Friday, 29 November 2013

Liverpool Care Pathway - A Cost Efficiency

When you're counting the pennies the patients will have to look after themselves.

The HSJ says –
The 2015 deadline to create £20bn in savings looms large.
NHS England predicts it will fall short of efficiency savings for 2012/13 and the latest King's Fund report shows few trust finance directors are confident they will meet 2013/14 targets.
With many easy efficiency wins now found, the NHS must now turn to the private sector.
Sir David Nicholson set the £20 Billion savings productivity target for 2015. This was - and is - the Nicholson Challenge.

Nicholson's challenging targets went toward creating the catastrophic failures at Mid Staffs. This is the Nicholson Legacy.

Nicholson's been sent away with a lubbly jubbly, thankyou very much £2 Million pension pot; we're left with a corner-cutting target and more catastrophic failures to come.

It's all a corner-cutting exercise; this is what the programme to limit life is all about.

This is The Telegraph

The fine balance between the right to live and the right to die is now tipped toward the latter.
They must allow the terminally ill to refuse food and water if the patient does not want treatment that prolongs their life and must abide by “living wills” in which patients specify in advance that they do not want to be resuscitated. 
Doctors must also follow the wishes of patients as communicated through a friend or relative who has been designated their “legal proxy”, says the GMC. 
Doctors who flouted the guidelines would be forced to attend a fitness to practise hearing before the GMC and would be struck off if the case against them were proved.
This is what the 1% 'last wishes' documents are all about.

Doctors MUST respect wishes of patients and those close to them...
Close relatives and partners, as well as paid and unpaid carers, will be involved in discussing issues.
Serious or persistent failure to follow this guidance will put your registration at risk. You must, therefore, be prepared to explain and justify your actions.
- GMC Guidance
...when that means refusing treatment.

May we expect clinicians to be brought to task and suffer similar ignominy when they have proceeded in the execution of EoLC against and in the absence of these wishes?

This is the Northumberland Gazette

In September of last year, the family, including daughter Louise Simpson, told the Gazette that they believed a series of errors throughout his ordeal meant that he endured a distressing and horrific time.
But shortly after our story, the family faced more trauma, after learning that Mr Fell had been placed on the Liverpool Care Pathway (LCP) at Newcastle Freeman Hospital.
And they only made the discovery after requesting his medical records.
Louise says the family is disgusted and horrified that nobody at the Freeman consulted them, nor asked for their consent. She says she has lost trust in the NHS and wonders how many families this has happened to.
Mrs. Audrey Peace was taken into the University Hospital, North Durham (UHND) after Christmas 2011 following a fall which caused her to fracture her arm. 

This is The Northern Echo 

THE family of an elderly woman who died after her bed sores became infected have expressed concerns over the medical care she received.
An inquest heard how Audrey Hannah Peace, of Perkinsville, near Chester-le-Street in County Durham, contracted septicaemia from multiple pressure sores she developed while recuperating from a fall.
She died at the University Hospital of North Durham (UHND)on March 25 last year after being placed on the controversial Liverpool End-of-Life Care Pathway, which was abolished this summer.
Will the Multidisciplinary Teams (MDTs) involved be sought out to appear before the GMC to explain their actions - and struck off?


They didn't strike off Dr. Jane Barton (author of the Barton Method, forerunner of the GSF 'Surprise Question'). She knew too much.

Sir David Nicholson set the £20 Billion savings productivity target for 2015. This was - and is - the Nicholson Challenge. Why £20 Billion?
With the number of deaths set to increase by 17% to 590,000 by 2030, we are facing a ticking time bomb when it comes to end of life care. A rapidly ageing population and increases in the number of people with complex long-term conditions will lead to greater demands on providers of end of life care and rocketing costs for the NHS predicted to rise from £20billion to £25billion by 2030. This issue is the subject of a series of fringe events Patient Choice V Care being held by Marie Curie is partnership with Sue Ryder and Help the Hospices, during the political party conference season.- Huffington Post
Doctors MUST respect wishes of patients and those close to them...
Failure to communicate some or all relevant  information can lead to inappropriate treatment being given (for example, DNACPR decisions not being known about) and failure to meet the patient’s needs (for example, their wish to remain at home not being taken into account).   - GMC Guidance
This is what the 1% 'last wishes' documents are all about: downsizing care expectations and shipping them off home for palliative care.

