Sunday, 30 December 2012

Liverpool Care Pathway – Just A 'B in the Sky' Review?

Mr. Hunt, shame on you, sir.

This is The Telegraph -

Controversial Liverpool Care Pathway 'a fantastic step forward,' says Jeremy Hunt
The controversial Liverpool Care Pathway for patients who are dying is “a fantastic step forward” in the way hospitals support the terminally ill, Jeremy Hunt has said.
The controversial Liverpool Care Pathway for patients who are dying is “a fantastic step forward” in the way hospitals support the terminally ill, Jeremy Hunt has said.
The Health Secretary, Jeremy Hunt Photo: EDDIE MULHOLLAND
The pathway, designed to ease the suffering of patients in their last hours or days of life, has come under intense scrutiny in recent months.
It can involve the removal of drugs, nutrition and hydration if they are judged to be of no benefit to the patient.
But a number of families have complained that their loved ones were put on the pathway without their knowledge, while some doctors have claimed it can hasten death.
The Health Secretary insisted the protocol was far better than alternative arrangements and allowed those close to death to be comfortable and to spend their last hours with their families.
Mr Hunt told LBC radio: “It’s a fantastic step forward, the Liverpool care pathway, and we need to be unabashed about that.
“It’s basically designed to bring hospice-style care to terminally-ill people in hospitals. Inevitably people do die in hospital but they weren’t getting the quality of care in those final few hours.”
Mr Hunt said many patients did not want to die “with lots of tubes going in and out of their body” but would prefer their final moments with their families to be “dignified”
“The Liverpool care pathway was developed with Marie Curie, with Macmillan, with Age UK and a number of other charities, to try and bring that dignity to people in their last moments,” he said.
A national audit recently disclosed that almost half of dying patients who were placed on the controversial pathway were not told that life-saving treatment had been withdrawn.
The study suggested that about 57,000 patients a year are dying in NHS hospitals without being told that efforts to keep them alive have been stopped.
It also revealed that thousands of dying patients were not given drugs to make them more comfortable.
Mr Hunt said patients and their families must always be fully informed. “What should never happen is that people should be put onto that care pathway without patients being fully in the loop and their families and relatives being fully in the loop as well,” he said.
The minister confirmed that he was looking into reports of problems with the care pathway.
“I would be very sad if as a result of something that is a big step forward going wrong in one or two cases we discredited the concept that we need to do a lot better to give people dignity in their final few hours,” he said. “Most people would prefer to die at home – we need to do a lot better.”

Mr. Hunt, the review - if it isn't all just a stitch-up - is still ongoing. Should the outcome of the review be prejudged in this manner? You should not be offering any personal opinion you may have at this time.

Are you instructing the jury as to what the outcome of the review should be?

Is the outcome already decided and the review just an elaborate and cruel sham?

Mr. Hunt, a man in your position really should know better. Do you really hold us all in such contempt that you think these comments do not really matter? 

The Health Secretary should not be expressing an opinion at this time.

It is tantamount to the judge 
directing the court and finding for the defendant while the loaded jury is still out.

Just how 'far-reaching', how 'independent' is this far-reaching independent review? What is Mr. Lamb's commitment really worth when his colleagues undermine his credibility? 

Mr. Hunt, you were under pressure for your handling of the BSkyB takeover bid. Lord Justice Leveson said he had seen no "credible evidence of actual bias" in that case. We are trusting you, sir, that there is no "credible evidence of actual bias" in this case...
"In a hard-hitting speech last week Mr Hunt expressed concern about the culture of the NHS, warning that too many patients were forced to experience "coldness, resentment, indifference" and "even contempt". 
"He warned that in the worst institutions a "normalisation of cruelty" had been fostered."
(The Telegraph)
Can a failing health service be charged to operate the killing machine that is the Liverpool Care Pathway?

A disqualified driver in the driving seat of a faulty vehicle driving along a pot-holed Pathway will wreak devastation.
"Nearly 3,000 patients are dying a year because of needless hospital blunders, figures reveal.
Another 7,500 are severely harmed after being wrongly diagnosed, given incorrect drugs or poorly cared for.
Experts warn that such mistakes will increase because already overstretched staff will be unable to cope with the higher numbers of patients coming into hospitals.
Health Secretary Jeremy Hunt has admitted that there may still be ‘pockets’ of poor care like that revealed in Mid Staffordshire in 2008, where hundreds of patients died needlessly.
Figures obtained by Panorama in a BBC documentary to be aired tonight show that in 2011/12, a total of 2,864 patients died following mistakes by hospital staff.
This is up almost 5 per cent compared to the previous year when there were 2,726 deaths."
Mr. Hunt, you appear to be of the opinion that the problem lies not with the vehicle - the Liverpool Care Pathway - but with the drivers of the vehicle...

Mr. Hunt, there is a problem with the drivers, certainly...!

But the vehicle needs to be taken off-road immediately and consigned, straight way, to the breakers yard before it may do further damage and harm!

We may then consider what corporate liability there is for the taking of life that has ensued under this wicked regime...


  1. Good points, Eldoel.

    Like you, I am surprised that Jeremy Hunt has pre-empted the result of the Review in this manner.

