Monday, 29 April 2013

Liverpool Care Pathway - Shall We Permit The Tide To Turn?

They fought to defend our liberties, our democracy, against the jackboot of tyranny. Those liberties, that democracy, are once more in peril.

Our old ones were the young ones who faced the tyrant down. Their lives are now forfeit. They have no place except to be used as landfill for the pensions black hole that is one more gaping sore in the faltering economy.

Our struggles have been long and hard to establish what rights we have against home-grown despots, from peasants' revolt to Chartists' march to suffragettes' hunger strike.

"...we are all living in an “age of freedom” that has come about since World War II.

All this change has come about because there is freedom being enjoyed in this country by her citizens through democracy — a system that was “introduced” to the people of this country by the British in the “pre-independence” period. It was adopted as a system of governance by our own wise political leadership in the post-independence era –which in a way was a continuance of the previously introduced system. But it would have been impossible to adopt or continue it in the post-independence era (after 1947) if it had been destroyed in Britain, the mother of democracy, through defeat at the hands of Hitler. And it was saved in Britain, it is universally acknowledged, largely because of the vision, vigilance, determination, extraordinary power of expression, and inspirational leadership of one man — Winston Churchill."

Who lets their mind be ruled by complacency and their heart be swayed by indifference permits the tide to turn that will rob us of these hard-won liberties we enjoy and the rights we have won...

The stations of uncensored expression are closing down; the lights are going out; but there is still time for those to whom freedom and parliamentary government mean something to consult together. Let me, then, speak in truth and earnestness while time remains.  Winston S. Churchill 
The James family  had beloved husband, father and grandfather, David, taken from them by edict of the courts. They were even sworn to silence as to the name of the hospital that, first, sapped the health, took them to court, then, took the life of this gentleman. The expressed wishes of Mr. James and his family were ignored and overturned. And the lights are going out...

There are secret courts in this land that sit in judgement behind closed doors, not to decide and adjudicate heinous crimes, for they are overlooked and go unpunished - as at Gosport and Mid-Staffs; no, these are a cowardly breed who persecute the innocent.

We may yet speak out but, already, the censors' guillotine threatens to slice off our tongues should we dare to break the edict handed down by them not to speak.

This court may sit in absence and sit in secret. The publicising of its actions and its edicts may result in incarceration amongst Britain's vilest offenders, as has happened to Wanda Maddocks.

This is the awful, terrible power of the State that has become An Hideous Strength.

This is Wanda's story.

This is MailOnline -

She was subjected to a gruelling, secret legal battle, at the end of which she was thrown into a prison van, forbidden from speaking to a solicitor and sent to Foston Hall women’s prison in Derby — which once housed Maxine Carr, girlfriend of Soham killer, Ian Huntley.

For six terrifying weeks she found herself locked up alongside murderers and drug addicts.

‘Most of the inmates were serial offenders. Most were on drugs. They’d queue up for their methadone every day. I was a fish out of water, to say the least,’ she says.

‘I got myself into trouble when I said to one of the inmates: “I’m so glad I don’t have to share a room with anyone. Imagine if you ended up sharing with a murderer.” She replied: “I am a murderer”.’

In the bitterest irony of all, Wanda believes her incarceration was all for nothing and that her father’s worst fears came true. She claims he was so neglected by care home staff that he died of starvation within weeks of moving into one residence. ‘He died in their care. As far as I’m concerned, they killed him. The word they used on his death certificate was “inanition”. I had to look it up, but it basically means starvation,’ she says.

She also says her father’s body was covered in bruise-like marks, which the coroner failed to explain at the inquest.

Wanda was desperate to bring her father home, where she hoped to look after him herself, with the help of a full-time carer paid for privately. But she found she couldn’t have any influence over her father’s care without getting power of attorney over his affairs. This, however, proved easier said than done. ‘I spoke to endless lawyers. Some said it was too specialised for them. One guy wanted £15,000 in fees. We were on our own.’

