Wednesday, 20 May 2015

Liverpool Care Pathway - Transformation

Joined-up services and seamless care.
An integrated NHS and the efficient use of finite resources.



If you have Learning Dis. does that mean you are unwell? If you are Downs does that mean you are unwell?

You are different, as are we all different. You may become unwell, as may we all become unwell. That does not mean you are unwell because you are different.

A few years ago, James Churchill, then Chief Executive of the Association for Real Change, expressed concern that health was taking over social care –



“What I've noticed is how health seems to be taking over social care again,” he sighs. “Escaping from the clutches of the NHS and people who tell you that you’re ill and they need to guide what you do has been one of the major achievements of learning disabilities over the past 20-30 years.”

Although Churchill is pleased the government wants to provide seamless care, he fears medical models will again dominate. He says the Care Quality Commission is a prime example, and questions its ability to regulate both sectors.
- Community Care
Simon Stevens 'way forward' is supported by the £200m Transformation Fund. The Fund is also being hived off as a ‘dowry’ in a marriage of social and health service care.
The NHS has a responsibility to help local authorities cope with their “tough financial settlement”, health secretary Jeremy Hunt has said.

“We prioritised the NHS by protecting its budget, which meant tougher settlements for other departments including local government,” he said.

“But the interconnected relationship between the services we both offer to vulnerable people means that we in the NHS have a responsibility, as we move to fully integrated services, to help you [in local government] deal with a tough financial settlement.
HSJ
According to The Independent, Integrated Primary and Acute Care Systems (IPacs) will adopt Zeke’s value judgement Communitarian ‘Finite Resources’ priorities and direct funds to where they are deemed most needed.

 This is The Independent 
The announcement follows a landmark decision to hand over £5bn in NHS spending to a joint local council and NHS authority in Greater Manchester, dubbed “DevoManc”.

The current Health Secretary, Jeremy Hunt, called it a “pivotal moment for the NHS”.

A core aim of the reforms is to break down the traditional barriers that have existed between GPs, hospitals and council-funded social care services, which have existed since the foundation of the NHS in 1948.

NHS England has pledged that patients in the pilot areas will see significant improvements in their experience of health services, with different organisations working more closely, sharing patient information and removing the need for repeated health assessments.
This will facilitate ease of implementation in EPaaCs and of EoLC DNAR decisions.

The Independent reproduces a graphic to demonstrate the ‘increasing strain on NHS resources’. This shows those aged 65 or over as a percentage of the UK population in 20 year slices from 1951 to 2011.

A picture says a thousand words and a graphic illustrates what conclusion the draughter may wish to draw from the statistics.

Percentages of themselves can be misleading when not set against other factors which may affect the outcomes, such as parents having smaller families for instance.

Of greater significance are ‘plain sight’ figures such as the decline in projected numbers of 90 year-olds.

That there is further change afoot is clear. The boundaries between social and health care have become blurred. It is the declared aim that they should disappear.

The HSJ adds –
£200m transformation fund.
Some of the £200m transformation fund to support the development of new care models will be spent on projects not connected with NHS England’s ‘vanguard’ sites, HSJ has learned. The fund was allocated to the NHS by chancellor George Osborne in last year’s autumn statement, as part of a “down payment” to implement the NHS Five Year Forward View. NHS England’s Forward View Into Action planning guidance document, published in December, promised “a £200m would-be investment in new care models”. When it identified the 29 vanguard sites developing new care models in March, the authority said the project would be “backed by a £200m transformation fund”. HSJ understands that NHS England has now committed the funding to a number of projects, but not all of it will be spent implementing the new care models, while some will go to schemes unconnected to the forward view. Some of the £200m will be used to support NHS England’s “transforming care” scheme, which began nearly two years before the forward view was published. The initiative, established in response to the Winterbourne View scandal, is designed to improve services for people with autism and learning disabilities.
Community Care
The Clinical Directed Enhanced Services (DESs)for GMS contract states -

