Hospitals paid incentives for controversial end of life care

DENIED FLUIDS: Audrey Cummings

DENIED FLUIDS: Audrey Cummings

First published in News
Last updated
The Northern Echo: Photograph of the Author Exclusive by

HOSPITALS in the region have received more than £2m for using a controversial "end-of-life" programe which allows doctors to withdraw treatment and fluids.

Officials say the plan - called the Liverpool Care Pathway (LCP) after the Royal Liverpool University Hospital where it was developed - is a compassionate method of treating dying patients.

But the Government has ordered a review of its use after claims some families had no idea their relatives were on it.

Eighty-year-old Andrew Cummings, of Darlington, said he was completely unaware that his wife’s care in her dying days involved withholding fluids.

“It was like the secret service,” he said. “You are the relative but no-one tells you anything. The Liverpool Care Pathway wasn’t mentioned because the first time I heard of it was after she died and realised that was what had happened to her.”

However, the Department of Health says staff must discuss the treatment with patients (where possible) and their families. Any failure to do so is "unacceptable".

Nationally, 130,000 dying patients are put on the programme every year. Hospitals that adopt the LCP receive financial rewards.

South Tees Hospitals NHS Foundation Trust, which runs the James Cook University Hospital in Middlesbrough and the Friarage Hospital in Northallerton, was given £1.4m in 2010 and 2011-12.

County Durham and Darlington received £641,000 and North Tees and Hartepool was given £395,000.

The LCP was developed to give patients a peaceful death by withdrawing unnecessary medications and tests, and not giving fluids when a patient has stopped being able to eat or drink.

Mr Cummings wife, Audrey, was admitted to Darlington Memorial Hospital with a urine infection on Saturday September 15 last year before being diagnosed with severe heart problems.

He said: “We got called into this little room and a doctor just reeled it off parrot fashion that there was nothing more they could do for her and she was going on palliative care.

“My son and daughter came down and realised that Audrey wasn’t getting anything to eat or drink.”

Mr Cummings praised nurses who cared for his wife but he said he had to insist on seeing a doctor after nurses said they were unable to provide any more medication when she started having spasms.

Mike Wright, Executive Director of Nursing at County Durham and Darlington NHS Foundation Trust, said: “We would like to offer our condolences to Mr Cummings for the loss of his wife. We acknowledge that we could have communicated better but are pleased that he was satisfied with the care his wife received."

Mr Wright said the LCP was a "national model of best practice" and denied the Trust was paid to put patients on it. The incentive payments related to staff training on LCP and improving care for dying patients.

However, critics say introducing a financial incentive to end-of-life care is not appropriate. They fear it could sway the decision-making process.

Some Roman Catholic doctors have voiced concerns that the programme speeds up dying. Alert, an anti-euthenasia pressure group, claimed it was designed to "finish people off".

Professor Edwin Pugh, head of palliative care at the North Tees and Hartlepool NHS Foundation Trust, said: “I am very aware of the national debate. Dying is a normal event. We don’t want to medicalise it. The LCP is for patients in the last day or two of life who are more or less unconscious."

Comments (17)

Please log in to enable comment sorting

8:54am Mon 4 Feb 13

maur1 says...

what a cruel way to let someone die,why not give them an injection like you would an animal?rather than starve and have them getting no fluids . put the people who thought of this idea on this pathway for 2 weeks and see how they feel after 2 weeks.starvation and thirst.
what a cruel way to let someone die,why not give them an injection like you would an animal?rather than starve and have them getting no fluids . put the people who thought of this idea on this pathway for 2 weeks and see how they feel after 2 weeks.starvation and thirst. maur1
  • Score: 1

9:16am Mon 4 Feb 13

Idontknowaboutyoubut says...

