Saturday, 3 October 2015

Liverpool Care pathway - Killing On Demand

Deficient and wanting, or just different?

They wanted them to kill their child; they chose to let him live.

“Terminate.” That's the word they used. It sounds like Dr. Who and the Daleks.

It’s actually killing. Say it how it is. Killing is become both a therapy and a treatment.

Sky News

This is Jaxon Emmett Buell. He was diagnosed with anencephaly and was born with most of his skull missing. He was given days to live.

Jaxon has confounded the predictions and lived to see his first birthday. In that year, he has both given and experienced the joys of living, something he might never have known.

Jaxon has been dubbed 'Jaxon Strong' and has his very own Facebook page.

Life has its highs and lows but that is life. There are peaks and there are troughs.

Without the hard climb, how else may we go freewheeling down the other side?

That is life's lesson.

Killing is become both a therapy and a treatment. It’s still killing, whatever else you call it. Say it how it is.

Another kind of killing is here discussed. It is called Euthanasia.

This is News.Com Australia –

FIVE minutes after Simona de Moor heard her daughter had died from a heart attack, she decided she wanted to end her life, too.

The 85-year-old mother, who was considered healthy by doctors and was not taking any medication, made arrangements to be quietly put to death.

More than 8000 people, probably more, have been euthanised in Belgium, where assisted suicide has been legal for 13 years. Patients don’t have to be terminally ill, just deemed to be suffering “incurable, unbearable pain” by a doctor.

The country has faced controversy over the soaring numbers of cases in which people with psychological problems, from depression to dementia, are asking to die. With the rest of the world moving towards bringing in euthanasia laws, some people are asking where and how you draw the line.
Journalist Brett Mason went to Belgium to film Simona being killed for a ‘Dateline’ special that aired September 15 on Australia's SBS (Special Broadcasting Service) network.
We could be looking at Australia’s future. In July, the Victorian parliamentary inquiry into end of life choices began hearing from medical professionals and palliative care providers about possible changes to Australia’s legislative framework. The inquiry will report back on 31 May 2016.

An Assisted Dying Bill was debated in the UK parliament this month, but did not pass its second reading debate on 11 September and will make no further progress.

It’s clear that giving people the right to die is not a simple decision.

“Most of us have reached a low in our lives where we’ve lost a loved one or suffered a trauma,” said Brett.

“The challenge for doctors — many with no psychological training — is being able to make that call and know when someone’s pain isn’t going to heal. I’m not sure I could. For me, there will always be a ‘what if” with Simona’s euthanasia.”

Killing is both a therapy and a treatment.

Killing as policy

HSJ has published an investigation which purports to show an ‘unwarranted and unfair’ disparity in elective surgery.

Knee Replacements
Hip Replacements
In the regard of both knee and hip replacements, that is something which is commanded by demographics.

As an example, Tower Hamlets has a more youthful and diverse population than does Guildford.

Professor Stephen Page, from Bournemouth University, has said there will be a growing polarisation by age of local populations. This will distort the uptake figures.

The borough of Tower Hamlets, for instance, has the lowest median age in the country at 29 along with Newham, compared to the London average median age of 33.

Guildford and Waverley by contrast has the largest 5 year cohort aged 45-49 reflecting the baby boom of the early 1960s. The fastest growing cohort since 2001 is the 60-64 age group which has increased by 35%.

As older people become more dominant in the local economy, young people often go away to university and get jobs in bigger cities and don't come back, further distorting the local age profile.

What the researcher wishes to demonstrate will depend on how the statistics are presented as readers of these pages will know.

This 'disparity in elective surgery' is not even new news.

Read the 'olds' in this paper dated 26 November 2010 from Public Health Wales Observatory -

The Daily Mail has picked up an investigation published by Pulse -

Perhaps, we are all selective in what we present and the manner in which it is presented but, again, as readers of these pages will know, GP incentives are not new.

The report says:
GP practices are being offered thousands of pounds to refer fewer patients for specialist care, including those with suspected cancer, finds a Pulse investigation.

Pulse has learnt that in at least nine CCGs, practices are being offered payment for keeping within targets for outpatient referrals and follow-ups. And some of these schemes even count two-week cancer wait referrals towards the target.

