Wednesday, 8 July 2015

Liverpool Care Pathway - Second Class Delivery

Is this a blind date enough to send you on a blinder...?

Many years ago, when Royal Mail first introduced a two tier delivery service, it happened that this came up as a topic of conversation with an American cousin. This cousin had the acquaintance of a USPS delivery worker who had commented to her that it was a sure fire thing that Royal Mail had made a bad decision. The service would suffer he said because that was exactly what had happened with USPS.

Looking back, who can say that isn’t so?

There is now a First Class (999) and a Second Class (111) emergency number.

Further reading -
Liverpool Care Pathway - 111, EPaCCs And The 999 Downgrade 
Liverpool Care Pathway - On The Final Stretch
A target-driven approach has been delivered for some years. A lone paramedic may be sent out in place of an ambulance to achieve a faster response time.

In January of this year, NHS England further downgraded the First Class delivery. Pilot schemes were launched giving 999 call handlers an extra two minutes to decide on whether to send out an ambulance.

Time is crucial. The imperative, however, is always the target and the prioritised use of finite resources, not the patient.

Two minutes lost on the First Class delivery. Precious time wasted on the Second Class delivery.

Expecting someone who may not, and most likely does not, possess that knowledge to determine how much of an emergency is an emergency to make the call which service to use is erring on the side of irresponsibility.

The decision is yours and it really could be a bit of a blind date.

The Telegraph reports -

The computer system used by staff to assess callers can refuse to send an ambulance even if a patient has symptoms of a heart attack. Our reporter, working at the telephone service in Oxfordshire, was unable to send a crew to a man suffering from chest pains, because he could not be sure about the cause of his symptoms.
Call handlers were told that when ambulances are “stacked” due to a backlog of requests, emergency crews should not be dispatched without the specific approval of a clinician unless the patient was having a stroke or heart attack. On one occasion when ambulances were “stacked” a senior staff member warned: “People are having heart attacks, they’re not breathing, they’re not getting ambulances.”

The reporter’s mentor was recorded on video admitting: “As horrible as it sounds, one way or another everyone in this room has killed someone indirectly because of what we’ve done…”
More than 96% of the population have an SCR and it is already being successfully used in many settings across the NHS, such as A&E departments, hospital pharmacies, NHS 111 and GP out of hours services and walk in centres. [HSCIC (Health and Social Care Information Centre)]

The HSCIC has responsibility for collecting data from across the health and social care system.

HSCIC has been quietly collecting and storing a broad cross-spectrum of information ever since it was set up in April last year.

In new plans announced 23 June, Community Pharmacists across England will also be given access to the Summary Care Record (SCR).

As 'horrible as it sounds', provision of access to records of patients who have downsized care options in place to call handlers may result in prioritisation to a DIUPR (Death in Usual Place of Residence) rather than an 'inappropriate' hospitalisation against the patients recorded 'wishes'.

"You can get people to say 'no' to almost anything if you ask it in a certain way."

So that's the way the grooming works...

Additional reading -
Liverpool Care Pathway - It Cast Its Shadow Long
Opting out of SCR does not opt out of

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