"The NHS is one of this country's greatest achievements. At the same time as we are protecting its budget, we are building an NHS able to meet patients' needs and expectations now and in the future." (Health Secretary, Jeremy Hunt)There has been a focus on ‘dying at home’ in recent months. This phrase has been on the lips of many. However, it is valid to ask: Is the NHS encouraging frail patients to die at home rather than to seek life-saving treatment which costs money?
Part of the CQUIN framework is the PROM. PROMs "are a means of capturing patient perspectives on the effectiveness of their care". The only problem with PROMS in regard to the LCP, of course, is that the patient is (more than likely) dead.
A super highway is now in place. A Rapid Discharge Pathway -
This will greatly facilitate the freeing up of beds by shipping out those diagnosed as 'dying' cluttering up our hospitals!
Are we witnessing the creation of the Communitarian Health Service?
Graeme Archer writes in The Telegraph -
I wonder if the creators of the Liverpool Care Pathway are familiar with Anthony Trollope’s writing? Not the Barsetshire books, nor the Palliser series, but his little-read 1882 novel, The Fixed Period.
What’s amazing about that book is that it’s a work of dystopian science fiction. It describes Brittanula, a former British colony that, in the heat of its founding assembly’s post-colonial rush, instigates a raft of liberal and humane measures; the death penalty is abolished, for example.
The death penalty for criminals, that is. The first generation of young Brittanulans, mostly in their thirties, also pass a law requiring all citizens over the age of 67 to be euthanised, in order to spare them the indignities of infirmity, as well as preventing a financial drain on a young nation.
The youthful disdain for old age, legislatively expressed by Brittanula’s founding fathers, turns, of course, to horror, as the end of the oldest citizen’s “fixed period” finally approaches. The government of the former colonial power, Britain, decides that it cannot tolerate state-sanctioned euthanasia, and that it must re-involve itself with Brittanulan affairs.
Which is when you remember that the novel is fiction, whatever some of the more hair-raising stories about the Liverpool Care Pathway might lead one to believe. Disquiet over the LCP isn’t that patients close to death don’t receive every possible medical intervention that could prolong their existence; the worries about LCP arise from reports that it is sometimes invoked without informing either the patient or family (there is a chilling passage on the NHS website that discusses the “pathway”, stating calmly that “legal consent is not required to place a patient on the LCP”).