Liverpool Care Pathway - The Rationale Of Rationing

This is Communitarianism -

It's rationale is the rationing of finite medical resources according to strictly defined Communitarian principles.

Here is the Communitarian Complete Lives System treatment priority curve:

Govind Persad BS, Alan Wertheimer PhD and Ezekiel J Emanuel MD published this in The Lancet  (Principles for allocation of scarce medical interventions) in 2009.

It's all about whose life is and is not worth saving. Every procedure and protocol now operates, in practice, using a flowchart as a guide.You could almost run it through as a new software tool for medical professionals to utilise to determine level of treatment priority, even for GPs to select their 1%.

This redefines the physician’s duty. The duty is no longer to the patient but to what is considered the greater good. That is the Communitarian definition of health care.

The CQC has warned - 

"an ageing population and funding pressures from “reduced economic growth” meant care homes and hospitals faced more “challenging times” ahead."

Such a scenario fits implementation of a Communitarian Health Service.

This is the Telegraph -

Care Quality Commission: Elderly denied dignity and respect

Elderly patients are suffering “poor” and “unsafe” care as nursing homes and hospitals fail to treat them with basic respect, a watchdog has warned.

By Tim Ross, Political Correspondent

7:00AM GMT 23 Nov 2012

A growing number of pensioners with dementia are denied help to eat and drink, robbed of their privacy and treated “as if they were not there”, as care homes and hospitals struggle to cope, the Care Quality Commission said.

In a major report based on 13,000 inspections, the regulator warned that too many nurses and care home staff oversaw “a care culture in which the unacceptable becomes the norm”.

The growing pressures of staff shortages, poor training, and rising numbers of patients with complicated health conditions were compromising standards of care, it said.

The watchdog called on managers of nursing homes and hospitals to ensure that patients were treated as individuals and involved in decisions about their own lives.

However, the CQC warned that an ageing population and funding pressures from “reduced economic growth” meant care homes and hospitals faced more “challenging times” ahead.

Jeremy Hunt, the Health Secretary, said there must be “no hiding place” for “substandard” care services and promised a greater focus on patients’ experiences in future.

Charities working for the elderly said the “shocking” report was “a serious indictment” of the treatment older people received.

In its annual State of Care report, the CQC investigated whether the government’s “essential standards” were being met for the quality of care across the NHS, care homes, and dental surgeries in England.

There were “many examples” of care homes and hospitals that provided an “excellent” service to patients.

"But CQC’s inspectors also see examples of providers who struggle to cope and fail to deliver the quality of care that people have a right to expect. We will not leave this poor care unchallenged,” it said.

One in five nursing homes, one in seven hospitals and one in 10 residential care homes denied patients help with “the food and drink they need”, the report said.

“Given that this is so vital to good care – particularly for older people – this is a real concern,” the report said. A similar pattern was seen in NHS hospitals.

One in 10 NHS hospitals inspected during the last year failed to treat patients with dignity and respect, “including an obvious lack of privacy, call bells being out of reach, and staff speaking to patients in a condescending way”, the report said.

Among nursing homes, caring for patients with dementia who require more intensive support, 15 per cent failed to meet basic standards for “respectful and dignified care”.

These failings were often characterised by “care staff talking over the person as if they were not there; having things ‘done’ to them, rather than ‘with’ them; and getting people ready for bed at a time that suits the staff rather than the individual people being cared for”.

The vast majority of nursing homes, care homes and homecare agencies fell short of the minimum standards for giving their staff “proper training, supervision and development”. Many failed to manage residents' medicines properly and keep adequate records.

The CQC said some NHS hospitals have “struggled to make sure they had enough qualified and experienced staff on duty at all times” who were properly supervised and trained.

Wards are running with “high vacancy rates” and “staff being asked to do too many different roles at once”.

Independent hospitals, which have much more predictable workloads, performed much better in treating people with dignity and respect, as 98 per cent met the legal minimum standard.

Janet Morrison, chief executive of the charity Independent Age, said the report was “shocking and unacceptable”.

“It is deeply concerning that the CQC suggests that pressure on care services is increasing the risk of poor or unsafe care,” she said.

Michelle Mitchell, director of the charity Age UK, said ministers must ensure hospitals and care homes receive adequate funding because elderly care has been “stripped to the bone”.

“This report is a serious indictment of the way that older people are cared for in England,” she said.

The Health Secretary, Mr Hunt, said “much more” work would be needed to improve standards of care across England.

“Next year, we will be measuring and publishing the experiences that patients have in hospital,” he said. “Where there are problems we expect the CQC and other regulators to take swift action.”

Mike Farrar, chief executive of the NHS Confederation, urged more hospital staff to blow the whistle on poor quality care on their wards.

“It is extremely worrying that some organisations are still not getting the basics right every time,” he said. “It is every patient's fundamental right to be treated with dignity and respect, and that means more than just personal privacy.”