Liverpool Care Pathway - A Scandalous Affair

To everything, there is a season and a time for every purpose under heaven. But it is not for us to determine or decide...



There are new life and death concepts being slipped in under the radar.

This is being sensible...
This is winding down our lives...
This is accepting and understanding the inevitability of death...

This is responsible decision making.

An elderly couple in Belgium fear they will not be able to fund their care in later years. Their three children will not have the means, apparently, and have sought out a 'Euthanasia Practitioner' to take their parent's lives from them.

Strange is it not that those who scrimped and scraped to make ends meet to clothe us and feed us as babes and bairns may not expect the same from us?

A 'Euthanasia Practitioner'...!

I suppose we might call this person an EoL Facilitator...?

Their attitude will be applauded by some. This is a responsible approach to life and death, after all.

Their lives have reached a defining moment and, adopting a realistic approach to dying, they are planning appropriately for the event. This is a 'healthy' approach to death.

This is recognition of the 'Complete Life'.

They are being supported by those closest to them. Their three children have gained them access to high quality care that will gently ease them from their mortal coil, devoid of prejudice in relation to their personal situation.

There was a time to live and, now that is done, they seek a 'quality' outcome; living and dying well, arrangements have been put in place in advance to prepare.

You have to be 'matter of fact' about these things.

We bystanders, we ask, 'How did we come to this; how did we get here...?'

 'A Time To Die'

 This is Simon Caldwell reporting in the Mail -

Cash-strapped councils are acting like robber barons to fund what has been accepted as the cornerstone of the ‘social contract’ of NHS care – to be cared for from ‘cradle to grave’.

Further essential reading -

Liverpool Care Pathway – Another 'National Scandal'

The State enters into a social contract with the people by accepting money in the form of compulsory deductions taken from income (salary/wages/profits) at source, along with employer's contributions. This is the National Insurance which funds benefits and healthcare.

Having demanded and accepted payment for a service - the provision of healthcare - the State, the government, the NHS or such body designated by State or government to oversee public healthcare, bound by moral duty (and by the laws pertaining to contract!) has a responsibility of continuing care it cannot deny nor fail to keep.

Money has been taken in payment of a service. The provider, therefore, has an obligation and responsibility to provide that service.

You have paid your dues - you have had no choice but to pay - and have worked hard all your lives to pay for your home and to provide for your family...

and then they make you pay for it by snatching it all back to take care of you!

On the same page of the Mail is the following story...

Then, they do 'take care' of you!

The LCP continued in name long after the Lamb promised to scrap it. Some were actually still using version 11!

Where it has ceased to be used, it persists under numerous guises purporting to be a 'personalised' plan but, in essence and in spirit, still the same LCP. At Wirral, they made no bones about it and simply changed the name.

In September, Nursing Times published a defence by Anthony Wrigley of this killing machine, pointing out that the Review was actually an investigation into its use and not of its integrity.Wrigley sees no issue with applying the LCP within the 'Gang of 21' Guidelines.

June saw the publication of these Guidelines in One Chance To Get It Right. This was the much vaunted, long-awaited Wee Bee Long Alliance Fudgeway of 'five priorities'.

On a roll, this past week, Nursing Times owned up to its continued use in a report by Jo Stephenson.

This is the lead line beneath the banner -

Clinicians are continuing to use the controversial Liverpool Care Pathway for end of life, despite a major review concluding it should be scrapped last year, Nursing Times has been told.

 The report continues... 

Anthony Wrigley, a senior lecturer at Keele University who specialises in medical ethics and palliative care, argued that the LCP was “probably the best guidance in the world”, having been developed over many years.

“I am aware that certain institutions have gone back to relying on it,” he told Nursing Times. He said health professionals using the LCP would be “understandably reluctant” to say so, due to its tarnished reputation.

The report quotes Helen Brewerton as saying that there was never any problem with the Pathway and that it was 'assassinated' by the media.

'Never a problem...'

Not even with the pre-version 12 which the Review, significantly, failed to review?

And they are still diagnosing dying...

This is NHS Wales –

"Together for Health - End of Life Delivery Plan" was published in 2013 and provides a framework for action by Local Health Boards and NHS Trusts working together with their partners. It sets out the Welsh Government's expectations of the NHS in Wales in delivering high quality end of life care, regardless of diagnosis, circumstance or place of residence in Wales.The Plan sets out clear ways in which the voice of the individual, supported by those closer to them, is heard and respected at the centre of the services they need.

The vision:

For our population we want:

• People in Wales to have a healthy, realistic approach to dying, planning appropriately for the event

• People dying in Wales to have access to high quality care wherever they live and die whatever their underlying disease or disability, devoid of any prejudice in relation to their personal situation

We will use the following indicators to measure success:

• % of people dying in place of preference

• % of people with palliative needs on a primary care practice Palliative Care Register six months prior to death

• % of people who die in usual place of care

• % of people in Wales who die intestate

These are new life concepts that are being slipped in under the radar.

Being sensible...
Winding down our lives...
The inevitability of death...

A 'healthy' approach to dying.

Stated aims are -

To live and die well and to improve outcomes between now and 2016.

Detect and identify patients early for palliative care.

Living and dying well and supporting 'quality' outcomes may preclude curative options where such outcomes are determined insufficiently qualitative.

"Really, do you want to live like that...?"

Falconer's EoL Euthanasia Bill is due for a reading in the House of Lords in November. This is a signal event. Now, we are come to this.

The focus is on 'quality' outcomes.

This is Heywood, Middleton and Rochdale Clinical Commissioning Group -

The absolute focus on treatment options which improve ‘quality’ outcomes is a ‘quality of life’ judgement of treatment outcome.

‘Healthier people better future’ may be seen in a totally different light in the context of fewer unhealthy people through non-pursuit of outcomes which lack ‘quality’ via palliative rather than curative options.

If the demand is outstripping the available resources, quite simply, you cut down the demand on those available resources...

The spending authority [NAO] said councils may increasingly have to consider “managing demand or reducing services”, - The Telegraph

Read further here -

Liverpool Care Pathway - Crying Wolf

Footnote:

Yes, whether distinguished journalist...

- This is Wiltshire

or renowned musician...

- Liverpool Echo

or the countless anons who have perished in this medical holocaust...

You may be sure you will be treated likewise, without fear of favour and ‘devoid of any prejudice’ in relation to your personal situation, for that is the Communitarian ethos.

The 'slippery slope' has an Hideous Strength that determines its path. This is no chance outcome but a growing and relentless pressure...

Liverpool Care Pathway - Still Chasing The Pathway