Wednesday, 20 August 2014

Liverpool Care Pathway - Data Is Power

Do they care dot data? You bet they care dot data! But will they dare dot data?





This is The Bolton News –
A spokesman for the Bolton Clinical Commissioning Group said: “People should be reassured this is a national NHS programme, which will adhere to the highest standards of privacy and confidentiality.
"The information will be stored in a secure way and the HSCIC is bound by legislation to ensure confidential data is protected at all times.”
People were not reassured and the roll out was postponed.

The Mail claimed victory as theirs but MP, David Davis, urged caution and concern...
The NHS (National socialist Health Service) said the project would be postponed until the autumn while it runs an awareness campaign, but it would remain an opt-out rather than an opt-in scheme, just as organ harvesting has become and is becoming. Civil liberties are being trodden underfoot.
Lancaster Guardian

Well, here we are, half-way through the summer, and I don't see that anyone is any more aware than they were. What campaign has proceeded, if there has been one, has been on a par with the laughable but not funny Common Market misinformation campaign that had  co-opted everyone in and culminated in a referendum in 1975 in which everyone voted Yes or No to stay in without realising the significance of that.

The Times actually published a letter from some of the country’s most senior doctors and health executives in defence of and justification for the Dot Data plans.

From afar, Newspoint Africa reported –


After Dr. Gordon Gancz decided to opt out all his patients from a NHS scheme to extract their details, Health Service officials have threatened to shut down his GP surgery.
Dr. Gancz has been practicing medical services for almost 40 years and he accused the NHS of bullying doctors and patients to fall in line with their scheme. The scheme will automatically extract private medical information of patients until they opt out. Dr. Gancz has received a threatening email that if he breaches the contract, he will face a shutdown of his practice.
Some local GP surgeries made opt out leaflets available...

This is The Visitor –
Local GP surgeries in Morecambe and Lancaster are offering leaflets allowing patients to opt out of having their details uploaded.

Care.data say the database will enable them to assess diseases, examine new drugs on the market and identify infection outbreaks, as well as monitor the performance of the NHS. But Lesley Archer, of Rhylstone Drive, Heysham, who cares for 88-year-old Robert Nightingale, is worried no-one knows about it. She said: “I had a leaflet put through my door but I don’t know anyone else who has had one.
“All your medical records will be sent from your GP to a giant central database and you have to actively opt out to prevent that happening, rather than consent to get involved.
“The delay is so that people can be brainwashed really.
“The NHS haven’t got a good record on keeping things confidential.”
NHS England agreed to delay the roll-out of Care.data by six months until the autumn amid criticism of how it has run the public information campaign about the project.

“The NHS haven’t got a good record on keeping things confidential.”

How's this for confidentiality, even if the records have been, supposedly, anonymised...?

This is HSJ –
The medical records of almost 50 million NHS hospital patients have been sold for insurance purposes, it has been reported.
The revelation comes less than a week after controversial plans to share medical records were delayed until later this year.
Both the British Medical Association and the Royal College of GPs have warned that patients are being kept in the dark about the plans.
Dot Data is an extension to a centralised database of what has already been proceeding at a local level. The Electronic Palliative Care Coordination System (EPaCCS), amongst others reported in these pages, is already synced with the Death Lists.

It all seems such reasonable and innocuous stuff, but perception is 99% of the law. When the Law comes knocking at your door, the composure of threat determines 99% of the response.

We are witnessing the coming together of a fascist regime and we are only half-way there.

We are witnessing the coming together of a fascist regime and nowhere is this being challenged.

This is -
Liverpool Care Pathway - Appointment With Death
This is HSJ –


What’s this? The police want greater access to confidential GP medical records without necessarily obtaining the prior consent of the individual concerned?

When NHS England’s plans to collate GP metadata from us all for research - and commercial - purposes took a faltering step forward in February, it hit a wall of tabloid hysteria and stepped back to rethink devices for voter reassurance.