There is good evidence that patients with learning disabilities (LD) have more health problems and die at a younger age than the rest of the population. The existing QOF registers do not differentiate LD by severity. 
This DES is designed to encourage practices to identify patients aged 18 and over with the most complex needs and offer them an annual health check. Local authority (LA) lists of people known to social services primarily because of their learning disabilities, are to be used as the basis for identifying patients to be offered the checks. The rationale is to target people with the most complex needs and therefore at highest risk from undetected health conditions (usually people with moderate to severe learning disabilities). From the prevalence figures available, it is estimated that approximately 240,000 patients fall into this category across the country. Generally LA criteria for access to social care services are related to complexity of need, although sometimes individuals with mild learning disabilities and other additional health needs, usually associated with mental health needs, will meet social services eligibility criteria.
This is all about identifying suitable candidates for downsized care. See –
Liverpool Care Pathway - The DES

Mark Goldring of Mencap has said that DNR orders are frequently placed on patients with a learning disability.

When boundaries are become blurred they are crossed.

Risk Assessment/Management Plan Form including tick box for Advance Directive -


Liverpool Care Pathway - Back To A Way Forward
Big Nanny State has stepped up to the mark and is already clumping around, trying Big Brothers' size nines out for size.

See -
Liverpool Care Pathway - In Whose Best Interests?
Liverpool Care Pathway - AC/DC
If you have Learning Dis. does that mean you are unwell? If you are Downs does that mean you are unwell?

You are different, as are we all different. You may become unwell, as may we all become unwell. That does not mean you are unwell because you are different.

Additional reading -
Liverpool Care Pathway - A Cry For Caution, A Voice For Valour

Liverpool Care Pathway - So This Is New Year...

Liverpool Care Pathway - A Devonian EoLC

Sunday, 17 May 2015

Liverpool Care Pathway - Awareness Week

This is Living Matters Awareness Week! Whether it is your belief we only live once or more than once, still, LIVING MATTERS!



What will YOU do for Living Matters Awareness Week?



What plans do you have for YOUR
Life Café...?


This little chap is barely into this world and, already, he is an example to us all. He has suffered but has not succumbed. With his family's love and support, he has endured!

This is from Saturday's ARGUS, the must read paper of Sussex, Brighton and the south coast -


At just eight months old little Hunter Hill has experienced more trauma and pain than most of us.

And there may be more to come for the brave youngster, who was diagnosed with a rare eye cancer just days after he was born.

His parents will have to wait almost five years to find out whether Hunter’s sight will be permanently damaged by the treatment he has had to have to battle his cancer.

The cancer, called retinoblastoma, causes tumours to form in the retina of one of Hunter’s eyes.

The youngster has had to have four doses of chemotherapy along with laser surgery to tackle the tiny tumours which have been forming in his eye.

Hunter’s parents Louise and Robert will have to take the youngster for regular tests and check-ups and he faces further treatment to remove any new tumours that form.

Mrs Hill,32, was diagnosed with the same condition, retinoblastoma, when she was a small child and it has left her with 10% vision in one eye and only light perception in the other.

It was because of the family history that Hunter was diagnosed so early, meaning his tumours are being targeted before they have a chance to develop.

Mrs Hill, of Birchgrove Crescent, Brighton, said: “Luckily my condition was picked up when I was being checked for an unrelated squint. It was a fluke because there was no history of it in our family. We are hoping in Hunter’s case he will be okay but we will have to wait and see.
Louise Hill has been backing World Retinoblastoma Week, which has been raising awareness of the cancer and the importance of eye tests.


So, what will you do for this Living Matters Awareness Week?

It's not too late...

Joy Felgate of CHECT says: “In the UK, almost every week a child under the age of five is diagnosed with Retinoblastoma.

Will YOU hold a collection and share this story of one brave little lad at YOUR Life Café?

You can email at info@chect.org.uk or phone 44 (0) 207 377 5578 for a collecting tin, posters, help and information.

Life is precious.

Living matters.

Will YOU text for brave little chaps like Hunter?

Thursday, 14 May 2015

Liverpool Care Pathway - The Final Word

You cannot be serious...!
But you won't die laughing...







Correspondents continue to vilify the Mail...