Payments of between £6K and in excess of £11K are being offerred. The payments come following on from recommendations just a year ago to double cancer referrals.

This is BBC News –

GPs got beavering away and, before anyone knew it, Pulse had a banner headline in January of this year proclaiming: "Urgent GP cancer referrals increased by 50%"

Pulse reported –
There has been a 51% increase in the number of GP urgent referrals for suspected cancer cases in the last five years, a major audit of cancer outcomes has found. The National Audit Office’s ‘Progress in improving cancer services and outcomes in England report’, released today, lists improvements ‘across a range of indicators’, including GP urgent referrals, five-year survival rates and a drop in overall mortality rates. The report states: ‘Urgent GP referrals for suspected cancer increased by 51% between 2009-10 and 2013-14 from 0.90 million referrals a year to 1.36 million referrals a year.’


Reports, reports and more reviews, the fact is that command control distorts and does not address issues.

The fact is that killing as policy has been proceeding for a long, long time via EoLC policies imposed by a grand alliance of State, Third and Private Sector interventions and strategies, in downsizing care expectations and designing programmes, death lists and pathways.

There is  crisis.

The news is dire: Addenbrooke’s recovery ‘could take years’; Shelford Group Trust and West Herts are in special measures; more than one in ten Trust chief posts are unfilled; a third of CCGs may ration services; bailouts have ‘rocketed to £1.2bn; GP practices may get a £1m emergency assistance fund after one in six practices have closed their lists…

GPs have been asked by commissioners to not refer to a local acute trust for at least three months to allow the hospital to clear up its backlog of operations.

The chair of NHS Redditch and Bromsgrove CCG, Dr Jonathan Wells, shared the letter online which asked GPs ‘to refer patients to another NHS or independent sector provider other than Worcestershire Acute Trust for an initial period of three months’.
Just a year ago The telegraph reported on a 'debt timebomb' –

A Westminster think tank, the Institute of Economic Affairs called for ‘radical measures, including a smaller NHS’, to deal with the ‘debt mountain’.

Time bombs, silver-haired tsunami...

We have heard all this before -
Liverpool Care Pathway - Of CQuINs, Tipping Points And QUELCAs
Further reading - 
Liverpool Care pathway - A Life Less Perfect, Or Just Different...?

Liverpool Care Pathway - 'Informed Consent'

Liverpool Care Pathway - A Perverse Symmetry

Wednesday, 30 September 2015

Liverpool Care Pathway - It STILL Ain't Over!

When the pail of moral restraint leaks half-full it will not be long before it leaks half-empty.

For the man for whom it wasn’t over until it was over, the inimitable Yogi Berra, it is finally over.

We mourn the passing and celebrate the life of the man who was larger than life; who, resolute and defiant, even had a bear named for him: "Yogi” Berra.

Berra passed unassisted. It just finally got late early out there. The fork came in the road and he took it.

The Yogi-isms are many and endless and, even if he didn't say half of what he said, their resounding, light-hearted positivity are rousing for the spirit, a joy for the heart and abundant with that sound Yogi advice.

- Metro
Is there a true British hero living who would not stand in the shadow of the man? Of what kind of mettle are our men of metal made?

Top politicians and top brass have betrayed our service men and women.

Are all our policy makers of melt instead of meld? Is this melted butter dripping from their brains or is it 'brain fever'?

They are put in the pale and are beyond the pale.

At our humble scheme, we are familiar with the pontifications from on high of what is "best practice" but not adhered to and "Charters" and policy documents handed down as though they are tablets of stone or the issuance of kings.

This “charter” is current and issued this year. It declares at the foot that we are a “trading name” of the parent bodies, both “exempt charities”.

The declarations in this ‘Great Charter’ might, at first sight, appear innocuous enough but closer examination reveals either a naivety or something more sinister and far beyond the pale; an innocence or lack of that will betray the innocent to the ordeal of political correctness...

This "Charter Of Rights" solemnly declares that our clients will have the right:

To have their social, emotional, religious, cultural, political and sexual needs accepted and respected.
Can this be real? The other ‘needs’ quite apart, what ‘sexual needs’ are these?

The cause célèbre has always been the 'persecuted minority'.

