Tuesday, 16 October 2012

Liverpool Care Pathway – An Affordable Outcome

As a recent study, showed, the better the care, the better the outcome. 

The study, published in the Lancet, says -

Doctors concede that there is simply not the money to provide such a level of care for all patients.
But they say hospitals need to improve care for “high risk” patients, such as the very old

What the NHS is looking for is an affordable outcome.

The Liverpool Care Pathway is all about affordable healthcare and "how best to apportion care in the circumstance of a scarcity of care provision with 'both procedural and substantive insights for developing a just allocation of health care resources' and the allocation of those scarce resources considered or not considered as basic." (Where Civic Republicanism and Deliberative Democracy Meet and The Lancet)

Here is Liverpool Care Pathway – And The Rationing Of Resources -
The NHS is in dire financial straits. Both those of this and those of that political ilk each lay the blame at each other's door. Much of this 'blame' must be laid at the door of the PFI's (Private Finance Initiatives) indulged in frivolously and thoughtlessly by the last Labour government.

What is referred to as 'affordable care' — in the States, Obamacare — by implication, suggests affordable to the individual. In practice, this is healthcare that is affordable to the State. It is the rationing of care to the lowest common denominator of availability.

This is The Telegraph -

The NHS is paying for Labour’s dodgy deals

The state faces huge costs because of flaws in PFI contracts agreed by the previous administration

Ailing: the Princess Royal Hospital in Bromley, part of the struggling South London Healthcare Trust
Ailing: the Princess Royal Hospital in Bromley, part of the struggling South London Healthcare Trust Photo: Alamy

Yesterday afternoon, the Queen opened the South West Acute Hospital in Enniskillen. She will doubtless have been impressed: the facility, the first to be built in Northern Ireland for more than a decade, is a gleaming shrine to 21st-century healthcare. What may not have been mentioned, however, was that the £276 million hospital was constructed not with public funds, but by a consortium under the Private Finance Initiative – and that the deal to build it included a 30-year “facilities management” contract for one of the firms involved.
The Enniskillen deal may be a shining example of value for money. But many PFI contracts are not. Ministers are on the verge of taking over the South London Healthcare Trust, after it proved unable to cope with a bill of more than £60 million a year in interest alone. One of the trust’s three hospitals, the Princess Royal in Bromley, took £118 million to build, yet will cost roughly £1.2 billion. All told, Labour signed 103 PFI deals for the NHS, at a value of £11.4 billion and an eventual price of more than £65 billion. The diversion of that money away from patient care will put inexorable pressure on budgets, to the point where some hospitals will crack under the strain.
PFI, in short, is not merely about £22 light bulbs and £875 Christmas trees – it is about budgetary incompetence on a monumental scale. And it comes as little surprise that it can be traced back to Gordon Brown, who turbo-charged the Tories’ fledgling public-private partnerships in order to buy schools, hospitals and more on the never-never. This allowed him first to evade spending restrictions, and later to splurge on public-sector salaries; in the mean time, the credit card bills got higher and higher.
Many PFI deals delivered what was promised – but where things have gone wrong, as in Bromley, the contracts were often drawn up so poorly that there is little the Coalition can do. Ministers have renegotiated some deals to claw back costs, and should make every effort, and twist every arm, to do more. They should also remind voters of the ignominious parts played in this debacle by Ed Miliband, Andy Burnham and Ed Balls. But, above all, they need urgently to produce a way of funding infrastructure that draws on the private sector’s strengths rather than exploiting the public sector’s weaknesses. Jesse Norman, the Tory MP who has led the way in exposing PFI’s flaws, points out that the state must spend more than £200 billion on new infrastructure over the coming decade, and cannot do so without private help. The Treasury is beavering away on a new model of funding. If it repeats the errors made by Labour, the cost to the nation will be heavy indeed.

Again, The Telegraph -

Wards in a fifth of NHS hospitals face the axe

Emergency departments, labour wards, paediatric units and other services are under threat at up to a fifth of NHS hospitals in England, an investigation by The Daily Telegraph has found.