Here's David Oliver in HSJ 
The Daily Mail’s Dignity for the Elderly campaign does more to ramp up fear and anger around do not resuscitate orders than it does for facilitating productive end of life care discussions, writes David Oliver. 
I never thought I’d see the headline “Hospitals bribed to put patients on the pathway to death” outdone, but the Mail’s front page on 27 April managed it. In bold 60 font “Over 75? Sign here if you’re ready for death”.
Foul infamy

David Oliver gets quite indignant:
This didn’t leave much room for prose but those not already choking on their breakfast with indignation could turn to page 4 for the detail.
This is the article on Mail Online –


David Oliver continues -
Reading on, the story concerned “new NHS guidelines urging GPs to draw up end of life care plans for over 75s and younger people suffering from cancer, dementia, heart disease or serious lung conditions” and allegedly doctors being “told” to ask all over 75s if they “agree to a do not resuscitate order”.

I got pretty concerned myself then reading of “nurses in some surgeries cold calling patients and asking them over the phone if they want resuscitation”.

Let me be clear, if this has been happening anywhere, I find it as unacceptable and insensitive as the Mail does. Its bound to upset many older people and their families.

The article carried on with barely related “while we’re at it” content – harking back to 2013 “Liverpool Care Pathway-gate”.
What does the Mail actually say...?
In some surgeries, nurses are cold-calling patients over 75 or with long-term conditions and asking them over the phone if they have 'thought about resuscitation'.

Other patients have spoken of the shock of going in for a routine check-up and being asked about resuscitation.

The extraordinary new guidance has been brought in despite the outcry over the use of 'do not resuscitate' orders under the Liverpool Care Pathway (LCP).
Wow!

But can this be true you are really choking on your cornflakes Mr. Oliver?

Last year...
Liverpool Care Pathway - The 'Art' Of Good Grooming
District nurses HAVE been sent to the homes of patients aged over 75 to ask such questions.

Just ask Roy Lilley, health policy analyst for the King’s Fund. He actually witnessed this for himself.

Mr. Lilley was at his mother’s house when the nurse visited. He described the policy as ‘callous’ and called for it to be banned. And here we are, a year later, and it is being extended.

Mr. Lilley commented: “People will be frightened to death thinking the district nurses know something they don’t and will feel obliged to sign the form so as not to be thought a nuisance.”

Age UK have been working with a dodgy pro-euthanasia group doing likewise. See, for instance, -
Liverpool Care Pathway - A New Hope...? 
Liverpool Care Pathway - The Importance Of Remaining Zeke
This dodgy pro-euthanasia group have even had a report, Divided in Dying, published by both the King's Fund and Age UK.

GP practices are being awarded accreditations.

Doctors are assessing patients during routine consultations...
Liverpool Care Pathway - A Perverse Symmetry
The Mail actually goes on to say -
The discredited pathway was scrapped last year after the Mail revealed that doctors were placing 'DNR' notices on patients without their knowledge and depriving them of food and fluids.
Well, no, actually...

David Oliver gets to the point and confirms what we have been saying in these pages all along:
Not much room for prose

Anyone challenging risks being slapped down and vilified – just check journalist Melanie Phillips’ condemnation of clinicians who took issue with her initial Liverpool Care Pathway “exposés” in 2013.

These created the momentum that ultimately led to the pathway being killed off after the Neuberger report – though it was, in effect, resuscitated.
Resusced!

No DNR  for the Pathway...
Hospitals continue to document palliative care decision making in dying patients much as they did before rather than pretending it doesn’t matter for fear of further accusations. The Mail seems to find this a problem.
Yes, David Oliver admits it. The Review was all but a sham to shut everyone up.

What have you to say to Mr. Lamb?

The Lamb has been silenced by the electorate. His party squeezed from power, he is pushed from post to be pilloried for his shamble of a Review!

And Denise...

Denise, Denise, what a slap in the face for you and all your good efforts.

But what of you, Mr. Hunt? You are still in post. Are we going to see some movement on Health & Safety and some belated prosecutions at long last?