Back in the early seventies, one such group of people politicised what had hitherto been considered sexual abuse, presented themselves as a 'persecuted minority' and became another cause célèbre of the woolly-brained Left, of melt instead of meld.

Further reading -
Liverpool Care Pathway - Telling It More How It Is
The GLF (Gay Liberation Front) was fresh out the LSE (London School of Economics), the hotbed of all things Left and Loony. The same argument put to support Gay rights was made to support ‘rights’ for Paedophiles. As Gays are attracted sexually to the same sex, it was argued, so Paedophiles are attracted sexually to children.

This "Charter Of Rights" demands that sexual needs are accepted and respected. Is this really real? Do they really mean that without any qualification?

On training, we are told that there are four different types of paedophile. They are allotted fancy Greek terms.

In reality, there are only two types.

  1. Those who know that this is abuse but for whom it has become a 'vice' an obsession that has overcome them. For these, redemption is possible.
  2. The second type 'knows' that this is a natural attraction they feel. Of this they are convinced and those who deny that conviction are denounced as not 'advanced' as they. Society has yet to catch up with them. These are the politicised abusers who call themselves and want you to call them - Paedophiles.

Bibliophile, from the Greek, means book lover, a lover of books. Likewise, Paedophile, also from the Greek, means child lover, a lover of children.

The defined acts of the latter are a grotesque distortion of the meaning of the word. They want to be called and want you to call them - Paedophile. Don't; it is a moral get out of jail card and self-justification to redefine what is acceptable.

What is the purpose of these 'charters'? What are these 'mission statements'? Are they there as just window dressing? The 'job' we used to go to to earn a crust of bread is, it seems, no longer just that. Is there an agenda and to what end and for what purpose?

Was it naivety or was there purpose in the construction of this 'Charter'? Those who were around then and offered support to this 'persecuted minority' are still around now. Is that support and that sympathy still held?

Are they also subtly moulding our thoughts, through ‘training’ and ‘Statements’ and ‘Charters’?

In the UK and across Europe, the social scientists are moulding our lives "without us being aware they are doing so" [Economic and Social Research Council].
Social scientists influence our lives usually without us being aware they are doing so. For example:
  • the role of governments in an increasingly market-based society has been determined by famous thinkers such as John Maynard Keynes and Karl Popper
  • it was an economist who came up with the idea of the National Health Service
  • the payment of billions of pounds of state benefits for the needy has been influenced by the work of social scientists.
Social science research findings continue to provide invaluable information whether you are a parent, a local councillor, a police officer, or a business executive.
 - Economic and Social Research Council 
Keynes was a friend of Shaw, both of them Fabians. Keynesian economics provides for State intervention.

Keynes, wrote in his preface to the German edition of The General Theory, 1936, that the ideas of his book could more readily be carried out under an authoritarian regime:
Nevertheless the theory of output as a whole, which is what the following book purports to provide, is more easily adapted to the conditions of a totalitarian state, than is the theory of the production and distribution of a given output under conditions of free competition and a large measure of laissez-faire.
The General Theory of Employment, Interest and Money

And this theory the National Socialists promptly applied.

Is this obsession for ‘training’ and ‘Statements’ and ‘Charters’ in the workplace indoctrination?

This is concerning if not worrying as we see the Grand Alliance growing and spreading.

The Fabians and the 'Fabians' have been at work for more than a century both subtly and overtly influencing governments and the role of the State.

The social scientists mould our lives "without us being aware they are doing so".

ALWAYS essential reading...
Liverpool Care Pathway - Nudge, Nudge, Say No More...
Liverpool Care Pathway - The Bee Wee Consultation
Liverpool Care Pathway - The Communitarian Nudge
Liverpool Care Pathway - Dignity In Living 
Liverpool Care Pathway - The Side Effects

Liverpool Care pathway - A Life Less Perfect, Or Just Different...?

Liverpool Care Pathway - There Are Always Consequences

Liverpool Care Pathway - The Palliative-Medical Complex

Thursday, 24 September 2015

Liverpool Care Pathway - The Likely Customers

"If you can catch their eye, you've got their attention and you're in."

The elderly are of a generation old enough to have made a personal sacrifice or to remember that of their parents or to have been displaced in this extraordinary attempt to save OUR children.

