Friday, 21 December 2012

Liverpool Care Pathway - Either, Or... Else

"It ain't over till it's over." - Yogi Berra

"I've always been inspired by people who, as I say, 'Never face the facts.'" - Marlo Thomas

Seven weeks or seven hours, every last moment of life is precious.

So, what is going on? What is this focus on a ‘good death’? Whatever happened to a ‘good life’?

The one is immediately affordable and containable; the other, quite simply, is simply unsustainable. Health and Well-being Boards...? (Should we read, 'Death Panels'?)

“This kid is dead, you got that?” - Michael Goldstein, Director, Nassau University Medical Center

We'd have been telling Yogi, "Look, if it's over, it's over: you got that? You're in a slump; you just ain't hitting!"

And we'll be saying that the problem is not with the individual greed of bankers and the ineptitude and connivance of politicians, but with the old, the vulnerable, the frail and the fragile, who cling to life and make impossible demands on the public purse which they have contributed to all their working lives!

There is big money and mutual benefit in dying to all partners in this palliative-medical complex that sits as a parallel, godfather figure in the halls of power in Whitehall and at Westminister. What Nick Seddon called an 'incestuous' relationship between the State and the voluntary sector is an interdependent, mutually profitable, symbiotic one.

This growing fusion between corporates possessing charitable status - charities which have become and behave like corporates, encompassing both the voluntary and the private sector - and the State providers of medical services must pose a threat to democracy when Mr. Lamb, clearly neither simpleton nor liar, is chillingly unaware of what is proceeding apace in plain sight in the department under his charge.

ACEVO is the Association of Chief Executives of Voluntary Organisations. ACEVO "support, connect, develop and represent the third sector's leaders which include Chief Executives".

Here is Third Sector -

New Charity Commission chair is out of touch on key sector issues, Sir Stephen Bubb says
By Andy Hillier, Third Sector Online, 7 December 2012

Sir Stephen Bubb, chief executive of Acevo, has accused William Shawcross, the new chair of the Charity Commission, of being out of touch after he criticised charities that rely on state funding and expressed opposition to face-to-face fundraising - 'Chugging'.

Chugging is a blight on the good reputation of charity. Employing chuggers is an insult to honest, decent folk who give up their time free of charge, come rain or shine, to collect for the charity they love!

Writing in his blog, Bubb said: "He is right to warn that in our work our main priority remains our beneficiaries and our mission. However, delivering public services for beneficiaries on contract does not make charities dependent, nor need it mean mission drift."
William Shawcross, chair, Charity Commission

Lord Shawcross has said that some charities risk becoming too dependent on the State. Actually, some charities, possessing a valuable branding, behave less and less as you would expect charities to behave and more and more like for-profit corporate entities.

In Lord Shawcross' first speech to the charity sector at Acevo's annual conference, he said that "charities should not become junior partners in the welfare state", stressing that the independence of the sector is vital. He said that most members of the public believed that charities should be "funded from private donations."

Quite simply, it is become problematic as to who is controlling whom. Is there a 'junior' partner? Issues of mutual interest continue to coincide such that there is almost a unity of policy and decision-making. There is a parallel power at work, working alongside the elected power.

Those in the position of propagating these Pathways have now been placed in the position of adjudicating on them. There are problems of collusion and self-interest here. The public purse is involved on either side and is being dipped into for promotion of a mutual self-interest. On the one side, the source is by public donation via 
charitable offerings; on the other side it is by public sequestration via taxation.

The National Council for Palliative Care has led the Dying Matters Coalition since 2009.

From the NCPC Report and Financial Statements 31 March 2012 -

"It has been a busy and successful year for NCPC and the national Dying Matters coalition, which we lead, and which exists to raise awareness and change behaviour in relation to death dying and bereavement.

"We continued the organisational review that began in 2010-11, which has led to increased integration between our three main areas of activity: people with personal experience; public-facing activity through the Dying Matters coalition; and policy and parliamentary affairs, which includes our data and intelligence analysis, so that all three now inform and support each other."

2011-12 also saw significant external political developments resulting from the Government’s health and social care reform programme and the extensive consultations in relation to what eventually became the Health and Social Care Act, which we have pro-actively engaged with and influenced.

