Sunday, 8 December 2013

Liverpool Care Pathway - Nottinghamshire Going For Gold

This quotation is both topical and relevant: "The greatest glory in living lies not in never falling, but in rising every time we fall".

In the Nottinghamshire County Council March 2013 Newsletter

Dying Matters gets a mention (of course) and McKinley Syringe Pump training is offered.

Rolling out of GSF training, successful downsizing of care expectations and recruiting of EoLC Champions is also proceeding apace.

The knowledge that you are following a protocol is self-justification of the protocol. You know you are doing the right thing because the protocol informs you of that. It is creating the same mindset that resulted from LCP training.

Comment on the training:
It gave us the confidence to know what we were doing was good. WE are delivering good EOLC. It has empowered staff, it is easier to appraise them and it has boosted their confidence. It has lowered hospital admission rates because staff ask questions now and see what they can do before sending someone to hospital.
Key achievements this year have included increasing end of life registers held at GP practices to 32% - an 8% increase in year; commissioning a rapid response service to include end of life care, increased numbers of patients dying away from hospital, improved training for health care professionals, greater input into care homes through our Care Homes Urgent Care team and the re-launch of our Care Co-ordination Centre.
- EoLC Newsletter March 2013
 and targets:
For the coming year, the CCG has set challenging targets around End of Life including:
   • 85% of patients realising their preferred place of death
   • 40% of patients expected to die in the next year on practice registers
   • 13% reduction in prior admissions
On the to do list includes    implementation of an Electronic Palliative Care Co-ordination System.

The December 2013 Newsletter mentions the Review of the Liverpool Care Pathway and publication of 'More Care, Less Pathway'; the setting up of the Leadership Alliance and the announced public engagement events is also mentioned in context of two EoLC Trainers, Steph Pindor and Elise Adam, being sent along to attend one of these in November...
We were asked questions about the engagement document and the proposal to develop personal palliative care plans. There was a lot of debate about: 
• These plans being similar to advance care planning documents but there would also be a section on the last few days of life. But ACP already exist so is this a repetition of documents or should they have a completely new document that covers the whole of the period from diagnosis to death? 
• The cost implications for the development, launch, resources or education linked to a new document 
•  Ownership of the document (would it be patient held?) and the issue of accessibility of information/sharing of information. 
•  The need for clear guidance to support staff who are not familiar with palliative care, rather than relying on the knowledge of the clinician alone 
•  The “senior responsible clinician” is mentioned throughout the guidance (GP or consultant) and this left a question regarding the role of senior/specialist nurses. 
•  The ability/willingness of some senior clinicians to recognise when someone was dying/was for palliative care, and how this could impact on the introduction/use of the new document.
Similarity and overlap with existing documents is noted. That does, of course, address somewhat the expressed concern in regard to cost implications.

Ownership of the document is an important point because it must be available to and accessible by different agencies, most importantly first responders.

The final point in this list was a topic of conversation that arose in the rolling out of Amber in New South Wales (NSW). The Amber document has been embraced by the NSW Government and Advance Planning for Quality Care at End of life is an EoLC Action Plan for 2013 - 2018. In this is discussed 'end of life conflict'.
End of life conflict is defined as disagreement which occurs about the goals of care or treatment decisions at the end of life and where such conflict is not resolved by the usual recourse to time and further discussion between the patient, the family and the treating clinicians, as appropriate.
The point of foreseen conflict is on the issue of what is considered the appropriate response.

Further reading -
The Barton method is embraced by the GSF and embodied in the 'Surprise Question'. This is generally, but not universally, accepted as good practice. The problem of actually 'diagnosing' dying is not a scientific one, but one of perception.

Dr. Adrian Treloar in his BMJ article concluded:
It is clear from this study that the LCP appears to give non specialists in particular a false confidence in their ability to diagnose dying alongside clear guidelines as to what they should do once they have (unreliably) diagnosed dying. And many of the actions set out as good practice may then cause death at least among those who are wrongly diagnosed.
The above comment taken from the March Newsletter in regard to GSF training begins to ring alarm bells. 

- EoLC Newsletter December 2013
Accreditation is both authoritative and reassuring, but what does this mean? It is conferred by the GSF itself, as are its standards of accreditation (Beacon, Commend and Pass).

The LCP (now referred to as a toxic brand) was also regulated in like manner  and promoted by Marie Curie et al. Marie Curie still find ('I see no faults') no fault with the LCP but only with the training. Dr. Bee Wee...?

These Accreditations are worth no more, effectively, than many a degree or certificate obtained from online colleges of no standing. If the premise may be contested scientifically in that the actual diagnosis of dying and the application of the Surprise Question (the Barton Method) is fallacy, then the whole structure of GSF collapses.

Congrats are awarded to aforementioned EoLC Trainer, Elise Adam, who has passed her MSc in Health & Social care (Palliative and Eolc). What does that mean? What is this worth? Who/what is the assessing body and by what standards is this 'pass' set?

Nelson Mandela has just passed on. Anyone in like circumstance in the UK, whether in hospital, care home or hospice, would long ago have been consigned on an EoLC Pathway to the great beyond.

Refuse to be downsized! Remember you're worth it and life is ALWAYS worth it...

What is futility and 'quality of life'? Like beauty, it is in the eye of the perceiver...

I Love Living Life. I Am Happy.

They are being groomed and grooming others to downsize care expectations. Lives have been shortened. A programme to limit life is proceeding. The really frightening thing is that they genuinely believe that what they are doing is right.

Comment on the training:
It gave us the confidence to know what we were doing was good. 
A medical holocaust has proceeded. There is only one further relevant quotation to make. It is from Luke 23:34 -
"Father, forgive them, for they know not what they do."

No comments:

Post a Comment