An army of children were taken away and billeted with strangers; well-meaning strangers, but still strangers. These were the evacuees.

“By this time I wanted my Mummy and Daddy and to be back in that little terraced house all together again. 

Later, in a strange cold bed at the end of that long weary day, I hid under the bedclothes and cried. Then I remembered that we hadn’t  said our prayers and with this as an excuse I climbed into my brother’s bed while he said, “Gentle Jesus...” At the end of our prayers we curled up together and my little five-year-old brother said, “Don’t cry, Jean, I’ll look after you.””

These elderly have been frugal and prudent enough to have worked and to have saved through their lives to be self-sufficient and to own their own homes. Having been turfed out of their homes a lifetime ago as this land endured the deprivations and terrors inflicted by a foreign Jackboot State, along comes a homegrown Spendthrift State to turf them out again.

Their cards are marked

In the eye of the Communitarian, the bed blockers are also home blockers.

- Mail Online
The elderly, already pressured into pint-sizing their care expectations by an aggressive lottery-funded campaign promoted by a pro-euthanasia group, are now being pressurised into pint-sizing the roof over their heads.

The social architects who want to design our lives are amok with ideas to make them complete.

'Charity' has become radicalised and redefined as the so-called Third Sector. Traditional charity has been transformed, so-called registered charities are in abundance and the Charity Commission is very much out of its depth.

The above-mentioned pro-euthanasia group is a 'charity'. It is a registered charity. Permitting your group to be called a 'charity' gives it a 'Colgate Sparkle' and raises its profile almost to sainthood.

The Third Sector has spread like a noxious fume, a virtual third arm of the State in forming policy and then participating in its promotion and enactment as with the LKP.

In 2012, Lord Shawcross took over the helm at the Charity Commission and was very critical of the aggressive fundraising tactics being employed in the Third Sector.

This is Civil Society –

Giving evidence to the Public Administration Select Committee (PASC) today, Shawcross agreed with Tory MP Charlie Elphicke, a long-standing opponent of chugging, that it was “damaging to the brand of charity”.

But Shawcross said it would be a huge responsibility for the Commission to start regulating fundraising in place of current self-regulation. “It would be a huge departure for the Charity Commission to police chuggers,” he said. He suggested instead that the public should put pressure on charity trustees about chugging.
Sam Younger, chief executive of the Charity Commission, also said chugging was a real concern, but that there was a resource issue and it would cost the Commission an estimated £4m to regulate fundraising.

The Commission's stance is at odds with the minister for civil society, Nick Hurd, who also gave evidence to the PASC today. He defended chugging, saying self-regulation appeared to be working, referring to recent activity between the PFRA and the Local Government Association in promoting local site management agreements.
This claim of Nick Hurd that self-regulation was working has been demonstrated to be nonsense and has ended in tragedy.

Nick Hurd's insensitive and ill-thought  response upon how to deal with aggressive chugging was to "cross to the other side of the road".

Vulnerable people - likely customers - are sought out and pursued and might not escape to the other side of the road. These are 'charities' and you cannot refuse to spare a few coppers each week that will go barely noticed.

Aggressive chugging, once permitted and left unchecked, as all things inevitably do, spread and entered the home via mailshots and came into earshot via cold calling.

A Review has just been published. This is NCVO (National Council for Voluntary Organisations) –

Lord Shawcross has given his response to the Fundraising Self-Regulation Review. This is The Charity Commission –

William Shawcross, Chairman of the Charity Commission, said:

"Sir Stuart’s review is an important step towards rebuilding public trust in charity fundraising. The review makes recommendations to reform and strengthen self-regulation. Charities must now step up and lead the way forward.

"The Charity Commission will play its part to support the development of any new fundraising regulatory body. It is crucial that charity trustees meet their obligations to oversee fundraising and I welcome the emphasis on this in the review."
The Charity Commission
The Report
Another Review, another report, another regulator. The Third Sector is still intact. All change. Nothing’s changed. The ‘stakeholders’ again are consulted, agree and approve; themselves are the participants, the promoters of the selfsame uncharitable tactics that have prompted the Review.

