Liverpool Care Pathway - Bold As Brass And As Brazen

And when the swing is complete, it will have gone full circle...






This is Commissioning person centred end of life care –

This is all just overboard PC or sounds like it; this is all just puff ‘n stuff for a Mission Statement –

We have:

•Given due regard to the need to eliminate discrimination,
harassment and victimisation, to advance equality of
opportunity, and to foster good relations between people
who share a relevant protected characteristic (as cited
under the Equality Act 2010) and those who do not share
it; and

• Given regard to the need to reduce inequalities between
patients in access to, and outcomes from healthcare
services and to ensure services are provided in an
integrated way where this might reduce health
inequalities

•We have also given due regard to the responsibility that
CCGs have a duty to actively involve local people as
stated in the Health and Social Care Act [2006 amended],
2012 Health and Social Care Act (amending the NHS Act
2006) c. 7 PART 1 Further provision about clinical
commissioning groups Section 26 Section 14z(2)1,
Health and Social Care (Safety and Quality Act) 20152.

What is this? What has this got to do with health care? Sorry, I forgot. This is not health care; this is end of life care.

Meanwhile...

The revisionists are hard at work attempting to rehabilitate Joe Stalin. This is classic revisionism:

This is the Transforming end of life care in acute hospitals - 'How to' guide -

NHS England's first strategy for end of life care in England, published in 2008, has succeeded in reversing the trend of increasing the proportion of deaths taking place in hospital. 

The EoLC Strategy actually produced the medical holocaust that was the LCP.

The EoLC strategy subsequent to the discrediting of the LCP has been to carry on as before but call it something else and, using EPaCCS, shunting the punters out the hospital back into the community and, better still, signed off onto an AD that keeps them in the community setting.

Here is NHS England with "Commissioning person centred end of life care – a toolkit for health and social care" -

Providing high quality end of life care that is truly centred around the needs of the individual and their loved ones is an important outcome to aim for. Given the complexity of ensuring all the patient’s needs are met, wherever possible, requires all the agencies to work together.

As Lenin might have asked: What is to be done?

What is all this obsession about ‘end of life’ care? What about just basic ‘care’?

Let’s look at that statement again with some basic amendments…

“Providing high quality end of life care that is truly centred around the needs of the individual and their loved ones is an important outcome to aim for. Given the complexity of ensuring all the patient’s needs are met, wherever possible, requires all the agencies to work together.”

THAT should be basic to ALL care. That should be at the heart of all care. So, why isn’t it?

And all that Mission Statement twaddle above…?

Of COURSE there is discrimination. Just ask the Cancer Drugs Fund why Ibrutinib was suddenly ‘disappeared’ off the NHS website last November/December!

Everyone must have fair and reasonable access to dying but not fair and reasonable access to living.

This is Ambitions for Palliative and End of Life Care -

The building blocks for achieving these ambitions:

Honest conversations

Person centred care 

Helping to take control

Clear expectations

These may be ‘said and dones’ for all care. To single out ‘end of life’ is discriminatory. Determining ‘end of life’ and ‘diagnosing’ dying is a self-fulfilling prophecy.

Ambition statements:

“I live in a society where I get good end of life care regardless of who I am, where I live or the circumstances of my life.”

“I live in a society where I get good end of life care regardless of who I am, where I live or the circumstances of my life.”

“I get the right help at the right time from the right people.”

“Wherever I am, health and care staff bring empathy, skills and expertise and give me competent, confident and compassionate care.”

These are musts for all care, not just EoL care. But it isn’t.

Forward Ambitions for Palliative and End of Life Care:

“Death and dying are inevitable. Palliative and end of life care must be a priority. The quality and accessibility for this care will affect all of us and it must be made consistently better for all of us. The needs of people of all ages who are living with dying, death and bereavement, their families, carers and communities must be addressed, taking into account their priorities, preferences and wishes.”

A New Perspective:

Death and dying are inevitable; therefore, care is always a priority. The quality and accessibility for this care will affect all of us and it must be made consistently better for all of us. In this world 'nothing can be said to be certain, except death and taxes' [Ben Franklin]. Everyone, of what any age, is living with dying, death and bereavement. Death does not differentiate; Death is the ultimate leveller. Therefore treasure life. Treasure the life we create in the womb. Treasure life until the end of life. Life is too readily snuffed out. Life is not too readily ‘reassembled’ [Johnny Five]. Life and concern for life is always paramount because life is precious and living matters.

