Liverpool Care Pathway: A National Scandal: Liverpool Care Pathway

It's not what you say but how you say it; that's what brings results. Downsizing expectations is the key to downsizing care.

It is not scientifically possible to diagnose dying, but -

NHS West Kent Clinical Commissioning Group (CCG) has commissioned the training and education programmes to increase the skills of people working in care homes and give them confidence in successfully managing people who are dying. The CCG has also commissioned training for health and social care professionals and those working in the voluntary and domiciliary sector to support people to die in their place of choice.- This is Kent

This has enabled people to die on the LCP in their home setting rather than in hospital and save money -

The result of this, combined with talks from the Heart of Kent Hospice on end of life care, was that in the six homes initially targeted, the number of deaths of residents in hospital dropped from 57 per cent to six per cent.
This meant that many more people had a peaceful death in familiar surroundings, rather than spending their last days and hours in hospital. It also saved NHS money which was then reinvested in health services.
The project is now being extended to other homes to help staff to understand when it is and isn't appropriate to ring 999. Dr Tony Jones, who leads the project, said: "This can help to avoid hospital admissions at the end of life."- This is Kent

Invicta is a two year project commenced in April of last year. This is Invicta -

The Invicta Project aims to integrate health and social care for patients at the end of life through the use of the My Wishes East Kent End of Life register and partnership working to use available resources more efficiently. The My Wishes register will be available to all care providers which will help facilitate quick and easy access to updated information about patients’ care plans. Services will be coordinated through the use of a Care Navigation Centre run by Pilgrims Hospices which patients and care providers can access to organise care. The service will only be available to patients on the locality wide end of life register (My Wishes).
It is proposed that through integration more patients will be able to spend the end of their life in their preferred place of care and unplanned and inappropriate hospital admissions can be avoided.
Identification of patients appropriate for entry onto the My Wishes Register can be undertaken by using a variety of tools that are available these include:

The Supportive and Palliative Care Indicator Tool (SPICT^TM) Used in collaboration with NHS Scotland and with kind permission by Dr Kirsty Boyd and Prof Scott Murray. This tool is also used by Coordinate my Care in London.

GSF Prognostic Indicator Guidance

The Supportive and Palliative Care Indicator Tool (SPICT^TM) aims to identify patients with one or more advanced, progressive illnesses and a limited prognosis to enable more people to benefit from pro-active care and support in the last year of life. Identifying patients with one or more advanced, progressive illnesses is essential if more people are to benefit from pro-active care and support in the last year of life
The SPICT^TM is a clinical tool initially developed following a literature review of key clinical indicators suggesting advanced illness
The SPICT^TM can be used to identify patients with advanced, progressive, incurable conditions or who are at risk of dying of a sudden acute deterioration who may have unmet supportive or palliative care needs

The SPICT^TM is a diagnosing dying guide similar to the GSF Prognostic Indicator Guidance. It claims to give reliable guidance for identifying people at risk of dying within the next 12 months.

These are tools useful to GPs to find their 1%.

The Invicta programme is East Kent’s solution to downsizing care expectations. As at January of this year, 19 GP Practices were enrolled and up and running with the project.

The proposed outcomes of Project Invicta are:

To improve end of life care experience for individuals, carers, family and friends
An increase in the number of patients dying in their place of choice
A reduction in the number of acute emergency admissions, for patients at the end of life
A reduction in the number of end of life care patients dying within an acute hospital setting
A reduction in the number of fast track NHS continuing healthcare placements
An increase in the number of patients whose final days are managed on the LCP
An increase in the number of patients with an updated DNACPR
An increase in the number of patients held on an electronic end of life register

Diagnosing EoL means downsizing care expectations.

My Wishes is an EoL Register. My Wishes is Invicta's provision of an Advanced Care Directive or 'Living Will' -

1.2 What is My Wishes – East Kent’s End of Life Register
My Wishes – is an electronic end of life register which records details of patients
who are nearing the end of life. Patients will be asked to give consent for some
key information about their decisions, to be recorded on this system. These
decisions and any needs identified are then shared appropriately to help provide
the best care possible. The system will enable patient preferences and needs to
be communicated among staff and organisations that are responsible for their
care, either now, or in the future 24hours a day 7 days a week. Access to this
information will help staff make every effort to follow patient’s wishes about
their care at this stage of their life.

Once the 'Living Will' is on the system, it's there. You are persuaded and encouraged to make such wishes known with such 'fireside chat' language as, well, if you don't say, when the time comes you may not get the treatment you would have wanted.

Making such hypothetical decisions out of the woods is vastly different from having to make them when you're actually lost in the woods and, yes, please do send out those search parties!

DNACPR actually does mean don't even bother trying to save me.

A Care Navigation Centre run by Pilgrims and Wisdom Hospices will coordinate access to "My Wishes " to "improve communication" and care. This will include the ambulance service so that paramedics will know whether and how to actively respond. More at This is Kent.

This is Teachers Corner -

It ain’t what you say, it’s the way that you say it

Monday, March 4th, 2013

Most people are aware these days that the way we communicate is at least as important as the content of our communication. A different pitch, a different facial expression, a tone, a register, can all turn what you’re saying into the complete opposite. If you don’t believe me, imagine how you would feel if someone told you ‘I love you’ while slowly conjuring up a nice goose egg from your scalp by tapping you softly on the head with a rolling pin. Actions speak louder than words, it is said, and some words can speak louder than others.