Monday, 28 July 2014

Liverpool Care Pathway - On Pint-sizing Perceptions of Care And The Betrayal Of Trust

They need your consent. To get your consent, they have to get you to pint-size your care expectations and see the glass half empty.

With a literature review published on PMC, this is The British Journal of General Practice –
Heart failure is an unpredictable, progressive, and incurable condition. Around 1 million UK citizens1 and 5 million US citizens are estimated to be living with heart failure: 1% of the general population and 15% of those aged over 80 years. Heart failure is a leading cause of hospital admissions, and a substantial drain on healthcare resources: it is mentioned on one in eight US death certificates.
A “leading cause of hospital admissions...”

A “substantial drain on healthcare resources...”

Already, the mindset is cost, not care.
The prognosis associated with a diagnosis of heart failure is poor, worse than for many cancers; 38% of patients are dead within 1 year of diagnosis and 60% within 5 years. Around 50% of deaths are sudden, especially in the less severe stages, from arrythmias or ischaemic events; many of these patients are reported to have had a good quality of life in the month before death.
The prognosis is “worse than for many cancers”.

But it is the interpretation of data which determines perception...

62% of patients actually survive longer than one year; 40% survive longer than 5 years. 50% of deaths are not sudden.

Clearly perceptions are being pint-sized to confine expectations to finite horizons of care.

There was early recognition that reduction of hospital admissions is key to cost-cutting...
Community-based heart failure nurses have been in place since 2003: their focus is primarily on optimising medical management and admission reduction
This precedes introduction of the EoLC Strategy.
Clinicians often have a treatment imperative that makes it difficult for them to face the limitations of modern medicine and introduce EOLC issues. Prediction of the time of death is almost impossible, confounding even the best prognostic models: in one study more than half of those who died within 3 days had been estimated to have a prognosis of over 6 months. Patients may have been close to death on several occasions, and seek hope through a positive reconstruction of the threat to life.
“Prediction of the time of death is almost impossible, confounding even the best prognostic models

The EoLC Strategy recognises that pint-sizing care expectations is key to cost-cutting...
The first step of the 2008 NHS EOLC strategy ‘End of life care pathway’ is entitled ‘Discussions as the end of life approaches’.
The EoLC Strategy...
calls for ‘a significant culture shift within the public and the NHS’
literature reveals that many ‘EOLC conversations’ are largely limited to advanced directive paperwork and choices for resuscitation rather than communication about goals and future care options. There is a low level of agreement between doctors and patients, and doctors and family members, as to whether EOLC conversations have taken place at all, and discrepancy between these groups regarding their perception of the amount of information exchanged; this raises questions concerning the reliability of clinician reports and the adequacy of the form and content in which clinicians discuss EOLC.
There is always the assumption that what can be done will be done. You don’t just throw in the towel.

Every day is a bonus and to be able to squeeze another day out of the toothpaste tube is always a plus. You just stay positive.
Recent years have seen dramatic therapeutic advances in the management of heart failure that have significantly improved patients' survival and quality of life
As EOLC comes to the fore across the NHS, there is a growing tension between active management and the need to communicate an uncertain and poor prognosis: a double message that is difficult for clinicians to communicate and for patients to receive.
Pint-sizing care expectations has become imperative to successful implementation of EoLC.
Doctors tend to focus on current aspects of medical management rather than the future, approaching heart failure as a problem to be fixed instead of a terminal illness; this may hinder communication concerning wider and longer-term patient needs. They fear alarming patients unnecessarily, creating anxiety and depression, destroying hope, and causing patients to give up the fight for life. Doctors tend to focus on current aspects of medical management rather than the future, approaching heart failure as a problem to be fixed instead of a terminal illness; this may hinder communication concerning wider and longer-term patient needs. They fear alarming patients unnecessarily, creating anxiety and depression, destroying hope, and causing patients to give up the fight for life.
The Macmillan-funded study concludes...
Heart failure patients need clinicians to be sensitive to their individual wishes for EOLC conversations, which change as events and time unfolds. Clinicians who tend to avoid such difficult conversations need to learn to pick up the cues that the patient would like to talk further. Those who view open awareness as the best way to prepare for the EOL need to live with the internal tensions created when patients are reluctant to discuss this. A dual approach of continuing active treatment while acknowledging the possibility of death, at least to ourselves, is perhaps the way forward: ‘hoping for the best but preparing for the worst’.
The researchers agree that those discussions are all-important. Stephen Barclay is a leading researcher in this study.