Big Brother
Professional and public suspicion - reflected in website analysis and comment - is a mixture of paranoia and concern that such data is open to abuse or exploitation, commercial or otherwise.
Edward Snowden’s revelations were fresh in the public mind, reminding us all just how invasive Big Brother technology now is, and not just at GCHQ level either.
Late for supper one night I phoned my son to say “we’re on our way”. “No you’re not, you’re still parked outside the house,” he replied. My iPhone tracker gave me away.
Back in February David Davis, the libertarian Tory MP, challenged health minister Dan Poulter.
He confirmed that police pursuing serious crime will have “backdoor” access - which was Mr Snowden’s complaint about spy agency dealings with Google - to the NHS’s new arm’s length database, even the records of patients who have opted out. Previously they would have had to trace a suspect’s GP.
Big Brother is a public guardian who knows better than we what is best for us and will take charge of us and our affairs for our own good. 1984 was 30 years off the mark and we are walking into Big Brother's world with a smile and a grin to welcome him with arms open wide.

God is watching us on a CCTV monitor.

How will police respect Care Dot Data? The same way they respect any and every opportunity that comes their way...?

At our scheme recently, a client, a vulnerable adult with mental health issues, became involved in a misunderstanding. An altercation ensued. Our client attempted to explain himself and, when this failed, he took it upon himself to phone 101 on his mobile phone. Just then, a police patrol car happened to pass by.

The two officers in the car arrested our client and he was taken to holding cells where he had all his possessions removed from him. A Solicitor and Appropriate Adult were appointed.

At first, our client chose to remain silent. The Appropriate Adult persuaded our client to explain what had happened and what his intentions had been. Our client did so.

Our client's mother phoned the following morning. She had been trying to phone her son and he was not answering. At her request and our joint concerns for his well-being, we used the master key to check his room.

At no time were we or his mental health team informed by police of what had happened to our client. We learnt from other clients that two uniformed officers had entered the house the previous evening, letting themselves in, and used a key to enter our client's room.

Our client returned later that morning to his home and began preparing himself a meal. He had not eaten.

He had just attended an appointment with his mental health team. He had not told them, he said, because he felt shamed by his arrest. No, he did not know police had come to his home. No, he had not given permission for them to use his keys.

Our Service Manager is looking into this reported intrusion and uninvited entry into the house and invasion of our client's room.

This is quite extraordinary. There was neither warrant obtained nor was there consent to enter supplied. This was an act of trespass for which explanation shall be sought.

At the end of the day, will it all be down to plausible deniability? Who is to be believed: a fine upstanding officer of the law, or a fruit and nut mental case? 

Really?

Lesley Archer said, “The NHS haven’t got a good record on keeping things confidential.”

The NHS haven’t got a good record on keeping things, full stop.

Reporting on Wirral Hospital, home of the Wirral Integrated End of Life Pathway, here is the Liverpool Echo –
More than 1,500 cancer patients’ medical records were mixed up in a computer bungle at a Wirral hospital, the ECHO can reveal.
The Clatterbridge Cancer Centre admits there was an error in the way they uploaded some data into a system they use called PACS (Picture Archiving and Communication System) which meant that as many as 1,598 medical records ended up containing some wrong information.

The hospital said there was no risk of patients being misdiagnosed – told they have cancer when they have not – as the affected scans and X-rays are for planning treatment only. Their patients have already had diagnostic scans.

The problem is said to mainly affect Clatterbridge, with a smaller number of records being affected at other trusts who have the same network.

These include the Royal Liverpool Hospital, Liverpool Women’s, Liverpool Heart and Chest, The Walton Centre, Fazakerley, Alder Hey, St Helen’s and Knowsley, Warrington and Halton and Southport and Ormskirk hospital.
And this is BBC News Berkshire – 
A woman who was wrongly told she had Alzheimer's and cancer when her medical notes were mixed up with those of her dead husband has received an apology.
Kathy Patient, 71, from Bracknell, Berkshire, went for a CT scan at Frimley Park Hospital last Friday due to heart problems and blood clots.

She said before the procedure the nurse was insistent she had a number of other conditions.

Mrs Patient said: "The nurse said you've had [a CT scan] done before. I said, 'no I haven't'; she said, 'yes you have'.
'Started crying'
"She asked me to confirm my date of birth and name. She left me for few minutes, then came back and said, 'you've got Alzheimer's and cancer'. I said, 'no I haven't'; she said, 'yes you have'."
Yes, you have; you have Alzheimer’s and you can’t remember, poor dear...
The nurse later returned and admitted she had mixed up Mrs Patient's records with those of her 80-year-old husband - who died 18 months ago.
The hospital, which sent a bouquet of flowers, said it was "extremely sorry" and was taking the matter "very seriously".
"We are currently investigating how Mrs Patient's late husband's history became attached to hers on our electronic radiology record," it said.
At a centralised level, on a national scale, the ‘Big Guardian’ element aside, this has ponderous considerations and worrying implications of consequence and consequences.

