Liverpool Care Pathway - The End

In the beginning was the end and in the end is the shape of things to come.

The forces, routed, have reformed their regiments and renewed the Long March to 2020.

Fahrenheit 451 (Ray Bradbury, 1953)

“We must all be alike. Not everyone born free and equal, as the Constitution says, but everyone made equal. Each man the image of every other; then all are happy."

- Fire Chief, Beatty

Revisionist History:

"Established 1790, to burn English-influenced books in the Colonies. First Fireman: Benjamin Franklin."

- Fireman’s Rulebook

"Do you ever read any of the books you burn?"

He laughed. "That's against the law!"

"Oh. Of course.”

"You're not like the others. I've seen a few; I know. When I talk, you look at me. When I said something about the moon, you looked at the moon, last night. The others would never do that. The others would walk off and leave me talking. Or threaten me. No one has time any more for anyone else. You're one of the few who put up with me. That's why I think it's so strange you're a fireman. It just doesn't seem right for you, somehow.'"

"I sometimes think drivers don’t know what grass is, or flowers, because they never see them slowly. If you showed a driver a green blur, Oh yes! he’d say, that’s grass! A pink blur! That’s a rose garden! White blurs are houses. Brown blurs are cows. My uncle drove slowly on a highway once. He drove forty miles per hour and they jailed him for two days. Isn’t that funny, and sad, too?"

They crashed the front door and grabbed at a woman, though she was not running, she was not trying to escape. She was only standing, weaving from side to side, her eyes fixed upon a nothingness in the wall as if they had struck her a terrible blow upon the head. Her tongue was moving in her mouth, and her eyes seemed to be trying to remember something, and then they remembered and her tongue moved again: "Play the man, Master Ridley; we shall this day light such a candle, by God's grace, in England, as I trust shall never be put out."

How inconvenient! Always before it had been like snuffing a candle. The police went first and adhesive-taped the victim's mouth and bandaged him off into their glittering beetle cars, so when you arrived you found an empty house. You weren't hurting anyone, you were hurting only things! And since things really couldn't be hurt, since things felt nothing, and things don't scream or whimper, as this woman might begin to scream and cry out, there was nothing to tease your conscience later. You were simply cleaning up. Janitorial work, essentially. Everything to its proper place. Quick with the kerosene! Who's got a match?

Fahrenheit 452 (Reality Check, 2016)

"The Constitution, as a charter of negative liberties, says what the States can't do to you, says what the Federal Government can't do to you, but it doesn't say what the Federal Government or the State Government must do on your behalf." 

- Commander in Chief, Obama

Revisionist History:

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.  

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

-  Express

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

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.

They are being sent home to die...

The final word must go to the Archdeacons of the Pathway, Chairman Ellershaw et al –

“It might strike lay people as odd, but there is little empirical data on the physician skill of diagnosing imminent death. It would appear that much remains to be learned.” There is limited evidence in medical literature of how the dying phase can be identified.
- Diagnosing Dying

That said and done, there are those who boldly go where none have gone before:

The Mail

Priority assessments and downgraded responses.

The paramedic took a quick look.

GSF Barton Method assessment made, the paramedic follows the Lakhani Recommendations and goes on standby.

Further reading -

Liverpool Care Pathway - On The Final Stretch

- Mail Online

Ambulance crews responding to 999 calls are being alerted if a patient is on a list, and can refuse to take them to hospital if they have previously expressed a wish to die at home.

Further reading -

Liverpool Care Pathway - Second Class Delivery

Liverpool Care Pathway - The Terminator

We care. We can help you end your life. In Ontario, doctors are being invited to register their interest in providing assistance to die.

Federal legislation, passed on June 17, 2016 has amended the Criminal Code to permit the taking of life.

Active killing is become a medical therapy.

Doctors and nurse practitioners in Ontario can now provide medical assistance in dying. There is even a referral service available should there not be a doctor or nurse practitioner available to provide treatment.

Your treatment is your right. You may not be abandoned.

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

GPs have been dropped between a legal rock and a hard place. While the Data Protection Act demands that personal data is handled transparently and held in confidence, the Health and Social Care Act has stated that GPs are legally required to provide data to the Health and Social Care Information Centre for the Care.data programme with presumed consent.

Presumed consent is the positive rights and negative liberties model. It is the 'deemed consent' model adopted for organ donation in Wales.

Care.data pseudonymised and anonymised personal data. Even so...

For purposes of demonstrating to Commissioners 'value for money', we are required to pseudonymise and anonymise clients data online using reference numbers instead of names. The reference numbers consist of the Scheme identifier and the tenancy identifier. Effectively, anyone who is determined to discover the client’s identity may do so.

Care.data pseudonymised and anonymised personal data, likewise, has not been impregnable to anyone determined to source identity.

No more...

The NHS announced that the scheme to store all patient data on a single database would be cancelled following the publication of a long-awaited review from Dame Fiona Caldicott, the National Data Guardian (NDG).

In response, NHS England said: “In light of Dame Fiona’s recommendations, NHS England has taken the decision to close the care.data programme. However, the government and the health and care system remain absolutely committed to realising the benefits of sharing information, as an essential part of improving outcomes for patients.

“Therefore this work will now be taken forward by the National Information Board, in close collaboration with the primary care community, in order to retain public confidence and to drive better care for patients.”
-  nhe

The NIB was set up to advise the Secretary of State for Health on the use of powers to set aside the common law duty of confidentiality in England where identifiable patient information is needed and where consent is not practicable.

NIB now works in collaboration with the DOH to digitalise the NHS and tweets as NIB @Health_2020.

The goal is a radical alliance of  Health and Social Care to move forward the digital revolution regardless.

Whatever impediment there is placed in the path the pathway will be followed...

And they are all back where Wee Belong...

It is 'not new or additional guidance' for it is only what has gone before they once belonged.

"It builds on legacy work from NHS Improving Quality and provides practical advice and support for frontline clinicians and leaders on ‘how to’ identify, lead and implement change for themselves to improve their local services in collaboration with their local partner organisations across their community."

It is now 'personalised care' but it is the same graphics and annotations.

The same questions are asked, the same documents sourced -

- Route to Success How To Guide - December 2015

And are we come full circle -

Liverpool Care Pathway – "Six Steps To Success"

From the Fireman setting fires, to the Medics taking lives...

So, get back John, John, get back to where you Wee Belong!

Some final reading for the end -

Liverpool Care Pathway - And Who Is The Victim?

Liverpool Care Pathway - Be Not Disarmed By The Caring Smile

Liverpool Care Pathway - 111, EPaCCs And The 999 Downgrade

Liverpool Care Pathway - The LKP Can Deliver