Monday, 21 October 2013

Liverpool Care Pathway - Pathways Vying For Position

The EoLC Stakes...
The GSF is the front runner.

Some punters will bet on anything. Some bookies will take a bet on anything. So, what are the odds on the GSF…? Quietly, this seasoned runner has been creeping up on the outside rails and is at least a length and a half in the lead of the opposition...

GSF is busy reconstructing the website in preparation to be the next 'Big Thing'. They have been rolling out into Care Homes and GP Practises and are branching out into Acute and Community Hospitals.
GSF Accreditation for Community Hospitals will commence soon, ready for presentation of GSF Quality Hallmark Awards in 2014. 
Gold Standards Framework
This is a front-runner for accreditation, the Dorset County Hospital NHS Foundation Trust

Wards at Dorset County Hospital are introducing gold standards of care for patients nearing the end of their lives.

"Gold standards of care."

That is already misleading. It infers 'best quality'. It doesn't; it refers to the GSF. LCP was/is also recognised as 'best practice'...

DCH NHS Foundation Trust
Staff wore gold accessories and decorated a trolley full of golden goodies to launch the scheme and spread the word about their work around the hospital.

This sly horse is a veteran of the course –

There is an established box-ticking ethos of achievement and award. Accreditation is the end-goal.

North Wales Extra

 e hospice reports on the GSF Conference -

"We had a time bomb on our hands as the elderly population increases..."

This is Dr. Alan Rosenbach who is Special Quality Lead at the discredited CQC -
"At the Care Quality Commission we place great value on the work of the GSF...

"GSF accreditation will shape the thinking of our new approach to inspection and regulation – a measure of the significance for this work. GSF accreditation can become a part of the inspection process.”

That really would be the jewel in the crown...

We are actually talking about a program to limit life through downsizing care expectations.

Lancaster Guardian
The GSF has gained a strong foothold in GP surgeries with the NCPC Dying Matters 1% Campaign. GSF protocols are used, most typically, the 'Surprise Question', otherwise known as the Barton Method.
The number of patients who are on Coastal Medical Group’s palliative care register when they die has increased fivefold following GSF training.

To QP or not to QP: that is the question...

Essex QP
Dr. Elizabeth Towers, Macmillan GP for Mid-Essex, uses the GSF Disease Trajectory pie chart tool in her infamous document. She recommends the GSF 'Surprise Question' and the GSF Prognostic Indicators.

Is the sly horse, the dark horse of the race, fast becoming an odds-on favourite...? 

This document is a resource for GPs from Cheshire and Merseyside Clinical Networks -

It incorporates further GSF tools and the Needs Based Coding chart. It also references: Find Your 1% Campaign, NEOLC Strategy, Macmillan Quick Guide, NCPC and The SPICT.

The GSF is coming into the home stretch...

But let's be serious. This is advice on how to set up those Death Lists.

Sorry, you may not like to hear them called that but that is exactly what they are. Just as the Ontario Consent and Capacity Board is a Death Panel.

This has nothing to do with being 'Right Wing' or 'Left Wing'. It has everything to do with what Dylan called Upwing and Downwing.

Sorry, you may not like to hear this, but Obama is, most definitely, Upwing.

These are Death Lists. By downsizing care expectations, you are downsizing care outcomes.

A Self-fulfilling Prophesy

Today, at a training Day, we were told an interesting story by our lecturer. It goes as follows -

A university lecturer used to tell his first-year students: "Half of you won't be here next term; you'll have dropped out." Next term, half of his student population had, indeed, dropped out. They weren't there. Their expectations of themselves had been successfully downsized.

Another lecturer was full of high expectation of his class. He encouraged them. Next term, one or two had dropped out but, in the main, they were all still there.

What does this tell us...?

What does it tell us!

This is BMJ Supportive and Palliative Care
Discussion Neither the GSF nor the SHF accurately predicted which patients were in the last year of life. The implementation of palliative care in heart failure patients may require a shift away from the traditional ‘end of life’ model used in cancer, and focus on the patient's increasing needs, understanding that death, itself, may remain unpredictable.
The GSF is not an accurate method of predicting or diagnosing dying, full stop!

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