Some further things to ponder upon -
Liverpool Care Pathway - The DES
Liverpool Care Pathway - A Land Of Confusion
Liverpool Care Pathway - When The Funding Had To Stop
Liverpool Care Pathway - The Palliative Option And Downsizing Care
Liverpool Care Pathway - After The Review, After Everything, They're STILL Killing People
Footnote:
The fact is that if the designs behind the Common Market are carried out, we are bound to be affected in every phase of our national life. There would be no national planning, except under the guidance of Continental planning—we shall not be able to deal with our own problems; we shall not be able to build up the country in the way we want to do, so far as I can see. I think we shall be subject to overall control and planning by others. That is my objection.
Earl Attlee, 1962

Sunday, 10 August 2014

Liverpool Care Pathway - The Final Countdown... And Counting

If we view our old ones as a “time bomb”, what does that say about us?




In May of this year, Hartlepool Care Home Managers forum ran a Local Study Day for Carers working in the area. Attendees of the study day, at the Borough Hall in Middlegate, were awarded a certificate of attendance to file in their training portfolios.

This is Care Industry News –


Course features included - managing continence issues in EOLC, implementing EoLC pathways and a Syringe Pump tutorial.



The major focal point of the day is to address the End of Life Care Pathways that change this year following the phasing out of the Liverpool Care Pathway. The Conference will have a two pronged approach, taking the opportunity to address the issues of Dementia in Elderly Care and looking towards agreeing an assessment tool that covers EOLC for people suffering dementing illness.
This is...
a time bomb that is in its final stages of countdown.
The "focal point" of the Study day was ringing the changes in EoLC brought about by the Neuberger Review. A year ago, it was announced that the LCP was to be 'phased out'... 

One year later, the LCP has not been phased out; there is no moratorium on its use and the sin city users are still hooked on its use.

They've re-branded. There are 'legal highs' like The Wirral -

Wirral Community EoLC Team
 At Wirral, they’re not going to get their fingers mucky...
What does the End of Life Care Team do?
We work with health and social care professionals
NHS and Care Home staff are encouraged to contact the team on the number below if you require support, education or guidance regarding implementation of any of the End of Life Care Tools.
Please note: Our staff do not have direct contact with patients

In June, the Wee Bee Long Leadership Alliance 'Gang of 21' published One Chance To Get It Right –

The Wirral Team have responded –
One Chance to Get it Right

The National Alliance has produced its report in response to the phasing out of the Liverpool Care Pathway. The report called One Chance to Get it Right identifies five Priorities for care of the Dying Person.

A task and Finish Group is being established on Wirral to look at how these five Priorities for care of the Dying Person can be incorporated into individualised care plans for patients. In the interim period the Wirral End of Life Care Quality Group has identified the need to adapt the current PACA (Patient and Carer Assessment) document to incorporate elements of the five Priorities for care of the Dying Person
The Wirral tools are the Gold Standards Framework, the Preferred Priorities for Care and the Wirral Integrated End of Life Pathway, which is, essentially, the LCP...

See -
Liverpool Care Pathway - There Are Many Pathways...
-  Wirrall Community EoLC Facilitators
The Wirral Integrated End of Life pathway incorporates the patient journey from diagnosis through to death and should be used so that prognostic indicators enable health & social care staff to anticipate care.
End of Life Care Facilitators 
The End of Life Care Facilitators are based within the Clinical Education and Development Team as part of Clinical Excellence. The role is to work within the framework of the Wirral End of Life Care Model. Ensuring best practice for End of Life Care for all conditions for patients and their loved ones.
The role of the facilitator involves the implementation and promotion of the End of Life Tools that are recommended within the Department of Health EOLC strategy (2008).

These 'legal highs' are a cape beneath which they conceal the uniform of their true loyalties.

To Stephen Barclay, who has his fingers in many an EoLC honey pot, the CAPE is a mapping tool...

Stephen is always looking out for that next cutting edge tool that will identify candidates for EoLC.

This is CAPE: Community cAre Pathways at the End of life: mapping the pathways to improve care.

