Tuesday, 28 January 2014

Liverpool Care Pathway - Hard At Their Purpose

The forces are marshaled; the war plans are drawn. The logistics of battle are laid...

Marie Curie has partnered with the RCGP (Royal College of General Practitioners) in a three-year mission to boldly take primary care where care has ne'er trod before.

Selected to direct the field of battle is Macmillan GP, Clinical Lead for EoLC and one percent veteran, Dr. Peter Nightingale.

The Marie Curie Ministry of Information has released documents which lay out the battle strategy clear and plain, including an exit strategy. Lesson to be learned here, Mr. Blair?

This is the Business case example from NHS North Lancashire -

Exit Strategy
If the scheme does not deliver the expected savings the following will be undertaken as an exit strategy.

This scheme is primarily about delivering high quality patient care and patient choice.

The scheme will be closely monitored to ensure that it is targeting the most appropriate patients.
The scheme is not at all about 'care provision'; the scheme is about delivery of expected savings. If these are not delivered, an exit strategy will be pursued.

Only the 'most appropriate patients' will be targeted for EoLC. The scheme will be closely monitored to ensure this.

Hang on, hang on...

Wouldn't you think that only those patients actually at the end of their life for whom there is no curative option should be on EoLC? What is there to monitor? Either they are or they are not. Is this scheme safe? Is this scheme sound?

This is Commissioning end of life care to improve patient outcomes from the RCGP -

If people do not die where they choose, mainly, it is because people do not 'choose' to die. We live by the glass half-full principle and do not relinquish hope so easily.

They are still targeting their one percent. They are targeting them to lower their sights and downsize their options.

So, what would YOOOOOOOU like to get out of today......?

This is serious stuff. This is the DEMOGRAPHIC TIME BOMB. We gotta get these folks put down!

Zeke really hit the coffin nail on the head. These oldies are a real burden. Take a long, hard butchers at this, will you...?

The scheme is absolutely NOT about 'care provision'; the scheme is about delivery of expected savings...

£3.2 grand for every hospital visit. 'Choice' of where you'd like to die has nothing to do with it.

Remember the Boiling Frog...?

This boiling frog of a time bomb has been ticking away since Patrick Gordon Walker's speech all those years ago, in July 1967!
The boiling frog story is a widespread anecdote describing a frog slowly being boiled alive. The premise is that if a frog is placed in boiling water, it will jump out, but if it is placed in cold water that is slowly heated, it will not perceive the danger and will be cooked to death. The story is often used as a metaphor for the inability or unwillingness of people to react to significant changes that occur gradually.- Wickipedia
They waited long enough until they thought it was safe to act. Culture and attitudes have been doctored and groomed. It seems they can now get away with anything, even referring to a dementia sufferer as 'Mickey Mouse'.

They are "NOT doing nothing"...

Gold Standards Framework for Acute Hospitals.
EPaCCS and ePIG (Electronic Palliative Care Co-ordination Systems and Prognostic Indicator Guidance) coming soon.

'Reasons To Be Cheerful (Part 3)'...

...Then permit us to dance in the rain and don’t make judgements on ‘quality of life’.

Don’t put us down when we’re poorly and because the prognosis is not good.
"If I should ever seek death - there are several times when my progressive condition challenges me - I want to guarantee that you are there supporting my continued life and its value. The last thing I want is for you to give up on me, especially when I need you most." 
Lady Jane Campbell
They may not guarantee you LC but, by golly, you WILL have EoLC!

Further reading -
Liverpool Care Pathway - Hot On The Scent For Their One Per Cent!
And just to guarantee that...

Macmillan has teamed up with NHS Greater Glasgow and Clyde (NHSGGC) - Scotland’s largest health board - to roll out a new Macmillan Pharmacy Service. This was developed jointly by NHSGGC and Macmillan with the University of Strathclyde.

This is NHS Greater Glasgow and Clyde -

New pharmacy service is first of a kind in UK 
21/01/2014 15:31
People living in the Glasgow and Clyde area can now benefit from an innovative new service, co-ordinated from their local pharmacy – the first of its kind in the UK.

Following a successful pilot in four local areas, which was funded by Macmillan Cancer Support, the charity has teamed up with Scotland’s largest health board, NHS Greater Glasgow and Clyde (NHSGGC) to roll out the new Macmillan Pharmacy Service.

The new service will work alongside the existing Community Pharmacy Palliative Care Network and other community care staff to provide patients and their carers with improved access to pharmaceutical palliative care in their local communities. This service, co-ordinated through local pharmacies, will help support palliative care patients (those with life-limiting or life-threatening illness) at their most vulnerable time. It will also support patients, should they choose, to die peacefully at home rather than spending their final days in hospital.

Ten new Macmillan pharmacy facilitators will work with existing community pharmacies and other community care staff.
This is Paul Adams, Head of Primary Care and Community Services in North West Glasgow and Chairman of the Macmillan Pharmacy Steering Group:
“This service, which aims to maximise the pharmaceutical care of patients with life-limiting illness, was developed jointly by NHSGGC and Macmillan Cancer Support with assistance from the University of Strathclyde. The service model was based on evidence gained from a three year project which is now being recognised in other parts of the country.”
They have the tools; now, they have the means. As if those 'Just-in-case boxes' weren't enough.

This is yesterday's Daily Mail which ran a spread on the nearly dead...

The Mail asked if we can foresee the death of a loved one.

Yes, we can. Yes, we can!

We have the Gold Standards Framework.

We have the Surprise Question and the Prognostic Indicator Guidance.

Yes, we can foresee the death of a loved one.

Yes, we can. Yes, we can!

And they shall choose the exact moment we die.

This is Dying Matters –
Useful resources
  • The RCGP has developed the Gold Standards Framework Identification Toolkit to help identify terminally ill patients. Not only does it boost the chances of early identification, it can help determine what stage the patient is at through the prognostic indicator guidance (PDF) tool. The tool can be used by individual clinicians or by multi-disciplinary teams to judge whether patients are entering the dying phase of their lives. If this is the case, a discussion should be initiated with patients about their wishes. 
  • The latest comprehensive clinical guidance for identification can be found on the Royal College of General Practitioner's End of Life Care microsite 

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