Sunday, 10 August 2014

Liverpool Care Pathway - The Final Countdown... And Counting

If we view our old ones as a “time bomb”, what does that say about us?

In May of this year, Hartlepool Care Home Managers forum ran a Local Study Day for Carers working in the area. Attendees of the study day, at the Borough Hall in Middlegate, were awarded a certificate of attendance to file in their training portfolios.

This is Care Industry News –

Course features included - managing continence issues in EOLC, implementing EoLC pathways and a Syringe Pump tutorial.

The major focal point of the day is to address the End of Life Care Pathways that change this year following the phasing out of the Liverpool Care Pathway. The Conference will have a two pronged approach, taking the opportunity to address the issues of Dementia in Elderly Care and looking towards agreeing an assessment tool that covers EOLC for people suffering dementing illness.
This is...
a time bomb that is in its final stages of countdown.
The "focal point" of the Study day was ringing the changes in EoLC brought about by the Neuberger Review. A year ago, it was announced that the LCP was to be 'phased out'... 

One year later, the LCP has not been phased out; there is no moratorium on its use and the sin city users are still hooked on its use.

They've re-branded. There are 'legal highs' like The Wirral -

Wirral Community EoLC Team
 At Wirral, they’re not going to get their fingers mucky...
What does the End of Life Care Team do?
We work with health and social care professionals
NHS and Care Home staff are encouraged to contact the team on the number below if you require support, education or guidance regarding implementation of any of the End of Life Care Tools.
Please note: Our staff do not have direct contact with patients

In June, the Wee Bee Long Leadership Alliance 'Gang of 21' published One Chance To Get It Right –

The Wirral Team have responded –
One Chance to Get it Right

The National Alliance has produced its report in response to the phasing out of the Liverpool Care Pathway. The report called One Chance to Get it Right identifies five Priorities for care of the Dying Person.

A task and Finish Group is being established on Wirral to look at how these five Priorities for care of the Dying Person can be incorporated into individualised care plans for patients. In the interim period the Wirral End of Life Care Quality Group has identified the need to adapt the current PACA (Patient and Carer Assessment) document to incorporate elements of the five Priorities for care of the Dying Person
The Wirral tools are the Gold Standards Framework, the Preferred Priorities for Care and the Wirral Integrated End of Life Pathway, which is, essentially, the LCP...

See -
Liverpool Care Pathway - There Are Many Pathways...
-  Wirrall Community EoLC Facilitators
The Wirral Integrated End of Life pathway incorporates the patient journey from diagnosis through to death and should be used so that prognostic indicators enable health & social care staff to anticipate care.
End of Life Care Facilitators 
The End of Life Care Facilitators are based within the Clinical Education and Development Team as part of Clinical Excellence. The role is to work within the framework of the Wirral End of Life Care Model. Ensuring best practice for End of Life Care for all conditions for patients and their loved ones.
The role of the facilitator involves the implementation and promotion of the End of Life Tools that are recommended within the Department of Health EOLC strategy (2008).

These 'legal highs' are a cape beneath which they conceal the uniform of their true loyalties.

To Stephen Barclay, who has his fingers in many an EoLC honey pot, the CAPE is a mapping tool...

Stephen is always looking out for that next cutting edge tool that will identify candidates for EoLC.

This is CAPE: Community cAre Pathways at the End of life: mapping the pathways to improve care.

Further reading -
Liverpool Care Pathway - There Are Always Consequences
Liverpool Care Pathway - On Pint-sizing Perceptions of Care And The Betrayal Of Trust

At Greenwich & Bexley Community Hospice, they're still openly using –

The use of the Liverpool Care Pathway helps to ensure unnecessary or inappropriate care is discontinued.

When the pathway is started, the dying person’s medication will be reviewed and any that is no longer helpful may be stopped or substituted for another form, sometimes new medicines may be prescribed just in case to help if a new symptom should occur and to prevent unnecessary delays.

Meanwhile, KNMG says morphine should not be used in palliative sedation –

Morphine and palliative sedation: Directive should be followed 
Morphine is not suitable to accelerate death or to sedate patients. The KNMG Guideline for Palliative Sedation classifies this as bad practice. The report-Danner makes the importance of compliance with this Directive insistently clear, according to the KNMG.
The Danner report was convened in response to the high mortalities reported at the Ruwaard van Putten Hospital.

The article suggests that Midazolam should be used in place of Morphine.

The article cautions that, if not sufficiently sedated, the patient could become confused and suffer myoclonic jerks.

The Netherlands Times reported that –
Smaller hospitals can have a lower mortality rate if doctors monitor each other better, and the medical staff follows national guidelines, and keeps better track of patient records. The Danner committee draws this conclusion after examining the deaths of nearly 800 patients in the Ruwaard van Putten Hospital in Spijkenisse.The Ruwaard van Putten Hospital made the news frequently the past few years because of many deaths in the cardiology department. The affair eventually led to closure of the hospital.
A committee headed by Professor Sven Danner was commissioned to examine the files of patients who died in the hospital between 2010 and 2012. The death of 1 out of every 11 patients proved to be partly caused by the treatment.
Much went wrong in care around the end of life of patients. One example cited the use of incomplete treatment methods, such as the use of morphine as a means to keep people asleep. Records in the files were also inaccurate.
Yet the health damage that patients in this hospital were subjected to is not different from the national average, the commission found.

At Hadamar, they used Morphine to kill 'Defectives'...

Hadamar Nurses

Don't think it can't happen here because it couldn't.

1200 people perish every year on the NHS...
These appalling figures are reported by Mencap -
The principle investigator of the confidential inquiry, Pauline Heslop of Bristol University, also cautioned that the seriousness of the issues raised by her report required "more immediate actions … which are largely missing from the Department of Health commitments".
She said: "We cannot allow the situation to continue in which people with learning disabilities are dying from causes of death amenable to good quality healthcare. That needs tackling with some urgency, and urgency of action appears to be lacking in the Department of Health response.
"In particular, we are disappointed that the Department of Health has not agreed to a national mortality review body to review future deaths of people with learning disabilities."
Jan Tregelles has said this is: “A scandal of avoidable deaths on the scale of Mid-Staffs.” 
The government’s reluctance to set up an investigative body to look into this scandal is on a par with Gosport.
This is The Danish Centre for Holocaust Studies -

Hitler's authorisation of the Euthanasia
Programme (Operation T4)
Euthanasia – the ‘mercy killing’ of disabled people in Germany 


After Hitler had received a letter from the father of a handicapped child, whom the father wished to be put to death as a mercy killing, the Fuehrer approved the Euthanasia Programme. The idea of the Programme was to “remove” the seriously disabled on a national basis.

They have already shifted perceptions. And we are only half way there.

Additional reading -
Liverpool Care Pathway - The Final Countdown
Liverpool Care Pathway - There's Life In The Old Dog Yet 

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