From The Mandate
"These priorities reflect the Government’s absolute commitment to high quality healthcare for all, while highlighting the important additional role the NHS can play in supporting economic recovery."

"The NHS Commissioning Board’s objective is to ensure that the new commissioning system promotes and supports participation by NHS organisations and NHS patients in research funded by both commercial and non-commercial organisations, most importantly to improve patient outcomes, but also to contribute to economic growth. This includes ensuring payment of treatment costs for NHS patients taking part in research funded by Government and Research Charity partner organisations."
The important additional role the NHS can play in supporting economic recovery...

Contribute to economic growth...

NHS patients taking part in research...

The focus of any health provider is to restore the patient to a condition of health. A healthy population is constructive to maintaining and encouraging a healthy economy but that is an entirely incidental consequence.

Alarm bells are already ringing. This could lead to significant conflicts of interest. Are permissions to be sought...?
NHS England Business Plan
We will act as a facilitator of research – for example, we are planning to investigate a system of ‘presumed consent’ to take part in research studies for all patients treated in teaching hospitals.
NHS England Business Plan

Presumed consent...?

Evidently not.

Commercial exploitation of patients...?

Privacy violations through access to patient data, medical records and genetic information?

There have been no study results posted as yet to this inquiry into The Effectiveness of the Liverpool Care Pathway (LCP) posted to Clinical Trials, a service of the US National Institutes of Health -

The Independent reported -
The Belgian study is recruiting 600 dying patients, half of whom will get usual palliative care, while the others will be cared for using the LCP.
As at June of this year, the sponsors, End-of-Life Research Group, were still recruiting volunteers.

Volunteers? A policy of presumed consent? Is it possible such trials may be run in these teaching hospitals? Don't say, "No; it's impossible". They've been killing people, cutting lives short, for years and no-one has batted an eyelid.

Presumed consent...

This is Barts Health NHS Trust
Our hospitals 
With a turnover of £1.25 billion and a workforce of 15,000, Barts Health is the largest NHS trust in the country, and one of Britain’s leading healthcare providers.
We have six hospitals which deliver high quality compassionate care to the 2.5 million people of east London and beyond.
Presumed consent...

Barts Health has been given a leading role in clinical research.

Barts, Royal London, leading London teaching hospitals.
We are based in leading teaching hospitals, and continually push the boundaries of medical research to ensure that we are able to provide the most advanced and successful technologies and treatments.Barts Health NHS Trust
Presumed consent...
Barts Health NHS Trust
Barts Health has been chosen as the lead organization for clinical research across north central and north east London, Essex and Hertfordshire, underlining the Trust’s wealth of experience in recruiting patients onto pioneering clinical research trials.

Barts Health is one of 15 NHS Trusts and Foundation Trusts across England that will host local branches of the National Institute for Health Research (NIHR) Clinical Research Network from April 2014.

The NIHR Clinical Research Network is the clinical research delivery arm of the NHS. It provides funding to hospitals and surgeries to pay for research nurses, scans, x-rays and other costs associated with carrying out clinical research in the NHS.

Commenting on the appointment, Professor Jo Martin Barts Health NHS Trust Director of Academic Health Sciences said: “We are delighted to be asked to play such a pivotal role in bringing the opportunity to participate in trials to patients.”

Professor Nick Lemoine, Director of Barts Cancer Institute, who has led the programme to speed up approval of trials across the network said: “With more time available to recruit, more patients will be recruited. Thus these ‘extra’ patients will be able to access the therapies being tested in the trials, which are potentially life-saving or life-changing.”

The Chair of the selection panel, Dr Jonathan Sheffield, Chief Executive of the NIHR Clinical Research Network, said: “The host organisations will help to set the level of ambition for clinical research delivery locally, and assist us in making sure that clinical research occupies the place it deserves in the day-to-day work of the NHS”.Clinical research provides evidence about “what works” and on how the NHS can best use its resources to provide better treatments for NHS patients across all areas of medicine.

The Clinical Research Network, supported by UCLPartners*, will develop the capability of all the hospitals in the region to increase the opportunities for patients to take part in clinical research, ensure that studies are carried out effectively and to collaborate in vital research into potential new life-saving treatments and diagnostics.