Further reading -
Liverpool Care Pathway - There Are Always Consequences
Liverpool Care Pathway - On Pint-sizing Perceptions of Care And The Betrayal Of Trust

At Greenwich & Bexley Community Hospice, they're still openly using –

The use of the Liverpool Care Pathway helps to ensure unnecessary or inappropriate care is discontinued.

When the pathway is started, the dying person’s medication will be reviewed and any that is no longer helpful may be stopped or substituted for another form, sometimes new medicines may be prescribed just in case to help if a new symptom should occur and to prevent unnecessary delays.


Meanwhile, KNMG says morphine should not be used in palliative sedation –


Morphine and palliative sedation: Directive should be followed 
Morphine is not suitable to accelerate death or to sedate patients. The KNMG Guideline for Palliative Sedation classifies this as bad practice. The report-Danner makes the importance of compliance with this Directive insistently clear, according to the KNMG.
The Danner report was convened in response to the high mortalities reported at the Ruwaard van Putten Hospital.

The article suggests that Midazolam should be used in place of Morphine.

The article cautions that, if not sufficiently sedated, the patient could become confused and suffer myoclonic jerks.

The Netherlands Times reported that –
Smaller hospitals can have a lower mortality rate if doctors monitor each other better, and the medical staff follows national guidelines, and keeps better track of patient records. The Danner committee draws this conclusion after examining the deaths of nearly 800 patients in the Ruwaard van Putten Hospital in Spijkenisse.The Ruwaard van Putten Hospital made the news frequently the past few years because of many deaths in the cardiology department. The affair eventually led to closure of the hospital.
A committee headed by Professor Sven Danner was commissioned to examine the files of patients who died in the hospital between 2010 and 2012. The death of 1 out of every 11 patients proved to be partly caused by the treatment.
Much went wrong in care around the end of life of patients. One example cited the use of incomplete treatment methods, such as the use of morphine as a means to keep people asleep. Records in the files were also inaccurate.
Yet the health damage that patients in this hospital were subjected to is not different from the national average, the commission found.

At Hadamar, they used Morphine to kill 'Defectives'...


Hadamar Nurses




Don't think it can't happen here because it couldn't.


1200 people perish every year on the NHS...
These appalling figures are reported by Mencap -
The principle investigator of the confidential inquiry, Pauline Heslop of Bristol University, also cautioned that the seriousness of the issues raised by her report required "more immediate actions … which are largely missing from the Department of Health commitments".
She said: "We cannot allow the situation to continue in which people with learning disabilities are dying from causes of death amenable to good quality healthcare. That needs tackling with some urgency, and urgency of action appears to be lacking in the Department of Health response.
"In particular, we are disappointed that the Department of Health has not agreed to a national mortality review body to review future deaths of people with learning disabilities."
Jan Tregelles has said this is: “A scandal of avoidable deaths on the scale of Mid-Staffs.” 
The government’s reluctance to set up an investigative body to look into this scandal is on a par with Gosport.
This is The Danish Centre for Holocaust Studies -

Hitler's authorisation of the Euthanasia
Programme (Operation T4)
Euthanasia – the ‘mercy killing’ of disabled people in Germany 

Background 

After Hitler had received a letter from the father of a handicapped child, whom the father wished to be put to death as a mercy killing, the Fuehrer approved the Euthanasia Programme. The idea of the Programme was to “remove” the seriously disabled on a national basis.

They have already shifted perceptions. And we are only half way there.

Additional reading -
Liverpool Care Pathway - The Final Countdown
Liverpool Care Pathway - There's Life In The Old Dog Yet 

Monday, 28 July 2014

Liverpool Care Pathway - On Pint-sizing Perceptions of Care And The Betrayal Of Trust

They need your consent. To get your consent, they have to get you to pint-size your care expectations and see the glass half empty.



With a literature review published on PMC, this is The British Journal of General Practice –
Heart failure is an unpredictable, progressive, and incurable condition. Around 1 million UK citizens1 and 5 million US citizens are estimated to be living with heart failure: 1% of the general population and 15% of those aged over 80 years. Heart failure is a leading cause of hospital admissions, and a substantial drain on healthcare resources: it is mentioned on one in eight US death certificates.
A “leading cause of hospital admissions...”

A “substantial drain on healthcare resources...”

Already, the mindset is cost, not care.
The prognosis associated with a diagnosis of heart failure is poor, worse than for many cancers; 38% of patients are dead within 1 year of diagnosis and 60% within 5 years. Around 50% of deaths are sudden, especially in the less severe stages, from arrythmias or ischaemic events; many of these patients are reported to have had a good quality of life in the month before death.
The prognosis is “worse than for many cancers”.

