Sunday, 8 June 2014

Liverpool Care Pathway - Crying Wolf

Granma, what big eyes you've got! All the better to see you with, my dear...

The independent auditors are picking up the danger signals everyone is missing...
The National Audit Office found that despite a Government pledge to protect social care from the impact of austerity, spending on help for older people in England plunged by 12 per cent in just two years in real terms.The Telegraph
The Municipals have grasped the nettle.
Tender-handed stroke a nettle,
And it stings you, for your pains:
Grasp it like a man of mettle,
And it soft as silk remains.
- Aaron Hill
If the demand is outstripping the available resources, quite simply, you cut down the demand on those available resources...
The spending authority said councils may increasingly have to consider “managing demand or reducing services”.The Telegraph
Further reading –
Liverpool Care Pathway - Integrating The Death Lists
The Municipals are working together and in harmony, going gung ho (gōng hé, as they say) to set in place the necessary structures that will enable the cost-effective care demanded by Mr. Lamb...

Essential reading –
Liverpool Care Pathway - The State Rules, Okay?
Rochdale Borough Council are joining other Councils in downsizing the cost of care by downsizing care expectations and care options, switching from curative to palliative care.

This is Heywood, Middleton and Rochdale Clinical Commissioning Group -

A NEW integrated end of life and palliative care service for the Rochdale borough is due to launch in summer.
The joint approach between NHS Heywood, Middleton and Rochdale Clinical Commissioning Group (HMR CCG) and Rochdale Borough Council aims to increase the number of patients who receive palliative and end of life care in their preferred place while reducing the number of end of life treatments and inappropriate deaths in hospital.

The CCG has awarded Springhill Hospice a three-year contract to integrate palliative care provision across the borough. They ‘can’t wait’...
"We are truly excited at being given this opportunity to improve the palliative and end of life services available for families in the borough. Patients and their families will be far better supported and be offered more choice as to what they receive and where. We can't wait to get started."
 The Telegraph article continues -
Meanwhile pressure on councils to cut costs is threatening the financial viability of private providers, such as care homes and home care agencies, it adds.
They in turn are passing on the costs to the middle class users who do not have their care provided by the state, effectively using them to “subside” the rest, it notes.

“Rising needs, reducing local authority spending, and reductions in benefits may be putting unsustainable pressure on informal carers and acute health services,” the report concludes.

It adds: “National and local government do not know whether the care and health systems can continue to absorb these cumulative pressures, and how long they can carry on doing so.”

Caroline Abrahams, director of Age UK, said: “This independent, authoritative report underlines the true scale of the crisis in care and reaches some potentially devastating conclusions, contrasting the uncertainty about how effective the Government’s policies will be for improving the quality and reach of social care with the daily reality of rising demand and falling council funding.

“As a result, the NAO says neither central or local government can be sure the system will be able to cope.”

Sandie Keene, president of the Association of Directors of Adult Social Services, said the report’s warning that it was unclear how long the system could cope was an “understatement”.

"[It] is a simple, stark warning of how badly the situation might have deteriorated over the past 12 months, and how it might deteriorate further in the years to come if the same financial restraints which have been promised us are maintained on local government and adult social care spending," she added.
This is from the National Audit Office report published in March –
While the need for care continues to rise, local authorities’ spending on adult social care fell by 8 per cent in real terms between 2010-11 and 2012-13. The longer term trend of reducing the amount of care provided has continued, but NAO analysis shows that local authorities have also improved their ability to control their costs in delivering core services since 2010-11. Local authorities are making efficiency savings by changing contractual agreements, paying lower fees and negotiating bulk purchasing discounts.
This is not new news. In December of 2010, it was reported that core funding was to be cut by 12.1%. As with the Doc Foster report, the NAO are alerting to danger signals that do not factor in the context of the EoL Programme and continuing Strategy which, according to the NCPC, is only halfway there.

Read further here -
Liverpool Care Pathway - Active Killing...?
The independent auditors are crying wolf, but the wolf is all dressed up as Granma and is made welcome at every door.

Age UK, in collaboration with a pro-euthanasia organisation and with lottery funding, are signing up "vulnerable older people” in an end of life advocacy service. An East London pilot is now being rolled out nationally. This is very worrying.