With half of the country’s clinical trials taking place in north east and north central London, partners in the network are well placed to take advantage of the announcement to improve the health outcomes for their patients.

As the chosen Trust for North Thames, Barts Health NHS Trust will be awarded a five year contract from the Department of Health through the NIHR, and will take responsibility for distributing £29m worth of funding per year, to support clinical research across the parts of London, Essex, Hertfordshire and Bedfordshire.

Last year, more than 630,000 patients took part in clinical research studies supported by the NIHR Clinical Research Network.
Barts Health NHS Trust

The National Institute for Health Research (NIHR) is a member organisation of Bee Wee's Leadership Alliance for the Care of Dying People.

Say no more.

Wednesday, 27 November 2013

Liverpool Care Pathway - "A Toxic Brand"

When the problem is the branding, it's time to change the labelling. You don't throw the baby out with the bath water.

This is Dr. John Hughes on BBC Radio Norfolk
I think the problem with the Pathway, the Liverpool Care Pathway, is that it’s become rather a toxic brand.
This is NHS England

The Leadership Alliance for the Care of Dying People -
We have identified 10 outcomes which we think should be the hallmark of good care in the last days of life. Each of these outcomes has a set of guiding principles for professionals, and we have explained what this should mean for people who are approaching their last days of life, and their families. 
Instead of replacing the LCP with another tool, we want these outcomes to act as the ‘ground rules’ for care in the last days of life. 
If we can agree these ‘ground rules’, then we can also match guidance, education and training to make sure that this care can really happen on the ground, whether this takes place in hospital, care homes, at home or elsewhere. 
These outcomes and guiding principles have to be clear, strong and workable. So, we want to hear your views – help us to improve on them wherever you think this is possible. 
Our proposals are set out in a written document. You can contribute to the feedback by signing up for one of the 12 regional workshops that we are running across the country or submitting your response on our website
Bee Wee - Leadership Alliance for the Care of Dying People
These 10 outcomes are labelled A. to J. and may be found in the Engagement Document. It is these outcomes that Bee Wee wants feedback on. It is these 10 outcomes that are up for discussion; nothing else.

The Engagement Document is all about tidying up the loose ends. They're not interested in disagreement or dissent.

NHS England says –
In July 2013 the independent review of the Liverpool Care Pathway (LCP) published its report ‘More Care Less Pathway’. In response to its recommendations, the Leadership Alliance for the Care of Dying People was set up to lead and provide a focus for improving the care for these people and their families in response to the recommendations made in the report.

The alliance is chaired by Dr Bee Wee, National Clinical Director for End of Life Care at NHS England. Member organisations include:

A list of organisations is provided. All are complicit in their uncritical, unwavering support of the LCP. All are complicit in their blatant denial that anything was wrong or could be wrong - either with the LCP itself or in its application. Even when the press - local and national - took up the gauntlet to protest and to report what was happening, it was dismissed as 'anecdotal' and as press sensationalism. The Daily Mail was even referred to dismissively by some as "The Daily Fail".

Amongst the member organisations listed is the CQC. This is a regulatory body set up to police the health service in both the state and the private arena.

A regulatory body must always stand apart. If it makes itself a part of the processes it is set up to regulate, it becomes – deliberately or unintentionally – complicit in its actions and compromises its critical stance. Its independence is nullified. A regulatory body stands on its own; it is always in opposition. It is a watchdog to enforce standards and compliance to those standards.

The reputation of the CQC is already tarnished, its impartiality questioned by its actions and its treatment of Kay Sheldon. Have things changed at the revamped CQC? Perhaps not...

They have an agenda to stick to and they're sticking to it.

In view of the disgraceful manner in which the NHS has conducted itself - and been conducted - it is paramount and imperative that a Leadership Alliance for the Care of Living People be set up. Essential and immediate protection is required for all living people at whatever stage of their life's journey who seek medical attention and advice.

The end of the road is the end of the road but, if you ain't dead, then you ain't dead yet.

"These people". We are all living until we die. On life’s journey, from conception or birth, we are set out on life’s path to its terminus – death. From the moment of conception or birth, effectively, we are ‘dying’. Therefore, life is precious – every last second of it – and living matters. Every extra day is a bonus!

