Saturday, 6 October 2012

Liverpool Care Pathway – An Unhappy Message

It should be a no-brainer, but a recent study actually does confirm this to be the case - Better care means better outcomes.

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

Doctors say hospitals need to improve care for “high risk” patients, such as the very old.

Here follows an article published in the Scunthorpe Telegraph that is shameful to relate. Is this really 'our' NHS so loudly lauded at the London Olympics?

An elderly lady is referred to hospital by the GP to receive precautionary care. What then proceeds is, unfortunately, not at all extraordinary or anomalous. A similar story of elderly neglect is related in these pages -
She told me that one ‘old girl’ had fallen out of bed. Mum had kept calling for someone to come but no-one came. They were “all stuck in their cubby hole,” she said. I looked across and, by my own observation, they were. Eventually, a nurse had come, apparently, not shocked or concerned, but offended by the nuisance of it.
The neglect this elderly lady suffered demonstrates a lack of even the most basic sense of compassion.

The suffering this lady endured demonstrates a lack of even the most basic palliative care.

The Scunthorpe Telegraph bemoans the "fragmented" provision of 'end of life' care. Actually, it is the very absence of any kind of care!

Profile image for Scunthorpe Telegraph     
  Scunthorpe Telegraph

Thursday, September 27, 2012
Family complains to Scunthorpe General Hospital over quality of care given to mum 'who died in a place she did not want to be'

A daughter who has raised a complaint with the quality of end of life care her mother was given at Scunthorpe General Hospital has spoken out after a scathing report into mortality rates at the Trust was published.
The damning report, commissioned by the North and North East Lincolnshire Clinical Commissioning Groups, revealed that Scunthorpe General Hospital has one of the worse mortality rates in the country.

COMPLAINT: From left, Hilary Morrison, Nicola Glover and Kaye Farrell. The family has lodged a complaint about the level of care given to Monica Glover at Scunthorpe General Hospital
One of the key problems identified in the report was the fragmented arrangement of Scunthorpe General Hospital's end of life care.
Nicola Glover, of Kirton in Lindsey, said her and her family felt her mother Monica Glover, 80, died "a horrible and undignified death" in Scunthorpe General Hospital on August 10 last year.
Miss Glover claimed her mother endured hours of pain and discomfort before passing away.
"My mum was first admitted into Scunthorpe General Hospital in January 2011," said Miss Glover.
"She had been recovering from a chest infection and her GP wanted to admit her in order to keep check on her progress.
"She was terrified about going in as she was over 20 stone so knew she would need special care.
"When we got to mum's allocated bed we discovered it was not the right type so we put my mum in a chair and waited for a new bed.
"This never came and when I returned the next day my mum was sitting in the same chair.
"She was transferred to another ward and was still not given a suitable bed so was getting very upset by this point.
"She had dressings on her legs for pressure wounds and these had become saturated. They were leaking with excess fluid."
Miss Glover said she was upset by how long it took to give her mother a bed.
She said: "We felt disgusted with her care and discharged her."
Miss Glover said her mother spent the next six months in and out of Scunthorpe General Hospital.
Miss Glover said: "My mum was admitted into hospital for the final time on August 1 with a urine infection.
"She quickly developed sepsis and renal failure and she deteriorated very rapidly.
"It was very upsetting for the whole family.
"On August 9 we were told by an intensive care doctor that nothing could be done.
"I don't think the end of life care system was put in quickly enough. I believe she died in an undignified manner in a place she did not want to be in.
"I don't think mum received the best care.
"We are seeking legal advice into the case."
Wendy Booth, trust director of clinical and quality assurance, said: "The family of Monica Glover have made a formal complaint which we have fully investigated and responded to.
"We have also met with the family on July 23, 2012 to further discuss their concerns.
"We are still waiting to hear back from the family as to how they would like to proceed with the complaint."
The chairman of North Lincolnshire Council’s Health Scrutiny Panel said she was “disappointed but not surprised” with the findings of the mortality report.
Councillor Jean Bromby said at the group’s latest meeting that they had been aware of the figures published in the report for just under a year.
She said: “We have met with members of the health board and they have been very defensive.
“We have been waiting for the report from Transforming Health with baited breath and are disappointed but not surprised with the outcome.
“We have asked for a meeting with the chief executive and will be asking her a lot of questions.
“We want to work with everyone to try and improve the figures and need to support the relevant people.
“The whole council needs to be behind this report and the message we need to get out is support. The report is an unhappy message to send to the population.”
The panel’s next step is to conduct a meeting with chief executive of Northern Lincolnshire and Goole Hospitals NHS Foundation Trust Karen Jackson on October 8.
Board members have set up another visit to Scunthorpe General Hospital to discuss patient care.
The report into increased mortality rates has highlighted that staff who were interviewed did not feel a high enough priority was given to end of life care.
Some of the issues raised about end of life care in the report are the lack of specialist consultants and poor access to specialist support and GPs out of hours.
The report also identifies how the hospitals have insufficient resources such as palliative care and Macmillan nurses.
The report identifies poor access to hospice facilities including lack of bed and out-of-hours care.
In particular it was identified that the use of gold standards frameworks, a system to optimise the care for patients nearing the end of life, and the Liverpool Care pathway (LCP), a model used to sustain quality of the dying in the last hours and days of life, throughout is not consistent and there is a lack of supporting patients in their preferred place to die.
The report concludes: “Further work is needed to use data rather than rely on perceptions about end of life care.
“End of life care is fragmented and it is hard to establish a complete picture of provision, gaps, priorities and progress.”
Of the report, a spokeswoman for Who Cares, an independent local health and social care watchdog, said: “The Summary Hospital Mortality Ratio (SHMI) published by Northern Lincolnshire and Goole Hospitals Foundation Trust (NLaG) was one of the highest such ratios in England. This is obviously of great concern to Who Cares. While we are encouraged by the measures NLaG has and will be implementing to address this serious issue, their progress will be closely monitored by Who Cares.”
This elderly lady 
"was terrified about going in as she was over 20 stone so knew she would need special care."

The study referred to above confirms that better quality of care means better outcomes. Had this lady received the attentive care her family - certainly, her GP - had expected she would receive, would the outcome have been a very different one?

The outcome was, tragically, that she died in a place she did not want to be!

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