Thursday, 6 August 2015

Liverpool Care Pathway - Not By A Long Shot

It is freely admitted. There has been a medical holocaust. The crimes are legion, without number. There is no complete record.

The seismic shift continues to pint-size care expectations and see the glass half-empty.

A whole generation of doctors have had their minds set by this mindset. All change! Nothing’s changed...

The Review was selective of what was reviewed. And the guilty go unpunished.

The NICE draft guideline is out for consultation with stakeholders.

The anticipated publication date for the final document is December 2015.

NICE sanctioned and backed to the hilt the validity of the death pathway (LKP) aka LCP. These same people are involved in compiling the new recommendations and the final document.

This is the draft document, Care of the Dying Adult –

The Mail did not falter, did not fail, but persevered and persisted to shake the very foundations of this monstrous edifice to bring it down.

Mail Online sings its own praises 

The Liverpool Care Pathway caused NHS staff to take an ‘industrialised approach’ to the treatment of dying patients, a leading doctor has admitted.
Professor Rob George, president of the Association of Palliative Medicine, told of how medical staff became obsessed with ‘ticking the boxes’ rather than basic human compassion.
He was speaking as NHS watchdog the National Institute for Health and Care Excellence (NICE) published new guidelines to finally replace the pathway.
Professor Rob George, president of the Association of Palliative Medicine, says:
The problem in a sense with an industrialised approach to managing dying people is that everybody gets preoccupied with ticking the boxes and not looking at the person in front of them,’ he said.
‘Let’s not forget we are dealing with people who are dying and who are distressed.
‘It’s not about diagnosis and pathology, it’s about death and people.’
Dr. Tony Cole, chairman of the Medical Ethics Alliance, says:
You would think that the withdrawal of something as obviously wrong, flagrantly inhumane and at times downright cruel as the Liverpool Care Pathway would be a victory for common sense. But not a bit of it.

Nor can the axing of the controversial care programme — under which terminally ill patients were routinely deprived of food and water and kept under heavy sedation until their accelerated death — be described as a victory for politicians, or even for the medical profession to which I’ve otherwise been proud to belong for more than 40 years.

No, the withdrawal of the LCP, the demise of which was confirmed yesterday when new draft guidelines were published by the National Institute for Health and Care Excellence (NICE), was a victory for press freedom and for the Daily Mail in particular.
But it's not dead yet.

Not by a long shot.

They have changed the title, edited the script, but the story-line is the same.

They’re still diagnosing dying.

This is Pulse 

GPs are being encouraged to take more responsibility for informing dying patients and their families when the end of life is near, including being more open about prognosis, under draft guidelines from NICE that are intended to replace the Liverpool Care Pathway.
The draft recommendations also call for GPs to be more proactive in stopping any unnecessary medications in patients approaching the end of life, and anticipating what treatments the patient may want to alleviate symptoms.
GP experts welcomed the guidelines which they said reaffirmed current practice among GPs, but also provided more explicit standards and clearer advice on recognising when patients were dying.
  • ‘Discuss the dying person’s prognosis with them (unless they do not wish to be informed) as soon as it is recognised that they may be entering the last days of life and include those important to them in the discussion if the dying person wishes’.
  • ‘Provide the dying person, and those important to them, with accurate information about their prognosis (unless they do not wish to be informed), explaining any uncertainty and how this will be managed, but avoiding false optimism’.
  • ‘When it is recognised that a person may be entering the last days of life, review their current medication and, after discussion and agreement with the dying person and those important to them, stop any previously prescribed medicines that are not providing symptomatic benefit or may cause harm’.
This all sounds remarkably like the Ellershaw guidelines.

Mayur Lakhani, author of the Lakhani Recommendations, is cited:
Professor Mayur Lakhani, a practicing GP who chairs the Dying Matters Coalition and NHS West Leicestershire CCG, said the guidance was ‘very useful’ and ‘mainly confirms what is existing good practice’ as well as ‘offering much clearer guidance on recognising and identifying the dying patient’.

He said GPs should note that the guidance is ‘more explicit about the standards’ required, and they should be ‘more open about prognosis and telling patients and families that the end of life is near’.

Professor Lakhani added that ‘there will need to be more team working and involvement of GPs in the last few days of life and GPs should be prepared for this type of multidisciplinary team working’.
Amongst these additional Lakhani recommendations is that there will need to be more ‘team working’ and GP involvement in this ‘multidisciplinery’ team working.

Diagnosing dying is fraught with challenge. The LCP Review itself stated: “There are no precise ways of telling accurately when a patient is in the last days of life.”

It takes a determined and indomitable individual to beat their own drum and not become submerged in the mass. Individual reservation will defer to the authority and opinion of the group.

The Wee BeeLong Leadership Alliance for the Care of Dying People  has spoken.

All change! What’s changed...?

This holocaust has as its basis, as did its predecessor, an economic driver in the engine room...

As well as a syringe driver on the ward!

HSJ reports –
In a letter sent this afternoon, Monitor chief executive David Bennett has restated that the current financial forecasts for 2015-16 are “simply unaffordable”, and asked each foundation trust to revisit their plans.

The letter, seen by HSJ, tells trusts to “ensure vacancies are filled only where essential”, and ensure that existing safe staffing guidance has been adopted in a “proportionate and appropriate way”.

It also advises that financial impact should be considered while managing waiting lists, as well as patient experience.
The Monitor is easing up on the monitoring.

Trusts are failing. Trust is failing.

It bears repeating that it is not medically possible to diagnose dying or to forecast death with any degree of accuracy.

The problem is that, having suggested such a prognosis, and that such authoritative medical opinion is being expressed by the palliative care team, it becomes that much easier to persuade patient and patient's family of the futility of treatment in favour of palliative care.

DNR also provides a moral dilemma. A passive decision to not intervene to save a life is tantamount, morally, to an active decision to take a life.

DNR, also, is an "active killing" which the law permits.

DNRs are being promoted in an unholy alliance of a dodgy pro-euthanasia group and the well-respected Help the Aged Age UK.

Downsized Care

The Lakhani Recommendations have downsized CPR.

The Byatt Recommendations have downsized treatment...
Writing in the journal Evidence Based Medicine, Dr Byatt said: “The data strongly suggests that we are over-treating many over-80s.
The Telegraph

Further reading -
Liverpool Care Pathway - The Shameless And The Brazen

Liverpool Care Pathway - The 'Art' Of Good Grooming
These things considered...

Professor Pulliccino stated: “There is no scientific evidence to support a diagnosis that a patient is in ‘the last hours or days of life’. 
Professor Sir Mike Richards, speaking at OPCARE9, said "It is admitted that the signs and symptoms that indicate the onset of the dying process are neither clear nor understood."
Last word -
Liverpool Care Pathway - In The Beginning Was The Pathway...

Liverpool Care Pathway - The Reaper At the Town Hall Door

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