Monday, 18 March 2013

Liverpool Care Pathway - An Arrogance Of Infallibility And Denial Of Error

The Surrey Mirror reports that East Surrey Hospital sent an 87-year-old man with a broken neck home to 'exercise'.

 A GRANDFATHER was discharged from East Surrey Hospital with a broken neck and sent home to exercise, his family have claimed.
Alfred Hollands, 87, was shopping in Redhill on February 5 when he fell and hit his head, leaving him with severe facial injures. 
But despite his complaints of neck pain, doctors at East Surrey Hospital allegedly sent him home after stitching him up and X-raying his shoulder.
After four days of excruciating pain, Mr Hollands' family called an ambulance and he was rushed back to the hospital in Canada Avenue, Earlswood.
A second X-ray showed he had broken two vertebrae in his neck.
Recalling the first visit to hospital, his son Graham Hollands, of Wither Dale, Horley, said: "They examined my father and initially got him a neck brace, but they never put it on.
"You think to yourself 'what have we got to do?'
"We were saying this is an elderly man with a nasty head injury.
"They gave him neck exercises to do – if he had done them, I fear it could have damaged his spinal cord."
He added: "He is still in hospital now, he won't be coming out for quite a long time."
Mr Hollands says his father's problems did not end with a correct diagnosis.
As doctors recognised his broken neck, they also discovered he had suffered a minor stroke at some point.
Then, days later, as he lay on a ward, he says a nurse accidentally ripped out his catheter as she tried to move his bed.
Mr Hollands Sr, of Chequers Drive, Horley, is now recovering at Caterham Dene Hospital, but his son says the experience has taken its toll on him.

Now, we know they can actually chuck you out in the early hours and many hospitals operate a Rapid Discharge Pathway, but what's going on here? And if they can't diagnose a broken neck, how can they diagnose 'dying'?

Diagnosis of 'dying' involves personal judgement, a subjective perception of the patient's general demean; it requires an assessment of how the patient is presenting. It is quite frightening, therefore, that the nurses' perception of Mr. Hollands was to see his glass as half empty rather than half full...

 "He is doing as well as can be expected," he told the Mirror on Tuesday.
"It is quite sad just watching him. He is learning to walk again.
"He is proud today because he was able to walk to the dinner table with a Zimmer frame."
He added: "One thing that gets me is my father is 87, he drives, he's fit, but when he was in [East Surrey] hospital they were saying 'he must always find things tough'.
"It really grates me."
But he says the hospital transfer was not a smooth transition either.
On the morning of February 27, after his father had a scan at East Surrey Hospital, Mr Hollands junior was told he would be transferred to Caterham Dene.
At 9pm that night he had still not arrived.
After a series of concerned phone calls, Mr Hollands discovered his father had been lying on a bed in the departure area of East Surrey Hospital most of the day, waiting for an ambulance.
"He had been just laying there," he said.
"He was not a well man."

It is a matter of concern that this 'cup half-empty' perception should not persist at the Dene; it was there they put my dear mum down. May this gentleman improve rapidly and return safely home where he belongs. 

Surrey and Sussex Healthcare NHS Trust (East Surrey and Caterham Dene are both Surrey and Sussex hospitals) have produced this Quality Account alongside their Annual Report.

Priority 3, which may be found on pages 14/15 of this account, details EoLC provision.

An EoLC e-learning project is being rolled out. This may refer to the EoLC e-learning package initiated by Dr. Bee Wee, president of the Association for Palliative Medicine.

"Interactive exercises and multiple choice questions are included to test the learners' knowledge and animation and imagery help create a visually engaging experience. Opportunities for personal reflection are provided throughout." [Promotional write-up]

Dr. Bee Wee is described as National Clinical Lead for e-ELCA.
A Macmillan Newsletter describes the e-learning package for End of Life Care -

"Nearly all health and social care staff need training of some sort in end of life care. A new e-learning package aims to offer just that"

We are talking about someone dying.

In the context of End of Life training, it is inappropriate and, quite simply, offensive to describe the training offered as being "easy, fun and free". It is so described.

Dr. Bee Wee certainly seems to be 'having fun' in this photo-shoot picture from the Newsletter.

Clinical Effectiveness

Priority 3: Improve satisfaction with end of 
life care

Improved end of life care (EoLC) provision in acute
hospitals is crucial given that more than half of all
deaths take place there.

The Trust has an EoLC working group that has wide
membership across the Trust and an EoLC strategy
has been written and approved. The Trust has
invested in syringe drivers recognised as the gold
standard in delivery of medications (a syringe driver
is a small portable pump that can be used to give a
continuous dose of a painkiller and other medicines.
This method of giving drugs is very effective in
keeping people free of pain).

EoLC is included on statutory/mandatory training
for clinical staff and the Trust has received funding
through the SHA to the tune of £16,000 for nursing
staff to undertake 2-day courses in End of Life
Care, the content of which has been very positively
evaluated. This programme will be rolled out in
the first instance to medical students and FY 1 & 2
doctors. An EoLC e-learning pilot project is also being
rolled out and it is hoped that this combined work
will continue and become an area of training for
which SaSH is recognised.

