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20 Oct, 2013 17:30

UK doctors given bonuses for placing patients on ‘death lists’ - report

UK doctors given bonuses for placing patients on ‘death lists’ - report

General practitioners in England have been receiving £50 bonuses for placing patients on controversial ‘death lists’ in order to reduce the number of occupied hospital beds. The move is yet another tactic aimed at cutting NHS costs, UK media reported.

Each death which occurs outside an NHS hospital has been calculated to save the health system some £1,000 ($1,600) in England. On average, deaths which occur inside NHS hospitals cost the service around £3,065 (just under $5000), while those elsewhere cost £2,107 (around $3,400).

Doctors have been given bonuses for drawing up ‘end-of-life advanced care plans’ for patients they predict will die within a year.

The payments in question apparently have the intention of keeping NHS costs as low as possible.

According to documents seen by the Daily Mail on Sunday, a “key objective” of the project - which underwent a trial period in England’s east - was “to shift the place of death” away from hospitals, thus “reducing ...healthcare costs.”

“I think it’s got everything to do with money, with the cost of a hospital bed being £200 a day,”
Dr Anthony Cole, acting chairman of the Medical Ethics Alliance, told the paper. He stated his belief that its advocates were mired in financial concerns, and suggested that it may result in insufficient medical care in a patient’s final days.

The ‘Yellow Folder’ pilot scheme was trialed in 41 medical practices in Ipswich and East Suffolk, and lasted from July 2011 until last month. The doctors received payment for every care home patient they successfully signed up to an end of life plan. Ipswich and East Suffolk Clinical Commissioning Group (CCG), which ran the scheme, would not tell the paper how much money it allocated for bonuses.

Reuters / Luke MacGregor

Patients on the program were required to state their preferred location of death, whether they would like to be resuscitated, and their preferred drugs for the final hours of their life.

An NHS ‘Call to Action’ pack, available on the trust’s website, cited a “growing population with more complex needs” as one of the main issues facing British healthcare. It stated that the “number of people with multiple long term conditions [is] set to grow from 1.9 to 2.9 million from 2008 to 2018.”

However, people behind the development of the scheme have cited the primary motivation to be to give patients a more comfortable death. According to surveys cited by the Mail, 66 percent of people would prefer to be at home at the end of their lives, whereas only 43 percent actually do, on account of the majority being admitted to hospital.

On Thursday, Britain’s Daily Telegraph reported that senior members of Britain’s upper chamber, the House of Lords, said that the NHS is being faced with bankruptcy, as it will become unable to cope with Britain’s aging population. One member reportedly called the system a “demographic time bomb.”

NHS cost-cutting has been making waves in the British press over the past few days. On Saturday, it emerged that some patients are being transported to hospitals in police cars because of a massive shortage of ambulances. On Sunday, the head of England's Accident and Emergency departments said that a lack of available consultants during weekends posed a risk to patients.

Critics argue that the scheme could cause patients to be denied important medical treatment. Three months ago, the paper published a report documenting how ambulance crews can choose whether to transport people to hospital if they have stated on their ‘care plan’ that they would like to die at home.

Reuters / Luke MacGregor

“Why should a GP be paid for this conversation, as opposed to any other?” said Dr Gillian Craig, a retired geriatrician. “I feel doctors are paid very well and there should be no extra payments. Anything else is open to abuse and misuse.”

She added that the program may even block the course of treatment by “closing the door on potentially life-saving hospital treatment...a doctor may not realize that, while the person appears to be dying, they actually have a reversible condition.”

In a new study recently published in Britain’s Lancet, it was found that a separate UK palliative care pathway – Liverpool Care Pathway for the Dying Patient – “provides the same quality of care as that usually provided to cancer patients who are dying in hospital.”  The scheme was adopted in the late 1990s and began to garner serious criticism in the UK press as it grew. The study went on to add that “any initiative to replace the pathway in England should be grounded in scientific evidence and tested in controlled trials before it is implemented.”

NHS trusts adopting the Liverpool Care Pathway are offered financial incentives for doing so. More than six out of ten of those trusts – just over half the total – have received or are due to receive financial rewards amounting to at least £12 million (just under $19 million), according to The Daily Telegraph.

The scheme involves the withdrawal of tests or treatments deemed unnecessary for the patient. In a 2012 letter to the newspaper, six doctors warned that hospitals may be using the scheme to reduce strain on hospital resources.
“Remarks on the Liverpool Care Pathway by Professor Patrick Pullicino…gave rise to controversy. But he is not wrong to say that there is no scientific way of diagnosing imminent death. It is essentially a prediction. Other considerations may come into reaching such a decision, not excluding the availability of hospital resources,” the letter read.