Sunday, 13 October 2013

Liverpool Care Pathway - A Dedication, Steadfast And Sure

Dying is not a 'social matter'; it is a personal matter. I don't want the State interfering in my personal grief.

Mark Drakeford AM, Minister for Health and Social Services, and David Sissling, Chief Executive of NHS Wales, are quite deadicated dedicated people!

This document details EoLC delivery for Wales. It claims this End of Life Care Delivery Plan is a "compelling vision for success"!

This is Together for Health - Delivering End of Life Care -

This is not the world I grew up in. In the world I grew up in, health had something more akin with life, not death. Dying was a pretty unhealthy thing, all in all. 

These Unlikely Lads have declared themselves responsible to "promote and protect the health of people in Wales and plan and deliver high quality end of life care services".

What is health...?
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. - WHO
Well, now: "Together for health and delivering EoLC"...

This is an EoLC document. Try saying that all in the same breath; it's rather a chalk and cheese combination if ever there was.

The morgue is not the sort of place you'd put in the hospital reception. It's not exactly a good advertisement. These Unlikely Lads might think otherwise, it seems. We do a lovely EoLC with all the trimmings. We can hold it in the Death CafĂ© if you want. We can see the Python fans already grinning expectantly...

Promoting health is providing means and resources to maintain life. EoLC is the exact opposite of that. It is even downsizing all and any curative care expectations to accept the palliative.

This is surreal, bizarre, incongruous, almost too absurd to be considered even pythonesque and, really, quite inappropriate when the medical holocaust which has proceeded is given the due sombre and serious consideration it demands.

Right from page one, we are told that dying is a social matter. No, not really. Grief is a very personal thing. I don't think the State has any business sticking its nose in. Certainly, if dying were a social thing, then the Gosport deaths WOULD have been a matter of import to fund the inquests for!

But we're talking about Wales...

The same credo is recited...
Where death can be expected we must be prepared to have honest and open conversations about the end of life. It should not be a taboo subject...
What are these people on? I come from a generation whose parents commonly took out Life Insurance to pay for their funerals. It's never been 'taboo'.

These are real weirdos. No, really. On November 1st, they're holding their Day of the Dead. Read more here -
And Can You Say That This Is Not A Death Cult...?

"When death can be expected"... Oh, yeah? And what does that mean? When the doc tells you how it is, you tend to believe that's how it is. But...
It ain't necessarily so; it ain't necessarily so.
The things that they're liable to swear on the Bible,
It ain't necessarily so.
(Apologies to Gershwin)
Michele Halligan was told by the consultant, "You have to accept that your father is dying." Death wasn't a 'taboo' subject for Michele. That wasn't why she sought a second opinion. She loved her dad and wanted to do the best she could for him. What are these people on? Michele's forthright and determined actions prevented his options from being downsized and saved his life.

The document reports: The Marie Curie Palliative Care Research Centre in Wales is playing a vital role in developing a nationally recognised End of Life Research programme in Wales. Research...

Who's going to be the laboratory rat?

This Welsh EoLC Delivery Plan is no less ominous in its choice of language than any of its EoLC predecessors. Something a bit more poetic might have been expected, perhaps, from the Welsh Hills. Perhaps they have truly forsaken their Bardic heritage and thrown in their lot with the Death Cultists.

"Detecting and identifying patents early." This is an EoLC document.

”Appropriate interventions when conditions are likely to respond to treatment.” If the Doc says it's so, is it necessarily so?

In true Python manner, the document dares ridicule -
NHS Performance Measure
• Patient satisfaction surveys including data from iWantGreatCare
Part of the CQUIN framework is the PROM (Patient Response Outcome Measure). PROMs "are a means of capturing patient perspectives on the effectiveness of their care". The only problem with PROMS in regard to EoLC, of course, is that the patient outcome is that they are (more than likely) dead. Success!

Delivering "fast and effective" EoLC in hospice and in home. An EoLC Express.

"Advances in modern medicine and treatment have resulted in a growing population living longer with incurable diseases". This Mantra so oft repeated for this is the main focus for their concern...

Long, long time ago, just after the music died, the spark of an idea spawned by some focus group in some Wilsonian think-tank in Westminster's dark halls, perhaps...
One of the results of debates such as this—we have had a number on this subject—is that it has become generally understood, and is almost a truism, how rapidly the elderly population is increasing and will continue to increase. It is probable that by the 1980s there will be about 10 million people over retirement age, and between now and the 1980s—this is a very serious problem for those who have to plan the development of the social services—the proportion of the dependent population—those under school-leaving age, on the one hand, and those over retirement age, on the other—will be rising much more rapidly than the working population, which has to produce the wealth from which we pay for social security.Patrick Gordon Walker 1967
The Mantra is repeated across other Health Board documents...

A target priority is to increase the number of collaborative research projects with academic and industry partners, and explore resulting opportunities to protect and commercialise any potential intellectual property rights.

A priority for 2013 is to "actively support" the All Wales Integrated Care Priorities audit and research programme.

This is the All Wales Integrated Care Pathway (ICP) -

Recommended drugs in the ICP – Diamorphine; Cyclizine; Midazolam; Hyoscine Hydrobromide.

The document states: “All the drugs in the guidelines are compatible in mixtures in a syringe driver.”

Palliative Care in Wales is part of the Palliative Care Matters Network. This page reports the publication of the Review and notes the LCP is not in use in Wales. But a rose by any other name... And notes:
If there are any enquiries about the use of the All-Wales ICP from health boards or palliative care organisations, please contact Veronica Snow at or Tel. 02920 196113
They're all hoping to be the next Big Thing.

Palliative Care in Wales
This page also reports on the Palliative Medicine Silver Jubilee Gala Dinner - March 2014 at Cardiff University.

Twenty five years.

The eager and inspired Sister Hamblin would be preparing to ring the ward changes at Gosport...

They are now seeking those past and current students, Tutors, Markers or Examiners for the Cardiff University Palliative Care Education Courses.

No Pathway worth its salt is not already promoted to its umpteenth version and the ICP is now on Version 6. This could really be the next Big Thing.

These words could be uttered by any EoLC doctor:

The treatment was intended to relieve pain rather than to hasten their death.

Whether or not they would survive, they still needed proper palliative care to relieve their symptoms.

It was unlikely that having started on palliative care they would survive, but it did not hasten their death.

It would have been “inhumane” to take the patient off Diamorphine to see if their condition improved.

In fact, they were uttered by Dr. Jane Barton in the context of Mrs Gladys Richards.

To a challenge that this was euthanasia, Baroness Finlay, an invited key speaker at the Jubilee event, might have replied:

No, euthanasia is about intent. Palliative care intends to improve the care when people are inevitably dying. That's quite different.

And Dr. Barton could tell her patient was dying...

This is from The Big Questions -
Jackie Leotardi - 
Yes. One hospital was paid £308,000 for reaching targets for putting people on what is basically a euthanasia programme. Baroness, it is euthanasia.
Baroness Finlay -
It… No, euthanasia is about intent. The Liverpool Care Pathway doesn’t intend to kill people. It intends to improve the care when people are inevitably dying. That’s quite different.
The lines are become so blurred they are imperceptible to see.

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