[devil's advocate]
The medication has been reduced from 'several times a day' to 'once or twice a day' and this dosage is stable and provides adequate pain relief.
This maybe because the pain has decreased or because the medication was initially over prescribed or, if PRN, administered.
The higher dosage indicates a severe need.
The lower dosage indicates a high need.
[/devil's advocate]
Thanks nitram and stanleypj
An elegant devil's advocate argument nitram.
It is now impossible for the patient to articulate in any reliable sense whether the lower dosage has "stablised" the pain or to articulate reliably how intense the pain is. So should the MDT/CCG be given the benefit of the doubt?
Unless I have misunderstood how the drug works, factually this pharmaceutical gives no more than temporary relief for several hours. Hence why it has to be readministered. Once the analgesic effect has worn off logically the patient's pain returns. If the patient is given too much the drug would be fatal. As I said we are talking about administering a Class A drug used routinely for end of life care to a patient who (we hope) is not at end of life!
Thirdly, once the current dosages have been administered, and the drug has had time to take effect, even now when the patient is moved or transferred, the patient's carers (and I) observe the patient experiencing pain.
If my argument does not hold water then the words mentioned in the Secretary of States so called guidance that well managed needs are still needs and should not be marginalised are indeed just empty and entirely meaningless words.
I am also mindful that the courageous Pamela Coughlan (whose needs were stable at the time of her court case) would struggle to score a single "high" score if she were to be assessed using the 2012 Decision Support Tool criteria. However her Majesty's Court of Appeal in England & Wales have effectively decided that her needs are such that she should be able to reside in ANY CCG area and be found eligible for NHSCHC.
Our Loved One has needs some of which might be stable, some of which are not stable, which are the same as or greater than Ms Coughlan's and our LO's needs are primarily health.