Dr. Barclay leads the CLAHRC End of Life Care Research Group, which is based in the Institute of Public Health and is a member of the General Practice Research Unit.

Stephen Barclay was involved in the development of the Share my Care EoLC register. We have seen these registers spread and multiply. They have been called Death Lists.

Further reading -
Liverpool Care Pathway - There Are Always Consequences
Liverpool Care Pathway - The State Rules, Okay?
A culture-shift has taken place in the NHS across all levels, from GP Practice to hospital ward. Call it what you will, this is social engineering...
Liverpool Care Pathway - Nudge, Nudge, Say No More...
In November 2012, Mail Online reported -
The Health Secretary has acted after the Mail highlighted chilling cases in which patients were placed on the Liverpool Care Pathway – which involves withdrawal of fluids and food – without their relatives’ knowledge.

On Monday he will announce rule changes that will see end-of-life care included for the first time in the NHS Constitution.

The document lays down principles that all doctors must follow.

Last night Mr Hunt said he would enshrine the ‘basic right’ of patients to be involved in decisions when they are mortally sick.

He threatened ‘tough consequences’ for hospitals that fail to consult.

Patients and their families will be able to sue health trusts that break the rules and doctors who ignore their wishes face being struck off for misconduct.

Mr Hunt said he would enshrine the ‘basic right’ of patients to be involved in decisions when they are mortally sick.

Let’s say that again...

Mr Hunt said he would enshrine the ‘basic right’ of patients to be involved in decisions when they are mortally sick.

The Neuberger Review focussed on this, also –

One of the central issues causing difficulty in the use of the LCP seems to be misunderstanding and uncertainty over whether deciding to implement the LCP is a treatment decision, requiring the patient’s consent or requiring the decision to be taken in the patient’s best interests if they lack capacity. In some cases, relatives and carers incorrectly consider they are entitled to decide whatever treatment their relatives receive, and in others clinicians fail to seek consent from a patient or consult the relatives and carers in a ‘best interests’ assessment when treatment is being changed.

The LCP is not a single, simple medical procedure, and so there is no legal requirement for consent to be sought before it is used. Some aspects of the LCP do not concern treatment, but others, such as medication changes, do. Patients, relatives and carers are always entitled to explanations of how decisions have been made and a chance to understand them, but all too often they have not been afforded that opportunity. The LCP documentation is deficient in making distinct and clear where the need for consent and explanation exist.
Well, they had to say that to cover themselves against pre-V12 litigation but it does negate Mr. Hunt's stated assurances.

They do own up that...
The LCP documentation is deficient in making distinct and clear where the need for consent and explanation exist.
And that is quite alarming!

This is what NHS Choices has to say –

Consent to treatment is the principle that a person must give their permission before they receive any type of medical treatment or examination. This must be done on the basis of a preliminary explanation by a clinician.
Consent is required from a patient regardless of the intervention  from a physical examination to organ donation. 
The principle of consent is an important part of medical ethics and the international human rights law.
There does appear to be a fundamental principal of understanding that patients should have a right of say in the course of their treatment. That this should need to be a point of discussion at all is alarming; it should be a no-brainer!

In June, Lord Dyson ruled in the High Court that...
" there should be a presumption in favour of patient involvement."
and -
“doctors should be wary of being too ready to exclude patients from the process on the grounds that their involvement is likely to distress them”.
Further reading -
Liverpool Care Pathway - A New Hope...?
Liverpool Care Pathway - So Readily Do Perceptions Change...

On the day they decided to put her down, May was alert enough to respond indignantly to the doctor who hauled her about to examine her: “What are you doing?”

If May was in pain at that time, she would have moaned, groaned; she would not have responded in the manner she did.

The doctor ignored May’s remonstration and turned to address those members of the family present that he would get May an x-ray. The doctor went off.

He returned to say that he had consulted with his LCP team. The EoLC Nurses had already primed the family and they readily agreed for May to go on the LCP.

Minus one.

One of May’s daughters had stood her ground through and through and had warned of the LCP. She had been dismissed.

But wait...

May had capacity. The hospital readily admits to this. Did she not have a say in her care?

Read further here...
Liverpool care Pathway - A True Story

Liverpool Care Pathway - Responses Will Be Answered 
Liverpool care Pathway - A True Story Supplemental

The case is clear...
Patients and their families will be able to sue health trusts that break the rules and doctors who ignore their wishes face being struck off for misconduct.
How can this be then that, after all the uproar, furore and publicity, law firms have not heard of the LCP?

