Wednesday, 20 March 2013

Liverpool Care Pathway - Tooling Up

The review is proceeding to its almost certain outcome. Whichever what they decide to call it, it will be vindicated and they will carry on doing what they have been doing.

As reported in their Quality AccountSurrey and Sussex Healthcare NHS Trust (East Surrey and Caterham Dene are both Surrey and Sussex hospitals) is tooling up for the LCP whatever the outcome of the review.

The Pathway is dead. Long live the Pathway! 

Can the Trust be trusted to escalate its deadly armoury? They can’t reliably care for their living patients but they are making this investment in ‘care’ for their diagnosed ‘dying’ patients. A syringe driver makes economic sense, of course. Just set it up and leave it running...

What can go wrong? If the patient dies on the pathway, well, isn’t that what they’re supposed to do…? And if they die, well, that only goes to show the diagnosis was a correct diagnosis of ‘dying’.

There's no comeback. It’s win, win all round; it’s the six steps to success! And if the CQUINs continue, they're quids in and it's rewards all round for the Trust.

Sounds Pythonesque to me.

Can the Trust be trusted? Can East Surrey Hospital be trusted? It has a dismal record.

This is Mail Online -

Doris, 95, was left on a hospital trolley for 28 hours - and when her son asked where she was, doctors didn't have a clue...
  • Hospital 'lost track' of frail pensioner after she injured her leg in a fall
  • She was left in a room and forgotten as son frantically searched for her
  • Staff only found her after son threatened to file a missing person report

Frightened and alone, 95-year-old Doris Miller lay on her hospital trolley as hour after hour went by, wondering why no one had come to see her.

The old lady was exhausted and in pain after falling in the shower and hurting her leg. But following the drama of the ambulance dash to A&E, she had been wheeled into an ante-room . . . and parked there, like a piece of left luggage, for 28 hours.

Away from the routine meal-and-tea rounds on the wards, she had been given hardly anything to eat or drink and no proper medical care. She vaguely recalls being given a sandwich or two, but can’t quite remember by whom.

And she simply could not understand why her devoted son Michael had not arrived.
Harrowing delay: Doris Miller, 96, with her son Michael, who had been frantically
searching for her

As day turned to night, and night became morning, Mrs Miller became more confused, distressed, and fearful for her safety. She had no way of knowing that Michael, 67, had been frantically searching for her — but East Surrey Hospital in Redhill had completely lost track of where they had put her.

In fact, they managed to locate her only after Mr Miller called the hospital chief executive to say he was phoning the police to report his mother as a missing person.

‘I was furious,’ said Mr Miller. ‘This is what happens when you put too much pressure on a system that doesn’t work.’

An appalling but isolated case? If only it were.

Earlier this month, the College of Emergency Medicine (CEM), which represents A&E doctors, told NHS managers that they should routinely leave patients on hospital trolleys to alleviate overcrowding in casualty units.

A&E departments have become a bottleneck in a NHS that is struggling to cope with reductions in staff and services caused by Government demands for £20 billion in efficiency savings by 2014. All this at a time when A&E attendances at English hospitals have exploded from 12.9 million in 2001 to 20.7 million in 2010.

Some of this is caused by population growth, but much of it is due to GPs radically cutting surgery opening hours and out-of-hours visits, leaving patients with nowhere else to turn.

Casualty units are also severely affected by the continued rise of Britain’s binge-drinking culture following the introduction in 2003 of licensing laws which permitted 24-hour drinking.

Around a third of all A&E attendance and ambulance costs are alcohol-related, according to a report on the impact of drink on the NHS, published in 2009 by the Institute of Alcohol Studies.

The CEM says the demands being placed on A&E units are so great that it has become an unfortunate necessity to ‘board’ patients on trolleys in corridors outside full wards, queuing for beds to become free.

The new guidelines state: ‘Boarding patients in the corridors of the wards where they will be admitted is controversial but supported by the college.’

The college is also recommending that hospitals cancel routine surgery to help clear beds and take the pressure off casualty units.

It warns that casualty staff are now under such great stress that they are at much greater risk of making errors such as failing to prescribe life- saving drugs or spotting early symptoms of crises such as heart attacks.

It also warns of the dangers of patients being left lying in ambulances for hours before space in A&E can be freed to receive them.

The college says that leaving patients on trolleys should be a stop-gap measure only until the NHS modifies its procedures to cope with the ever-growing pressures. But patients such as Mrs Miller are already suffering.

She was taken to East Surrey Hospital at 10am on April 11 last year after the fall at her home in nearby Horley. Her son Michael, who was working in another part of the county, called the hospital  as soon as he heard and was first told she was ‘resting’ in A&E.

Hours later, when he checked again, he was told she had been transferred to a care home. ‘I asked which home she was in, but they wouldn’t tell me because of “data protection”,’ he says.

Mr Miller persisted, and an hour later the hospital rang him to say that she had actually been transferred to a ward within the hospital.

‘I rang the ward, but they said they had never heard of her,’ he says. ‘The next morning, I was told she was on another ward, so I checked with that ward, and again they said that they had never  heard of her.’

