Wednesday, 30 October 2013

Liverpool Care Pathway - Redefining The Options

Redefining, redefining, redefining... The key to downsizing?

They used to say, "Catch it early and it can be treated." No more...

This is Shots Health News from NPR

The National Cancer Institute convened a group of specialists last year to look at the problem of overdiagnosis and overtreatment of cancer. One idea: redefine what gets called cancer.
A new definition would be much narrower. The institute hopes to keep the word "cancer" out of some diagnoses to help calm patients' fears and minimize unnecessary treatments.
We won’t call it cancer; we’ll call it something else. It ain’t what you say; it’s the way that you say it...

We've heard that before.

The NPR article provides a link to an interesting submission to JAMA (Journal of the American Medical Association) which discusses problems of diagnosis in early detection. Herein, lies the real problem...

Readers of these pages will know of attempts to redefine death. Readers of these pages will know of attempts to redefine care. In that context, any attempt to redefine disease, such as cancer, must be viewed with caution and distrust.

This is particularly the case when Dr. Otis Brawley, the NPR interviewee, discusses a case in point of a gentleman diagnosed with prostate cancer...
And given his age, which was in his 70s, it's something that almost all doctors agree should be watched as opposed to treated. 
Therein lies the real problem. And there is more afoot...

There is currently a mega-huge, local-level, countrywide propaganda campaign by Macmillan -

Lancashire Telegraph
Express and Star

A CANCER charity has called on ministers to help more terminally-ill patients get their final wish to die at home, rather than in hospital...
 - The Telegraph and Argus

A national charity claims 250 cancer patients in Bradford died in hospital beds last year when they would have preferred to die at home...

Almost 2,000 people in the Westcountry were denied their last wish to die at home last year and instead ended their days in hospital...

Exeter Express and Echo

Southern Daily Echo

MORE than one thousand cancer patients in Hampshire are denied their last wish to die at home every year, according to new figures...

Macmillan Cancer Support has found that around 1,175 people across the county die in hospital each year despite their final wish to die in the comfort of their own home...
Bedfordshire News on Sunday

EACH year around 260 cancer patients in Bedfordshire who die in hospital beds wanted to die at home according to new figures released today by Macmillan Cancer Support...

In addition, Macmillan are doing a mass survey of Nursing Times subscribers.

Professionals are being asked to take a survey to provide feedback to Macmillan of their own experience in clinical practice.

Which means Nursing Times have facilitated Macmillan with access to personal email data they hold... 

Macmillan are promoting the Death Lists -
Hillingdon CCG

In 2008 28% of people in Hillingdon died in their usual place of residence. This did not align to the 50% of people who indicate that they would like to die in their own home. The first three year End of Life Care Strategy for Hillingdon – entitled ‘Making End of Life Care Everybody’s Business’ was agreed by Partner organisations and over the subsequent years progress was made so that by 2011/12 32% of people were dying in their usual place of residence.

In 2012/13 we aimed to increase this by another 5% to 37%. This has been achieved, in part through the introduction of an electronic patient record for patients who are identified as being in the end of life phase of their illness. The register, Co-ordinate My Care (CMC), is linked to the 111 programme in London. Hillingdon was one of the first implementers of both 111 and CMC.

The 2013/14 scheme has been planned to increase the percentage of people dying in their usual place of residence by a further 8% to 45%. Evidence from the National End of Life Department has shown the most progressed areas of the country are hitting 50%. End of Life Care (EoLC) is complex and buy in from all stakeholders is required. Improvements in delivery of EOLC require facilitation led through a change of culture. There is currently a lack of coordination between a number of organisations providing End of Life Care. We are utilising CMC and have been an early adopter of the system but need to enhance the involvement of primary care practitioners in its use. The following key issues are the main areas that need to be addressed:-

* Lack of Education/awareness of End Stage Prognostication in General Practice

* Advanced care planning is not widely adopted.

* EOLC register does not reflect true numbers of patients in the end of life phase
* CMC integration will enable co-ordination of end of life care by facilitating improved communication. Primary care is not fully utilising CMC

* Culture change

* Patient centred care and choice.

* Lack of integration.
As a result of the above, the Macmillan charity have suggested the possibility of pump priming a pilot to trail the introduction of a GP lead facilitator post. The only commitment required from the CCG will be a letter of support in principle for the post and a willingness to evaluate the effectiveness of the post. This Business Case has been developed as a partnership project between partner organisations (Macmillan, CNWL and THH) delivering End of Life Care services with the aim of establishing a GP Macmillan Post in Hillingdon. 

Redefining is the new signposting to downsizing care.

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