the East Kent Universities Hospital NHS Trust, and a Catholic, said that the end of the CQUIN payments was essential.

“It is very important that these CQUINs are removed,” Professor Pullicino said. “But it is only the start of things. The LCP itself has to be stopped.”

  • paulpriest

    Thank God for Bishop Egan!!!

    The LCP – despite Bishop Burns’s and David Albert Jones’s and a host of other reputable sources’ repeated reassurances to the contrary – DOES NOT conform to Catholic teaching – direct Papal guidelines regarding nutrition and hydration and sedation are being directly contravened to the extent that we now live in a situation where the NHS engages in Backdoor Euthanasia.

    I’ve said plenty here and elsewhere in regard to the LCP but the nation must be made aware that people are being dehydrated [accelerated by desiccating medications] and both poisoned and ‘put to sleep’ via long-term massive-dose sedation.

    Now the reason behind the reticence to oppose the LCP by Catholic commentators,

    officials, academics and Bio-ethicists is due to a highly understandable sheer terror that if the state acknowledges that euthanasia is already rife in our hospitals as to be considered normative practice – it is merely a hair’s breadth away from legislating for assisted suicide and direct euthanasia…

    Our Catholic representatives see the LCP as the leaky dam holding back the flood – yes thousands are being euthanised by those following the letter of the LCP guidelines but not the spirit of its palliative care intentions – but given we have the looming spectre of hospitals becoming virtual dignitas clinics and provisionally millions being murdered via euthanasia in the decades to come if the legislation changes – the lives being lost now are a price worth paying….

    A Caiaphas corollary – and it stinks!

    It is evil..and it must be stopped…now!

  • $40858710

    I am pleased this murderous filth is actually being condemned – it seems plain, however horrific it may be, that patients are being murdered in secret ”on the NHS” (as the expression goes) and murky euphemisms (Liverpool Care Pathway for one) used to hide the fact. As for ‘dehydration’ I can think of few fouler ways to die and if the vile ‘nurses’ who administer this loathsome treatment considered how their own parents would feel in they died the death of a poor wretch lost in the desert, which is what they are inflicting on the elderly in a hospital, they might be more reticent in their butchery!

  • Ro_Sciv

    When did he become Archbishop of Liverpool? Or is he merely positioning himself as the Sundance Kid to Bishop Davies’ Butch Cassidy?

  • NatOns

    A wise and loving pastor, yes indeed, and please God intelligent enough not to place his trust in princes .. even those with good intentions. For government inquisitions – be they inquest or inquiry – can only do so much; Catholic pastors also need to act personally for the common welfare.

    I would ask those overseeing the care of souls take care to see that Catholic institutions aim for the highest care, best moral practice, and receive frequent visitations/ inspections.

    A very big call, I know, on those with already stretched resources and minimal time to do all that they must, but lead from the front they must. Indeed, example is the best form of teaching but at times only the easiest from of preaching.

    God bless our priests and bishops in their truly self-sacrificing service.

  • Julian Lord

    FINALLY — but as long as there are not enough hospital beds, then incentives to commit evil will remain.

    Still, this is a cause for rejoicing !!!

  • 676aldhelmstown710

    Writing as a member of the Church of England I can assure readers that it is not just Catholics who are concerned about LCP and the value of human life. When he was a young boy a member of our church’s congregation was run over and severely injured. He was unconscious for several months, his parents were told that as there was a very little chance of him waking up from his deep coma it would be a good idea if his life support equipment was turned off and the hospital could harvest his body for organ transplants, his parents refused and eventually he regained consciousness. Although he had suffered permanent physical and brain damage he had over 25 years of good quality life and was a much loved member of our community. RIP Robert. A more disturbing case is that of another young man who appeared to be ” brain dead ” with absolutely no upper cerebral activity, after more than a year he came out of his coma when the professionals said that he was in a permanent vegetative state. His communication was limited to eye movements and blinking his eyelids but using the limited means at his disposal he made every one aware of his deep desire to live and not to be ” put out of his misery “. He was also able to inform all concerned that when he appeared to be in a PVS he was fully aware of what was going on around him when to all around him he appeared to be dead. I hope that the young man Bland who was crushed in a football incident several years ago was unaware of what was taking place concerning his LCP and euthanasia. Interestingly the Pagan Hippocrates in part of his Hippocratic Oath includes a chapter about the value of human life and its preservation.

  • Jim McManus

    We need to be balanced here.

    There are many Catholics and Christians who know the LCP can be a valuable and useful tool.