We have also participated in all three rounds of the
‘National Liverpool Care Pathway (LCP) in acute
hospitals’ audit. Since round two of the audit,
improvements have included:

• Percentage of all deaths on the LCP 29% (up from
• Percentage of non cancer patients on the LCP 76%
(up from 30%)
• Percentage of patients on the LCP with PRN
meds (when required medication) available 89%
(was 77%)

Out of eight key performance indicators, the Trust
was in the top 25% nationally for two performance
indicators and at the top end of the middle 60% of
Trusts for the remaining six indicators.

The Trust is really tooling up here...

Is this what it's all about...?

This is get SURREY -

'Ambulances queuing' as hospitals struggle to cope

By Nick Edmondson 
February 22, 2013

EMERGENCY services in Surrey are reaching "crisis point" as hospitals struggle to cope with the number of patients coming through their doors, sources have claimed.
An ageing population coupled with hazardous winter conditions has seen hospitals repeatedly placed on red and black alerts, as they become full to capacity.
Accident and emergency departments have been so busy on occasions that ambulances have had to queue outside hospitals, waiting for an available space to drop off patients.
Karen Peluso, of Save Our Surrey Community Hospitals, said: “This is something that is being discussed widely in the health service, but behind closed doors. The hospitals simply cannot cope with the number of people that are turning up at the acute wards.
“There is a steady increase in the number of lower acuity cases coming from elderly residents and the numbers are just too high.
"Hospitals will say that they are used to being on red alert and occasionally on black, but in reality this is a serious problem that will keep getting worse until we hit crisis point.
“What is needed is an urgent care centre that will provide somewhere for elderly people to be taken rather than to the hospital.”
Sources in the health service, who asked to remain anonymous, have reported queues of ambulances outside hospitals and increasing frustration as patients wait for treatment.
Virgin Care, which provides NHS services in Surrey, revealed that pressure on hospitals was so high that the number of daily conference calls between acute hospitals and their stakeholders aimed to maintain capacities had been tripled daily.
A spokesman said: “All of our community services are working very hard to support the acute hospitals in Surrey.
"Our beds are at full capacity. We are in regular contact with all the hospitals to make sure that patients are treated in the right place.”
John Coleman, deputy director of A&E at the Royal Surrey County Hospital, admitted there had been a "number of isolated delays in relation to ambulance handover times".
He said: “Being on red at this time of year is completely expected and not an indication that the hospital is in any way struggling with demand.”
He added that the Royal Surrey had not escalated to black alert so far in 2013, but said the hospital would expect to be on either red or black for the majority of this period of any year.
He said: “The national target for a patient stay in A&E indicates 95% of patients are seen within four hours and discharged or admitted.
“In relation to ambulance performance, all trusts in the sector are working with the ambulance crews to ensure no patients breach a one-hour waiting time and it is very rare for ambulance crews to wait this length of time.
“Even during busy periods the trust will clinically prioritise triage to achieve the handover within 15 minutes.”
A spokesman for South East Coast Ambulance Service said: “Delays in turnaround times and their risk to the trust are regularly reviewed at trust board level.
“Review meetings with hospitals and local liaison between our operational managers and hospital staff also take place when particular issues are identified.”

The problem with a pathway is that it creates an arrogance of infallibility and denial of error; a certain belief that, if you are on the pathway, you are on course.

It is a disrespectful respect and denial of dignity; it is a contempt that is contemptible.

They say they seek dignity in death. Whither, then, Dignity in Life? But no dignity in life or in death for this lady!

This is get SURREY -

'Little dignity' for dirty nightdress woman - inquest

By Amy De-Keyzer 
February 20, 2013

A PATIENT who died at East Surrey Hospital received a "low" standard of nursing care before her death, an inquest has heard.
Faith Taylor was admitted to the hospital, in Redhill, on April 22 last year with chest pains and later diagnosed with pancreatitis caused by gallstones.
The 66-year-old, known as Fay, died from pneumonia two weeks later, on May 5, while she was still in hospital.
Recording a narrative verdict this week, coroner Richard Travers said the treatment and clinical care she received was "appropriate", but he criticised her general care on the ward.
"There is no direct criticism in evidence of the clinical care she received but the degree of nursing care appears very low," he said.
"The observations were low in standard, her water was left out of sight and out of reach, she was left in a dirty bloodstained nightdress and was left uncovered with little dignity."
Her husband Peter Taylor, from Dormansland, was also unhappy with the communication between staff and the couple.
At the resumed inquest on Tuesday (February 19) at Woking Coroner's Court, Mr Travers said it was "most unsatisfactory" that there seemed to be a lot of confusion for Mr and Mrs Taylor over what treatment she would have, adding: "This highlights the importance that lines of communication between a surgeon and patient are clear."
In a statement read to the court, friend and neighbour Richard Kitts said he had accompanied Mr Taylor to visit his wife on several occasions and, following an operation, found Mrs Taylor in a bloody nightdress and not covered with sheets.
He said: "I believe Fay was treated very badly by the hospital. She was not even shown basic care."

