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.
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.
“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.