Small-time ambulance-chasers perhaps, but Senior Associates at high-profile law firms ...?


In June of last year, the NHS Litigation Authority, working with the Department of Health, appointed a new £400m legal advice panel of solicitors to provide legal services to 15 DoH organisations over the next four years.

Well then, what chance do we stand anyway to bring  a case when those paid by the public, working for the public and, therefore, with a duty to the public commit grave error against the public and then use those funds provided them by the public to pay lawyers to refute these charges the public have made against them?

They and their establishment cronies have literally got away with murder.

I rest my case.

Additional reading -

Liverpool Care Pathway - Culpable But Not Answerable

Wednesday, 16 July 2014

Liverpool Care Pathway - Telling It More How It Is

What nonsense! How could they connive medical mass killing? Unthinkable. How could they connive a cover-up of child abuse at Westminster...?

They call these child abusers Paedophiles. The Press rants of a 'Paedo Ring' at Westminster. That is to fall into a trap the Paedophile has set for you to fall into. Call them what they are: Child Abusers!

It began with small beginnings.

Give something a familiar and friendly handle and, already, it is halfway to being accepted and the mantle of guilt is lightened and put into a different, if distorted, perspective.

This is...
Liverpool Care Pathway - Telling It How It Is
And that is what happened in the late Sixties and Seventies. The Loony Left took up the Cause Célèbre of yet another ‘persecuted minority’ and Political Correctness soon placed these vile scum above and beyond any thought of wrong-doing or criticism.

The Woolly-brained Liberal-leaning Left like Fulford, who was involved with Shelter at that time, provided sympathy and support. Notoriously - incredibly! - the Paedophile Information Exchange actually won support from public funding.

It easily slips the mind that these Left Loonies drifted into the political mainstream, seeking and finding the prominence they always craved. MPs like Jack Straw contributed to Black Dwarf. Denis Healey was ex-Revolutionary Communist Party (not to be confused with the ossified CPGB).

Harman and Hewitt were leading NCCL activists and opposed such charges as "corruption of public morals" as outrageously outdated and more to do with the same 'religious claptrap' which had opposed homosexuality. Such charges were akin to a charge of 'witchcraft' being made, belonging to a bygone age, irrelevant and outdated to what they perceived as the advanced social and moral perspectives of the time.

Allen Ginsberg was an advocate of 'intergenerational sex'. The establishment interlopers, like Harman, would have been aware of this and that would certainly have influenced a decision to provide support – sympathetic if not actual – to people like Tom O'Carroll.

Cool man!

Harman denies support of PIE, but she has always followed the leader as the most convenient pathway to self-advancement. She both supported the Blair decision to back regime change in Iraq and condemned that decision under little bro, Ed, to the chagrin of big bro, David. The regime change, of course, was a resounding success; it just wasn't quite the regime change they anticipated or expected.

Give something a familiar and friendly handle and, already, it is halfway to being accepted.

The ‘funny man’ you were warned to steer clear of as a kid – which featured, I remember, as a bit character lifting a little girl onto his push-bike in a 1950s Jack Warner film in which Warner plays a London bobby - has had his profile raised, his conduct made a focus of his behaviour and politicised.

I can remember reading references in Black Flag which set the conduct of the Paedophile or 'child lover' apart from, for instance, the ‘Tom Brown’s Schooldays’ rampant power trip type of conduct such as that engaged in by Westminster MPs getting spiffing orgasms from the vile abuse of the young and the vulnerable.

This is back in the 20th century when the Black Flag was the Black Flag of Anarchy... which is what makes today's world so seriously surreally déjà vu. In this 21st century, young British men are seeking to overturn the establishment with the Black Flag of Islam!

This all stemmed from a distortion of the Reichian/Freudian concept of child sexuality. Reich was much in vogue in the late Sixties/Seventies. He has the odd distinction of having had his books burned by both rabid Nazis and an over-zealous, myopic FDA. Reich's premise was that sexual repression is at the heart of all human woes.

The author of the book, 'The Sexual Revolution' did not personally author the 'sexual revolution'. Reich's work, however, is a reference point for what proceeded.

The crime of committing political incorrectness, of being accused of being a Reactionary or of being Victorian was of greater consideration and import to them than the crime of child abuse. This was, after all, another minority needing promotion and support. It was Society that required grooming into acceptance.

This was yet another case of discrimination on the grounds of sexual orientation. The archaic social mores had to be challenged. Those who called themselves Paedophiles actually considered themselves 'advanced'. It was society that was lagging behind.

