Sunday, 16 June 2013

Liverpool Care Pathway - For The Downsized Patient

Niceties are all very NICE and pleasantries are all very pleasant, but if you're putting someone to sleep it is NICEr to say so.

It is the Liverpool Care Pathway for the Dying Patient.

It is intended to improve care of the 'dying patient' in the last hours or days of life.
Liverpool Care Pathway for the Dying Patient 
The Liverpool Care Pathway for the Dying Patient (LCP) is a model of care which enables healthcare professionals to focus on care in the last hours or days of life when a death is expected. It is tailored to the person's individual needs and includes consideration of their physical, social, spiritual and psychological needs. The Liverpool Care Pathway is recognised as a model of good practice in the last hours and days of life.
Got that?

The last hours or days of life.

This is from Talking Point, the Alzheimer's Society online forum:

Liverpool Pathway ?

Ok I am 'in principal' in agreement with the Liverpool Pathway. I belive treating someone agressively when they have dementia is prolonging that persons life when often their quality of life is not good
Anyway my father although in residential care now I feel has a reasonable quality of life. He is active and mobile ( even went indoor bowling !) , he eats well, even went to a regatta last week and apparently enjoyed himself. Yes he has prostate cancer too but to my knowledge now that he has a long term catheter in it is not uncomfortable.

Anyway I have been notified that he is to be treated on the Liverpool Pathway

I dont particularly want him to suffer but is this not a bit premature I am concerned that the doctors are going to not prescribe him antibiotics ( he gets loads of urine infections).

If he was to have a stroke or heart attack I would not want him shipped out to a hospital but if his catheter blocked I would want that treated.

Can I ask at what stage the Liveerpool pathway was mentioned to other families. Do we have a choice in whether this tool is used ?

Just have a horrible feeling my father is being written off before it is appropriate. Reading a little on the internet it seems that doctors get paid more for using this tool and it is seen as excellence in care.

I do intend to talk with the Manager in the CH but I want to get a feel of how this tool is being used so can anyone out there share their experiences please.

An exchange of posts follows. The contributor concludes the thread:

Thanks everone
Well after a fairly sleepless night ( worrying needlessly !) I have clarified things with the CH . Seems my relative that contacted me had got things wrong

What the care home are doing is an end of life care plan and no dad is not on the Liverpool pathway at the moment.

Pleased that they are doing this now so that we can all be reading from the same page regarding my fathers care in the future.

Just makes things a bit more real

The gentleman who is the subject of these posts may or may not be in the last hours or days of his life. How is that to be determined? If he is to be placed on the Liverpool Care Pathway for the Dying Patient it must be determined that he is.

However, it would appear that the gentleman is not, after all, on the LCP but on an 'end of life care plan'.

Most residential care homes use the Gold Standards Framework. Although, there are others.

According to Jane Barton and the Gold Standards Prognostic Indicator Guidance, one of the triggers that suggest patients are nearing the end of their life is the ‘surprise question’ which is, basically, an assessment of their general demean.

In other words, it is a matter of subjective judgement.

According to Jane Barton and the Gold Standards Prognostic Indicator Guidance, it is an intuitive assessment of clinical, co-morbidity, "body language" and "social and other factors that give a whole picture of deterioration".

It is an assessment of quality of life.

The Liverpool Care Pathway was developed by Royal Liverpool University Hospital and Liverpool's Marie Curie Hospice in the late 1990s for the care of terminally ill cancer patients.

At that time, the Liverpool Care Pathway was the Liverpool Care Pathway for the Dying Patient already diagnosed as dying.

Since then, the scope of the LCP has been extended to include all patients deemed dying. Patients are not being diagnosed with a potentially life-limiting  illness; they are actually being diagnosed as 'dying'. 

The Liverpool Care Pathway for the Dying Patient is no longer the Liverpool Care Pathway for the Dying Patient.

A spade is a spade

Why not call a spade a spade?

The LCP is a tool. It is a spade. It is a spade with which is dug the patient's grave.

It was, from its original conception, and is a cover for the practice of euthanasia long extant in British hospitals.

Consideration of 'futility' of treatment is a subjective observation.

It is an assessment of the 'quality of life' of the downsized patient.

In a climate of limited available resources, factored in with economic pressures that refuse to go away, however, there are more sinister forces at work.

Government sources continue to warn of the growing burden of elder care. Stark warnings and projections are made. For instance:
The number of older adults is increasing
• The absolute number of older adults and their proportion in the population is significantly increasing. From 1983–2008, the proportion of the total population aged 75 years and over in England increased by a third from 6% (2.9 million people) to 8% (4.0 million people). The population aged 75 and over is projected to increase to 7.2 million in 2033, and the number of people aged 90 and over is projected to increase from 0.4 million in 2008 to 1.2 million in 2033.(Office for National Statistics).
• Increases in the ‘oldest’ population have resulted from falling mortality rates in the second half of the 20th Century and increased birth rates at the beginning of the 20th Century (Dini & Goldring, 2008). In the UK, from 1968–2008 mortality rates declined by 51% in males and 43% in females (Office for National Statistics, 2009).
• In England, life expectancy (period expectation of life at birth) increased by over 6 years in males from 1980–82 to 2006–08, from 71.1 years to 77.7 years, and by over 4 years in females, from 77.0 years to 81.9 years (Office for National Statistics).
These factors sit very much at the heart of forward planning. The pensions black hole coupled with the cost of care of an elder population is causing nazti ideas to come crawling out of the woodwork.

Keeping people alive is a costly business

The euthanasia lobby has found growing support on both sides of the House and in both Houses. This isn't just about 'dignity in dying'; it is about digging the economy out of the pensions and benefits black hole into which it is plunging by filling it with the corpses of  the most frail and the most vulnerable members of the community.

Diagnosing dying and putting patients on a pathway sounds like death with dignity but it's going to save governments, and the taxpayers who fund them, a lot of dosh.

Of course it's not about killing people, but it's still cheaper to kill the seriously ill than to keep them alive in hospitals, nursing homes or hospices.

This isn't just about pensions and benefits. Hospitals under financial pressures and bound by targets don’t want bed-blockers clogging the wards eating up finite resources.

Of course there's no dark government plot to murder old people, but deficit-burdened Governments have other considerations. 

Death, particularly for the frail and the fragile elderly, the vulnerable and the disabled in mind or body, is a final and lasting solution.

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