But it is the interpretation of data which determines perception...

62% of patients actually survive longer than one year; 40% survive longer than 5 years. 50% of deaths are not sudden.

Clearly perceptions are being pint-sized to confine expectations to finite horizons of care.

There was early recognition that reduction of hospital admissions is key to cost-cutting...
Community-based heart failure nurses have been in place since 2003: their focus is primarily on optimising medical management and admission reduction
This precedes introduction of the EoLC Strategy.
Clinicians often have a treatment imperative that makes it difficult for them to face the limitations of modern medicine and introduce EOLC issues. Prediction of the time of death is almost impossible, confounding even the best prognostic models: in one study more than half of those who died within 3 days had been estimated to have a prognosis of over 6 months. Patients may have been close to death on several occasions, and seek hope through a positive reconstruction of the threat to life.
“Prediction of the time of death is almost impossible, confounding even the best prognostic models

The EoLC Strategy recognises that pint-sizing care expectations is key to cost-cutting...
The first step of the 2008 NHS EOLC strategy ‘End of life care pathway’ is entitled ‘Discussions as the end of life approaches’.
The EoLC Strategy...
calls for ‘a significant culture shift within the public and the NHS’
The...
literature reveals that many ‘EOLC conversations’ are largely limited to advanced directive paperwork and choices for resuscitation rather than communication about goals and future care options. There is a low level of agreement between doctors and patients, and doctors and family members, as to whether EOLC conversations have taken place at all, and discrepancy between these groups regarding their perception of the amount of information exchanged; this raises questions concerning the reliability of clinician reports and the adequacy of the form and content in which clinicians discuss EOLC.
There is always the assumption that what can be done will be done. You don’t just throw in the towel.

Every day is a bonus and to be able to squeeze another day out of the toothpaste tube is always a plus. You just stay positive.
Recent years have seen dramatic therapeutic advances in the management of heart failure that have significantly improved patients' survival and quality of life
However...
As EOLC comes to the fore across the NHS, there is a growing tension between active management and the need to communicate an uncertain and poor prognosis: a double message that is difficult for clinicians to communicate and for patients to receive.
Pint-sizing care expectations has become imperative to successful implementation of EoLC.
Doctors tend to focus on current aspects of medical management rather than the future, approaching heart failure as a problem to be fixed instead of a terminal illness; this may hinder communication concerning wider and longer-term patient needs. They fear alarming patients unnecessarily, creating anxiety and depression, destroying hope, and causing patients to give up the fight for life. Doctors tend to focus on current aspects of medical management rather than the future, approaching heart failure as a problem to be fixed instead of a terminal illness; this may hinder communication concerning wider and longer-term patient needs. They fear alarming patients unnecessarily, creating anxiety and depression, destroying hope, and causing patients to give up the fight for life.
The Macmillan-funded study concludes...
Conclusion
Heart failure patients need clinicians to be sensitive to their individual wishes for EOLC conversations, which change as events and time unfolds. Clinicians who tend to avoid such difficult conversations need to learn to pick up the cues that the patient would like to talk further. Those who view open awareness as the best way to prepare for the EOL need to live with the internal tensions created when patients are reluctant to discuss this. A dual approach of continuing active treatment while acknowledging the possibility of death, at least to ourselves, is perhaps the way forward: ‘hoping for the best but preparing for the worst’.
The researchers agree that those discussions are all-important. Stephen Barclay is a leading researcher in this study.

Dr. Barclay leads the CLAHRC End of Life Care Research Group, which is based in the Institute of Public Health and is a member of the General Practice Research Unit.

Stephen Barclay was involved in the development of the Share my Care EoLC register. We have seen these registers spread and multiply. They have been called Death Lists.

Further reading -
Liverpool Care Pathway - There Are Always Consequences
Liverpool Care Pathway - The State Rules, Okay?
A culture-shift has taken place in the NHS across all levels, from GP Practice to hospital ward. Call it what you will, this is social engineering...
Liverpool Care Pathway - Nudge, Nudge, Say No More...
In November 2012, Mail Online reported -
The Health Secretary has acted after the Mail highlighted chilling cases in which patients were placed on the Liverpool Care Pathway – which involves withdrawal of fluids and food – without their relatives’ knowledge.

