Thursday, 23 May 2013

Liverpool Care Pathway - The Six Million Dollar Plan

A medical protocol discredited... It should have been a mortal blow, but the situation has been retrieved. "We can rebuild this plan..."

We Can Rebuild it -

"The Liverpool Care Pathway, a Licence to Kill People. Gentlemen, we can rebuild it. We have the technology. We have the capability to build the world's only back-door euthanasia plan. The LCP will be that plan.
It will emerge from the review, better, stronger, faster."

 The Six Million Dollar Plan.

Bishop Philip Egan of Portsmouth -

“I am very grateful that the Government has now set up a review in order to fine-tune and improve the LCP...”

Mr. Lamb has asked a panel of experts, who will be undertaking a wide-ranging review of the guidelines, to come up with an alternative name.

Fine-tune, improve, rename...

Catholic Herald 

The bishops’ Department of Christian Responsibility and Citizenship commissioned Professor David Albert Jones to write their report, which has been submitted to the independent inquiry.

Professor Jones said that so far he had not “seen evidence to substantiate the claim that the LCP is structurally unsound or that it is inherently unethical”. But he continued: “It is clear that the LCP has frequently been badly implemented, and I hope that the Neuberger committee can identify practical ways to ensure that the LCP is implemented properly.”

Baroness Neuberger is chair of an inquiry into the LCP (Photo: PA)
Baroness Neuberger is chair of an inquiry into the LCP (Photo: PA) [Catholic Herald]


There are other Pathways in the wings. Enter stage left: The Dundee Dignity Care Pathway...

Stage right...

Marie Curie, stand aside: 
the Macmillan Gals are going for gold! No worries; your expertise is enlisted in the Stars Care Service partnership -

This is "a project to bring together, re-invigorate and locally ‘re-brand’ supportive and end of life care in Liverpool".

The STARS project will operate a computer template added to all GP systems in Liverpool.This will use triaged care level read codes which will prompt clinicians accordingly in regard to level of EoLC need.

Communication with 2ry /OOH CARE– if the template is filled in correctly it will produce a summary page with relevant info for patients with EOLC needs which can be viewed via EMIS web at point of contact.
EMIS is the web access to over 39 million patient records. Once they've got you marked down for the 1%, theres no getting away.

Yes, yes, yes, but...

The protocols have been unfairly attacked -

This is the BBC The One Show 22/05/13
Watch from 38mins for Q&A with Sir Bruce Keogh re: LCP

The One Show-22/05/2013

Justin Rowlatt -

Listen to this because this is from Phillip Charlesworth and his father went into hospital with breathing difficulties but was placed on the so-called Liverpool Care Pathway, which has been interpretted by some people as an effort to deny care to terminally ill patients to ensure they die quickly...

Philip Charlesworth -

My father was on the Liverpool Care Pathway. I'd like to know whether you think it should be suspended while the review is taking place and, if not, why not.

Sir Bruce Keogh -

What I would say to Philip is [pause] is no. You know, there have been a lot of unfair accusations about the Liverpool Care Pathway that, somehow or other, treatment is necessarily withheld or em or people are not fed or watered properly. This, this is simply not true. What the clinicians are trying to do is to make people's last few days as comfortable as possible. My reading of the Liverpool Care Pathway is [measured speech] that the doctors have the discretion em, along with the family, to treat patients as both would see as appropriate and compassionate and honest.

You have rather given the game away there, Sir Bruce. It was always and only a review of how the LCP is used in practice; it was never to question the validity of the protocol itself.

It is a review set up with an outcome already in sight.
It could never be anything else.

The Communitarian Agenda is cemented in place:

The challenges for the health and social care system in our rapidly ageing society and the pressure associated with ongoing public spending constraints are clear for all to see.
Faced with these twin challenges, we can either stand by and oversee a gradual decline in the quality of care provided or we can seize the opportunity to fundamentally change the way we do things. Our task is to find new ways to deliver better care for a greater number of people with fewer resources.
[Health Service Journal]

And e-hospice -

Calls for better training echo those from Help the Hospices, who this week stressed the importance of staff training to ensure the appropriate and effective use of the LCP, as part of its submission to the independent review.

A survey of doctors last month by the BMJ also highlighted the need for training in the use of the pathway, in particular around recognising a dying patient and communicating this to patients and relatives.

Referring to these survey findings, David Praill, chief executive of Help the Hospices, said that the lack of training and understanding of the LCP must be addressed. He said: "Hospices can share learning about identifying patients most likely to benefit from being on the pathway, as well as the structures and processes which will ensure its best use.

"Hospices are well placed to share their expertise in working and talking with patients and families to achieve common goals for care at the end of life, and support for bereaved families and carers."

The RCN and Help the Hospices are among a number of organisations to have signed a consensus statement supporting the appropriate use of the LCP.

The RCN has also developed the joint end of life care patient charter with the Royal College of General Practitioners, and plans to deliver further training, following workshops on end of life care delivered with the National Council for Palliative Care and the National End of Life Programme last year.

If they had been investigating the aircraft, they would have grounded the aircraft. If they were investigating the crashes for pilot error, they would have grounded the aircraft. Any fair investigation could not do otherwise without accusation of bias. The investigation is so biased.

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