Sunday, 4 July 2010



At the beginning of the twentieth century, the period of life expectancy at birth was around 48.5 for males and 50.4 for females.

The period of life expectancy at birth in the United Kingdom, as per the United Nations (2005-2010) is now 77.2 years for males and 81.6 years for females.

With advances in medicine and a resulting reduction in infant mortality; availability of treatment; better diets and decreased poverty - people are living longer.

According to there were 20 million people aged fifty and over in the UK in 2003. This was a 45% increase from 13.8 million in 1951. The projected increase by 2031 is a further 36%, with an estimated 27.2 million aged fifty and over.

An aging population equals a higher propensity to long term medical conditions - many of whom don't realise that some of these conditions are terminal. However - again according to government statistics - consider themselves to be in good health, even if they have a long term illness that restricts their daily activities.

Unfortunately, an aging population is regarded as a burden on the state. Despite the fact that they contributed to the system - they were not expected to live so long, and therefore - to take so much out of it.

It has therefore become necessary to initiate culling strategies. First there came the Liverpool Care Pathway (LCP) - which I am sure was formulated with the best on intentions (and I will blog about it on a later date) - and now there is the push towards Advance Decisions to Refuse Treatment (ADRT). As stated - both devised with the best of intentions - but both are wide open to abuse.

A number of my colleagues recently attended a PCT meeting re Care Planning at the End of Life. Its secondary title was "Anticipatory Care Planning in Care Homes." Its prime aim is to enforce as a requirement, the implementation of ADRT.

" ************* Care Homes Project.

The project has three main strands:
  1. Link GPs - the development of a Link GP role whereby a dedicated GP is contracted to work with each participating care home. The role is to support the care home in the implementation of clinical policies and procedures and to support and encourage the home to adopt clinical guidelines that are discussed during educational sessions
  2. Educational Programme - eight sessions over the course of twelve months, designed for care home staff and the Link GPs. The meetings will include anticipatory care planning, end of life care, falls and osteoporosis, COPD, chest infections, UTIs, nutrition and wound care.
  3. Anticipatory Care Planning - Link GPs will work with patients in care homes to develop anticipatory care plans in association with their families and care home staff."
The above may appear quite a breakthrough - GPs actually wanting to work with care homes (!) - but it is not!

The whole affair is quite scary and we fear that it is a further nail in the coffins of the elderly. When we first had experience of the LCP - we thought it a wonderful, caring thing that enabled the dying a pain free release. Now we can state (with an almost 95% degree of certainty) which residents admitted to hospital (GP initiation) with a RTI, will return home to us and who will be placed on the LCP! This knowledge is not based on the fact that we know that resident A is sicker than resident B; it is dependant on the support system of their NOK primarily and other known factors.

More to follow.......

Anna G.


Nortthern Doctor said...

I'm not sure I would be happy to call the LCP a 'culling strategy' - I've always felt it was a really good thing and has done a huge amount to reduce the lottery of end-stage terminal care.

I'll watch for your future post on it with interest though.

HyperCryptical said...
This comment has been removed by the author.
HyperCryptical said...

We are honoured that you posted our first comment Northern Doctor - thank you!

I (AG) totally agree with your thoughts on the LCP in that it provides a dignified and comfortable death for those with a terminal illness. However, it is unfortunately a fact that the LCP is used inappropriately and is, at times, utilised as an exit procedure to clear beds of those whose only sin appears to be that they are elderly and vulnerable.

As said, more to follow.....

Dr No said...

Used correctly, the LCP is good - but it is wide open to abuse eg Barton (she may not have called it the LCP, but she used the same ideas). The crucial bit is getting the diagnosis of imminent death right. Over-diagnosis is never good, but when it leads to premature death it is really bad.

But this post is as much about ADs in there various forms, and the implications of no NOK, as it is about the LCP. It seems to me that this PCT is keen to get the old and frail to sign up to 'no treatment for me' orders. If so - and I look forward to further posts on this - then that is truly sinister.

HyperCryptical said...

Thank you for your comment Dr. No.

It is our fear that we are being asked to assist in directing residents to attach their own 'use by' labels.

We also fear that if we do not comply, we will be viewed as 'difficult' and our relationship with (most, but not all) Gps will become further strained.

This strained relationship is not of our doing and we want to have a good professional relationship with visiting GPs.

I will not carry on and will write a post about this too!