These people in this Bee Wee consortium are a vile Death Cult. We are all individuals and, if Holism is now a watchword of the NHS, we should be treated as such, in the context of ourselves and not as a group of 1% to be singled out for the Lambherd to set his trained pack of GPs on to groom us up and pen us off for the cull. 
The End Of The Road

Ev'ry road thro' life is a long, long road
Fill' d with joys and sorrows too
As you journey on how your heart will yearn
For the things most dear to you
With wealth and love ‘tis so
But onward we must go
Keep right on to the end of the road
Keep right on to the end
Tho' the way be long, let your heart be strong
Keep right on to the end
Tho’ you're tired and weary still journey on,
Till you come to your happy abode
Where all you love, you've been dreaming of
Will be there, at the end of the road

With a big stout heart to a long steep hill
We may get there with a smile
With a good kind thought and a mile end view
We may cut short many a mile
So let courage ev’ry day
Be your guiding star alway

- Harry Lauder

Tuesday, 26 November 2013

Liverpool Care Pathway - A "Cruel And Unusual Punishment"?

The death penalty - the ultimate sanction - is still widespread in the States. But controversy reigns. Is this drug safe for use in the US penal system?

This is Reuters
Seven death row inmates have a case pending in U.S. district court in Jacksonville, claiming that the Constitution's ban on "cruel and unusual punishments" should bar use of midazolam as the first part of the three-drug death protocol adopted by Florida's Department of Corrections.
In the two previous executions involving midazolam last month, the Department of Corrections said it was a humane replacement for pentobarbital, the sedative used previously, but refused to identify research or scientific studies, saying that would compromise security.
America's National Public Radio is also reporting on this important debate. This is NPR 

A Witness To Lethal Injection In 1989, William Happ was sentenced to death for the murder and rape of 21-year-old Angie Crowley. For decades, Happ appealed and lost. 
His death sentence remained, but the method of execution had changed since his conviction. Since 1924, Florida had used the electric chair to execute prisoners, but in 2000, facing pressure from the Supreme Court, the state switched to lethal injection. 
More than a quarter century after Crowley's murder, Happ's execution date was finally set for Oct. 15, 2013. But the state had a problem: Supplies of pentobarbital, a drug commonly used for executions, were running low. As the execution date approached, the state ran out of the drug altogether. 
So the Florida Department of Corrections decided to use a new drug — a sedative called midazolam that had never been tested for execution. Nobody knew exactly how it would work.

This is all something somewhat Pythonesque. This is dark humour, surely...

They are concerned for the welfare of a convicted killer, that this drug, Midazolam, is not safe to use. Its use is being challenged in Texas, also, and elsewhere.

This drug, Midazolam, has been in common use across the UK in hospital and in hospice, in home and in care home. It is a protocol drug in use in the EoLC Programme to limit life, in use in the Liverpool Care Pathway (LKP) and its partner protocols mentioned in these pages.

It is not safe for use on Death Row...

A medical holocaust has proceeded and there is none to raise the hue and cry.

Liverpool Care Pathway - It Is MURDER!

Mrs Jean Tulloch was starved until dead.

A report by an expert consultant has found that lack of nutrition brought about Mrs Jean Tulloch’s death.

According to NHS Lothian, the 'care' that Jean received was compassionate, professional and in her 'best interests'.

The Sunday Post 

A son has launched a legal action against the NHS amid claims his mum starved to death in a Scottish hospital. 
Peter Tulloch, 56, has also demanded police open a fresh criminal inquiry into the death mum Jean, 83, after a damning new medical report criticised her care as “negligent” and “unlawful”. 
The dossier by a respected hospital consultant says the gran of 11 was given less than a days’ calorie intake over her entire three and a half week stay at Edinburgh’s Western General, where she was being treated for a urinary tract infection. 
It was commissioned by a lawyer acting on behalf of Peter after he raised concerns about the use of the Liverpool Care Pathway on his mum. 
This independent report — which comes as both Scottish and the UK Governments look to introduce jail time for medics found guilty of wilful neglect — concludes that: 
While Jean’s death certificate officially lists “end-stage dementia” as killing her, the “starvation diet” she was put on “materially contributed to her death.”The retired nurse was put on the controversial Liverpool Care Pathway without proper consent. 
And medical staff ignored her son’s rights to make decisions on her behalf as her legally appointed welfare guardian. 
Last night Peter blasted: “I have called for a murder enquiry to be opened into this now. As far as I’m concerned this is proof that my mum was neglected in hospital. 
“I was concerned that my mother was not being fed at the time and raised the issue in formal complaints which were not treated properly. 
“No attempt to feed her was ever made. She was let down by the NHS and I want answers. Doctors and nurses should face stiff penalties for neglect. 
“A few prominent convictions would concentrate people’s minds and prevent a lot of the abuse that has been exposed recently.”
-  Daily Record