The shocking face of Camerons "Big Society"Britain.If you want care,proper care,for yourself,or your loved ones,club together with friends and neighbours,and do it yourself.Dont look to the NHS,or the State to provide care.They are actually hastening the end for people by withholding treatment food and liquids, and offering what is effectively a BONUS to hospitals who stop treatment.
This is manslaughter by neglect.If an individual were to treat a family member in this way,untill they died,I am sure that they would be so charged,and rightly so,and doctors/nurses should be prosecuted. Caring professions ???
The shocking face of Camerons "Big Society"Britain.If you want care,proper care,for yourself,or your loved ones,club together with friends and neighbours,and do it yourself.Dont look to the NHS,or the State to provide care.They are actually hastening the end for people by withholding treatment food and liquids, and offering what is effectively a BONUS to hospitals who stop treatment. This is manslaughter by neglect.If an individual were to treat a family member in this way,untill they died,I am sure that they would be so charged,and rightly so,and doctors/nurses should be prosecuted. Caring professions ??? Idontknowaboutyoubut
  • Score: 1

10:45am Mon 4 Feb 13

EyesWideOpen7 says...

The Pathway is flawed and dangerous. The Pathway is giving clinicians a tremendous power which is often wielded precariously. I unreservedly make this statement, not as an "uninformed" and "stupid" person (these are some remarks made on a "Pro-LCP" webpage) but as someone who values the life of all beings, and as a Grandaughter to the most beautiful, strong and amazing woman ever to have walked this Earth. To have experienced first-hand people playing God, deciding she had reached the end of her days and terminating her life with no discussion surrounding this with Nan (who was fully compos mentis before they terminally sedated her) or the family, but instead deceiving us in order to have Nan admitted to a hospital (for physio, which she never received, as they pumped her with morphine instead) where they could carry out their evil plan, is but one example of the depraved and corrupt practice that is operating right now within the medical industry.

To anybody who has been affected, directly or indirectly, left without answers or had the doors slammed shut any time you try to question what happened - please read and show your support for the following petitions calling for the withdrawal of the LCP - http://www.thepetiti
onsite.com/1/Liverpo
olCarePathway-ANatio
nalScandal/ and https://www.change.o
rg/petitions/ban-the
-liverpool-care-path
way-a-national-scand
al and http://www.gopetitio
n.com/petitions/live
rpool-care-pathway-a
-national-scandal.ht
ml
The Pathway is flawed and dangerous. The Pathway is giving clinicians a tremendous power which is often wielded precariously. I unreservedly make this statement, not as an "uninformed" and "stupid" person (these are some remarks made on a "Pro-LCP" webpage) but as someone who values the life of all beings, and as a Grandaughter to the most beautiful, strong and amazing woman ever to have walked this Earth. To have experienced first-hand people playing God, deciding she had reached the end of her days and terminating her life with no discussion surrounding this with Nan (who was fully compos mentis before they terminally sedated her) or the family, but instead deceiving us in order to have Nan admitted to a hospital (for physio, which she never received, as they pumped her with morphine instead) where they could carry out their evil plan, is but one example of the depraved and corrupt practice that is operating right now within the medical industry. To anybody who has been affected, directly or indirectly, left without answers or had the doors slammed shut any time you try to question what happened - please read and show your support for the following petitions calling for the withdrawal of the LCP - http://www.thepetiti onsite.com/1/Liverpo olCarePathway-ANatio nalScandal/ and https://www.change.o rg/petitions/ban-the -liverpool-care-path way-a-national-scand al and http://www.gopetitio n.com/petitions/live rpool-care-pathway-a -national-scandal.ht ml EyesWideOpen7
  • Score: 1

11:09am Mon 4 Feb 13

Not a Friend of the Hospice says...

