Liverpool Care Pathway - Transformation

Joined-up services and seamless care.
An integrated NHS and the efficient use of finite resources.



If you have Learning Dis. does that mean you are unwell? If you are Downs does that mean you are unwell?

You are different, as are we all different. You may become unwell, as may we all become unwell. That does not mean you are unwell because you are different.

A few years ago, James Churchill, then Chief Executive of the Association for Real Change, expressed concern that health was taking over social care –

“What I've noticed is how health seems to be taking over social care again,” he sighs. “Escaping from the clutches of the NHS and people who tell you that you’re ill and they need to guide what you do has been one of the major achievements of learning disabilities over the past 20-30 years.”

Although Churchill is pleased the government wants to provide seamless care, he fears medical models will again dominate. He says the Care Quality Commission is a prime example, and questions its ability to regulate both sectors.
- Community Care

Simon Stevens' 'way forward' is supported by the £200m Transformation Fund. The Fund is also being hived off as a ‘dowry’ in a marriage of social and health service care.

The NHS has a responsibility to help local authorities cope with their “tough financial settlement”, health secretary Jeremy Hunt has said.

“We prioritised the NHS by protecting its budget, which meant tougher settlements for other departments including local government,” he said.

“But the interconnected relationship between the services we both offer to vulnerable people means that we in the NHS have a responsibility, as we move to fully integrated services, to help you [in local government] deal with a tough financial settlement.
- HSJ

According to The Independent, Integrated Primary and Acute Care Systems (IPacs) will adopt Zeke’s value judgement Communitarian ‘Finite Resources’ priorities and direct funds to where they are deemed most needed.

 This is The Independent –

The announcement follows a landmark decision to hand over £5bn in NHS spending to a joint local council and NHS authority in Greater Manchester, dubbed “DevoManc”.

The current Health Secretary, Jeremy Hunt, called it a “pivotal moment for the NHS”.

A core aim of the reforms is to break down the traditional barriers that have existed between GPs, hospitals and council-funded social care services, which have existed since the foundation of the NHS in 1948.

NHS England has pledged that patients in the pilot areas will see significant improvements in their experience of health services, with different organisations working more closely, sharing patient information and removing the need for repeated health assessments.

This will facilitate ease of implementation in EPaaCs and of EoLC DNAR decisions.

The Independent reproduces a graphic to demonstrate the ‘increasing strain on NHS resources’. This shows those aged 65 or over as a percentage of the UK population in 20 year slices from 1951 to 2011.

A picture says a thousand words and a graphic illustrates what conclusion the draughter may wish to draw from the statistics.

Percentages of themselves can be misleading when not set against other factors which may affect the outcomes, such as parents having smaller families for instance.

Of greater significance are ‘plain sight’ figures such as the decline in projected numbers of 90 year-olds.

That there is further change afoot is clear. The boundaries between social and health care have become blurred. It is the declared aim that they should disappear.

The HSJ adds –

£200m transformation fund.
Some of the £200m transformation fund to support the development of new care models will be spent on projects not connected with NHS England’s ‘vanguard’ sites, HSJ has learned. The fund was allocated to the NHS by chancellor George Osborne in last year’s autumn statement, as part of a “down payment” to implement the NHS Five Year Forward View. NHS England’s Forward View Into Action planning guidance document, published in December, promised “a £200m would-be investment in new care models”. When it identified the 29 vanguard sites developing new care models in March, the authority said the project would be “backed by a £200m transformation fund”. HSJ understands that NHS England has now committed the funding to a number of projects, but not all of it will be spent implementing the new care models, while some will go to schemes unconnected to the forward view. Some of the £200m will be used to support NHS England’s “transforming care” scheme, which began nearly two years before the forward view was published. The initiative, established in response to the Winterbourne View scandal, is designed to improve services for people with autism and learning disabilities.

- Community Care

The Clinical Directed Enhanced Services (DESs)for GMS contract states -

There is good evidence that patients with learning disabilities (LD) have more health problems and die at a younger age than the rest of the population. The existing QOF registers do not differentiate LD by severity. 
This DES is designed to encourage practices to identify patients aged 18 and over with the most complex needs and offer them an annual health check. Local authority (LA) lists of people known to social services primarily because of their learning disabilities, are to be used as the basis for identifying patients to be offered the checks. The rationale is to target people with the most complex needs and therefore at highest risk from undetected health conditions (usually people with moderate to severe learning disabilities). From the prevalence figures available, it is estimated that approximately 240,000 patients fall into this category across the country. Generally LA criteria for access to social care services are related to complexity of need, although sometimes individuals with mild learning disabilities and other additional health needs, usually associated with mental health needs, will meet social services eligibility criteria.

This is all about identifying suitable candidates for downsized care. See –

Liverpool Care Pathway - The DES

Mark Goldring of Mencap has said that DNR orders are frequently placed on patients with a learning disability.

When boundaries are become blurred they are crossed.

Risk Assessment/Management Plan Form including tick box for Advance Directive -

Liverpool Care Pathway - Back To A Way Forward

Big Nanny State has stepped up to the mark and is already clumping around, trying Big Brothers' size nines out for size.

See -

Liverpool Care Pathway - In Whose Best Interests?

Liverpool Care Pathway - AC/DC

If you have Learning Dis. does that mean you are unwell? If you are Downs does that mean you are unwell?

You are different, as are we all different. You may become unwell, as may we all become unwell. That does not mean you are unwell because you are different.

Additional reading -

Liverpool Care Pathway - A Cry For Caution, A Voice For Valour

Liverpool Care Pathway - So This Is New Year...

Liverpool Care Pathway - A Devonian EoLC