Wednesday, 9 January 2013

Liverpool Care Pathway - Just Another 'Thing To Do'

Trying to patch up a shoddy tool is only trying to make the best of a bad job.

Of flawed concept, the vehicle continues to career upon its deadly path.

Envigoured by their arrogance and the certainty of their own infallibility, these Death Race drivers throw their vehicle into hyper-drive, scoring CQUIN payments for their efforts.

The vehicle hurtles on along its preordained Pathway. Is there no-one who will call a stop to this...?

Reference 1: "The Solid Facts: Palliative Care" edited by Elizabeth Davies and Irene J. Higginson
The report highlights a myriad of challenges of mainstreaming palliative care: the fact that most common chronic diseases (unlike cancer) have uncertain prognoses, which makes assessment of the need for palliative care difficult
"Without a doubt, end-of-life care is fraught with complexity and controversy. For example, there is continuing debate whether it devalues life by abandoning curative efforts too early, or is more respectful of life as it seeks to give the dying greater dignity and quality of life. While most respect individual choice and one's right to die with dignity, interpretations—whether individual, societal, cultural, religious or clinical—of what constitutes "quality of life" in one's dying years vary greatly. There is also a lingering perception that palliative care can result in substandard medical treatment, or is a way to end the burden of caregivers." 
Ethos Perspectives — May 2007 Soh Tze Min and Sheila Ng Social Policy)

In expanding palliative care, one must, however, be mindful of vulnerable groups, such as the minorities or the disabled, and ensure that they have access to palliative treatment, without compromising their curative options.
Ethos Perspectives — May 2007 Soh Tze Min and Sheila Ng Social Policy)

LCP Professionals make playground banter on Facebook; LCP Leaders smile glibly from facetiously-posed newspaper mugshots making superficial assurances that all this is not at all what we know it to be...

This is not care; this is careless.

This is the Telegraph -

Hospitals treating Liverpool Care Pathway as just another 'thing to do'
Hospitals are placing patients on the controversial “pathway” to death without proper training for staff or even understanding how it works, some of Britain’s leading specialists in care for the dying have acknowledged.

Hospitals treating Liverpool Care Pathway as just another 'thing to do'
Dr Bee Wee said some hospitals appeared to be treating the pathway as just another 'thing to be done'

 By , Social Affairs Editor
10:00PM GMT 08 Jan 2013

Inadequate monitoring of the use of the Liverpool Care Pathway and wide variations in standards have helped sow confusion and fear among patients and even doctors, they warned.

Some patients are now so afraid of being placed on the pathway, after a string of high profile cases in which it was allegedly used inappropriately, that they are reluctant even to go to hospital to get the treatment they desperately need, the doctors said.

Meanwhile reticence by medical staff to speak frankly about death has fuelled confusion and fear among relatives, they added.

The admissions came as it emerged that an official review of the operation of the pathway has stalled after a consultation survey for doctors was leaked on the internet, enabling members of the public to pose as doctors potentially skewing the results.

Meanwhile the Association for Palliative Medicine (APM), which represents 1,000 doctors specialising in care for dying people, published new guidance warning of a growing shortage of doctors with expertise in the field.

The pathway, developed in Liverpool, was designed to allow people in the final stages of terminal illnesses to have a more comfortable and less painful death by applying principles of care used in hospices to hospitals and elsewhere.

It involves removing treatments deemed to be more harmful than helpful including, where appropriate, reducing food and fluids.

But the Department of Health has ordered a review of its operation after a string of cases in which relatives claimed that their loved one was put on the LCP either without discussion or where they might not have been imminently dying.

Dr Bee Wee, president of the Association for Palliative Medicine, said some hospitals appeared to be treating the pathway as just another “thing to be done” rather than a something to be handled with extreme care.

She added that the cases which have come to light suggested that “packaging up” principles used in hospices for hospitals had caused difficulties.

“There’s a very big difference in the culture of hospitals,” she said.

“So the environment and the attention to training and support ongoing is an important point.

“We know that there are some hospitals were the Liverpool Care Pathway is introduced, there is very little training of the staff, there is nobody who is going around making sure that it is used correctly – it is simply a thing to be done.