Three years ago, it was a 'resource issue' that prevented the Commission from policing. It was estimated £4m would be required to regulate fundraising.

Setting up a new regulator and all the infrastructure required for that is going to be substantial in itself, the actual cost of regulation aside. is this all just a window dressing attempt to address the issues?

In a response to the above Civil Society report, Helen Cowell of Disability Challengers commented:
I agree with William Shawcross. 'Chugging' is a legal loophole that has been milked by some charities. The collection of money on the High Street is governed by the Police, Factories (Miscellaneous Provisions) Act 1916 which states that collectors of cash must be stationary, positioned at least 25 metres apart and cannot approach shoppers. The only reason 'chuggers' get away with what they do is because they are not collecting actual cash and the rules do not apply. I think the law needs updating in line with cash collections.
Was all that was needed was a simple change in the law with provision to cover the extension of those selfsame tactics that has been pursued? It is harassment, plain and simple, after all.

Three years ago, Lord Shawcross came under heavy fire for his then comments about the aggressive tactics being employed.

This is Third Sector –

ACEVO (Association of Chief Executives of Voluntary Organisations) Chief, Sir Stephen Bubb, accused Shawcross of being ‘out of touch’.

Bubb is the Chief Executive of the Chief Executives.

Hallelujah! This man is the King of Kings of the Charity Leaders Network, the 'Third Sector Coalition' which Esther Norman champions in Tameside. 

Esther Norman has successfully sidled up with Age UK to pick out the likely customers to sign up to ACDs.

ACEVO has its Annual Conference in November -

And what will be the out of that and what will they have to say about yet another regulator?

Additional reading -
Liverpool Care Pathway - NICE One!

Friday, 18 September 2015

Liverpool Care Pathway - Litigating The Litigants

Fool me once, shame on you; fool me twice, MORE shame on you!

We have been very busy addressing a number of matters at our little project. Everything from dealing with a flood and temporarily re-accommodating clients to answering such longstanding and profound questions as:

When is a HMO (House in Multiple Occupation) not a HMO?

When it’s a... HMO?

We fit the description for a HMO and as such the local Council could shut us down for falling down on compliance issues which we constantly chase up and get slapped down on.

We fit the description for a HMO but a HMO is only a HMO if it has a private landlord.

We fit the description for a HMO; however, because we are and have a social landlord it seems they can get away with murder. We hope and pray that ‘murder’ will remain a metaphor.

It does seem that this grand alliance of State, Third Sector and Smart Alecs can and do get away with it and, when they can’t, can afford themselves of the protective umbrella the Alliance provides.

This is Nursing Times 
Fitness to practise hearings against five midwives from the University Hospitals of Morecambe Bay Foundation Trust have been delayed because of legal action by their defence lawyers, Nursing Times’ sister title HSJ has learned.
The Nursing and Midwifery Council had been intending to hold misconduct hearings against five midwives involved in the treatment of baby Joshua Titcombe, who died in October 2008 at Furness General Hospital.

The midwives are Greta Dixon, Holly Parkinson, Joanne Watts, Catherine McCullough and Lindsey Biggs.

At a preliminary hearing last month, lawyers acting for all five midwives revealed they were planning to lodge legal applications before the misconduct hearings take place. In a letter, seen by HSJ, the NMC said this could “substantially affect the progression of all of the cases”.

Joshua’s father James Titcombe, who campaigned for an independent inquiry into poor care at the hospital, told HSJ he was “saddened and upset” by the delays.

He said: “It’s vital and in the public interest that open hearings take place so that the truth can be properly established. It’s coming up to what should have been Joshua’s seventh birthday and it’s disgraceful that the NMC processes have taken so long.
There is legal protection for those who stand accused but what legal redress for the pursuant of the complaint?

James Titcombe has been invited to participate on the panel of a review led by Baroness Julia Cumberlege into NHS maternity care provision following the disclosures of the Kirkup Inquiry. Members of the public and professionals are being invited to share experience, suggestion and opinion.

Denise Charlesworth-Smith was invited to participate on the panel of a review led by Baroness Julia Neuberger into LKP care provision following the disclosures  that trickled then flooded out of the medical holocaust of the LKP. Members of the public and professionals were invited to share experience, suggestion and opinion.

