Living and Dying Well in Scotland

ACTION PLAN HERE

Living and Dying Well` aims to enable NHS Boards to plan and develop services. These services are about end of life care for patients and families.` Notice that LIVING AND DYING WELL is more about dying than living. The Government is encouraging NHS Boards to be on the hunt for vulnerable patients. It`s the same agenda as in Dying Matters who encourage GPs to look for their one percent.  Here is what they have to say:

We need to identify those who would benefit from it. [Benefit is not defined here]. Certain triggers will lead to an assessment or review of end of life care needs. [Needs appear to be physical, social, emotional and spiritual? But are some of these the business of the NHS?] The triggers for a review of end of care needs are:

diagnosis of a progressive or life-limiting illness [How limiting does it have to be? Not defined.]

critical events or significant deterioration during the disease trajectory indicating the need for a 'change of gear' in clinical management. [Change of gear? Stop thinking cure and start thinking palliative care.]

significant changes in patient or carer ability to 'cope' indicating the need for additional support. [What additional support?]

the 'surprise question' (clinicians would not be surprised if the patient were to die within the next 12 months)

onset of the end of life phase - 'diagnosing dying'.

[The problem is that diagnosing dying is not an exact science. So a change of gear may be inappropriate.]

 

 

Is the system being set up not more about cutting costs than providing care?

See The Liverpool Care Pathway - cost efficiencies



Why GPs are vital to end of life care

According to Dying Matters  HERE

On the Dying Matters website we read that GPs are the gate-keepers to health services in England. `If you do not plan community support for a dying patient, he or she will end up in crisis using emergency services.`

So in order to prevent these frail elderly from clogging up the system and costing the NHS a fortune it would make good economic sense to find the one percent of patients that statistics show die each year. Having identified them, patients can then be encouraged to have those sensitive conversations. Most will say they would prefer to die at home. It does not matter that many elderly will be shuffled off to care homes against their will - we`ll still call that a `home.` Let them die there.

Having found the GP`s 1% we can put theire names on a register and spread the information around the community. That includes the ambulance service who do not need to bother responding to emergency calls or giving these patients emergency treatment. After all, they`re on the register; they`re dying - maybe - and they wanted to die at home. So let them get on with it.

According to the website: `Caring for a patient right through to the end-of-life can be one of the most satisfying aspects of medicine.` !!

In other words GPs should not feel uneasy about what they are doing. After all, it`s satisfying.

Here is an example of an Ambulance Service which is prepared to deal with the frail elderly:

WMAS maintains an End of Life register for patients in Worcestershire to ensure that ambulance crews are aware of patients who are at the end of life and the arrangements that have been made between clinicians and patients. This means that patients’ wishes for their treatment are respected. [They may wish to die at home. Do not rescucitate or have guardians doing the `wishing` for them if someone says they lack capacity !! ] HERE

What is palliative care?

From: LIVERPOOL CARE PATHWAY - A NATIONAL SCANDAL

To a challenger that this was euthanasia, Baroness Finlay, an invited key speaker at the jubilee event, might have replied:

No, euthanasia is about intent. Palliative care intends to improvve the care when people are inevitably dying.

And Dr. Barton could tell her patient was dying...

This is from The Big Questions-

Jackie Leotardi - 
Yes. One hospital was paid £308,000 for reaching targets for putting people on what is basically a euthanasia programme. Baroness, it is euthanasia.

Baroness Finlay -
It… No, euthanasia is about intent. The Liverpool Care Pathway doesn’t intend to kill people. It intends to improve the care when people are inevitably dying. That’s quite different.

The lines are become so blurred they are imperceptible to see.
 

Read More

Golden Standards Framework

So there you are. You`ve just retired, looking forward to rounds of golf or more time with the grandchildren and getting into a more leisurely lifestyle. But No. The Golden Standard Framework insists you must think about death, make advanced decisions, and cut down your expectations about future treatment. All of this will make you feel better .

The Golden Standard Framework plays a part in Living and Dying Well in Scotland, so it would be a good idea to know what this is about.

Staff responsible for your care have been primed to have certain sensitive conversations with you and be warned that there are triggers when to have these conversations:

 Triggers

All residents on admission to care homes
Also life changing event e.g death of spouse
making or changing a will
retirement
following a new diagnosis of life limiting illness
assessment of patient need
in conjunction with prognostic indicators
multiple hospital admissions

The conversation will pressure you to make decisions about:

what you wish to happen and not to happen towards end of life (preferably what not to happen)
e.g do not rescucitate. Do not treat.
preferred place of care or death (preferably home, or homely setting, ie care home)
If you might lack capacity to make your own decisions,who is going to make these decisions on your behalf about these matters? Then think about setting up a power of attorney if you do not have one.(Because if you don`t have one we`ll make the decisions for you.)