Thursday, 20 August 2015

Liverpool Care Pathway - Doing The Addition

Deduction is elementary. The art is in the addition...

Dedicated and thorough researchers like Louise Smith are hard to come by.

Many thanks, then, to Alice Moore for this...

The Plymouth Herald reports –
DEVON Doctors have announced that out-of-hours GPs will no longer be called to verify deaths in Plymouth care homes - to help ensure help can always be given to the living.

As of October 1, 2015 the urgent out-of-hours GP service provider has said it will be the responsibility of the home to arrange for the death to be verified and for the undertakers and family to be informed.

When approached by The Herald, a spokesman confirmed the decision has been made but added Devon Doctors has been going "over and beyond its statutory obligations" up until this point.

He said: "The reality is that this is already what happens in many areas of the country.

"There are a number of organisations which provide training for care home staff in the verification of death and it is entirely legitimate for anyone who has successfully completed this training to verify death."

Verification of death, he explained, is different from certifying death, which explores the reasons why a patient has died and which, the law dictates, must be done by a medical practitioner and does not require the attendance of a doctor.

The spokesman continued: "There is a legal requirement for the certification of death to be completed by the medical practitioner who attended the deceased during their last illness, detailing the cause of death.
Remember those Yellow Folders...?
Liverpool Care Pathway - "Let Your Fingers Do The Walking..."?
This is a 'dynamic' document; as grooming progresses the care expectations may be progressively downsized. Amongst these expectations might be –
• I do not wish for an attempt for my heart and lungs to be restarted if they stopped functioning (Cardiopulmonary Resuscitation)
• I do not wish to be artificially fed or hydrated
• I do not wish to receive antibiotics for a particular infection (please state)
• I do not wish to receive Non-invasive Ventilation (NIV) if my breathing becomes more difficult
Planning for your Future Care

- West Suffolk CCG
These documents include a 'Patient Passport' which provides that:

The Doctor/GP caring for this patient agrees to complete a certificate unless there are reportable circumstances.

Down in Devon, they were frantically reviewing the Review...
Liverpool Care Pathway - Retracting Their Footsteps
And agreed to proceed with the Version 12 LCP as this "helps staff and supports the training programme".

Furthermore -
• Karen Ricketts, Consultant in Palliative Medicine, is undertaking an audit looking at the quality of the use of the Pathway to provide Board assurance that the Pathway is being used appropriately. An update of the audit results will be provided to the Quality Assurance Committee. 
Remember, the Review was not a review into the LCP and did not find against the LCP but into how it had been implemented in practice and it was in that respect it had been found wanting.

So, Ellershaw was let off the hook but Wee Bee Long's training programme was found less than adequate and wanting.

So, who did they charge to set in place new recommendations and revamp the old...?

Be not concerned; it will not harm you: North Devon Hospice had offered 'essential training' on version 12 at six sessions earlier in the year.

And the new recommendations finally released with a fanfare are, essentially, no different from the old.

Now, Devon Doctors, the out-of-hours on-call GP service, are declining to verify deaths.

So, what does this say to anyone who wants to do the addition?

The impact of implementation of EoL documents on GP-attended care home deaths are assessed in The realist evaluation of a palliative integrated care pathway -
CMOC3 – Care home deaths

In order to find whether care home deaths were increasing, a one-way repeated measures ANOVA was conducted. This compared numbers of care home deaths from 2007 to 2012, using Death Audit data.

The means and standard deviations for home deaths from 2007 to 2012 are presented in Table 16; the means show an increase in care home deaths since pre-ICP implementation (2007) to most recent data (2012), but with variation between these two dates.

The document confirms again that “Despite care home deaths not showing a statistically significant increase from 2007 to 2012, they do show a large increase from 2011 to 2012, as shown in Figure 38. This may be due to the recently implemented end-of-life care plan in care homes.”

The end-of-life care plan has only been implemented recently and may be the reason why care home deaths have increased a lot more between 2011 and 2012, in comparison to earlier years, despite the ICP being implemented.
 [Also] …the introduction of the care home end-of-life care plan has lessened the effect of the litigious context.
 Care home staff member: “There has been more emphasis on doing end-of-life care plans in the past few years (in care homes). And actually in (locality) we get assessed by a local authority and it’s all linked to how much we get paid. And they’ve had a big emphasis on end-of-life care plans and basically you get marked down if you don’t have one. So there has been an increase in end-of-life care planning”

This is The School of Sociology and Social Policy at Northumbria University -

This is a presentation of a specific programme theory of ‘embeddedness’ which was tested in different GP practices using various data sources.

