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..."

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