Thursday, 12 December 2013

Liverpool Care Pathway - So, Who's Sweeping Up In The Sweepstakes?

GSF is a front runner. It's looking good and, by golly, it does the job. The label actually 'sounds' good on the can. But can it pip the others to the post?

Let's see who's still in the running...

Amber's buzzed off to OZ, but don't be deceived; the old Amber's still got ample nectar in the EoLC honey pot.

There's the umpteen incarnates out of the "toxic" LCP stable, such as the Wirral.

At the Vanguard of the Movement is the Leadership Alliance and Comrade Bee Wee who has so many fingers in all manner of EoLC honey pots.

Is it all finger-licking good, clear cut, shipshape and spict and span, then...?

While the home-grown Dundee Dignity Care Pathway is a natural choice for NHS Scotland and Salmond's New Republic, is the whole 'Pathway' concept just, well - too toxic?

May Dignity be hybridised with that other pedigree from the Scottish stables, the SPICT? Will that be the choice for NHS Scotland?

The Spict... a natural homegrown choice for Scotland in itself. SPICT is mentioned here -
Palliative care in acute settings was the focus of a lively interactive workshop at the recent Scottish Partnerhship for Palliative Care conference in Edinburgh.

In an hour-long session, the attendees were offered an understanding of the Scottish response to providing palliative care in these acute settings, with a focus on advance and anticipatory care planning.
- e-hospice
So, what has the Spict been up to?

This is SPICT

Spict has been going international, branching out into England and far-flung shores.

It has been mentioned previously in these pages that the Invicta 'My Wishes' project in Kent incorporated use of SPICT...

Also using SPICT are:

Coordinate My Care in London; Coventry and Warwickshire University Hospitals NHS Trust; Doncaster and Bassetlaw NHS Foundation Trust; and NHS Birmingham South and Central Clinical Commissioning Group.
Not to be outdone, Coventry and Warwickshire have also introduced their own version of the Yellow Folders called, Greensleeves.

CASTLE - Coventry and Warwickshire
Care And Support Towards Life's End (CASTLE) uses SPICT.

Coordinate My Care is like the INVICTA Last My Wishes programme.

The Birmingham South and Central CCG is using SPICT to identify downsized patients.

Doncaster and Bassetlaw are using SPICT in GP Practices and in Care Homes. As a result, patients on the EoLC register have doubled and
Hospital deaths reduced from 64% to 47% and community deaths increased from 36% to 53% 
On far-flung shores, is SPICT outdoing Amber...?


SPICT is digging inroads into Oz. Located midway between Perth and Fremantle, Western Australia, this is Fiona Stanley Hospital

The Fiona Stanley is a $2 Billion state-of-the-art high tech hospital, that will rival any anywhere in Oz, opening in four phases over next year. Serco, which will manage the new public facility, is already recruiting.

In July 2011, the State Government awarded Serco Australia the facilities management contract for non-clinical and support services at Fiona Stanley Hospital. Serco is a major organisation with local, national and international experience in facilities management.
Serco, which may be facing fines over its running of community health services in Suffolk, is currently facing a criminal probe by the UK Serious Fraud Office.

Fiona Stanley Hospital will be one of the most technologically advanced hospitals in Australia. It will use state-of-the-art technology to deliver new levels of patient care and convenience – from streamlining admission, discharge, bookings and record-keeping to providing video links for doctors and patients – right down to bedside entertainment systems.  
For doctors and nurses, that means everything they need to know about a patient can be called up bedside on a single screen

That'll be handy for those life and death decisions.

Use of the SPICT for unplanned admissions to identify patients eligible for goals of care discussion and resuscitation planning on admission.

New Zealand

Other Resources
HealthPathways is a web based information portal for GPs.
Based in Canterbury, it is used by more than 17 health regions across both New Zealand and Australia.
The pathways are based on the best international evidence. But where the availability of local services cannot meet this need, the pathways strive to be explicit about that, explaining why a higher referral threshold has been set. 
To critics, this might look like the ultimate in cookbook medicine. But it has empowered GPs to do appreciably more in general practice and has helped to ensure that only those patients who need an outpatient appointment get one. Referrals are monitored: those that do not follow the pathway are rejected.
- HealthPathways - The Kings Fund


HealthPartners is a not-for-profit HMO along with Medical Groups and Clinics and our mission is to improve the health of our members and our community.  
Our goal in using a Partner SPICT is to educate our community on what hospice and palliative care is and does along with offering a guide for our providers (physicians, NPs) as to who is appropriate for hospice/palliative care.  We hope to have fewer patients who die in our program in under 7 days 

This is the same 'holism' as practiced in UK EoLC -
We provide expert pain management, symptom control, social and emotional counseling, and spiritual support. The medications and medical equipment are delivered directly to the place that the patient calls home.
This is going one step further in reducing both hospice and hospital admissions.

Over on the European mainland, Dr Anne Finucane, Research Facilitator at Marie Curie Hospice Edinburgh, Scotland, and Member of the Primary Palliative Care Research Group at the University of Edinburgh is published in EAPC (European Association for Palliative Care). Members of the Primary Palliative Care Research Group were involved in developing SPICT. This article also references GP palliative care registers (or "Find Your 1%") –

We examined if some patients were less likely to be identified for palliative care than others; and investigated the length of time between identification for a palliative approach and death.

GPs said that identifying cancer patients for palliative care was fairly straightforward; however, it was much more difficult for other patients.
At the Vanguard of the Movement is the Leadership Alliance for the Care of Dying People.
- EoLP Newsletter

But does Comrade Bee Wee have rival contenders for the Vanguard...?
Announcing: The End of Life Partnership – April 2014
The End of Life Partnership — working together to transform End of Life experience and care, as of 1st April 2014.
Over recent years, the CHE, EoLCSM and CLWDW teams have worked closely together, with an excellent track record and significant experience in their respective fields. They have well-developed relationships with local communities, workplaces and workforces, businesses and service provider and commissioner colleagues. 
 Pooling such expertise into one organisation will improve overall impact, responsiveness, effectiveness and capacity, and create a more compete and holistic approach to living well, dying well and loss. A crucial innovation will be the addition of a research and evaluation workstream to further develop the evidence base and outcomes, as well as potential independent research. 
 The merged organisation will also be more cost-efficient, financially viable and sustainable into the future.

Further reading -
Liverpool Care Pathway - Pathways Vying For Position

Liverpool Care Pathway - The Outsiders And The Also-rans

Liverpool Care Pathway - This Is The DCP

Liverpool Care Pathway - The Mob Are Sending In The Cleaners

Liverpool Care Pathway - On The Road To Dundee

Liverpool Care Pathway - Moving In For The Kill

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