There is a Foreword in the extended document -

The Foreword is signed off by –

Professor Bee Wee National Clinical Director for End of Life Care, NHS England
Dr Jane Collins Chief Executive, Marie Curie
John Powell Policy Lead for End of Life Care Association of Directors of Adult Social Services

The Wee Belong of the Leadership Alliance and her stiff unswerving advocacy of the LKP is well known to readers of these pages...

Liverpool Care Pathway - End Of Year Review Of Outcomes

Marie Curie launched and promoted the LKP via the DoH EoLC Strategy. Marie Curie's own Chairman Ellershaw, devised the LKP...

Liverpool Care Pathway - Cast Iron Protection

Liverpool Care Pathway - The Report

Marie Curie's new leader, also a staunch supporter of the LKP, has had mention -

Liverpool Care Pathway - The Trouble Bubble Shooter

John Powell has not had prior mention but the joining up of health and social care as cautioned by James Churchill some years ago has been discussed previously...

Liverpool Care Pathway - Crying Wolf

Liverpool Care Pathway - When The Funding Had To Stop

Liverpool Care Pathway - The Reaper At the Town Hall Door

The Health and Social Care Economy has arrived. Health is taking over social care, seamlessly, in a joint funding operation -

Liverpool Care Pathway - And Who Is The Victim?

The National Palliative and End of Life Care Partnership which publishes this document includes –

National Palliative Care Nurse Consultants Group

Readers of these pages will be acquainted with this group(s) and their lead, Margaret Kendall...

Liverpool Care Pathway - Of Deception And Infamy

Liverpool Care Pathway - Of Deception And Infamy (Part II)

Liverpool Care Pathway - Curiouser And Curiouser And Curiouser

Liverpool Care Pathway - Catch Up EoLC

And here they are again, bold as brass and as brazen.

Here is the Treatment Escalation Plans (TEP) from Royal Cornwall -

Review Date: 24 September 2015
Next Review: Aug 2016
Reviewed by: Jay Over - Resuscitation Officer

• A TEP must be completed if the answer to the life expectancy question “Would
you be surprised if this patient died within next 6-12 months? is no.
• A TEP must be completed for all patients who are at risk of deterioration/cardiac arrest.
• The responsibility for making treatment decisions including resuscitation rests with the consultant in charge of the patient’s care.
• In the absence of a consultant, other doctors with at least 3 or more years registration with the GMC (deputy) may make these decisions in urgent circumstances for adult patients only; CT1 and above. If there are any doubts about the right course of action, a consultant should always be contacted to discuss what to do.

An adult, over 18 years, with capacity can refuse treatment.
A patient cannot demand resuscitation which is not clinically indicated.

The Version 4 Decision Record contains the TEP -

The TEP document itself advises use of the GSF Barton Method as a prompt to enact the TEP.

Elsewhere, the document states:

1.3. Nevertheless, it is not an appropriate goal of medicine to prolong life at all costs with no regard to its quality or the burdens of treatment on the patient.

It may sound commendable to say, as this document does, that 'it is not an appropriate goal of medicine to prolong life at all costs with no regard to its quality or the burdens of treatment'.

However, a decision taken to not act to save a life is tantamount to a decision taken to take a life...

It is a cold and calculating judgement call over-riding the natural emotional response to plunge in and help -

Liverpool Care Pathway - On The Final Stretch

Liverpool Care Pathway - Life And Death Café

Liverpool Care Pathway - Doing The Addition

Wiltshire are also using TEPs -

Resource Pages on the Wiltshire website are using video presentations courtesy of South Devon TEP.

One of these is copyright 2012, the height of the LCP medical holocaust.

And it's business as usual...

“They (hospital staff) said they don’t really operate on people over 80-years-old.”
“They said ‘do you want to put him through that’. We said he has no chance of life without it.”
- Alison Turner

Liverpool Care Pathway - After The Review, After Everything, They're STILL Killing People

Over in the States, Affordable Care sounds like it means making care affordable; it doesn’t. It means what it means on this side of the pond; making care affordable for the provider, which means rationing care.

Rationing care means downsizing treatment expectations.

In this world nothing can be said to be certain, except death and taxes [Ben Franklin].

The circle is come full circle...

- The Mail

and complete...

Liverpool Care Pathway - Whether Shove Comes To Shovel, It's Still A Spade

But one last final thought to leave you with -

Liverpool Care Pathway - Advancing The Will To Live