Realist evaluation was used to test the programme theory of 'embeddedness' in a palliative care Integrated Care Pathway in primary care and the effectiveness of the use of Champions or Opinion Leaders.
Champion: aids innovation diffusion as they exert influence on others.

Opinion Lead: An opinion leader exerts influence through their representativeness and credibility and can have a positive or negative influence on how a new innovation is adopted (diffused into routine practice). They can be a peer or expert opinion lead.

Champion or opinion leads promote the palliative agenda. Better results (further embeddedness) were seen when champions or opinion leads were present to promote the palliative agenda.
Champions or Opinion Leaders actually do make a difference to keep the ball rolling.

A sample list of care(less) expectations from the 'dynamic document' is provided above.

Such advance care documents including DNRs are now being advanced to the vulnerable elderly by 'trained teams of motivated and committed volunteers'.

Mr. Lilley was objecting...
Liverpool Care Pathway - The 'Art' Of Good Grooming
Oxfordshire Age UK/Compassion in Dying have been recruiting –
Age UK
To co-ordinate the implementation of My Life, My Decision in Oxfordshire. This will include recruiting and supporting at least 3 volunteer Champions, running end of life rights training & awareness talks, promoting the Flagship in the local communities, liaising with Compassion in Dying and overseeing the face to face support for older people wishing to discuss end of life rights and choices.

Recruiting, developing and managing a well-informed, trained, motivated and committed volunteer team to support the Flagship delivery and ensuring that a sufficient number of trained volunteers are available at all times to support the delivery of the project.

Actively seeking service users who may be willing to act as ‘case studies’ to support the promotion of My Life, My Decision in local and national media, and other promotional literature and activities.

With the support of the My Life, My Decision Champions organise and run weekly training and awareness events in the local community.

Promoting My Life, My Decision and Compassion in Dying’s Information Line within the local community and social media; actively seeking opportunities to bring the Flagship to the attention of local community groups and statutory organisations.

Producing quarterly monitoring reports and assisting Compassion in Dying in responding in a timely manner to information & monitoring requests from Big Lottery.

Develop a strong professional relationship with the national My Life, My Decision team and Compassion in Dying’s Information Line.

With the support of the Age UK Oxfordshire Chief Executive for My Life, My Decision ensure that delivery of the service meet all the requirements of the funders and that any service level agreement and/or contract is delivered effectively.

Participate in project and Lottery promotional activities, including submitting posts for the
Flagship blog, attending training or publicity events and help organise promotional visits to
the service for funders if required.

Willing to travel to My Life, My Decision events hosted by Compassion in Dying. Many of

these events will be in central England and/or London.

Age UK

The Age UK logo sits at the head of this document. The job is to further the agenda and programme of Compassion in Dying.

This is classic Entryism. Compassion in Dying are well and truly 'embedded'.

Is this the 'Third Sector Coalition' in practice which Esther Norman champions in Tameside?

This document states:
Compassion in Dying was founded by the non-charitable campaigning organisation Dignity in Dying (DID).
And assures us that:
The organisations have separate boards, which operate independently, but they share a CEO, some staff and premises.
Sarah Wooton is Chief Exec of both organisations. Be not concerned: the Boards are separate. Only some staff and premises are shared.

What staff?

Perhaps some ‘office boy’, ‘take a letter’ admin people...? That would be questionable enough.

Davina Hehir is Compassion in Dying’s Director of Legal Strategy, Policy and Services, and holds the same role at Dignity in Dying.

Philip Satherley is responsible for undertaking and developing Compassion in Dying’s research agenda. Philip is also the Research and Policy Manager at Dignity in Dying.

There are a lot of very fundamental ‘cross over’ responsibilities here.

And wait. If the premises are shared, how is this entered in the books? Where does that sit in the balance of the accounts at the end of the financial year...?

Age UK's good name and resources have been effectively hijacked to promote the aims and objectives of the charitable organ of a campaigning, politically-motivated pro-euthanasia bandwagon.

