Sunday, 19 January 2014

Liverpool Care Pathway - Newthink And Newspeak

Remoulding the way we think is key to their programme.

Ellershaw sees More Care Less Pathway not as a condemnation but as a commendation of his LKP. This is Ellershaw –
In England we now find ourselves at a critical crossroads where our societal debate has at one and the same time both derailed recent progress and created a once in a generation opportunity to take the next steps in improving end of life care generally and care of the dying in particular. When More Care, Less Pathway, A Review of the Liverpool Care Pathway was published in July, 2013, it made over 40 useful recommendations, including central issues relevant to the ability of the National Health Service to provide best quality care for dying patients, such as the need for improvements in education, training, research funding, access to specialist palliative care services, and the need for care and compassion from all involved in caring for dying patients. The review found that the Liverpool Care Pathway for the Dying Patient (LCP) is ethically sound and provides good care when implemented properly.
Ellershaw sees More Care Less Pathway as an opportunity. This is pure Emanuel. "Never let a crisis go to waste." Ellershaw sees himself as an "activist". Be warned!
Which brings me back to the idea of activism. In both the USA and UK there have been different phases, challenges, and successes on the journey to understand what best care for the dying patient is and how we bring that best care from research and policy to the bedside. All of us who wish to do that must continue to be activists, must provide continuity of strategy and thinking, and must be prepared to remain focused on our goals for the best care whatever challenges present themselves. And we must engage in and lead the societal debate, taking the risks necessary to do so and recognising that we are entering a new phase, where things will improve and we will increasingly be able to support more people to experience a good death for themselves and their loved ones.
Ellershaw is reviewing a book by David Clark on overcoming cultural perceptions of dying and the Project on Death in the States. Ellershaw looks upon this as a "challenge" and sees many parallels between EoLC in the US and EoLC in the UK.

He is right, of course; it is a challenge. Getting that first responder to accept that it is far better to let the old gentleman go rather than put him through an horrendous ordeal...

Breaking his ribs to revive him. Putting the paramedics in the impossible situation, having done so, of having to use a defibrillator on the way to the hospital. Putting his poor wife through the worry and stress of being told he may not survive the night. Dragging the local vicar away from pressing affairs of the parish to attend the hospital with her where they both found the poor gentleman on life support. Then, to top it all, the poor gentleman had to undergo heart-bypass surgery.

And the cost to the NHS. This is not good Communitarian health policy at all.

Ellershaw wants to change our focus, but how glad they all are that first responder did act, that instinct and training kicked in, and for that they are eternally grateful.

And if she had failed in her endeavour? Well, then, at least she will have tried. For that is our instinct, to try, at least to try, because life is precious...

And living matters!

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