Saturday, 25 January 2014

Liverpool Care Pathway - The State Rules, Okay?

There is rhyme and reason to this and you WILL be subjected to EoLC...

Everything held on EPACCS (Electronic Palliative Care Co-ordination Systems) will be made available with the SCR (Summary Care Record). EPACCS are the electronic Death Lists compiled by GPs using the SPICT and the GSF, both of which employ the Surprise Question which is founded on the Barton Method.

All appropriate medical personnel will have access to this. All those ACDs (Advance Care Directives) and their logged DNACPRs will be available to first responder paramedics to view and this will permit YOU, as a ‘dignified person’, to slip away into the great Blue Yonder so THEY may, accordingly, eliminate that huge financial burden that is the focus of NHS Commissioners - along with YOU, the patient.

This will meet the targets set, for instance, by NHS Sussex - the so-called “Audacious Goals” - and, whether “My Wishes” (or Last Wishes!), or the EoLC Locally Enhanced Services Specification (also referred to as the Care LESS!), it's all the same...

This information will all be gathered up by HSCIC (the Health and Social Care Information Centre).

This is Community Care -
Care minister Norman Lamb has given his personal backing to free end-of-life social care, but said he could not yet commit the government to the measure.
Speaking in a debate on the Care Bill last Thursday, Lamb said although he was “not in a position to commit the government” to free end-of-life social care, he said that “I want us to do this” and was “determined that we achieve that objective”. He added that as the responsible minister he had “some degree of influence over decision-making”.
He made the comments in response to an amendment from Conservative MP Sarah Wollaston proposing that terminally-ill people be exempted from social care charges to allow them to die in their preferred place.
This recommendation was made by the government-commissioned Palliative Care Funding Review, which reported in 2012. On the review’s recommendation, the government set up eight pilot projects to test its proposed funding model. The pilots last two years and are ending in March.
Lamb added that NHS England wanted to expand the use of electronic palliative care co-ordination systems (EPACs)—which allow people to register their end of life wishes—to increase national coverage form 30% to 70% by 2015. He said in places where EPACs were established, 80% of people died in the place of their choice. Wollaston said she was “absolutely delighted with the minister’s assurance” on free end-of-life social care and would not press the issue to a vote.
Backing from charity
Macmillan Cancer Support, which has long campaigned for free end-of-life social care, welcomed Lamb’s comments.
“We are very encouraged by Norman Lamb’s comments during last week’s Care Bill debate and his assurance that he’s determined to introduce free social care at the end of life,” said Gus Baldwin, head of public affairs at Macmillan Cancer Support.
“We look forward to discussing this further with the minister with the aim of making quick progress as soon as the Palliative Care Funding Review pilots looking at this issue have ended in March.”
More EPACCS! Lubbly jubbly, and it's all there in the SCR to access. And those already targeted for EoLC and groomed to accept non-treatment will jump at the chance - after all, it's 'free'!

Mr. Lamb says the decision to go for free social care must await the outcome of the pilot schemes. These have been reported upon in these pages.
He said: “Obviously, I want to see the evidence and we have to be aware of the financial consequences, but I am determined that that will happen.”
What does Mr.Lamb mean?

Community Care
Mr. Lamb means that there has to be evidence that care can be successfully downsized and that there are demonstrable savings that will pay for the 'free' social care. It has to be demonstrated and the outcomes have to show that those targeted for the Death Lists can be successfully groomed to accept their lot. This is what it is all about, after all; it is about making those savings to make the NHS "affordable and sustainable, now and for future generations". And as any Councillor will tell you, they are stuck for dosh  at the municipal level, too. It really does have to be cost-effective.

Of course Macmillan support this announcement in the Commons by Mr. Lamb and, along with Sue Ryder, have promoted this measure; it's what they are about. The Death Lists are all about downsizing care expectations. Why, then, does Macmillan purport surprise that care is downsized for elderly patients...?

This is Mail Online -

Macmillan have produced a study which demonstrates that there are barriers to getting treatment
which include age discrimination and inadequate assessment methods
According to eGuidelines -
Up until now GPs have mainly considered cancer patients eligible for DS1500 attendance allowance as the criterion for inclusion on a palliative care register, but the new prognostic indicator guidance paper [GSF] is being used as a way forward for primary and secondary care to identify these patients and initiate supportive care for them. 
A key point is for all hospital and hospice clinicians who recognise that a patient may be in their last year of life to notify the patient's GP and recommend that the patient is added to the palliative care register. 
The recognition of the importance of palliative care is demonstrated by the addition of clinical indicators for palliative care in the revised QOF. This positive step will encourage good proactive palliative care in primary care. Although there are only six points for palliative care in the revised contract (which includes care for all patients estimated to be in the last year of life), when combined with cancer, dementia and other areas, practices can claim up to 52 points if they are using the Gold Standards Framework.
The "1% rule" is then discussed.

Whatever policy, whatever measure, there are always, always consequences. Are they all blind or oblivious to the effects of the measures they have proposed, initiated, promoted and enacted? It is all evidence that EoLC has borne fruit. Strange fruit...

They have called the tune, but can they face the music? Further reading -
Liverpool Care Pathway - There Are Always Consequences
You WILL have EoLC...
Liverpool Care Pathway - Moving In For The Kill

Liverpool Care Pathway - The Devil Is In The Detail

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