Or are you going to pass us from pillar to post?

Here's what Gloria Hunniford thinks about it, Mr. Oliver –

Appearing on ITVs’ Loose Women yesterday she said: “My fundamental premise is I want to live and if anyone cold-called me and said will you tick this box to say do not resuscitate me, I’d say on your bike.
"First of all I want to be resuscitated.
“My sister had a heart attack at one point and my brother rang me to say they wanted to switch off the machine. I flew over there and I said under no circumstances.

“My sister had at least two, maybe two-and-a-half years more with her family and more importantly her family enjoying her.

“I would hope that once it comes to the point when it’s about resuscitation that my lovely family will take that decision for me.

“This is a really bad message to send out, it’s like ‘You’re too old now, go away’, I hate that.”
It isn't just 'cold calling' though, Gloria. It's connived grooming as well.
This is all so unreal it's surreal. It's like some Pythonesque black comedy...
Wikipedia
And it gets worse.
This is the Mirror –
A family has been forced to sell their home to pay for treatment to help their daughter fight an aggressive tumour that leaves her screaming in agony every night.

Luke and Stephanie Henry revealed how they have taken the drastic step because medication that would help nine-year-old daughter Bethany is not currently funded by the NHS.

The youngster suffers from a condition called tuberous sclerosis which causes tumours on her brain, kidneys and liver and leaves her suffering up to 50 epileptic fits a day.

A drug, called everolimus, is licensed to reduce the tumours and stop more from growing but Bethany's doctor is unable to give it to her due to NHS red tape.

In a cruel twist, the family is also unable to bid for "exceptional funding" for the drug because the condition is not rare enough as there are more than 30 patients in urgent need of it.
You cannot be serious, man!!!

This condition is both too rare and not rare enough for her to be prescribed the drug which would provide relief.

Well...

What can I say?

This has to be the final word that vindicates Professor Patrick Pullicino...

This is Mail Online -

A father who doctors ‘gave up’ on following a stroke is now recovering after The Mail on Sunday highlighted his plight.

Doctors applied four times to place a ‘do not resuscitate’ order on the medical notes of Paul Scoble, 48, after he suffered the devastating stroke last August.

It meant they would not have tried to restart his heart if he had gone into cardiac arrest, and would have left him to die.
This bears repeating...

As if once was not enough, doctors, sworn to do no harm, applied FOUR times to have this man put down on a DNR!

A final word -
Liverpool Care Pathway – CQUIN Quotas

Monday, 4 May 2015

Liverpool Care Pathway - In Hope We Trust

When all you have left is hope, you hope. The alternative is defeat and despair.





Of Hollow Conviction, Falsity and Farce.

‘False hope’...

Come on, be realistic -

Mayur Lakhani on seeing the glass half empty:
Speaking on the Kelly Alexander Show, a popular Canadian podcast, Professor Lakhani, a practising GP of 30 years’ standing, said he felt “very strongly” about patients and their families being offered the “false hope” of CPR.

Dr Lakhani said research has shown that when a patient is very elderly or frail the chances of survival or recovery when CPR is administered are “so small as to be discounted and actually could leave someone very damaged”.
- NCPC - Dying Matters
But what is the alternative?

Claire Lomas on seeing the glass half full:
‘They didn’t work my legs,’ she says. ‘The view was the legs don’t work, so they’d only offer physiotherapy to the bits that do work that could improve.
‘I wanted to exercise the bits that didn't work and try to maintain my fitness in case research reaches a point to enable me to use them again. They don’t want to give you false hope – but I don’t think a bit of hope is a bad thing,’ she says.
- Metro
And some Life Café...

This is the Leicester Mercury –
Paralysed London Marathon heroine Claire Lomas has met the man who can walk again after pioneering surgery - thanks to the charity she champions.

Claire, 34, of Eye Kettleby, near Melton, met Darek Fidyka, who was paralysed from the chest down in a knife attack in 2010, who can now walk using a frame.

The therapy, carried out in Poland - thanks to funding by the Nicholls Spinal Injury Foundation (NSIF) - involved transplanting cells from the patient’s nasal cavity into his spinal cord.

