Saturday, 23 August 2014

Liverpool Care Pathway - The 'Art' Of Good Grooming

Good grooming, the art of persuasion and the power to influence people.

Good 'grooming' is not to beg that their ears may be 'lent', but to bend them, grab them and to lead them by the sweet substance of what is being said that they may willingly take your medicine down.

Good grooming may capture the eye and win the heart, but what bends the ear is the power of the word. Every good and eloquent speaker will say as much: 'Tis the singer, not the song.

This is Mail Online –

The NHS has agreed to review controversial guidelines that instruct nurses to ask the elderly whether they would agree to a ‘do not resuscitate’ order.

The Mail revealed yesterday how patients are being visited at home by nurses they have never met before, and asked sensitive questions. These include where they want to die, and if they want doctors to try to resuscitate them should their hearts stop.

Following criticism of the initiative, the NHS’s Chief Nursing Officer for England, Jane Cummings, said yesterday: ‘We will review the [questions] again, with patients and clinical staff, in the light of the poor experiences described in the media, and make any changes that are needed.’
District nurses have been sent to the homes of patients aged over 75 and those with long-term conditions armed with a form about their medication and care which includes the controversial questions. 
Health policy analyst Roy Lilley – who was at his mother’s house when the nurse visited – described the policy as ‘callous’ and called for it to be banned.‘People will be frightened to death thinking the district nurses know something they don’t and will feel obliged to sign the form so as not to be thought a nuisance,’ he said.

Mr Lilley, a respected health commentator and former chair of an NHS trust, was at his mother’s home earlier this week when a district nurse arrived 45 minutes late for a scheduled visit. 
She began going through the form with his mother and within ten minutes of first meeting her asked where she would like to die and if she had agreed to a DNR or Do Not Resuscitate order.
Interviewing people for the Death Lists has been proceeding for some time. GPs are being paid to find their one per cent.

The End of Life Rights Advocacy Project has been pursuing these DNR interviews. It started out in the East End and has now gone nationwide.

The Advocacy page is slick and bears some prestigious logos. The Daily Mail, the National Lottery Fund, Age UK...

and, what's this?

Compassion in Dying? Well, that sounds like a nice thoughtful and concerned outfit. And the page is hosted by Compassion in Dying, too.

Mr. Lilley must know all about Compassion in Dying. The King's Fund published a Compassion in Dying report a while back.

My Wishes is another EoL Register. My Wishes is Invicta's provision of an Advanced Care Directive or 'Living Will'. You are persuaded and encouraged to make such wishes known with such 'fireside chat' language as, well, if you don't say now, when the time comes you may not get the treatment you would have wanted.

Making such hypothetical decisions out of the woods is vastly different from having to make them when you're actually lost in the woods and, yes, please do send out those search parties because I really don't plan on checking out just yet!

But DNACPR actually does mean don't even bother trying to save me.

This will affect such decisions as whether it is ‘appropriate’ to call an ambulance.

Of course, it really does matter how these things are put. That can make all the difference...

Some further reading -
Liverpool Care Pathway - It Ain’t What You Say, It’s The Way That You Say It
Liverpool Care Pathway - Moving In For The Kill
This is Roy Lilley's bio on The King's Fund –

Roy Lilley is an independent health policy analyst, writer, broadcaster and commentator on health and social issues. Previously, a Visiting Fellow at the Management School, Imperial College London, he was also formerly at the Centre for Health Services Management at the University of Nottingham.
Roy Lilley says these questionnaires are 'callous'.

Roy Lilley is a person 'in the know'. He really should know.

This is -
Liverpool Care Pathway - Changing Minds
Presentation is everything. Change the name; change the image; retain your goals but present yourself differently.

Compassion in Dying, a pro-euthanasia pressure group, is the charitable arm of Dignity in Dying.

The King's Fund and Age UK have both published a biased report released by the pro-euthanasia pressure group, Compassion in Dying.

What is Age UK doing publishing any report released by pro-euthanasia activists?
We are all really excited in Compassion in Dying to have put together some new promotional leaflets. Following a number of requests for materials for GPs surgeries, end-of-life events, community noticeboards and other charities' referral teams, we now have an Information Line leaflet and an Advance Decision leaflet.
Cutting costs means cutting care means downsizing care means downsizing care expectations, achieving the impossible by making it desirable.

     Dying is a positive life choice.
     Let's talk about it...

Anything can be made to appear desirable if presented in the right way. The groomed have themselves become the groomers. In Scotland, they openly use psychometrics in the programme to limit life.