Jeez, the 'spasms' she was having were actually side effects of a large overdose of morphine..what they do is render them unconcious BEFORE they tell you what they intend to do. That way they're unconcious..the law says if someone doesnt have an advance directive specifically refusing a treatment or care pathway, the doctors can act in whatever they consider to be the patients' 'best interests'...and with an old person, it'll always be their white, middle class opinion that you die!!! Brillant conjuring trick....look for pinprick pupils ...morphine overdose....and dont ask permission to take them home...CARRY THEM THE HELL OUT OF THERE!
Jeez, the 'spasms' she was having were actually side effects of a large overdose of morphine..what they do is render them unconcious BEFORE they tell you what they intend to do. That way they're unconcious..the law says if someone doesnt have an advance directive specifically refusing a treatment or care pathway, the doctors can act in whatever they consider to be the patients' 'best interests'...and with an old person, it'll always be their white, middle class opinion that you die!!! Brillant conjuring trick....look for pinprick pupils ...morphine overdose....and dont ask permission to take them home...CARRY THEM THE HELL OUT OF THERE! Not a Friend of the Hospice
  • Score: 1

11:14am Mon 4 Feb 13

Not a Friend of the Hospice says...

Write an advance medical directive now ...include the phrase 'I dont ever want to be given palliative care only, or any licensed or off licence doses or opiods or sedatives or anxiolytics, or to be rendered unconcious by any means before being consulted in the presence of my family or friends and giving my informed consent, and obtaining the opinion of a truly impartial doctor who is not associated with the healthcare workerscurrently making a decision about my treatment options...'
Write an advance medical directive now ...include the phrase 'I dont ever want to be given palliative care only, or any licensed or off licence doses or opiods or sedatives or anxiolytics, or to be rendered unconcious by any means before being consulted in the presence of my family or friends and giving my informed consent, and obtaining the opinion of a truly impartial doctor who is not associated with the healthcare workerscurrently making a decision about my treatment options...' Not a Friend of the Hospice
  • Score: 1

11:50am Mon 4 Feb 13

LAbabyx says...

maur1 wrote:
what a cruel way to let someone die,why not give them an injection like you would an animal?rather than starve and have them getting no fluids . put the people who thought of this idea on this pathway for 2 weeks and see how they feel after 2 weeks.starvation and thirst.
maur1 wrote:
what a cruel way to let someone die,why not give them an injection like you would an animal?rather than starve and have them getting no fluids . put the people who thought of this idea on this pathway for 2 weeks and see how they feel after 2 weeks.starvation and thirst.

How is this a cruel way to let someone die? My grandma passed away 4th February 2012 after being on pathways for 7 days, she was on a constant morphine drip to block out the pain. Its not a nice thing to see but neither is watching someones body give up whilst on medication, food etc... they aren't aware of how they feel what if the person had been suffering for a really long time and keeping them here was causing them more pain? it could be in their best interest until you've been through it don't make bad remarks!
Although if a person is being put on pathways they're family should have this decision without a doubt.... it shouldn't be made by just nurses or doctors. family should be informed before hand, what happened to this poor lady and her family is disgraceful
[quote][p][bold]maur1[/bold] wrote: what a cruel way to let someone die,why not give them an injection like you would an animal?rather than starve and have them getting no fluids . put the people who thought of this idea on this pathway for 2 weeks and see how they feel after 2 weeks.starvation and thirst.[/p][/quote]maur1 wrote: what a cruel way to let someone die,why not give them an injection like you would an animal?rather than starve and have them getting no fluids . put the people who thought of this idea on this pathway for 2 weeks and see how they feel after 2 weeks.starvation and thirst. How is this a cruel way to let someone die? My grandma passed away 4th February 2012 after being on pathways for 7 days, she was on a constant morphine drip to block out the pain. Its not a nice thing to see but neither is watching someones body give up whilst on medication, food etc... they aren't aware of how they feel what if the person had been suffering for a really long time and keeping them here was causing them more pain? it could be in their best interest until you've been through it don't make bad remarks! Although if a person is being put on pathways they're family should have this decision without a doubt.... it shouldn't be made by just nurses or doctors. family should be informed before hand, what happened to this poor lady and her family is disgraceful LAbabyx
  • Score: 1

2:23pm Mon 4 Feb 13

irene ogrizek says...