The Edinburgh News continues 
Jean Tulloch’s “starvation diet” was found by a top medical consultant to have “materially contributed to her death” at the Western General. 
Hospital bosses officially put her death down to end-stage dementia but a damning report, commissioned by a lawyer acting on behalf of the 83-year-old’s family, has prompted son Peter to demand a murder inquiry. 
He claims the decision to put Jean on the Liverpool Care Pathway – a process that accelerates dying by withdrawing food and liquids – killed a woman who was “far from dying”. 
The 56-year-old said: “I have called for a murder inquiry to be opened into this now.”

Further reading -
Liverpool Care Pathway – 'Helpless And Abandoned'

Liverpool Care Pathway – A Pathway Of Convenience

Liverpool Care Pathway – An Unforgivable Offence

Liverpool Care Pathway - A Crime Of Convenience

Liverpool Care Pathway - "Sneaky And Underhand"

Monday, 25 November 2013

Liverpool Care Pathway - The Ellershaw Revival Hour

If you can't flog a dead horse, how about a dead patient..?

This is PubMed

This submission by Ellershaw et al to PubMed bears the grandiose title: 'Assessing the Quality of Care for Dying Patients From the Bereaved Relatives' Perspective: Further Validation of "Evaluating Care and Health Outcomes-for the Dying"'
This is another tool from the Ellershaw stable...

ECHO-D. That's: 'Evaluating Care and Health Outcomes - for the Dying'!

Only a third of those deemed suitable for canvas responded. The results were not dissimilar to those found by the Massimo Costantini Italian model.

Both models attempt to put a positive spin to their findings.

In response to Costantini, we said:

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 and the LCP, of course, is that the patient outcome is that they are (more than likely) dead.

In the case of this trial, what is being recorded and assessed is the subjective impression of the observer, not the objective experience of the subject. That is not a particularly scientific test. It must suffice, however, in the absence of a recorded impression of the subject - unless they can bring on board a soul midwife to initiate a conversation with the dearly departed.

That is, of course, what a successful LCP send-off is all about: the observer's impression; not the subject's experience.
Say no more, Squire...

Liverpool Care Pathway - Life Is Always The Best Interest

However late it is, it's never too late. Just one more glimpse of the sun dawning on a new

Now, there's a life-affirmative thought. Make this your theme for your next Life CafĂ©.

James Wilson was a life-long sufferer of cystic fibrosis, a life-limiting illness. James’ condition was such that the multidisciplinary team (MDT) put James on the LCP. His brothers travelled half way across the world to say their goodbyes. That was two years ago.

He might easily have been one more of the many who have had their lives cut short before their time, just one more statistic in the medical holocaust that has proceeded.

This is The Argus
An action-loving surfer, snowboarder and footballer has died aged 26 from the debilitating condition he refused to let hold him back.
Tributes have been paid to James Wilson who died earlier this month from cystic fibrosis.
Two years ago he defied doctors who put him on the Liverpool Care Pathway for dying patients with his brothers travelling from the US and New Zealand expecting to say a final goodbye.
A positive attitude and a refusal to accept futility pushed James to achieve more than do many blessed with good heath and vigour. Despite an eight month stay in hospital, James went on to take up gardening and drive to the south of France in a mini cooper.
James, from Chesham Street in Brighton, also won a place to study history at Kings College in London and had managed to complete two years of study before his death. 
His funeral will be held on Friday at Our Lady of Lourdes Church in Rottingdean. A fundraising page for the cystic Fibrosis Trust has been set up |in his memory. To donate visit
James was an example to us all. In his tragically short life he refused to give in and give up and succeeded in doing his 'bucket list' many times over.