    Perhaps he might like to consider the following from the EUclid Network Limited, one of the directors of which is ACEVO director, Sir Steven Bubb.

    EUclid Network.

    Some quotes from a "Report of the Round table on innovation and value in palliative care in Europe"

    "Introducing the Saiatu pilot"

    "71% of Saiatu patients die at home (the Basque average is 30%)"

    "The service saves the government about €5,000 per patient on average and mobilises existing services to enhance the care given to the patient and the families. Mean costs per activity were significantly lower that other
    services. Co‐ordination of social and healthcare services can reinforce effectiveness."

    "Savings are in the days patients do not spend in hospital"

    "The pilot offers a community centred model that empowers patients and families. It is a new model for public service with the potential for job creation too."

    "Although context and culture of service provision varied, there were common challenges."

    "...the impact of the twin pressure of ageing society and austerity is affecting service provision."

    "Too many people die in hospital which is too expensive. There is a need to channel money from hospitals to community based provisions, or innovate within hospital led systems; otherwise the costs will become unsustainable."

    "A community based model can deliver savings to the health care sector through reduced hospital admissions. Therefore, hospitals can reduce hospital beds."

    "Experiments like the Department of Health in the UK, developing a tariff for palliative care may shape payment in future."

    to be continued

  2. Continued from above post:

    "Pitching the Business Case"

    "The focus of the “pitch” was a unique service in Spain which saves the government for 100 patients an average of €500,000 in hospital beds and admission while the costs are only €200,000."

    "The service is fast in reacting to moments of crisis for the patient, which can be impossible for the means tested Spanish health care system. The panel posed various questions and offered suggestions too."

    "The overall picture of benefits should be stressed. 3 main points were mentioned:

    1) labour market and employment;

    2) the cross silo evaluation of the project (savings to health and social departments);

    3) the beneficial impact on wider economic and social costs to families of caring for the dying. For example bereavement support means that wage earners could continue or get back to the workplace sooner."

    "The integrated approach to care makes it stronger as well as more interesting for investors."

    "When pitching to governments or others commissioning public services, one should also bear in mind their interest in actual cash savings as distinct from reduction of use of hospital beds ‐opportunity costs."

    "The assumption that government had to make real savings form a social investment partnership might be challenged. Could government get more for its taxpayer contribution instead, for example through a better service for patients and families or reaching more patients with a service."

    "Social investment offers new opportunities but may not always be the right approach."

    "Intermediaries are working more and more with service designers, rather than focusing only on the initially predicted return. This is because sometimes a proposed model can be adjusted to make it more attractive to investors."

    "However, palliative care is a complex topic and social investment needs to take this complexity into account."

    "Scaling up presented challenges for a project which was tailored personally to patient needs: would that personal touch be lost? There could be efficiency trade‐offs. Instead of scaling‐up, scaling out might provide another solution of exporting and growing a service by creating a network of personal and localised services."

    Don't you just love the buzz words! Perhaps they've been watching too many episodes of The Apprentice? Why do so many of these organisations use these embarassing, wide boy expressions? I know of no other businesses that use them.

  3. Euclid, the Mathematician who was discredited by a genius who believed in God: Einstein
    God aways wins :o)

  4. A little more about the Euclid Network:

    "Euclid Network wants to help leaders of civil society organisations grow, by working together and sharing knowledge. We are not a stiff membership body but a living network relying on active participation. So, what do you want your network to be"

    "Roundtable on innovation and value in palliative care in Europe
    Europe House, Smith Square, London - 13th November 2012, 9am - 5pm"

    "Euclid Network wants to help leaders of civil society organisations grow, by working together and sharing knowledge. We are not a stiff membership body but a living network relying on active participation. So, what do you want your network to be"

    "Roundtable on innovation and value in palliative care in Europe
    Europe House, Smith Square, London - 13th November 2012, 9am - 5pm"

    "Dying is an issue that is seldom discussed - especially when it comes to financing services that make this process as 'comfortable' as possible. But deaths will soon begin to outnumber births in some countries, with some facing having one in three citizens over retirement age. Healthcare needs are becoming more complex, and the demand for palliative care is increasing in a tightening fiscal environment."

    They seem to have EU funding.

  5. More about Saiatu from the above website:

    "1. Executive Summary"

    "•Our proposal.

    Saiatu offers a new ” intensive in home social palliative care support service”."

    "•The evidence."

    "Saiatu has proven to offer a new complementary service that makes the existing resources more efficient, highly valued by the user, that also saves resources to
    the health and social protection systems."

    "•The benefits."

    "Saiatu can save about 5000 euro per case."

    "•The costs."

    "The Health Service only pays back 50% of the demonstrated savings."

  6. The 'end of life care' intelligence network for the NHS - audit for 2011-12 CANNOT EVEN SHOW the EoL care programme represents a cost saving to the NHS...

    pdf available here...and note John Ellershaw (who wrote the LCP) and Dr Bee Wee were on the committee,along with everyone else feeding off of this hideous disgusting 'care' pathway.


  8. Here are the 'tools' that primary care trusts are supposed to use when 'commissioning ' end of life care...