Wards in a fifth of NHS hospitals face the axe
Senior doctors and NHS managers have become increasingly convinced that these changes are essential to improve care at nights and weekends, and to deal with financial constraints.  Photo: ALAMY

One in 10 accident and emergency departments has either closed recently or could shut in the near future, while a similar proportion of labour wards is at risk.
Significant numbers of children’s units, surgical departments and wards for the elderly are also being considered for closure or downgrading, the analysis of England’s 300 acute hospitals found.
Almost all those at risk are part of major plans to reorganise services and prune back departments to concentrate staff and resources at bigger hospitals.
Senior doctors and NHS managers have become increasingly convinced that these changes are essential to improve care at nights and weekends, and to deal with financial constraints.
They say the potential closures outlined so far are only the start.
Health campaigners fear that the lives of people who live far from remaining hospitals or departments will be put at risk, particularly those in rural areas. They are also worried that single department closures will lead to a “domino effect”, causing other specialties to tumble, and eventually affect the whole hospital.
Given the state of Britain’s finances and the enormous size of the NHS budget - more than £100 billion a year - campaigners are concerned that “reconfiguration” could be a “smokescreen” for cuts.
The Daily Telegraph has found that 25 A&Es - 10 per cent of the total - have either closed recently or could be shut or downgraded under existing plans. There are recent or planned changes to close or downgrade consultant-led maternity wards at 18 hospitals, accounting for about one in nine departments throughout England.
And some 11 paediatric wards have shut or face the threat of closure, out of about 175.
In Northallerton, North Yorks, campaigners have been objecting to plans to downgrade a labour ward to a midwifery-led unit, and to proposals to shut the inpatient paediatric facility at Friarage Hospital.
David Williamson, a nurse and spokesman for the local campaign, said: “We fear being further from hospital. These reconfigurations put people in rural areas at greater risk.”
If children’s services were downgraded a “domino effect” could result, he said. “People fear that eventually the whole hospital could go, that it will be death by many cuts,” he added. A hospital spokesman said no decision had yet been taken.
In Gateshead, the Queen Elizabeth Hospital is soon to stop providing inpatient care to children, while there will also be no overnight emergency care.
Dr Helen Murrell, a local GP, said: “The consultation has been a sham. I have no doubt that this is a disaster, I am sure children will die because they will have to travel further.” She argued that the changes were principally driven by a desire to save money, a charge rejected by the hospital trust.
Meanwhile, north-west London is in the midst of a major reorganisation that could see four of nine A&Es closed, at Hammersmith, Charing Cross, Ealing and Central Middlesex hospitals. Dr Mansoor Bhatti, a consultant gastroenterologist, argued that these closures would “jeopardise a fundamental principle of emergency care” - that most A&E patients would be seen within an hour. Concerns have also been raised that the remaining A&Es will struggle to cope with demand.
Katherine Murphy, chief executive of the Patients Association, said: “I totally appreciate that concept of centralising services, but you can’t jeopardise lives elsewhere.” She also feared that there would be financial pressure to diminish investments in remaining hospitals.
Peter Carter, chief executive and general secretary of the Royal College of Nursing, said the institution would support reconfiguration providing the plans did not represent a “short-term, ill-thought-out closure to save money”.
The other medical colleges are broadly in favour of centralisation. The Royal College of Physicians is leading a major review which could call for large numbers of hospitals to be closed.
Senior figures say that the point of centralisation was to ensure better care.
Many hospitals struggle to fill night and weekend rotas, leading to death rates that are, on average, 10 per cent higher than during the week. Mike Farrar, chairman of the NHS Confederation, which represents managers, said heart attack survival rates had risen by 20 per cent in east Lancashire after A&E centralisation.
Dr Chris Roseveare, president of the Society for Acute Medicine, said smaller facilities struggle to provide a seven-day service, but added: “We’d be concerned if reconfiguration was a smokescreen for cuts in service overall”.
A Department of Health spokesman said: “We have put doctors and other healthcare professionals at the heart of ensuring that patients receive the very best and safest care in the right place.”
A spokesman for NHS North West London said its proposals “will save hundreds of lives” through “better care”.
Under such pressures of shortages and scarcity, it is clear where and how the choices and decisions are being taken.

As managers squeeze doctors to squeeze "more value from every £1 they spend", communitarianism is coming into its own.

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