Do these sound like people to entrust with a deadly pathway?




In October 2008 my grandma, Pamela Goddard, died painfully in hospital. Her death was unnecessary. She had been wrongly placed on the Liverpool Care Pathway, the controversial Department of Health approved scheme for end of life care. Once on the Pathway, fluid and drugs are withdrawn and the patient is sedated continuously until death. The scheme is accused of forcing some terminally ill patients to die prematurely, whilst masking any potential signs of improvement in their condition.

After contracting breast cancer in the 1960s, my grandma overcame several recurrences of the disease, but was diagnosed with cancer once again in June 2008 while being treated in hospital for a broken leg. Cancer treatment appeared to be working, and she was fully expected to survive. However during the course of her treatment she developed a painful bedsore which, as a result of inadequate treatment, became infected. Her care was then switched to palliative without consulting the family; what resulted was four weeks of torture before she finally died, pumped full of painkillers and deprived of water and medication.

Read more here -

Liverpool Care Pathway – "Not A Convincing Answer"

Always on the look-out for a nice earner, though...

Not fast in coming forward with information, hiding behind Data Protection; careless when it comes to protecting it...

And everyone remembers those awful scenes from that Dispatches programme...
This is Surrey Link -

Hospital braces for Channel 4 undercover investigation East Surrey 
Hospital will be the subject of a Channel 4 Dispatches investigation after a patient used a tin of chocolates to film staff 

Surrey and Sussex Healthcare NHS Trust Chief Executive Michael 
Wilson contacted the Mirror on Thursday after he was told by TV 
production staff his hospital and staff had been secretly filmed.

The documentary – to be aired on Monday (February 28) at 8pm –
will focus on the care provided to three patients as they face their 
final few weeks, one of which was an elderly man at East Surrey 

A hidden camera placed inside a tin of Quality Street chocolates 
next to the patient's bed filmed up to 24 days of care inside an
acute medical ward – which has not been named prior to transmission.
Mr Wilson is furious with Channel 4 as they have refused to let him 
see the footage before millions of other viewers get to Monday.
He said: "They wrote to me last week and said there are a couple of 
things they would like clarity on, but I cannot give clarity to Channel 4 
on any of those things because I have not seen the footage.

"It is absolutely outrageous. So much for a right of reply." It's made 
more complicated by the fact Channel 4 is negotiating with 
the production company on things like whether to keep the staff 

"They will argue that filming these things secretly is in the public 
interest. But I also think it is in the public interest not to frighten 

"I don't think Channel 4, in my view, is acting responsibly as they are 
going to frighten patients quite unnecessarily before we get a right 
of in an app

“I am deeply saddened and distressed by this and my thoughts are with Mr Rasheed’s family” 
[Michael Wilson Chief executive East Surrey Hospital]

Finally, here's another hospital that can't diagnose a broken neck.

But they can diagnose 'dying'...!

Here's the Mail Online -

Anger of plasterer sent home from hospital with broken neck after being dismissed as 'just another Friday night drunk'


A plasterer who suffered a broken neck in a fall was forced to drag himself home after being dismissed as 'just another Friday night drunk', it has been claimed.

Bob Davies, 60, suffered the injury on December 16 and was rushed to the Princess Royal Hospital in Telford, Shrops, but was sent home in a taxi despite insisting he couldn't move his arms and legs.

The next day his concerned wife called a local medical helpline and admitted him to hospital for the same hospital for a second time because the doctor was worried he had suffered a stroke.

An expert told Hazel Davies to admit her husband into hospital again so he could be examined by medics for a second time.

And it was only after the second visit, an x-ray and CT scan that doctors then found self-employed Mr Davies had broken his neck.

Mr Davies, from Boulton Grange, Shropshire, must now spend at least six weeks in Oswestry's Orthopaedic Hospital for treatment of his injury.

His wife Hazel said: 'I just think it's disgusting.

'They obviously didn't examine him properly or they would never have sent him home in that position - he couldn't move, and his legs and hands weren't working. His right hand is still like a claw.

'They just classed him as another Friday night drunk.

'He couldn't understand why things weren't working, he just knew he was in trouble.'

A spokesman for the Shrewsbury and Telford Hospital NHS Trust said: 'While we cannot comment on individual cases, patients who come to our A&E departments are assessed for the clinical symptoms they present with and the history of their injury.

'If any patient or their family has concerns about this assessment process we would encourage them to contact us so we can investigate their concerns.'

Mrs Davies added: 'They told me to phone 999 immediately for an ambulance to get him into hospital to be examined properly.

'Bob was X-rayed and had a CT scan and they discovered he had broken his neck.

'On the Monday he was moved to the Oswestry Orthopaedic. He had another scan and they discovered he has damaged his spinal cord, so he might not get better at all.'

Mrs Davies said her husband had been out for a Christmas drink with work friends. As he was making his way home he 'felt funny' and the next thing he knew he had fallen on his face and was being put into an ambulance.

She said Mr Davies had had a few pints but told her he wasn't drunk.

She said her husband has now been told that he did not suffer a stroke, and that his broken neck was a result of the fall.

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