As an umbrella charity, NCPC has always existed to inform and influence government national policy, and by achieving consensus and identifying good practice we continue to support those using, commissioning and providing services. Our leadership of the national Dying Matters coalition also enables us to inform and influence the public and to target key groups.

We continued to develop our national role strategically, which includes the following key relationships:

We continued to work with the Department of Health (DH) and NHS End of Life Care Programme (NEoLCP) to support the successful implementation of the End of Life Care Strategy which was published in July 2008. NCPC is represented by both our Chairman and Chief Executive on the DH’s End of Life Care Implementation Advisory Board. We also work to support end    of life care in other national strategies, e.g. the National Dementia Strategy and the Carers’ Strategy.
We have supported the development of the new National End of Life Care Intelligence Network (NEoLCIN) and our Chief Executive and Director of Policy & Parliamentary Affairs both sit on its stakeholder group.
We celebrated our 20th anniversary in 2011, with a major event and celebration at the Royal Society of Medicine. This included the premier of a new play, “Home Death” by Nell Dunn, as well as an expert speaker panel and debate chaired by Dame Joan Bakewell titled “Is a Home Death Achievable?”. Andrew Lansley, Secretary of State, gave a keynote speech which included his personal story of ”Why Dying Matters to Me”, and also used this event as a listening forum for his reform agenda.

We are one of the DH’s Third Sector Strategic Partners, and have worked closely with the DH and other Strategic Partners to reach out to many more beneficiaries. Our Chief Executive and members of our senior team have met regularly with the Secretary of State, ministers and senior policy makers.

Our Chief Executive attends the DH’s National Stakeholder Forum and Social Care Advisory Board.

We are supporting the DH’s agenda to extend Quality Innovation Productivity and Prevention in the NHS (QIPP) and leading the public-facing Find Your 1% campaign with GPs. We are a leading member of the end of life care workstream, and also part of the long-term conditions work-stream for the voluntary sector.

There were two significant NICE consultations during the year, on an End of Life Care Quality Standard and on the use of strong opioids. Our consultation responses were informed by extensive feedback from our working groups as well as by people with personal experience of end of life care,and many of our key recommendations were accepted.

Our surveys and research identified GPs as key target group for Dying Matters and 2011-12 has seen further rollout of the confidence building training with GPs on initiating and undertaking end of life care conversations with patients, as the public indicated that they wanted. NCPC has also produced a DVD of the training, launched jointly with the Royal College of GPs.

The Dying Matters website hosts the DH’s Quality, Innovation, Productivity and Prevention (QIPP) programme’s 1% campaign to encourage GPs to find the likely 1% of their patients in the last year of life in order to provide better, more joined up end of life care.

Priorities, 2012-13:
A focus on the continued raising of the confidence of GPs to initiate end of life discussions, through an ongoing training programme in partnership with the End of Life Care Programme, whilst campaigning via the 'Find your 1%' campaign for increased use of end of life care registers.

There is an intrigue of involvement here.

This is from the NCPC website -

Dying Matters – raising public awareness

In 2008 the government published the End of Life Care Strategy for England, in which NCPC was invited to lead a national coalition to increase public awareness, discussion and debate around dying, death and bereavement. NCPC accepted the challenge and in 2009 the Dying Matters Coalition was born. In a short time the coalition has become established and respected and now boasts over 16,000 members. Whilst the Dying Matters Coalition’s main focus is England, we support and encourage better public awareness across the UK.

NCPC today

NCPC celebrated its 20th birthday in 2011 and is going from strength to strength. We produce a range of publications, leaflets, DVDs, conferences and training programmes to help our subscribers around the country deliver the best levels of care. We work with government, the NHS, the voluntary and private sectors to shape future strategies and plans. We involve patients, carers and families in everything we do to ensure our work is informed by people with real experience.

When the State intervenes and starts throwing public money around, lucrative gain calls, the corruptible are corrupted, independence is lost, and the charity becomes a tool to promote State policy and State policy becomes a tool of vested interests, indistinguishable, to procure mutual gain. There is complicity if not conspiracy.

The DOH is instigatory in rolling out the LCP and the CQUIN payments are DOH policy crafted in association with and implicit support from the NCPC.

Is this a 'junior partner'? Who is in charge; who is controlling whom?
Mr. Lamb, you are either a fool or a liar.. else, the dupe of this parallel authority that struts the halls of power alongside the elected authority of the land.

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