Like the case of the Emperor's New Clothes, no-one dared to stand up and stand out and challenge. Is this how so many got away with it for so long?

And the loony left is still around. A work colleague has confided that her group are seeking to "distance" themselves from NAMBLA, the US man/boy love association.

ILGA (International Lesbian Gay Association), which achieved UN consultative status, also had links with pro-paedophile activists.

NAMBLA presents itself as anti-authoritarian, pro-liberty, pro-freedom-of-thought and cautions on the expanding Regulatory State.

The presentation is glib, slick.

Well now...

There are parallels here in the manipulation of language to alter perception and to change minds.

For many, many moons that slipped unnoticed and ignored upon their solitary course across heaven’s dark vault, a concerned and campaigning Daily Mail has thundered forth its campaign for Dignity For The Elderly...

The whistle has been blown, a shrill and persistent rousing blast: a call to act!

And the rules of the game have been rewritten and the goal posts moved.

At long, long last is come to fruition the response to the tireless efforts of that newspaper and, in answer to the rally call, is offered the one and only ‘dignity’ the elderly may be promised, may expect, or may find...

And Falconer's Bill has gone to the Lords to be debated when the Bill receives its Second Reading on Friday 18th July.

It began with small beginnings.

Give something a familiar and friendly handle and, already, it is halfway to being accepted and the mantle of guilt is lightened and put into a different, if distorted, perspective.

Notoriously - incredibly – a pro-euthanasia group has also gained support from public funding.

The pro-euthanasia 'charity' Compassion in Dying, in cahoots with Age UK, has won National Lottery funding to provide an 'Advocacy' for the frail and vulnerable elderly.

This is...
Liverpool Care Pathway - The Shameless And The Brazen
Liverpool Care Pathway - Changing Minds

The choice of words...

Dignity, compassion; it inspires confidence.

The presentation is glib, slick.

It is the manipulation of language to alter perception and to change minds.

It began with a silver line phone line. Mostly harmless...

Mail Online
The grooming begins early.

Euthanasia has long been a topic for discussion in RE for GCSE Religious Studies, looking at Christian views.

Is this to make the course topical and relevant or to instil a normality about what is actually medical killing? To ease and to share the burden that life may have become is really not the same as putting the burden down.

This is The Mail in 2011 –

Pupils are being taught about euthanasia with a video featuring a notorious assisted suicide campaigner nicknamed Dr Death.

Dr Philip Nitschke is shown demonstrating his machine that delivers lethal injections in the film, which is already being shown to pupils as young as 14 across the country.

There is also footage of him giving workshops on assisted suicide methods, which church leaders have criticised as an 'invitation to commit suicide'.
Young minds are being softened up, asked to undertake research into what support there is for euthanasia.

What support is there? What substance is there in claims that are made?

How do you phrase the question such that it does not predetermine the response...?

Should you ask:
“Suppose a person has a painful and incurable disease. Do you think that doctors should be allowed by law to end the patient’s life, if the patient requests it?”
- From the 2010 BSA survey which found that 82% of the general public agreed
Or should you ask:

Suppose a person has a painful and incurable disease. Do you think that doctors should provide counselling to support the patient and to continue to ease and to share the burden that life may have become?

There is social engineering going on before our very eyes and we are blind to it all...

Additional reading -
Liverpool Care Pathway - In The Beginning Was The Pathway...

Liverpool Care Pathway - The Reaper At the Town Hall Door

Thursday, 10 July 2014

Liverpool Care Pathway - A Tragedy Of Errors

Euthanasia has slipped in like an old friend at the back door and awaits only the nod to be welcomed into the parlour.

Medical mass killing has proceeded as a connived strategy which, according to the NCPC, is only halfway there.

Down at Tiverton, Deep in the Heart of Wessex, they've been having trouble with those forms.

This is Mid Devon Gazette –
INPATIENT services could be closed at Tiverton Hospital unless improvements are made to the way details of end-of-life care planning for elderly and vulnerable patients are recorded.

Health watchdogs found assessments and conversations with family were not properly noted by doctors, and have demanded urgent improvement.

Inspectors from the Care Quality Commission have issued a warning notice on inpatient services because of problems it found with the recording of information on TEP – Treatment Escalation Plan – forms.

A form can be completed by a patient's GP or by an experienced doctor in hospital. The aim is to enable patients or their relations and carers to see that clinicians are working together to support patients on their care pathway.
The Systematic Reviews used to guide evidence based medicine are not sound...

