Liverpool Care Pathway – Evidence Based

This is the 21^st century.

 

The following headline appears in MailOnline

Is this what we get for spending MORE on the NHS than ever before? Shameful neglect of the elderly in ONE FIFTH of our hospitals breaks the law, says watchdog

This is the 21^st century and what a sorry state we are in.

·         Medical staff trained to obediently adhere to Mission statements and dedicatedly complete tick-box forms.

·         Medical staff trained to blindly follow procedure.

·         Everything, on paper, on computer, recorded and evidence-based.

Is it…?

 

Sophie Borland reports:

One in five hospitals is breaking the law in its level of neglect of the elderly, a damning report revealed yesterday.

The Care Quality Commission found at least 20 hospitals where care was so poor that patients were denied ‘the basics in life’ – eating, drinking and going to the toilet.

This was a fifth of the hospitals investigated by the Government watchdog. It warned that staff in some NHS trusts were ‘putting paperwork over people’. 

Health Secretary Andrew Lansley insisted the Government's planned changes to the NHS will help address many of the problems.

The watchdog visited 100 hospitals between March and June to

check they were meeting the basic standards required by law, which

ensure that elderly patients are properly fed and treated.

(file picture)

On some wards inspectors saw frail patients rattling their bedrails or banging on water jugs to try to attract the attention of staff.

On others, nurses had ignored doctors’ instructions to put dehydrated patients on drips and abandoned them without fluids.

The watchdog visited 100 hospitals between March and June to check they were meeting the basic standards required by law, which ensure that elderly patients are properly fed and treated with dignity.

The inspections were partly triggered by a campaign by the Daily Mail and the Patients Association which exposed the appalling standards of care on some wards.

Today the CQC’s director of operations Amanda Sherlock told the BBC's Today programme: 'Some of the examples of poor care our inspectors identified are truly appalling and truly shocking and there should be no excuse from the trust boards, from nurses and doctors and care assistants providing care.

'Older people have a right to expect basic standards of dignity and nutrition. Care should not be a lottery.’

Inspectors monitored whether nursing staff were helping frail patients eat their meals and making sure they had enough water throughout the day.

They also checked whether nurses responded to patients’ calls for help, assisted them to the toilet or helped move them to prevent bedsores.

Last week the watchdog announced it had found that 49 hospitals, nearly half, were not doing enough to ensure patients did not go hungry or thirsty. 

Yesterday it unveiled its full report, which revealed that in 20 NHS trusts, the standard of nursing care was so poor it was in breach of the Health and Social Care Act 2008

The danger of processes and procedures are that they place the practitioner inside a box out of which it is not permitted to step. The protocols of the Pathway supercede all others and must be adhered to. The processes and procedures are there, however, not to safeguard the person on the delivery end of the service provision but solely for the benefit and protection of the provider.

On The Frontline

Medical staff trained to obediently adhere to Mission statements and dedicatedly complete tick-box forms. Medical staff trained to blindly follow procedure. Everything, on paper, on computer, recorded and evidence-based.

The tick-box LCP, also evidence-based, is a 'Gold Standards Framework' that cannot be contested precisely because it is 'evidenced-based'.

Not at all untypical or exceptional, this comment was made on the Care2 Liverpool Care Pathway petition site:

11:48, Sep 11, 
My mother was killed on the liverpool care plan at the james paget hospital she was given two days to drink before they removed the drip it was later found that her false teeth had been stuck together because of a paste like food they had given her and she could not open her mouth to drink she had recieved no mouth care.Who gives the nhs the right to play god

The ‘evidence’ shows one thing but, in the real world, those on the receiving end of this blunt instrument that is the LCP protocol know otherwise.

The LCP is 'authoritative' evidence; it is 'Gold Standard’ and evidence-based. Our evidence is 'anecdotal' and, therefore, not considered reliable.  Of course, our evidence is 'anecdotal evidence'; we are telling it how it is and not how it looks! In that respect, it is more reliable, as the revelations unfolding in the press continue to disclose.

It is interesting to note that, in their continuing investigations, the CQC inspectors have found, and continue to find, patients denied fluids and food. 

This was the case at a hospital, one amongst many others, singled out for mention - the JAMES PAGET Hospital, pictured left, the very same hospital cited in the post, above!

The CQC report states that nurses ‘defied orders to give dehydrated patients drips.’ 

That is the tale the inspectors were spun. 

However, according to the account given by the petitioner on the Care2 Liverpool Care Pathway petition site, this was not done in defiance but done in compliance - with the Liverpool Care Pathway (liverpool care plan) at the James Paget Hospital!

Almost 50 NHS trusts are in severe financial trouble, including 20 which are ‘non-viable’, a report says.

In some cases, costly Private Finance Initiative deals have landed hospitals with huge debt repayments they can no longer afford.

The analysis by the National Audit Office says deep-seated problems could lead to the break-up of local hospital services.

NHS managers said time was running out before some services went bust,  and predicted more care would have to  be moved out of general hospitals into  specialist centres and patients’ homes.

Under PFI deals, a private contractor builds a hospital and retains ownership for up to 35 years. During this period, the public sector must pay interest and repay the cost of construction, as well as paying the contractor to maintain the building.

CQUIN is the DOH funding policy. CQUIN has set targets for 2011/2012 with regard to the End of Life LCP program. The forward plan is to increase the number of patients identified to be on the end of life care pathway from a baseline of 0% to 20%; it is further planned to have 30% of all patients who die in hospital dying on the Liverpool Care Pathway.

To ensure they receive their provider income in full, Trusts have to comply with or exceed these goals.

We've been here before. It’s a small world...