Tuesday, 27 September 2011

Liverpool Care Pathway - A Forward-Planning Document For Dying As An Accepted And Acceptable Policy For Incorporation Into A Strategy And Stratagem Of Planned Financial Constraint In the Non-Hospice Setting

It should be apparent that the prominence being given to the Liverpool Care Pathway and its emplacement across the NHS is part of a deliberate campaign to soften up the British public to accept death as a valid life-choice; to prefer a ‘quality’ death to a life deemed or adjudged to lack or be lacking in quality.

In a cash-strapped NHS, where hospitals are being closed and elder abuse is on the rise, there is growing prejudice against the chronically ill and disabled who are seen as disproportionate consumers of limited resources. The LCP is a legalised death-choice instigated at the discretion of those that society has always understood were there to maintain and preserve life-choices. This is a sinister about-turn that places vulnerable lives at risk and actually raises great cause for concern.

It is already the Dutch experience that the controversy surrounding euthanasia may be side-stepped by the practice of CDS. Statistics now show this to be the case in the Netherlands. We should not be placing before health providers in Great Britain the temptation to consider aiding dying as a therapeutic option to be used in the patients' "best interests".

As is borne out by the outrageous opinions expressed by Baroness Warnock, there is growing prejudice against the chronically ill and disabled. Such outbursts are sure to become more commonplace as government financial restraints become more and more stringent. Such outbursts are sure to be given greater acceptance and receive greater approval as a valid stance to adopt, made respectable by those ensconced in respected positions in society.

With the introduction of LCP, killing has become a ‘legal’ therapy!

LCP provides a ‘controlled’ dying environment; it is ‘death by induction’ at the end of life, much as the controlled environment provided by induction at the beginning.

Clinicians, practitioners are being encouraged to proactively look for ‘signs’ of death. It will become not merely the policy of choice but, with implementation being proactively encouraged by the DOH funding policies, one of necessity, an obligatory requirement placed upon clinicians to adopt.

CQUIN is the DOH funding policy. CQUIN has set targets for 2011/2012 with regard to the End of Life LCP program. The forward plan is to increase the number of patients identified to be on the end of life care pathway from a baseline of 0% to 20%; it is further planned to have 30% of all patients who die in hospital dying on the Liverpool Care Pathway.

To ensure they receive their provider income in full, Trusts have to comply with or exceed these goals. Some, like Royal Brompton, have upped the plan expectations:

1) 95% of patients identified as end of life (last 48 hours of life for expected deaths) are offered an EOL care planning discussion

2) 80% of patients offered a discussion should have an advanced care plan

3) 98% of patients who have an advanced care plan should have a record of the decision to resuscitate stated clearly in the notes

4) 50% of patients who die in hospital (expected deaths) should die on a Liverpool care pathway

It is the DOH which is the driving force behind rolling out LCP across the NHS!

From 'cradle to grave' was the promise. Cradle to grave has become a bit of a stretch, especially now with the pressure of financial constraints being imposed. Putting pressure on clinicians to identify patients as 'dying' to place them on LCP simply to achieve these DOH targets is fraught with peril! Clinicians will be hounded, against their better judgement, by cash-strapped Trust's business and finance managers to meet targets in order to sustain funding.

The Pathway is established as a legal "therapy" and, through DOH CQUIN payments, has been made the subject of cost/benefit assessment by health managers and economists. And in a cost conscious health service £5 for a lethal injection will be a tempting therapeutic option to £500 per week for effective palliative care.

The ‘legalised’ killing provided by LCP puts vulnerable people - the elderly, chronically sick, disabled - at risk. These people are already a financial or emotional burden on relatives, carers or society and this is why they need strong legal protection. This sinister about-turn that has taken place makes the unthinkable thinkable and possible.

The "right" to die a dignified death has replaced the right to live a dignified life and can so easily become a coercive offer, a duty to die. Vulnerable people are being placed at risk.

Rogue doctors such as Dr Harold Shipman are going to have a field day!

A Death Pathway is not needed in this country. Instead, we need the excellent palliative care already available to be made much more widely accessible. What is needed is a protocol for life to provide life with dignity up to the last moment of life.

The lingering question is pursed upon all our lips: 
Can the NHS afford to keep you alive?

No comments:

Post a Comment