I have had a very bad experience trying to save my mother from a death pathway here in Canada. I signed a DNR and when she survived, and asked me to reverse it, I had an extraordinarily difficult time making that happen. We don't have a specific protocol here in Canada, so care is withdrawn surreptitiously and that makes abuse harder to spot. Consultation with families seems to be the issue, and yet it is so easily remedied. Why are healthcare professionals willing to sit down with families? Here is an article I wrote: http://ireneogrizek.
ca/2012/12/28/5762-t
he-right-to-choose-l
ife-or-death/
I have had a very bad experience trying to save my mother from a death pathway here in Canada. I signed a DNR and when she survived, and asked me to reverse it, I had an extraordinarily difficult time making that happen. We don't have a specific protocol here in Canada, so care is withdrawn surreptitiously and that makes abuse harder to spot. Consultation with families seems to be the issue, and yet it is so easily remedied. Why are healthcare professionals willing to sit down with families? Here is an article I wrote: http://ireneogrizek. ca/2012/12/28/5762-t he-right-to-choose-l ife-or-death/ irene ogrizek
  • Score: 0

2:39pm Mon 4 Feb 13

IanfromCrook says...

Completely against this. Personal experience tells me that older people, especially those with any kind of neurological disease have no rights. Their families have no rights. This bonus scheme will make matters much worse. The patient wants to live at all costs, family agrees, staff do not........patient dies. Now we add.....hospital receives income. Life apparently does have a price.
Completely against this. Personal experience tells me that older people, especially those with any kind of neurological disease have no rights. Their families have no rights. This bonus scheme will make matters much worse. The patient wants to live at all costs, family agrees, staff do not........patient dies. Now we add.....hospital receives income. Life apparently does have a price. IanfromCrook
  • Score: 1

3:01pm Mon 4 Feb 13

maur1 says...

LAbabyx wrote:
maur1 wrote: what a cruel way to let someone die,why not give them an injection like you would an animal?rather than starve and have them getting no fluids . put the people who thought of this idea on this pathway for 2 weeks and see how they feel after 2 weeks.starvation and thirst.
maur1 wrote: what a cruel way to let someone die,why not give them an injection like you would an animal?rather than starve and have them getting no fluids . put the people who thought of this idea on this pathway for 2 weeks and see how they feel after 2 weeks.starvation and thirst. How is this a cruel way to let someone die? My grandma passed away 4th February 2012 after being on pathways for 7 days, she was on a constant morphine drip to block out the pain. Its not a nice thing to see but neither is watching someones body give up whilst on medication, food etc... they aren't aware of how they feel what if the person had been suffering for a really long time and keeping them here was causing them more pain? it could be in their best interest until you've been through it don't make bad remarks! Although if a person is being put on pathways they're family should have this decision without a doubt.... it shouldn't be made by just nurses or doctors. family should be informed before hand, what happened to this poor lady and her family is disgraceful
you try going without food or water its cruel , she was on it 7 days its a long time no food dry mouth , sorry about your grandma , and i have been through it so i feel qualified to comment
[quote][p][bold]LAbabyx[/bold] wrote: [quote][p][bold]maur1[/bold] wrote: what a cruel way to let someone die,why not give them an injection like you would an animal?rather than starve and have them getting no fluids . put the people who thought of this idea on this pathway for 2 weeks and see how they feel after 2 weeks.starvation and thirst.[/p][/quote]maur1 wrote: what a cruel way to let someone die,why not give them an injection like you would an animal?rather than starve and have them getting no fluids . put the people who thought of this idea on this pathway for 2 weeks and see how they feel after 2 weeks.starvation and thirst. How is this a cruel way to let someone die? My grandma passed away 4th February 2012 after being on pathways for 7 days, she was on a constant morphine drip to block out the pain. Its not a nice thing to see but neither is watching someones body give up whilst on medication, food etc... they aren't aware of how they feel what if the person had been suffering for a really long time and keeping them here was causing them more pain? it could be in their best interest until you've been through it don't make bad remarks! Although if a person is being put on pathways they're family should have this decision without a doubt.... it shouldn't be made by just nurses or doctors. family should be informed before hand, what happened to this poor lady and her family is disgraceful[/p][/quote]you try going without food or water its cruel , she was on it 7 days its a long time no food dry mouth , sorry about your grandma , and i have been through it so i feel qualified to comment maur1
  • Score: 1