“It is actually hard to imagine how it could possibly be well done in that situation – you are dealing with a difficult and intensive process of care.”

By contrast other hospitals have staff dedicated solely to going around wards to ensure that staff are properly trained and using the system correctly.

“There is this huge staff turnover and there can be an assumption that once it is used everybody can use it,” she added.

Dr Wee, who is a hospital consultant and Oxford University lecturer, said she was particularly troubled by cases in which relatives claim they only discovered in passing that their loved ones were on the pathway.

“We deal with this every day, in and out, we sit with patients we are with them as they face death but a lot of our colleagues don’t do that on a daily basis, it’s hard, it’s really tough for them,” she explained.

“And we have spent years just trying to get people to actually say ‘your mother is dying’, it’s a hard word to use – my sense is that we have slightly got people perhaps using this as another euphemism.

“That is some of the things we’ve got to help with and that really comes back to training and education.”

She added: “There is now such a bad name, if you like, such adverse publicity around the LCP and people are worried.

“I’ve even heard of a story where somebody did not want to be admitted because they were worried about that and that is tragic.”

Prof Irene Higginson, of Kings College London, added: “We have to bottom out what the concerns are that people have.

“What we don’t know really is whether it is the way that the LCP is being used and the environment that is in or whether it is something within the LCP which has confused people or made them use it in a way which doesn’t work so well.”

Dr David Brooks, a consultant in palliative medicine at Chesterfield Royal Hospital said it was clear that relatives of people given end-of-life care in hospitals were far more likely to be dissatisfied than those whose loved ones died in hospices.

“When you take a programme of care, a way of doing things from one setting to another, particularly from a small fairly well confined setting like a hospice and try and put it into a larger organisation where the focus is not simply on caring for patients at the end of their life, then you have different challenges,” he acknowledged.

Yesterday the APM published new guidance for commissioning specialist palliative care emphasising the need for doctors and nurses to work as part of a team with experts ranging from pharmacists and dietitians to social workers and chaplains.

But the document also warns that specialists in the field are now so overworked that they have no time for professional training.

It also warns workloads are likely only to increase because of ageing population and changes to the NHS.

Norman Lamb, the care minister, said: “It is clear that everyone wants their loved ones' final hours of life to be as pain free and dignified as possible, and the Liverpool Care Pathway is an important part of achieving this aim.

“However as we have seen, there have been too many cases where patients were put on the Pathway without a proper explanation or their families being involved. This is simply unacceptable.

"I have committed to appoint an independent chair to review how end of life care is working and oversee the reviews into the LCP.

“This review will also consider the value of locally set incentives, and whether they are leading to bad decisions or practice.

“It is vitally important that everyone can be confident in the findings of this work – and that we learn lessons where they are needed, so we can ensure that end of life care is as good as it can be."

This is not care; this is careless.

This is the Telegraph -

Liverpool Care Pathway: 'We want the very best in care for people,' says leading doctor

Irene Higginson, Professor of Palliative Care at King's College London says there are many myths about the Liverpool Care Pathway, but if something needs to be modified, it should be.

9:53PM GMT 08 Jan 2013
Professor Higginson said: "What people are trying to do with the Liverpool Care Pathway is to take the principles that have worked very well in hospice care and put them into hospitals.
"I think that's a very good and important and laudable goal."
But, she acknowledged that there had been a great deal of controversy surrounding the LCP: "What we want is the very best in care for people – and if that means that something needs to be modified or refined then that's what we should be doing."
She added: "I think we need to be looking not only at the LCP but also at other inequities that are going on in palliative care – for example, the fact that people with non-cancer conditions are often missing out on the best of palliative care, and that older people seem to miss out on the best in care.
"So, for example, work that we've done has shown that older people are half as likely as younger people to get adequate pain relief at the end of life. That's outside of the LCP but it's a huge inequity which we need to be addressing by better training, support, and also a lack of ageism in end of life care."

Professor Irene Higginson discusses the Liverpool Care Pathway in her video interview and "where it has worked well and where it has worked badly".

May we expect that, "where it has worked badly", charges of corporate manslaughter shall be brought?

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