Every extra day is a bonus. Every second counts, because life is precious and living matters...

Sunday, 24 November 2013

Liverpool Care Pathway - Lamb's Move And Mate...

If you got the moves, it all adse up to game, check and mate...

NHS England is looking for “efficiencies”. GP FHS services face cuts. The GPC has condemned this. This is GP Online 

 NHS England has said it is working to address technical problems that emerged when responsibility for payments transferred from PCTs to its area teams, but is also looking at reform of family health services (FHS) administration services. 
A spokeswoman for NHS England commenting on its efficiencies plan said: ‘As is the case with all parts of the NHS, we have to live within our resources and so far these services have not been subject to the same review as other support services. We will be looking to identify where there is any room for efficiencies in this area, but ensuring a high-quality service will be our priority.
In all parts of the NHS, NHS England is looking for “efficiencies”. 

EADT24 picks up on the fifty quid inducement payments to GPs for signing up care home candidates to their EoLC lists -

In this context, the holier-than-thou, self-congratulatory concern expressed that patients are being denied their right to die at home will be seen in a wholly different light. This will actually, save a tidy penny. This is all financially driven. It is well known that there is a reluctance to allow the elderly, the frail and the fragile of mind or body, the vulnerable, the opportunity of access to procedures and treatments.

Preparation of such lists, psychologically preparing (grooming) those added to it at an early stage for palliative care and winding them down to accept their demise would obviate all and any such demands from the patient/family/carer that access to these procedures and treatments be offerred. Those so resigned will resolve to die at home.

Commissioning Toolkit
The 'Toolkit' which initiated these Death Lists was launched by Care Minister, Norman Lamb, at the National EoLC Conference last year. It is doing it's work as skilfully as the doctor's bag.

The 'Toolkit' - a Toolkit on Commissioning Person-centred End of Life Care - identifies the commissioning process across all sectors.

They have all had their fingers in the jar...

The toolkit was developed by the NEoLCP, working with Help the Hospices, Marie Curie Cancer Care, Macmillan Cancer Support, the National Council for Palliative Care, ADASS, SCIE, NICE, NHS South of England and the Royal College of General Practitioners.

- The Toolkit on Commissioning
Person-centred End of Life Care
The 'Toolkit' is slick and clever, providing Four Stages in commissioning, designing, planning and delivering pathways.

The reader is introduced to the Six Steps mentioned elsewhere in these pages. This will be remembered for that now infamous and shameful offering by Carmel Wiseman which is reproduced here -

They are watching a slide show. Then comes the final slide.

This is supposed to extort a chuckle from the gathered throng of healthcare professionals who haven't already dozed off!

They have been discussing a document to put someone, a year hence, onto The Pathway, a Communitarian version of the Final Solution.

Is this intended as an analogous representation, perhaps, the mousetrap signifying death, the cheese the Pathway, and the mouse the unfortunate victim?

Old man, there's no need to feel down
I said, old man, they'll put you in the ground
I said, old man, 'cause you're in a new town
They still got you on their IT...

They want you, they want you
They want you as a new recruit
- With apologies to Village People for the licence.
The 'Toolkit' then provides a link to Dying Matters -

This provides important information to the GP on selecting their 1% for the Death Lists and encouraging them to sign up for the 1% Newsletter.

They have all had their fingers in the jar.

Analyse and Plan...

Identify your 1% and initiate those conversations.
- The Toolkit on EoLC 

A year later and all these recommendations are well advanced and entrenched.

The Conference launched the DoH's End of Life Care Strategy Fourth Annual Report which was also introduced by Mr. Lamb.

EoLC Conference 2012
Mr. Lamb addressed that Conference in his shirtsleeves, following the example of his bosses - the masterful duo, Cameron and Clegg - when they have been out and about together. He praised the NEoLC Programme in achieving 30,000 home and care home deaths via successful EoLC programmes such as the LCP.

Mr. Lamb also praised the electronic databases (EPaCCSs - Electronic Palliative Care Co-ordination Systems) being set up across the country, many of which have been mentioned in these pages. These are to ensure that the restorative or curative option is not attempted by any first responder by providing them access to it and across different IT systems.