3:14pm Mon 4 Feb 13

maur1 says...

my mum suffered a stroke in 1990 aged5 9. they at that time wanted to not feed her ot give her fluids said it would be better to do this, my sister and i said nooooo way my mum knows we are here she was squeezing our hand at certain times , she seem to pick up we were so relieved, then they decided to put her in bath she was walking , dont know what then happened they said she collapsed a further stroke often wondered if they had her up too soon , if she had not been fed and fluids she would died sooner but she was recovering. we all do what we think is best our parents grandparents.
my mum suffered a stroke in 1990 aged5 9. they at that time wanted to not feed her ot give her fluids said it would be better to do this, my sister and i said nooooo way my mum knows we are here she was squeezing our hand at certain times , she seem to pick up we were so relieved, then they decided to put her in bath she was walking , dont know what then happened they said she collapsed a further stroke often wondered if they had her up too soon , if she had not been fed and fluids she would died sooner but she was recovering. we all do what we think is best our parents grandparents. maur1
  • Score: 1

5:59pm Mon 4 Feb 13

stevegg says...

This wont probably be an issue in 50 years time with global population explosion, wide spread famine, climate change, depleted oil reserves gone and a huge (and expensive), elderly population to look after. Governments of the day will more than likely rationing services and encouraging the elderly and critically ill to end it all. Euthanasia will be widespread as there wont be the capability, resources or money to look after these people unless inviduals do it off their own backs.
This wont probably be an issue in 50 years time with global population explosion, wide spread famine, climate change, depleted oil reserves gone and a huge (and expensive), elderly population to look after. Governments of the day will more than likely rationing services and encouraging the elderly and critically ill to end it all. Euthanasia will be widespread as there wont be the capability, resources or money to look after these people unless inviduals do it off their own backs. stevegg
  • Score: 0

6:19pm Mon 4 Feb 13

steapuk says...

I'm just pleased I'm not old or terminally ill because both parties get a raw deal. I just visited my 92 year old aunty in a care home (non nursing) only to find she has a DNR on her care file. She's as fit as a lop. More worryingly was the fact that it has my name (spelt wrongly) on it yet no discussion ever took place. When i questioned why I was told it came from the hospital....

Totally shocking

Suffice to say its been removed!
I'm just pleased I'm not old or terminally ill because both parties get a raw deal. I just visited my 92 year old aunty in a care home (non nursing) only to find she has a DNR on her care file. She's as fit as a lop. More worryingly was the fact that it has my name (spelt wrongly) on it yet no discussion ever took place. When i questioned why I was told it came from the hospital.... Totally shocking Suffice to say its been removed! steapuk
  • Score: 0

1:49pm Tue 5 Feb 13

Homshaw1 says...

Why do they need £2M to refuse people food and drink until they die?

Disgusting
Why do they need £2M to refuse people food and drink until they die? Disgusting Homshaw1
  • Score: 0

5:34pm Tue 5 Feb 13

Homshaw1 says...

Professor Pugh says it is only for people that are unconcious and in the last day or two of life. Reading other comments above this would not seem to be the case.

I think he is kidding either himself or trying to hoodwink the general public
Professor Pugh says it is only for people that are unconcious and in the last day or two of life. Reading other comments above this would not seem to be the case. I think he is kidding either himself or trying to hoodwink the general public Homshaw1
  • Score: 1

6:45pm Tue 5 Feb 13

maur1 says...