The Dundee Dignity Care Pathway is a psychometric questionnaire designed to groom the patient into accepting palliative care in place of curative options.

It is all about changing minds.

That's what Compassion in Dying are about. They're using the Daily Mail logo on their page...

The Daily Mail...?

Mail Online reported this three years ago -
A right-to-die pressure group has announced plans to sponsor the UK's first helpline aimed at speeding the terminally ill towards 'a good death'.
The free phone line, to be set up by a charity called Compassion in Dying, will 'promote greater patient choice and control where possible'.
The charity is an offshoot of euthanasia campaign Dignity in Dying and is led by the right-to-die group's chief executive.
Its plan to provide advice on the rights of the desperately sick sparked protests from antieuthanasia activists, who said the helpline would be used to shorten lives. The charity says it exists to highlight 'existing end-of-life rights' and will pass on information to callers.
However, it comes against a background of growing tolerance of assisted suicide by prosecution authorities, increasing political pressure for the legalisation of assisted dying, and a rising toll of Britons travelling to the Dignitas suicide clinic in Switzerland to end their lives.
Mr. Lilley is concerned for his mum. 

This is Nursing Times with a discussion on District nursing from August 2012 –

District nurses deliver a range of nursing care to adults in their own homes. However, practitioners have not effectively demonstrated the value of this care to primary care commissioners (Queen’s Nursing Institute, 2009). As a result, district nursing numbers continue to decline at a time when there is increasing demand from an ageing population for more care to be provided at home (Royal College of Nursing, 2012). If district nursing services are to receive the resources they need, practitioners must measure and communicate the impact of their care through “quality indicators” agreed with commissioners.
It is a statistical certainty that every person in their elder years is 'approaching the end of life'. Old age is a 'terminal condition'.
“District nurses discuss and record the needs of those approaching the end of life at dedicated multidisciplinary team meetings, preferably monthly but quarterly at a minimum”
If a person of elder years falls seriously ill, however, that does not mean that they are terminally ill; it means only that they require that much more care and attention to improve or to maintain their condition.

This is rather typical of modern science: having decided that something is so, they then seek the evidence to substantiate it is so. The decision to determine EoL and to 'diagnose' dying is a self-fulfilling prophecy.
“The team has a register of all patients for whom they are providing end-of-life care, which includes key information such as preferred place of care”
They have your card marked. Just when you need that extra TLC, they wind down the care and 'make you comfortable'.

The Lakhani Recommendations have rubbished CPR.

Are these the Byatt Recommendations to downsize treatment?
Writing in the journal Evidence Based Medicine, Dr Byatt said: “The data strongly suggests that we are over-treating many over-80s.  
“The largest trials of antihypertensive therapy and statins in this age group show at best a marginal clinical reduction in stroke and very modest clinical reduction in other cardiovascular end points.”  
Dr Byatt said studies have shown that: “these medications are greatly over-prescribed in the healthy elderly, and largely irrelevant in the frail elderly.”
“In my experience, it is not uncommon in the oldest of these often frail but relatively disease-free patients, to see death as the next natural event in their life, especially welcome if they have outlived their peers,” he added. 
“However this cohort is often deferential to the doctor, whom they frequently want to please or at least not upset. - The Telegraph
When someone visits the quack, it’s usually because they have a health issue they would like addressed. They may be happy or not happy with the treatment, but to extrapolate that dissatisfaction to demonstrate a preference to 'die naturally' is, frankly, bizarre.

The Telegraph article pleads:
'Stop medicating elderly and let them die naturally'
Whatever age you are there's many an illness, if it isn't medicated, will most certainly cause you to die 'naturally'. Are the rules determined by your positioning on the Complete Lives priority curve?

District Nursing, as a profession, must demonstrate that it is implementing the quality indicators such as EoLC required by Commissioners in order to attract the funding which will pay for the resources district nursing services so desperately need.

Quality indicators must be achieved and evidenced.

Signing up the punters is what it's all about, Mr Lilley.

Whether with faith or of no faith, you may yet have faith, Mr. Lilley.

God bless your dear mum and grant her long life.

May God take her when her time comes, Mr. Lilley, and not some vile priestess or 'soul midwife' bent on some Pathway. We who have had our dear mums taken thus would not wish her - or you - that.

Some additional reading -
Liverpool Care Pathway - In The Beginning Was The Pathway... 
Liverpool Care Pathway - The Shameless And The Brazen 
Liverpool Care Pathway - 'Newthanasia' 
Liverpool Care Pathway - Telling It More How It Is 

And some particular reading -
Liverpool Care Pathway - The Palliative-Medical Complex

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