Danielle Hamm, Compassion in Dying Director, blogs here on the Dignity in Dying web pages –

She shares her Blog page with Dignity in Dying slogans and campaigns in plain view.

Two campaigns, one agenda.

My Life, My Choice!

My Life, My Decision!

It would be to split hairs to say one does not cross over into the other. They are, effectively, indistinguishable; they sit but a stepping stone apart on the same journey along the same pathway.

And do rights become wrongs and these wrongs the undoing and unravelling of 'rights'?

Rights have been seized and written into law, supposedly to ‘protect’.

'Rights' that next of kin have traditionally assumed were theirs by right have been assumed by the State. Big Brother has taken charge and become a Public Guardian...
Liverpool Care Pathway - The Dispassionate, The Merciless And The Cowardly
Liverpool Care Pathway - In The "Best Interests" Of The Interested?
The Big Lottery Fund is quite aware of the connection between DiD and CiD.

Those who do not deem the demarcation of responsibility either a moral imperative or even necessary see nothing amiss.

They are, after all, only promoting Government policy.

The DoH EoLC Programme was outsourced to the NCPC to groom the British public into accepting dying as a positive life choice. Out of this was formed the Dying Matters Coalition chaired by Mayur Lakhani.

NCPC has focussed on the continued raising of the confidence of GPs to diagnose dying and initiate end of life discussions through an ongoing training programme in partnership with Macmillan, whilst campaigning via the 'Find your 1%' campaign for increased use of end of life care registers (death lists) to pint-size care expectations and the training of health and social care staff to initiate and continue end of life care conversations in particular with people affected by dementia.

Everyone was roped in to promote DoH policy and support the roll-out of the Ellershaw (Marie Curie) death pathway (LKP) aka LCP, even as evidence mounted of the medical holocaust that was proceeding.

Everyone was complicit; everyone looked the other way, in self-denial. Even then, the Review which finally proceeded was selective in what was reviewed and remained uncritical of the principle of the Pathway itself and of the practice of diagnosing dying.

CiD has come a long way from promoting a free phone line sponsored by DiD to "working in partnership with 7 local Age UKs".

This dodgy pro-euthanasia set-up didn’t take long to wise up to the fact that they had taken the wrong tack.

They have donned the innocuous red cloak, the hood, palled up with Age UK in London’s East End and what had small beginnings has gone nationwide...

“What big eyes you’ve got, Granddaughter…”

“All the better to see you with, Grandma...”

“The project will also work to raise increasing awareness of End-of-Life rights among GPs and other health care professionals, care homes, and community groups.”

The specific programme theory of ‘embeddedness’ was tested in different GP practices and demonstrated the effectiveness of the use of Champions or Opinion Leaders.

His life; his decision; his choice...

Suicide is never an act of rationality but one of desperation.

When the unsolvable has neither end nor apparent solution, a path opens up conveniently before us and temptingly invites us to follow it to its final destination.

Euthanasia is assisting in the act of suicide, the taking of one's own life.

If the act of taking life is murder, euthanasia is murder.

Compassion is in care, not killing.

This is The Independent –

A boy who saved the life of a suicidal man by simply asking him "Are you okay?” has said he did it because he likes to help people who need help.
Jamie Harrington, from Ballymun, Dublin, told the Humans of Dublin project about a meeting with a man in his 30s sitting on the edge of a bridge and about to jump off it.

After sitting down and speaking to the stranger for 45 minutes, 16-year-old Jamie persuaded the man to go to hospital and seek treatment.

The unnamed man is now expecting a baby boy with his wife, who they will name after the teenager.

Jamie told the Independent: “It was just instinct to help that man and now lots of people around the world know about it.
“I hope it makes people open their eyes to what is going on around them.
So casual do we watch another die? So casual is become our estimate of life.

Instinct really does ‘kick in’ to save and to preserve another’s life. That is a part of being human.

To watch a suicide and stand by and do nothing is inconceivable; to assist in a suicide is inhuman.

Euthanasia will change everything forever.

Further reading -
Liverpool Care Pathway - Changing Minds

Liverpool Care Pathway - A Decision With Many Outcomes

Liverpool Care Pathway - A New Hope...?

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