Liverpool Care Pathway – Why Is There A Pathway?
The opinion has been expressed in these pages that formal care pathway protocols were established to provide cover for what has been in place for years.
Compliance with
documentation
Integral to this process of continuous quality improvement is the assessment of the level of compliance with record keeping on the ICP (Campbell et al 1998).
"Good record keeping is essential in all aspects of healthcare, and it has been noted that absent or poor record keeping can hinder the defence of health care cases that are brought to court (Gray 2008)"
"ICP's can offer a mechanism by which to standardise documentation, and it has been cited that when it comes to legal implications of record keeping 'practitioners were better protected if they could show that their decision-making was based on care pathways or guidelines, since this would indicate that care had been provided in a controlled environment that supported reflective clinical practice' (Tingle 1997)."
Why do we need the LCP?
ReplyDeleteMoney, or lack of it, is usually the root of all evil in such matters.
Many NHS Health Trusts are said to have taken on very expensive PFI deals that they cannot afford. As a consquence, many Trust are in financial trouble and one in five Trusts are said to be in danger of going bankrupt. Desperate situations may seem to require desperate remedies. Trusts have been said to be grabbing at policy solutions on the hoof as a result.
Non emergency admissions make money for Trusts, emergency admissions lose money for Trusts. It's the Trusts, isn't it, that have adopted their own unique version of the Liverpool Care Pathway - in order to cut the number of loss making emergency ommisions?
"Financial pressures are mounting on the NHS and a growing number of hospital trusts are finding themselves pushed towards a cliff edge.
The NHS budget is flat when other public services are facing cuts but we still have to battle unrelenting inflation, driven by the needs of an older population and by the cost of new drugs and equipment.
To keep pace, we must find £20bn of efficiency savings in five years, something that has never been done before. While the NHS budget overall is in the black, some trusts are near breaking point. We've seen the first NHS trust to go in to administration at South London Healthcare trust. And it will not be the last.
We have just completed interviews with chief executives at 10 of the worst affected NHS trusts in England in order to pinpoint the common issues. They told us that the issues at the SLHT were typical of the problems these organisations are facing. What is needed is a fundamental overhaul of where and how their services are provided.
The trusts commonly face a relentless rise in emergency admissions for which they are often paid less than the cost of provision. This is exacerbated by the insufficient investment in health and social care services in the community, leaving hospitals as the last port of call, to pick up the pieces." (Guardian)
http://www.guardian.co.uk/healthcare-network/2012/oct/31/financial-problems-hospital-trusts
In addition, PFIs like the Association for Palliative Medicine of GB and Ireland and The National Council for Palliative Care are private limited companies t. Where do their grants come from? Government? The EU? Am I correct in thinking that both associations are in favour of the pathway 'solution'? seem to be pushing the pathway 'solution'?
How many of the directors of these PFIs receive much funding from research projects requiring funding directly or indirectly approved by the DOH or EU or from private organisations which have an interest in the extension of palliative care? Some do, one extensively so.