We won't get fooled again...

This is Nursing Times 

Don't be taken in, James, that your opinion may count or be counted.

This is Denise on BBC Radio Norfolk -
Denise Charlesworth-Smith
I think it stinks to be quite honest; I think it’s a total cover-up. And I think it’s a case of, ah, that I’m purposely being blocked from going to this, em, Newmarket Workshop and, as far as I’m concerned, this is something that I had to fight to get onto; I had to fight to get down to meeting in London, which was held in September where I first found out that there were going to be Workshops and, now that there are Workshops being dotted around the country, I think the only people who are going are the people who supported Bee Wee on End of Life Care. I don’t think there’s anyone there who, em, has had a negative experience of it so they can actually put a balanced view across to what they’re proposing. So, I think the whole thing is a total farce. I’m absolutely livid.
Further reading -
Liverpool Care Pathway - The Bee Wee Consultation
Once again, the focus is some ‘high quality’ protocol ordained from on high, not the individual patient in front of you, their needs, their demands.

Tip your hat to the new constitution
Take a bow for the new revolution...
We won't get fooled again?

Beware the zealot pushing the agenda.

Pertinent and essential reading -
Liverpool Care Pathway - Who Monitors The Monitors And The Monitors Of Monitors...?
In 2003 the Shipman inquiry recommended significant changes to the way deaths are recorded. The existing system was believed to be deficient and wanting.

Those reforms were never fully introduced.

Shipman pursued his own care pathway with the same zeal that the Morecombe zealots pursued their purpose.

In The Report of the Morecambe Bay Investigation Dr. Bill Kirkup recommended -

“the appointment of medical examiners, initially proposed by Dame Janet Smith as a recommendation of the Shipman Inquiry, subsequently endorsed by the Luce review, put into enabling legislation in 2009 but not yet implemented. It is our view that implementing these proposals should be reactivated as the best means to provide the necessary scrutiny, not just of maternity-related deaths, but of all deaths.”

This is the Report on the Pilot Centres set up in 2009 -
An initial aim of death certification reform was -
To ask the next of kin whether they had any concerns about the death that might justify further action (subsequently referred to as ‘The Shipman Question’)
The report goes on to say -
Implementation was subsequently strongly supported by the Francis Report into the failings of Mid-Staffordshire NHS Trust. Francis recognised that asking the relatives to identify their concerns, an approach he referred to as ‘The Shipman Question, was also a valuable way to obtain independent warnings about failing healthcare providers. Implementation was similarly urged by the Morecambe Bay report into maternity services.

Asking the Shipman Question is contentious and controversial. They would far rather ask the Surprise Question (The Barton Method).

And now we have gone full circle to the report in The Plymouth Herald and out of hours GPs ceasing to verify deaths in Care Homes, just the sort of places where those Surprise Questions are asked.

Asking the Shipman Question might just complicate things.

Further reading -
Liverpool Care Pathway - Another Committee, Another Review

Liverpool Care Pathway - They Do Not Have The Paperwork

Liverpool Care Pathway - A Rose By Any Other Name

Liverpool Care Pathway - In Hope We Trust

Liverpool Care Pathway - The Six Million Dollar Plan 

The final say from Dr. Suzy Lishman, president of The Royal College of Pathologists –

There was a surge in media interest in medical examiners in January to coincide with the 15th anniversary of Harold Shipman’s conviction. I was interviewed live on the Today programme with Chris Bird, whose mother was one of Shipman’s victims. To hear him speak so powerfully reinforced just how important the role of medical examiner could be.

An eight-minute interview on Going Underground on RT UK, a global online news service, was aired several times and gave an opportunity to explore the topic in more depth. Letters outlining the main issues were sent to parliamentarians, including the Prime Minister and Secretary of State. Shadow Health Secretary Andy Burnham quoted the College statement in his response to the Francis report on whistle-blowing in the House of Commons in February and Liz McInnes MP referred to it in the discussion of the Morecambe Bay inquiry. In that debate, Secretary of State Jeremy Hunt said, “I can only commit now to us introducing independent medical examiners as soon as possible. We are wholeheartedly committed to this,” which is probably as much as we can hope for at this stage in the parliament.