Desperate to help him build up his strength, Wanda brought him some vitamin B complex tablets, which she had read were helpful for Alzheimer’s sufferers. This, she says, sparked ‘another battle in the war’.

‘I was made to feel like I’d “sneaked” drugs into my father. I would never do that. I gave them to the nurse and it was all above board. But that was it. After that I couldn’t be with my father unsupervised.’

Wanda says the breaking point came when she visited her father on Christmas Day but was allowed only one hour with him, supervised by staff.

‘Dad begged: “Can I not have some time alone with my daughter?” But they wouldn’t allow it.
‘I went home and cried, and called my brothers. They were furious.’

The family began to hatch a plan to get their father away. On Boxing Day, Wanda’s brothers went to the home, got him out of the fire door, took him for a meal, then called Wanda.
‘I told them to bring him to me and I would take him to Turkey.’

Despite the awful chain of events this action sparked, Wanda says she has no regrets. She claims her father’s health flourished during this time and he — ‘the man the authorities seemed to think was some sort of vegetable’ — was walking miles every day and eating hearty meals.

‘It was proof to me that his medical condition wasn’t as acute as they claimed. They had him down as some sort of vegetable. That simply wasn’t the case.

‘When we visited him in care, he was lethargic and depressed. I’m sure he was drugged up for a lot of it. But here, he was free, he was Dad again.’

While authorities insist that he was well cared for and saw a GP and other medical professionals on five separate occasions in the weeks leading up to his death, nothing will convince his daughter that his death was unavoidable.

Wanda sighs. ‘I can’t help but think that if I’d kept him here, he would still be alive today.’

She watches an old woman on the steps below. ‘Do you know, in Turkey, they don’t even know what a care plan is. I tried to tell a friend here about getting power of attorney over my Dad and they didn’t have a clue what I was talking about.

Here, they don’t have care homes. Old folk move in with their children, and stay there until they die. I can’t help but think they have got the right idea, but it is too late.’

Sunday, 28 April 2013

Liverpool Care pathway - A Tale Oft Repeated...

This is a story in five parts. It is Eddie and Annette's Story, a tale oft repeated, of a monstrous caricature of care that is the Liverpool Care Pathway.

In August 2012 Margaret Smyth was killed on the Liverpool Care Pathway. This is her story...

Margaret - Eddie and Annette's Story - Part 1.

Margaret - Eddie and Annette's Story - Part 2.

Margaret - Eddie and Annette's Story - Part 3.

Margaret - Eddie and Annette's Story - Part 4.

Margaret: Eddie and Annette's Story - Part Five (of Five)

Liverpool Care Pathway - The Dispassionate, The Merciless And The Cowardly

Not content with one insult, this secret court adds further insult to injury in its determined pursuit of assault on decency.

Who are these witchfinder-generals who persecute and imprison the innocent?

Do they call this newspaper the Daily Fail because it does not fail to cling on resolutely and neither flag nor fail in its determination to publish the truth?

This is Mail Online -

After John Maddocks was placed in one care home his family believed his condition was deteriorating and his daughter flew him out to her home in Turkey where he spent 13 weeks before returning to England and another care home, run by the local authority.

Ivan Maddocks said yesterday: ‘After he was put in the care homes something was really wrong. He wasn’t happy. He wasn’t eating properly. I took him out one day and he fell asleep. He was all out. I think they were over-drugging him. He collapsed in the care home.

‘In three weeks his kidneys were failing. He was just bones, dead thin with his eyes rolling over occasionally, on a drip, twitching. On the death certificate it said he had died because he hadn’t been eating or drinking.

‘Wanda was right all along. Something was really wrong. He would have been better living with the family. If he’d have been allowed  to stay with Wanda he’d still be alive. In Turkey, he liked the sun, he seemed healthy. Dad, in his last home, wondered why Wanda hadn’t visited. I said I’m not supposed to tell you this – and don’t tell the council – but they locked her up.

‘He thought Wanda wasn’t seeing him because she was fed up of him. It was because they kept her from him. I said no, she still loves you. He just went quiet. I’m sure he understood what I said.’