On Monday he will announce rule changes that will see end-of-life care included for the first time in the NHS Constitution.

The document lays down principles that all doctors must follow.

Last night Mr Hunt said he would enshrine the ‘basic right’ of patients to be involved in decisions when they are mortally sick.

He threatened ‘tough consequences’ for hospitals that fail to consult.

Patients and their families will be able to sue health trusts that break the rules and doctors who ignore their wishes face being struck off for misconduct.

Mr Hunt said he would enshrine the ‘basic right’ of patients to be involved in decisions when they are mortally sick.

Let’s say that again...

Mr Hunt said he would enshrine the ‘basic right’ of patients to be involved in decisions when they are mortally sick.

The Neuberger Review focussed on this, also –
Consent

One of the central issues causing difficulty in the use of the LCP seems to be misunderstanding and uncertainty over whether deciding to implement the LCP is a treatment decision, requiring the patient’s consent or requiring the decision to be taken in the patient’s best interests if they lack capacity. In some cases, relatives and carers incorrectly consider they are entitled to decide whatever treatment their relatives receive, and in others clinicians fail to seek consent from a patient or consult the relatives and carers in a ‘best interests’ assessment when treatment is being changed.

The LCP is not a single, simple medical procedure, and so there is no legal requirement for consent to be sought before it is used. Some aspects of the LCP do not concern treatment, but others, such as medication changes, do. Patients, relatives and carers are always entitled to explanations of how decisions have been made and a chance to understand them, but all too often they have not been afforded that opportunity. The LCP documentation is deficient in making distinct and clear where the need for consent and explanation exist.
Well, they had to say that to cover themselves against pre-V12 litigation but it does negate Mr. Hunt's stated assurances.

They do own up that...
The LCP documentation is deficient in making distinct and clear where the need for consent and explanation exist.
And that is quite alarming!

This is what NHS Choices has to say –

Consent to treatment is the principle that a person must give their permission before they receive any type of medical treatment or examination. This must be done on the basis of a preliminary explanation by a clinician.
Consent is required from a patient regardless of the intervention  from a physical examination to organ donation. 
The principle of consent is an important part of medical ethics and the international human rights law.
There does appear to be a fundamental principal of understanding that patients should have a right of say in the course of their treatment. That this should need to be a point of discussion at all is alarming; it should be a no-brainer!

In June, Lord Dyson ruled in the High Court that...
" there should be a presumption in favour of patient involvement."
and -
“doctors should be wary of being too ready to exclude patients from the process on the grounds that their involvement is likely to distress them”.
Further reading -
Liverpool Care Pathway - A New Hope...?
Liverpool Care Pathway - So Readily Do Perceptions Change...

On the day they decided to put her down, May was alert enough to respond indignantly to the doctor who hauled her about to examine her: “What are you doing?”

If May was in pain at that time, she would have moaned, groaned; she would not have responded in the manner she did.

The doctor ignored May’s remonstration and turned to address those members of the family present that he would get May an x-ray. The doctor went off.

He returned to say that he had consulted with his LCP team. The EoLC Nurses had already primed the family and they readily agreed for May to go on the LCP.

Minus one.

One of May’s daughters had stood her ground through and through and had warned of the LCP. She had been dismissed.

But wait...

May had capacity. The hospital readily admits to this. Did she not have a say in her care?

Read further here...
Liverpool care Pathway - A True Story

Liverpool Care Pathway - Responses Will Be Answered 
Liverpool care Pathway - A True Story Supplemental

The case is clear...
Patients and their families will be able to sue health trusts that break the rules and doctors who ignore their wishes face being struck off for misconduct.
How can this be then that, after all the uproar, furore and publicity, law firms have not heard of the LCP?

Small-time ambulance-chasers perhaps, but Senior Associates at high-profile law firms ...?

Hmmm.

In June of last year, the NHS Litigation Authority, working with the Department of Health, appointed a new £400m legal advice panel of solicitors to provide legal services to 15 DoH organisations over the next four years.

Well then, what chance do we stand anyway to bring  a case when those paid by the public, working for the public and, therefore, with a duty to the public commit grave error against the public and then use those funds provided them by the public to pay lawyers to refute these charges the public have made against them?

They and their establishment cronies have literally got away with murder.

I rest my case.

Additional reading -

Liverpool Care Pathway - Culpable But Not Answerable