Claire - who is heading towards the landmark figure of raising half a million pounds for the foundation - hopes one day it will help her realise her own dream of walking again.
There has been a cultural shift. With the acceptance of the idea of dying as a positive life choice, euthanasia or ‘assisted suicide’ has become popularised and entered the mainstream.

They have changed the way we think. A culture of death has cast its net wide to capture and ensnare opinion. A dark shadow is stalking our hospitals and care homes. The right to death is become paramount over the right to life.
Lomas wasn't awarded with a medal for completing the marathon as rules state entrants need to complete the course within 24 hours. However, 18 runners sent their own medals to her instead.

‘That meant a lot more than being awarded one of my own,’ Lomas says, adding that she’s surprised by the number of letters she gets from people thanking her for inspiring them to overcome challenges in their own lives.

She gives talks to schools and has a similar response from the students. ‘They say: “You’ve changed the way I think.” I just want to encourage them to get out there and do stuff. It’s strange. I’d never have had this opportunity if I was still on horses.

‘I sat and dwelt on the things I couldn't do for a long time after the accident and then stopped and turned it around. If I hadn't, I’d still be sitting there thinking “poor me”. That creates a miserable life. Thank goodness I stopped myself because I've had the best days of my life since the accident. Just amazing days. And I’d never have believed that was possible in the first year, ever.’
Metro
Is this false hope, but hollow conviction, to never give in, never give in, never, never, never?
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.

Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.

Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.

And you, my father, there on that sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.
- Dylan Thomas
No, it is not falsity...
How can I just let you walk away,
Just let you leave without a trace?
When I lie here clinging to every breath,
You're the only one who really knew me at all

I wish I could just make you turn around
Turn around and see me cry
There's so much I need to say to you
So many reasons why
You're the only one who really knew me at all

Help me stay the fight against all odds
It's the chance I've got to take
Take a look at me now

There are several times my life challenges me,
But I'm not yet past the post -
The last thing I want is for you to give up on me,
especially when I need you most.
With apologies,-  Phil Collins / Lady Jane, Baroness Campbell of Surbiton
And Claire Lomas continues to inspire...

itv NEWS
Claire Lomas from Leicestershire, who was paralysed after falling off a horse, is about to ride again - this time on a motorbike!

Claire who lives near Melton Mowbray is having a go at biking at Donington Park racetrack.

She became a paraplegic after a horse riding accident in 2007. She went on to make history when she completed the London Marathon in a robotic suit.

Today's challenge has been organised by the Bike Experience which gives disabled people the chance to go motorcycling.

Claire Lomas -motorbike


It is not falsity to strive in the face of adversity but, when the hospital is a university, then rage for here is farce.

This is HSJ reporting on the deaths of mothers and babies at the University Hospitals of Morecambe Bay NHS Foundation Trust 

The Health and Safety Executive has been criticised for not intervening over the deaths of mothers and babies at the University Hospitals of Morecambe Bay Foundation Trust.

James Titcombe, whose son Joshua died at the trust in October 2008, has criticised what he called an “arbitrary policy decision” by the HSE not to bring prosecutions over poor care at the trust’s Furness General Hospital between 2004 and 2013.

However, he praised Cumbria Constabulary for its decision to investigate poor care at the trust. He said: “Without the police investigating, other families would not have come forward and the wider pieces of the jigsaw would never have been put together. We are very grateful to the police.”