This is Pub Med –

Systematic reviews are utilized in evidence-based medicine and are increasingly being used to help guide standards, guidelines, and clinical practice.
There is citation and self-citation in support of the evidence base. This is also connived.

This is –
Liverpool Care Pathway - Curiouser And Curiouser And Curiouser
They will pay no heed to the warnings. It is become a political imperative of policy to install euthanasia onto the statute book.

This is yesterday's Mail...

They have been warned. How will they decide?
“But here must end the story of my life,
And happy were I in my timely death
Could all my travels warrant me they live.”

― Will Shakespeare from 'The Comedy of Errors'
Some additional reading -
Liverpool Care Pathway - So Readily Do Perceptions Change...
Liverpool Care Pathway - Crying Wolf

Liverpool Care Pathway - The Dangling Conversation...

Liverpool Care Pathway - Crossing The Rubicon

Liverpool Care Pathway - Giving In And Letting Go

Monday, 7 July 2014

Liverpool Care Pathway - A Devonian EoLC

When is a DNR not a DNR? When it’s a TEP.
TEP – It’s the new DNR.

In the backwoods of olde England, in the land where, only recently, was discovered V.12...
Liverpool Care Pathway - Retracting Their Footsteps
This is Torbay and Southern Devon Healthcare in September 2012 turning on the tap to TEPs –


Is that 'To Ensure Prompt service'...?

No, it's the Treatment Escalation Plan!
This policy is two fold in its remit. Firstly outlining the Treatment Escalation Plan (TEP) and Resuscitation Decision Record (RDR) and, secondly through application of the TEP/RDR across all health sectors in Devon to ensure continuity across the health community.

By resuscitative interventions we mean treatment modalities such as antibiotics, intravenous fluids, blood transfusions, ventilatory support, inotropy/vasopressor therapy, renal replacement therapy and CPR. The TEP will be the form which will be the documentation of those resuscitative interventions which are and are not appropriate for the individual patient.
That pretty much sews up all the positive treatment options.
One way of identifying this group of patients is by the use of the surprise question, “Would you be surprised if this patient died within the next 6–12 months?” For those where the answer is “no” the TEP should be completed for patients across the health community. If the answer is “yes” then a TEP may still be appropriate although the expectation would be that the answer would be “yes” to most or all treatment modalities outlined on the form. A TEP should be completed at the discretion of the general practitioner. The patient’s physical location should not be a bar to this process.
Even if the answer is “yes” a TEP may still be appropriate...
One crucial question to be addressed in the TEP is: “Is admission to an acute hospital appropriate?” The Second Annual Report of the End of Life Care Strategy suggests that many people are still needlessly sent to hospital to die simply because care home staff do not know what else to do. We should be making every effort to decrease that figure.
TEPs are, typically, Advance Care Directives and much more.
Date of Issue: November 2012
Next Review Date: September 2014
Links or overlaps with other strategies/policies: Liverpool Care Pathway (LCP) version 11
The Mental Capacity Act 2005 is also referenced.

Version12 LCP was published in December 2009. This was issued November 2012 and they are still referencing V. 11. This may be the sticks, but this is not merely prehistoric; it is positively Devonian.

The Northern Devon Healthcare NHS Trust Quality Assurance Committee Minutes noted –
Significant Issues of Interest:
  • Item 138/13 – There has been a Devon-wide agreement to proceed with the Liverpool Care Pathway Version 12 as this helps staff and supports the training programme to provide palliative care.
This was 26 November 2013!

This is the TEP and Resuscitation Decision Record –
The Second Annual Report of the End of Life Care Strategy (DH, 2010 Life Expectancy) recognised the challenge of identifying who is approaching end of life, and acknowledged that we need to do more to improve the present situation. One of its recommendations was the adoption of the 'surprise question', where a health professional asks themselves, 'Would I be surprised if this patient were to die within the next 6 – 12 months?’
To ask the Surprise Question is the very first action required to embark upon this programme of downsized treatment. All subsequent actions/non-actions are then prejudiced by that one crucial decision to act upon that arbitrary and subjective response...

The surprise answer to the doctor’s Surprise Question...
"There was a marked deterioration, she was dying. She was being unresponsive, she was not eating or drinking. She had a haunted, harrowed expression. She just wasn't just frail, she was dying." 
The doctor is employing both clinical experience and the protocols of the GSF Prognostic Indicator Guidance to determine a diagnosis of dying.

Who is this doctor...?

Who is the patient...?

The doctor's name is Dr. Jane Barton.

Her patient's name is Mrs. Gladys Richards.

