Tuesday, 18 June 2013

Liverpool Care Pathway - The Many Pathways To The Perdition That Awaits Us

There are many paths says the scripture and they all lead to the One.
So, there are many Pathways, and they have many names, but it is to perdition that they all lead...

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 hell of a lot of £££s.

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 or, even, at home.

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

Of course there's no dark plot to murder people, but deficit-burdened Governments and hard-stretched councils 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.

Brighton & Hove City Councillors are concerned...


49.5 Councillor Barnett stated that she believed the Liverpool Pathway did withdraw fluids and food. She had observed this happening in her own family. 
49.6 The Chief Operating Officer replied that within the pathway there was a full discussion with people about what the pathway meant for the person and the family. Councillor Barnett made the point that dementia was often diagnosed too late for the person to be involved in decisions about their future. 
49.7 Councillor Mears stated that she did not support the pathway in any way and wanted to see a revised report she was happy with. She considered the Liverpool Pathway involved the removal of fluids and food. She was not happy with the tone of the report and considered that the emphasis should be how people were cared for. Councillor Mears was concerned that the membership of the Brighton and Hove Stakeholder Group only had one lay member. She referred to page 38 of the agenda – Appendix 1 Summary of Pathway – Section 5 - which stated “Implement Liverpool Care Pathway as appropriate.” 
49.8 Councillor Jones broadly welcomed the proposals. He thought it was a good pathway but acknowledged that there were issues that arose towards the end of life. He welcomed early intervention with the emphasis on the person who needed care. He stressed the importance of early diagnosis and directing people to appropriate services and medication. Treatment worked best in the early stages. However, he considered that it would be useful to have more information about the Liverpool Care Pathway. 
49.9 The Chief Operating Officer stressed that the pathway was about early support for people and their families. Discussions would be held at an early stage. 
49.10 Councillor Norman agreed that it was important to work with people in the early stages of dementia. The only mention of the Liverpool Pathway was on page 38 of the agenda and if this caused a problem he suggested the reference to the pathway should be removed. Councillor Norman stressed that the Liverpool Care Pathway was only as good as the people who used it and should not be used without education and training. 
Councillor Norman thought that the pathway was a good step forward to help people in the last stages of their lives. It did not suggest withdrawing anything from a person. 
49.11 Councillor Meadows agreed that there were good proposals in the report, particularly in relation to early intervention and diagnosis. However, she had witnessed her father being given a sponge on a stick rather than fluids and had seen how distressing this could be. Councillor Meadows was concerned about how the pathway would be implemented. She was unhappy with the word implement and stated that if this word was left out she might be able to support the strategy. The emphasis should be on discussion with the person and their family. Councillor Meadows considered that the Older Peoples Council should be consulted about the proposals and noted that they were not mentioned in the report. 
49.12 Councillor Wilson questioned what happened when someone entered the pathway at a late stage and could not make a decision. 


Adult Care and Health Committee

3.5 Adult Social Care Health Committee March 18th 2013
This pathway was discussed on March 18th 2013 at the Adult Care & Health 
Committee and has now been revised, subsequent to its submission to the 
committee. In response to members concerns re consultation, we can now 
confirm that 2 members of the Older People’s Council and one member of 
Pensioners Action were part of the LiNK Steering group (now B&H Health 
Revisions have also been made to the pathway in section 5 of the summary and 
phase 5 of the full pathway the wording “Implement Liverpool Care Pathway 
(LCP)” has been removed in response to members concerns. After discussion it 
was agreed that this level of detail is inappropriate in such a broad pathway, and 
discussion around the LPC should be solely a clinical discussion in consultation 
with family/significant others. 

The Councillors have issue with the word 'implement' and with the wording of the document in respect to 'implement Liverpool Care pathway (LCP)'.

They’re arguing over the detail of a word.

But the Devil is always in the detail!