He told HSJ: “Under health and safety legislation, the HSE do have the power to investigate and prosecute NHS organisations that fail to take ‘reasonably practicable’ steps to prevent exposing patients to serious risks of harm. It’s a lower threshold than the police but the HSE have chosen not to apply it. They have taken an arbitrary policy decision not to apply the law. The HSE could have done a lot more, sooner, and events wouldn’t have cascaded into what happened.”
James Titcombe’s views are fully supported by Sir Robert Francis in the Mid Staffs Public Inquiry Report  –
13.143 The starting point must be that at the moment there is no criminal sanction available, other than that under the HSWA for failures of safety systems to protect patients, unless these follow failure to remedy a breach of certain regulations after issue of a warning notice by the CQC. Only the HSE has power to prosecute for an offence under the HSWA. The policy reasoning behind this may well be that adopted by Professor Sir Liam Donaldson: that it is generally undesirable to bring the criminal law into the clinical arena, as it inhibits openness and improvement. The alternative view is that in appropriate and serious cases it is in the public interest that those responsible for serious breaches of safety requirements should be held to account. Unless such an avenue is available, there is a serious danger that public confidence and trust in the health service will be undermined. No-one sitting through the two inquiries into the Trust can have been left in any doubt about the impact on public confidence of no individual or organisation having been brought to account for the failures in Stafford.

13.144 Given the current gap through which serious cases of safety breaches in a healthcare setting are likely to fall, the approach of the HSE is not calculated to maintain public confidence, even though such an agency is perfectly entitled, and indeed under a duty to take resource allocation into account in making decisions on what to investigate.143 The approach has the appearance of looking for reasons for not taking action rather than starting from a consideration of what is in the public interest. A concentration on the effect of a decision on resources has led to the unacceptable position where the more serious and widespread a failure is, the less likely it is that the HSE will decide to intervene, even where it is apparent that no other regulator is likely to do so.

13.145 Therefore, there is an unsatisfactory gap in the ability of regulators to enforce criminal sanctions in serious cases, in particular those involving death or serious harm to individuals where serious deficiencies in standards are involved. For understandable reasons, given the breadth of its responsibilities, its lack of specialist expertise in healthcare issues, and the existence of regulators apparently better equipped to make judgements on them, the HSE has been reluctant to take a less restrictive approach to healthcare cases. On the other hand, the CQC has relatively limited powers to prosecute. This restriction has, in part, been formed by reservations about the value of criminal enforcement in healthcare.
‘No individual or organisation was brought to account’.

The guilty escaped justice.

Moreover, the LCP which continues in use was a prime suspect involved in the deaths investigated at Mid Staffs -


The Telegraph
Figures disclosed by the hospital under the Freedom of Information Act show that use of the Liverpool Care Pathway (LCP) rose markedly in the wake of the introduction of targets promoting its use in 2009.

The system of care, intended to give patients greater dignity and less pain in the final hours of their lives, is under review after claims that medical staff across the UK had put people in it without proper safeguards.

It involves removing treatments deemed to be more harmful than helpful including, where appropriate, reducing food and fluids.

But a series of families have come forward to claim that their loved ones were placed on the treatment regime without any consultation or even when they were not imminently dying.

It emerged last year that almost two thirds of trusts using the system had been receiving payouts from the state for hitting targets linked to its use
The costs of the Inquiry up to November 2013 were approximately £13 million which amounts to some £100 thousand a day for every day the Inquiry sat. [Mid Staffs Inquiry]

And the chap in charge who overlooked this debacle walked off with a tidy lump sum and a pension thankyou very much.

No individual or organisation was brought to account.

The guilty continue to escape justice.

The regulators did not and do not investigate and bring to justice those responsible.

No, this is not farce but foul infamy.

And to some the Daily Mail continues to be the Daily Fail...


HSJ
Supplemental reading -
Liverpool Care Pathway - A Rose By Any Other Name

Liverpool Care Pathway - Who Monitors The Monitors And The Monitors Of Monitors...?

Liverpool Care Pathway - A Failure Of Care

Liverpool Care Pathway - Have You Read the Olds Lately?

Post partum -
 North-West Evening Mail
CLINICAL negligence and legal costs totalling more than £45.3m have been paid out by the trust that runs Barrow’s hospital since 2003.

The stark figure includes a £12.5m bill to cover claims for failures within maternity services across Morecambe Bay between 2006 and 2013 – years in which shocking clinical failures resulted in the avoidable deaths of 11 babies and a mother at Furness General.

A breakdown of the individual claims and settlements was not provided by the University Hospitals of Morecambe Bay NHS Foundation Trust – despite a request submitted by the Evening Mail under the Freedom of Information Act.