LAbabyx sorry hope i didnt upset you. was no way my intention im an ex careworker; i posted because my mum they got it wrong we all do what we hope is best, 2 days if they die is good but to me speaking from experience if it goes longer no food no fluids its cruel......my own opinion im over 60 now so older than my mum when she died i told my kids neverrrrrr put me on this pathway, seems like hospitals get a load from car parking..........had loads to pay my mum and mum in law for parking when they were dying, now nhs puts you on a die fast soon my own opinion yes hope people do positive posts like nhs went out there way to save me,,,,,,is it good to be british? and over 60
LAbabyx sorry hope i didnt upset you. was no way my intention im an ex careworker; i posted because my mum they got it wrong we all do what we hope is best, 2 days if they die is good but to me speaking from experience if it goes longer no food no fluids its cruel......my own opinion im over 60 now so older than my mum when she died i told my kids neverrrrrr put me on this pathway, seems like hospitals get a load from car parking..........had loads to pay my mum and mum in law for parking when they were dying, now nhs puts you on a die fast soon my own opinion yes hope people do positive posts like nhs went out there way to save me,,,,,,is it good to be british? and over 60 maur1
  • Score: 0

8:29pm Thu 7 Feb 13

doctoroncall says...

The Liverpool Care Pathway is best medical practice. It has years of research and evidence behind it to confirm that it DOES NOT hasten death but DOES give a more peaceful and dignified death.

Patients are not denied fluids on the Pathway but in the last days of life our bodies are unable to process fluid as they usually would and it most often just accumulates in our tissues without being put to use. Good mouth care is an essential part of the pathway to ensure that the patient does not feel thirst.

A patient can only be placed on the pathway if death is expected in the next 72 hours and they fulfill strict criteria such as they are bed bound, semi comatose, can only take sips of fluid and can't take oral medications.

The pathway anticipates the common problems that happen in the end of lie such as pain, agitation, secretions and shortness of breath and the prescriptions for medications to help with these are written up in advance so there is no delay in starting treatment.

The article written and the comments afterwards are ill-informed and scare-mongering.

My mother had a peaceful and painfree death after being placed on the pathway. It did not change the time frame but it did change how comfortable she was.
The Liverpool Care Pathway is best medical practice. It has years of research and evidence behind it to confirm that it DOES NOT hasten death but DOES give a more peaceful and dignified death. Patients are not denied fluids on the Pathway but in the last days of life our bodies are unable to process fluid as they usually would and it most often just accumulates in our tissues without being put to use. Good mouth care is an essential part of the pathway to ensure that the patient does not feel thirst. A patient can only be placed on the pathway if death is expected in the next 72 hours and they fulfill strict criteria such as they are bed bound, semi comatose, can only take sips of fluid and can't take oral medications. The pathway anticipates the common problems that happen in the end of lie such as pain, agitation, secretions and shortness of breath and the prescriptions for medications to help with these are written up in advance so there is no delay in starting treatment. The article written and the comments afterwards are ill-informed and scare-mongering. My mother had a peaceful and painfree death after being placed on the pathway. It did not change the time frame but it did change how comfortable she was. doctoroncall
  • Score: -2

10:19pm Thu 7 Feb 13

IanfromCrook says...

The publicity, the leaflet and the research (how do you research something when you cannot ask the patient afterwards,,,,,,,,ho
w was this for you) all say one thing which sounds perfectly reasonable. What happens is not always the case.
A lie repeated is still a lie, no matter how many letters after the persons name there maybe.
The publicity, the leaflet and the research (how do you research something when you cannot ask the patient afterwards,,,,,,,,ho w was this for you) all say one thing which sounds perfectly reasonable. What happens is not always the case. A lie repeated is still a lie, no matter how many letters after the persons name there maybe. IanfromCrook
  • Score: 0

Comments are closed on this article.

Send us your news, pictures and videos

Most read stories

Local Info

Enter your postcode, town or place name

About cookies

We want you to enjoy your visit to our website. That's why we use cookies to enhance your experience. By staying on our website you agree to our use of cookies. Find out more about the cookies we use.

I agree