This is Cllr. Christina Summers on Twitter:
Christina Summers @SummersCM "Concerned debate at Adult Care & Health committee about the "Liverpool End of Life Pathway" and how unreassuring the report is to some cllrs"

Agenda and Decisions

This is BBC NEWS Politics -

Core funding being cut by 12.1%, say councils

The Local Government Association has said the settlement for 2011-12 is the toughest "in living memory" and will "inevitably" mean cuts in services. Local government leaders say English councils face a 12.1% cut in their core central government funding next year.
  • Meanwhile, Commissioners will be commending CQUIN payments for 'best practice' measures such as this -

With at least one fifth of NHS spending relating to end of life care and large amounts of data to support the claim that end of life patients often access GP and acute services when greater support at home would meet the needs they present to doctors with, the potential for a significant improvement in the quality of care alongside savings is self-evident.

Cash-strapped hospital managers have been going overboard to meet the 'best practice' targets Commissioners have set them. Likely, the same will now happen in the arena of local government. 

The Dementia CQUIN for 2013 is well-advanced –

The National Institute for Health Research -

Summary of funded Dementia Research Projects

DTC-RP-PG-0611-20005 Supporting Excellence in End of life care in Dementia 

via an integrated care pathway (SEED programme) Northumbria Healthcare 
NHS Foundation Trust. 
This research aims to support professionals, both commissioners and providers, to 
deliver good quality, community-based end of life care in dementia.  Key outputs 
i) A prototype integrated care pathway (ICP) for end of life care in dementia 
ii) Educational resources to support the use of i) and 
iii) Commissioning guidance for clinical commissioners. 
Our ageing population will mean more people with long term, and age-related, 
illnesses like dementia. This will lead to an increased need for end of life care for 
those with complex needs living in the community.  People with dementia already 
receive poorer end of life care compared to those with cancer, with more hospital 
admissions and worse pain control. Still in contracting stage.  

How will the cuts impact on the elderly? They will impact  psychologically, limiting opportunities for social interaction. Isolation will be a major concern and this will impact on physical well-being.

And the final psychological blow..?

The elderly are a group who are going to be targeted for the GP death lists simply because they are elderly. This is the same demoralised group already targeted by spending cuts.

The final blow is this: to be put on the death list, told your days are numbered, advised to start making provision to wind up your affairs - not because you have been diagnosed with a life limiting or life threatening illness such as cancer, but because you tick off all or most of the categories in the Commissioners' list of things the GP is instructed to watch out for.  This includes the advice that GPs ask the 'surprise question' and use their intuition! (See the Dying Matters guide to GPs here and here)

According to the Local Government Information Unit -

Councils, with their new convening powers through the Health and Wellbeing Boards, are ideally placed to bring together health, social care and housing. Our report therefore calls for councils to take ownership of the end of life care agenda in order to enable people to spend their final days in dignity.

So, where is this going..?

                        The Telegraph

-  LGiU (Local Government Information Unit)

LGiU (Local Government Information Unit)
Few of us like to talk about dying. Despite the fact that death is a universal prospect for all of us, we often shy away from discussing the topic – uncomfortable to share our fears, let alone our hopes or expectations.
We do know, however, that most of us would prefer to die at home. Research shows that 70 per cent of adults would like to be cared for and die in their own home [1]. But the great majority of us still die in hospital, and only two out of ten are able to remain in their homes in their final days.
Whilst in recent years there has been progress within the health sector, with the NHS publishing its End of Life Care Strategy in 2008, the engagement of local authorities has been more mixed. This is significant because many local authority services, such as social care and housing, are crucial components when delivering high quality end of life care.
With this in mind, we recently published a report with Home Group, A Good Death: the role of the local authority in end of life care (PDF document), which examines the role of local authorities in end of life care provision and considers how councils can best develop their part in this important service provision.
Everyone is now on board. 

The Pathways, which bear many names, have stepped from the grand halls of Whitehall into ward room and nursing home; out of Council Chamber into surgery and home...

On the horizon, in tomorrow's dawn, do I perdition see...?

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