Bishop says he is 'delighted' that cash incentives for NHS Trusts taking up the LCP now seem likely to be abolished
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.”