The EoLC Conference pages also report –
A new advance care planning (ACP) toolkit will be launched by Professor Sir Mike Richards, designed to help care providers implement advance care planning with the ethos 'It all ADSE up' - Ask, Document, Share and Evaluate.
ADSE - EoLC Conference
This is the grooming toolkit...
Talking to people nearing the end of life and their families about their wishes can be a daunting prospect for any health or social care professional.

However, finding the right time, place and words can make a significant difference to how the person and their family prepare for death and its aftermath.

To help care providers approach the planning process with confidence and knowledge, a team at the National End of Life Care Programme (NEoLCP) has developed an 'Advance Care Planning: It all ADSE up' toolkit.
This 'Toolkit' provides 'top tips' and guidance and enables care providers to
  • empower the new recruit to downsize their care expectations (Ask)
  • record the discussions (Document)
  • make the record available to other intervention services/teams (Share)
  • Examine impact and outcomes - success. Did the mouse swallow the cheese? (Evaluate)
The benefits of getting everyone on board...

It all adds up.

It is a generally held belief, and studies have concurred, that positive thinking can help you feel better and improve outcomes.
Research published in Psychology and Aging, a journal from the American Psychological Association (APA), shows that while genetics and overall physical health play a part in how people age, positive thinking can also play an important role.
According to an APA news release, researchers found a link between positive emotions and the onset of frailty in 1,558 initially non-frail older Mexican Americans living in five southwestern states. This was the first study to examine frailty and the protective role of positive thinking in the largest minority population in the United States.
To have your GP rattle on to you about a Living Will and realising you have been identified to do your civic duty and die is going to be a real downer! As with the LCP, the ACP all ADSE up to a self-fulfilling prophecy. 

A year has passed. As reported in these pages in June -
Liverpool Care Pathway - A Cover For Euthanasia...?
and here -
Liverpool Care Pathway - There's Life In The Old Dog Yet
The Queen is being sacrificed. 

The  Mail Online also reports 
Bereaved family members of cancer patients were interviewed within four months of their relative's death, and the quality of end-of-life care assessed using a scale of 0 to 100
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 and the LCP, of course, is that the patient outcome is that they are (more than likely) dead.

In the case of this trial, what is being recorded and assessed is the subjective impression of the observer, not the objective experience of the subject. That is not a particularly scientific test. It must suffice, however, in the absence of a recorded impression of the subject - unless they can bring on board a soul midwife to initiate a conversation with the dearly departed.

That is, of course, what a successful LCP send-off is all about: the observer's impression; not the subject's experience.

There have been no study results posted as yet to this inquiry into The Effectiveness of the Liverpool Care Pathway (LCP) posted to Clinical Trials, a service of the US National Institutes of Health -

The Independent reported -
The Belgian study is recruiting 600 dying patients, half of whom will get usual palliative care, while the others will be cared for using the LCP.
As at June of this year, the sponsors, End-of-Life Research Group, were still recruiting volunteers.

A year has passed and Mr. Lamb's glad recommendations of great joy are moving ahead apace. New alliances are formed; existing alliances are entrenched...

Marie Curie and e Hospice with others have formed an EoLC Pan-London Alliance.

Marie Curie also reports on a new partnership.

This is the Palliative and end of life care Priority Setting Partnership which is also reported here –

Listed amongst the research partners here is the Economic and Social Research Council.

The ESRC has been funding research into 'terminal sedation until death' at Southampton University. Professor Sheila Payne is a member of the study group.

The Research Project discusses -
...the differences and similarities between 'continuous deep sedation until death' and euthanasia.
There is more here -
Liverpool Care Pathway - The Side Effects
and here -
Liverpool Care Pathway - The To-Die-For Tool
Footnote for first responders:
Assess the person and their condition. If they are elderly, appear frail, DO NOT - repeat: DO NOT - attempt CPR.

Success is slim; permit them "a naturally dignified death because they are a dignified person".

Further reading -
Liverpool Care Pathway - The QP EoL Pathways

Liverpool Care Pathway - The Steps Into That Darkness Are Always Gradual, But Ever Certain

Liverpool Care Pathway - Who Possess No Moral Humility Possess No Moral Restraint

Liverpool Care Pathway – "Let's Talk About It..."