Finally, the hospital admitted they were having trouble locating Doris. ‘It was now 2pm the following day,’ remembers Michael. ‘I rang the chief executive and said that if she were not promptly found I would report her to the police as a missing person.’

Ten minutes later the hospital telephoned to say she had been found in an ante-room at the A&E department, still on her trolley after 28 hours.

Under fire: Mrs Miller was taken to East Surrey Hospital (pictured), in Redhill, after a 
fall at her home in nearby Horley

‘When I finally saw her, she looked dehydrated, confused and distressed,’ says Michael. ‘She had received no proper care.’

Like many elderly people, Mrs Miller, who now lives in a care home, did not feel able to buttonhole the hard-pressed staff as they bustled past, and she had no buzzer to summon help.

‘I didn’t want to complain but I was in there a long time, and they left me alone for long periods in the corridor,’ she recalls.

The hospital insists Mrs Miller had been properly cared for in A&E, but that it had launched an inquiry into the communication breakdown.

Michael Wilson, chief executive of Surrey and Sussex Healthcare NHS Trust, has said of the case: ‘Clearly this is not the experience we want for our patients and I am pleased to say that the vast majority of our patients do receive good to excellent care.’

'She was dehydrated and distressed when we finally found her'

However, Mr Miller says: ‘They have closed two hospitals round here and East Surrey is caring for half a million people. It is the vulnerable who suffer.’

Vulnerable people such as 74-year-old Paule Ripley, who was admitted to Queen Alexandra Hospital in Portsmouth last year with an irregular heartbeat and breathing difficulties.

She arrived in A&E at midday and was wheeled into the medical assessment unit to await admission. There was never any doubt that she needed a hospital bed. Yet 12 hours later she was still there, lying on a trolley, hungry and thirsty.
‘The whole experience was very frightening,’ said Mrs Ripley, of Gosport.
A spokesman for the hospital trust, while refusing to comment on Mrs Ripley’s individual case, said: ‘In the five years to March 2012 we have never failed to meet the national NHS target of a maximum 12-hour wait on a hospital trolley. Portsmouth Hospitals NHS Trust has one of the busiest emergency departments in the country.’
But Mrs Ripley said her experience there was unbearable.
‘It almost killed me,’ she said. ‘The trolley was uncomfortable and I didn’t have the strength to lift myself. No nurses came to see me. The doctor, when he did come, said I should be in a ward, in a bed, immediately. I hoped what happened to me was  a one-off, but I fear it’s becoming the norm.’

If not the norm, then such cases are certainly becoming ever more common. One year after Health Secretary Andrew Lansley scrapped Labour’s target that 98 per cent of A&E patients must be seen by a medical professional within four hours, figures released last month by the NHS Information Centre reveal that many patients are now waiting up 24 hours, with many spending the night on trolleys. 

The new rule is that managers are expected to investigate if more than five per cent of patients wait more than four hours. 

But that limit is now being regularly broken every day across the country: figures from the NHS Information Centre show that nearly 900,000 people (5.6 per cent of patients) had to wait longer than four hours last year.

Janet Davies, director of nursing at the Royal College of Nursing, says: ‘We are hearing a lot of concern from nurses about this.

‘For patients to benefit from hospital care, they need to feel secure and to have their privacy and dignity protected.

'He died alone on a trolley with no one to hold him'
‘Patients also need to be able to interact with staff, to be able to reach call bells and to know they are visible. If the nurses are very busy, there is always the fear they will be forgotten.

‘On top of this, corridors cannot be considered physically safe places to park patients. It is a very high-risk strategy. Patients may not be in places where they can be routinely monitored and they may be physically distant from the specialist staff they need to treat them.

‘The result is that their recovery takes longer — and the hospital ends up with an even higher workload. That causes a vicious spiral. At our annual congress next month, members will be calling for an  end to putting patients in inappropriate places.’

The issue is also turning into a political battleground. Shadow Home Secretary,Andy Burnham, has warned that lengthening A&E waiting times show that ‘the NHS  is slipping backwards on the watch of a Prime Minister who promised to protect it’.

And Lord Howe, the Junior Minister with responsibility for quality in the health service, has said of the new trolleys policy: ‘Hospitals should ensure that those needing further care on a ward are transferred as quickly as possible.’

But as politicians debate the issue, there is no question that patients are suffering — even dying — after being left for too long on trolleys.

This was starkly highlighted last month when a 77-year-old man died alone and unnoticed on an A&E trolley in the Royal Victoria Hospital, Belfast, after being parked for 22 hours in the hospital’s A&E department.

The man, who’d had motor neurone disease for 18 months, died on March 6. His family do not wish to be identified, but his 71-year-old partner told reporters that she was heartbroken he died ‘alone on a trolley with no one holding his hand’.

The hospital is holding an inquiry into the incident and says it will not comment further until that investigation is complete. But it is reported to have promised the family that no patient of the hospital would ever again spend more than 12 hours on a trolley.

More than 12 hours? It seems a sad fact that we have already reached the stage where NHS managers think it reasonable to leave sick patients for half a day lying frightened and sick in corridors and side rooms because of lack of bed capacity.

If vulnerable people are expected to languish on trolleys for such extended periods, it is surely a proof that our health service chiefs are completely off theirs.

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