This is Journal of Medical Ethics –

The TEP explores wider outcome options than a simple DNR.

It is an Advance Directive, a My Wishes, a PACA; in the aspect of its “continuity across the health community”, it is comparable to EPACCS.
The Treatment Escalation Plan (TEP) was introduced into our trust in an attempt to improve patient involvement and experience of their treatment in hospital and to embrace and clarify a wider remit of treatment options than the Do Not Resuscitate (DNR) order currently offers.
A medical holocaust has proceeded. The pages are coming down.

If you can't find it on Google, it didn't happen.

This is The National Archives –

‘Snapshots’ have been taken...

Pages are missing...

Claims are made...

This is from The National Archives –
Throughout the study period hospital was the commonest place of death-48% of cancer deaths-whereas 24.5% deaths of cancer patients occurred at home and 16.4% occurred in hospices.

The proportion of home deaths increased after 2005 whereas the proportion of hospital deaths declined. The proportion of deaths in hospices also increased over the study period. The National End of Life Care Programme in England was launched in November 2004.
The study, funded by the NIHR, claims the EoLC Programme has been positive in permitting cancer patients to have their lives ended at home and in hospice rather than in hospital.

Sweeping statements are made...
Claire Henry, director of the National End of Life Care Programme, said: "This research has demonstrated that the National End of Life Care Programme has made an important difference and has helped more people to die in their preferred place of death. Supporting people to live and die well is what we were set up to do and we have never lost sight of this.
They didn't get it all right, as Jack Jones' family will tell you!

Even so, there is a real problem here.

The EoLC Programme was about extending this bounty of mercy to ALL 'diagnosed' EoL patients; not merely cancer patients.

Independently audited figures show that HOSPITAL deaths also increased over this period (see these pages).

The EoLC Programme utilised the LCP and other EoL pathways to 'diagnose' dying and put patients to death.

This is EPACCS on the national archive –

This discusses deaths in usual place of residence (DIUPR) -
The report describes:
  • Background information for the four evaluation localities involved in the study and the ‘control’ groups used;
  • The quantitative analysis undertaken as part of the evaluation, focusing on national data for deaths in usual place of residence (DIUPR), local information on EPaCCS costs, and data extracts from EPaCCS and Hospital Episode Statistics
There are tremendous £avings to be made; and, of course, this is what it’s all about.
  • There is sufficient evidence, with appropriate context taken into account, for recurrent savings after four years to be over £100k pa and cumulative net benefit over 4 years of c.£270k for a population of 200,000 people. 
  • Independent analysis of data from the South West of England covering 1.9M people shows a level of deaths in hospital for people on EPaCCS of below 10% (compared to the England average of 54.5% in 2008-10) and savings per 200,000 population pa of £47,952 using the same assumption of £399 per saved DIUPR as above (or £177,900 using the higher cost of a hospital admission identified in this report).
The South West might be positively Devonian, but didn’t they do well...?

And here is where they ran that pilot. This is from the Gloucestershire NHS EoLC Newsletter dated January 2010, uploaded in March of 2012 –

The Pilot continues in North Somerset and Bristol. The new edited version went ‘live’ before Christmas and a template to support the implementation process have been developed. Dr Simon Smith is leading on this piece of work so more details please contact Simon Smith on
In collaboration with the Gloucestershire County Council Education Department, all Home Support Officers from the Community Steps Team have been trained during November to train their Home Support Workers in how to use the LCP within their role.
They trained their Home Support Workers in how to use the LCP within their role.

Marie Curie must take some credit, of course...

Marie Curie
Curiouser and curiouser; according to the Editor's Blog in Pulse –

GPs in Somerset were told by their CCG that they could, with the blessing of their local area team, stop reporting QOF data for the rest of the year and instead expect to be paid based on 2012/13 achievement - and that the time saved could be used as ‘thinking space’ to ‘redesign’ QOF from April.

Elsewhere, the GPC reported that Devon and Cornwall CCGs had also negotiated an agreement with local LMCs to abandon chasing QOF points that would become redundant in April anyay, with the implementation of the 2014 contract.
"Thinking space"...

It's given them time to install V. 12...

Perhaps a rethink and a rebrand in the wake of the Review?

Is this all just a tall tale or is it a tail with a sting concealed therein that is best kept concealed?

Some additional reading -

Liverpool Care Pathway - The Sum Of All Fears

Liverpool Care Pathway - Moving In For The Kill
Liverpool Care Pathway – A DNR Directive For Paramedics And First Aiders