This is -
Liverpool Care Pathway - The Shameless And The Brazen
NICE organ donation guidance makes it explicit in its first recommendation that ‘organ donation should be considered as a usual part of “end-of-life care” planning.’ Discussions about resuscitation are also an important part of care plans.

The psychology of communication forms an important part of medical education. Discussions are sensitive and complex and are undertaken by experienced members of the healthcare team and documented carefully.

This is Nurse Education Today discussing the Simple Skills Secrets model of communication training 

An education platform such as this would have provided guidance, for instance, to that ‘lovely’ end of life nurse on how to broach such delicate matters with Mrs Kathleen Vine’s granddaughters that she was dying...

The only trouble, of course, was that she wasn't.
Kathleen Vine - Yeah. And I was being left to die! And they told my family that I was dying. If it hadn't a been for my family, darling, I would be dead now, I wouldn't be talking to anyone. I don't know, I'd be up there or down there, I don't know". I had too many boyfriends, I could've been down there.- Liverpool Care Pathway - The Report
This was attempted murder, plain and simple. Is there not a solicitor in this fair land worth their mettle to grasp the nettle and pursue these cases to gain justice and retribution for the victims?

The effectiveness of the implementation of the Strategy has been demonstrated by the Doc Foster findings. The carrot method of the CQUIN payments played an important role in this. The methodology is different this time. This time, it is the carrot and stick method.

As Mr. Pickles has said, savings are not cuts and savings will be made. These will be accomplished by devaluing the demand expectations on the finite resource. This has been piloted and cross-sector integration found to be key.

This is A Good Death: The Role Of The Local Authority In End Of Life Care –

In health circles, there has been a strong emphasis on end of life for several years.The Department of Health launched its 10-year End of Life Care Strategy in July 2008, followed by a Palliative Care Review in June 2011. Palliative care pilots based on the recommendations of the review are now under way in 11 areas of the country.
Nevertheless, end of life care is not the concern of the health sector alone. Local authorities also have a key part to play, through their provision of social care. In their broader role as place shaper, they also provide local leadership and are important players in bringing together public services in a locality.

And of course their increasingly prominent role in housing is vital to this agenda. In many cases simple adaptations and support can help people to remain in their own homes for longer, and councils can play an important role in ensuring that health, social care and housing are all equally engaged in delivering end of life care.
The need for better local authority engagement is recognised in the work of the National End of Life Care Programme (NEoLCP), which has promoted better integration between health and social care in delivering end of life care.

“We would see social care working with health provision in the support of an End of Life Care Pathway.”

“We would see social care working with health provision in the support of an End of Life Care Pathway.”

Integration, integration, integration...

Further essential reading -
Liverpool Care Pathway - The Many Pathways To The Perdition That Awaits Us
Health and Wellbeing Boards, introduced by the government from April 2012, are in charge of health in an area. Run by Local Authorities, they have a statutory responsibility to improve integrated working between local health care, social care, public health and other public service practitioners to co-ordinate your care. 

According to the Local Government Information Unit –
Councils, with their new convening powers through the Health and Wellbeing Boards, are ideally placed to bring together health, social care and housing. Our report therefore calls for councils to take ownership of the end of life care agenda in order to enable people to spend their final days in dignity.
They have downsized care. They have set out to alter our perspective and to change our minds. The landscape has changed and is changing. Old age is a terminal condition.

Footnote: The right to treatment?

A poll by the Louisiana State Medical Society found that nearly eight of 10 Louisianans support laws that require insurers and state programs to provide coverage to people diagnosed with potentially terminal diseases. Patients fighting life-threatening conditions already have limited options. If third party groups decide to further limit or deny access, it makes an already overwhelming time even more difficult. It forces them to worry about fighting the system to get access to treatment.

Final Advisory: Do not sign yourself up to a Living Will, but make a Will to Live.

Further reading -
Liverpool Care Pathway - When The Funding Had To Stop

Liverpool Care Pathway - The Reaper At the Town Hall Door

Liverpool Care Pathway - The Switchover

Liverpool Care Pathway – Intrusion By Stealth

Liverpool Care Pathway - The Devil Is The Detail

Liverpool Care Pathway - The Micawber Principle

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