    But let’s separate the pathway from the issues that still require clinical judgement. The LCP does not call for heavy use of sedatives and removal of hydration, decisions like these are down to clinical judgement, the LCP is a framework for making sure all the elements of

    The Neuberger review will hopefully make some recommendations about bad practice (like unnecessary sedation) as well as bad intent.

    The LCP was designed with good intent, and even many opponents recognise that. The issue is how well it is used. The use of the LCP does not mean every problem in care of those imminently dying is resolved, but it is a step forward. We still have to resolve issues like hydration, nutrition and the right to life as well as people who Catholics would feel act with bad intent.

    We also need to remember that CQUINS are not just used as financial incentives for the LCP, they are used widely in the NHS to incentivise what the NHS considers good practice. The Neuberger review will consider whether CQUINS in the LCP have encouraged bad practice. That’s welcome.

    The issue with the LCP, like any care pathway, is making sure it is used well, alongside good clinical judgement and with respect for the right to life. There are many Catholics and Christians who find the LCP a good tool.

  • Julian Lord

    The LCP was designed with good intent

    No form whatsoever of euthanasia is good — the French have a much more balanced concept, called “acharnement thérapeutique“, which describes the practice of providing useless medical care to objectively hopeless cases. The French attitude is to help the patients as much as possible — particularly with pain relief — but certainly not to accelerate the onset of death.

  • Pope Zicola

    (cue music bed. The High Chaparaal)

    Davis and Egan … two of the finest sheriffs/wranglers of sheep in town with quality sheep dogs to round ‘em up… and get this: they possess two well-calibrated croziers courtesy of the finest weapons arsenal the Vatican has in its General Store…

    Get this. They’re gonna clean up the Roman Catholic Church in England and Wales.

    Yup! One doggone parish at a time.

    And for every cheap shot you fire from your keyboard, you pound coin pole dancer, they’ll fire from the hip and flowers for the widow!

    You have been warned.

  • John Humphreys

    What do you call it when Merseycare deliberately poison a patient to place them on the LCP the Government use a gagging order to silence the press and the Police visit my home to intimidate me into silence. I call it murder look at my public folder

  • paulpriest

    The LCP DOES NOT PREVENT the removal of the natural care of nutrition and hydration – in fact version twelve’s ‘clarification’ is a negative of a negative in this regard – not opposing its retention – which is hardly an strong endorsement and falls straight into the hands of the direct vociferous policies of the Royal College of Nursing which wishes CANH-removal extended and made at the discretion of nursing staff!!!!!

    Fluids should never be removed unless they are directly accelerating and aggravating the death of a patient – do you wish the citations from the previous two Popes on the issue? Or the repeated statements of the Catholic Medical Quarterly in this regard.

    The LCP’s ‘safeguards’ are no such thing – words such as ‘in the patient’s best interests’ and ‘not detrimental to the patient’ can mean absolutely anything – they protect nobody.

    The LCP also drops all tests for the patient once the 72hr prognosis is determined – one of the most important being the test for potential opiate poisoning [which becomes increasingly likely if CNH is withdrawn AND desiccating medications are prescribed to accelerate this] where acceptable analgesia becomes – in the words of Pius XII – barbaric and gravely evil – long term sedation where a patient is denied their opportunity to die a dignified conscious death…]

    Opiate poisoning can also give false indicators that a potentially recovering patient is actually entering the final hours of their life [myoclonic jerks etc]…and need I remind you of the Trescott and Gomez studies which reveal that Opiate provision in non-cancer patients actually accelerates death?

    We are being bombarded with ‘informed Catholic expert’ advice which is repeatedly telling us that there is nothing wrong with the LCP and all those who are engaging in it are following Catholic teaching….
    THIS IS A LIE!!!
    Even when it is bringing about a good natural death with excellent palliative care – it is NOT within the letter of the LCP – which if followed in an arbitrary way – and I do not mean misused or abused – merely used – it can actuate backdoor euthanasia and lead to an horrendous agonising death through desiccation [muscular and organ necrosis is painful beyond all imagining] all covered-up by [poisoning] over-prescribed sedatives…this is a NIGHTMARE!!!

    When one in six of our national dead die via the LCP there must be the most stringent of safeguards to ensure that this doesn’t become tantamount to systemic genocide of the unwanted and the superfluous…

    …and at present – despite the bravest, most unswerving work of campaigners and the best medical experts to make every attempt [fighting all the way to v12 to at least make some difference and some safe provision] – nevertheless it still remains a means of actuating backdoor euthanasia and vastly accelerating death by weeks,months or years for tens of thousands…

    …and it must be stopped.