A spokesman for the care home has denied it caused the death of Mr Maddocks.

Ivan Maddocks said the family wanted a full investigation into the care their father received but spoke of feeling powerless after their experiences with the court system.

‘There were so many injunctions it was unreal,’ he added. ‘It’s wrong. People should be able to speak  out. I’ve never heard of anyone being jailed for trying to look after their father.’

The Witchfinder-Generals -

Matthew Hopkins, played by Vincent Price in the 1968 film (right) and Judge Martin Cardinal, played by himself, 2013 (left)

The Court of Protection was set up in 2005 under the Mental Capacity Act – one of Tony Blair’s most contentious laws. 

It gave legal force to ‘living wills’, instructions from patients ordering doctors to let them die if they became gravely ill. Here STEVE DOUGHTY looks at how the court works:

  • The court makes life-or-death decisions when the power to withdraw life-sustaining treatment is in dispute. It also governs the correct use of Deprivation of Liberty Safeguards, orders which can give care homes and hospitals the right to prevent a resident or patient leaving, if it is considered in their best interests. Backbench Labour MPs feared the legislation could be used to withdraw fluids and food from patients who might not wish to die.
  • The court makes rulings on power of attorney – decisions on who should have control of the money and property of those deemed no longer competent to handle their own affairs.
  • Originally Labour ministers said Court of Protection cases should be heard in public, but in 2006 the then Lord Chancellor, Lord Falconer, issued guidance which said ‘the court may order that identities of people involved in a case are not disclosed if it is considered necessary to protect their interests’. He added: ‘The circumstances under which the court may consider that all or part of a hearing should be heard in private are wide.’
  • Court of Protection judges rule in hundreds of everyday power of attorney cases, where people want control of the bank accounts of elderly relatives with dementia. In the past this function had been handled quickly and efficiently by officials as a matter of routine. Now families can suffer long delays.
  • By 2009 the average delay was four months – at a typical cost of £400 and the Court of Protection had attracted 4,000 complaints. The court is currently handing 2,700 cases a year – more than ten for every working day – and long delays continue.
  • Among the court’s current caseload is thought to be 30 life-or-death cases. Recent examples that came to light when judges published their rulings included a case in which a Muslim family tried to save their father. Hospital doctors said he should be allowed to die, but some witnesses had seen the man move his eyelids and grimace. In another case a judge ruled that a man with a disabling disease had consented to a living will by blinking at his wife and that his breathing machine could be disconnected.
  • No-one involved in any such case has ever been named. The secrecy maintained by the Court of Protection is such that in 2011 it obtained an injunction which forbade a newspaper to speak to any of 65 people, or to allow its journalists to go within 50 yards of a care home. The case involved a family who wanted an incapacitated elderly relative to be allowed to die.
  • Only one Court of Protection case is ever known to have been conducted under media scrutiny. The 2010 case involved the welfare of the Duchess of Cornwall’s nephew, blind and autistic pianist Derek Paravicini, and journalists were allowed in only after a lengthy application process.
  • And although Wanda Maddocks is thought to be the first person jailed by the court, no-one can be sure – someone else might have been imprisoned behind the court’s accustomed closed doors.

Friday, 26 April 2013

Liverpool Care Pathway - A True Story

The story you are about to hear is true; only the names have been changed to protect the innocent. It's just the facts; it's just the facts...

The Big Kill -

May was a mother devoted to her children. She came from a large family and she had a large family. One sister wed into a West Country farming family. Another sister wed into money. May just had her kids.

This last sister ever bemoaned May never had enough money, forever scrimping and scraping to find the rent and pay the bills. May always replied she had her wealth in stock. Meaning her kids.

Seven years ago, May was was given a year to live. She had cancer of the liver. She refused treatment. Seven years later, May was still here. She had proved the medics wrong...

Seven years later, and May was a frail and fragile lady of eighty-nine years young. Her personal needs had been few and her pension had accrued in her account. May had 'stock' but her family had had troubles and brought troubles of their own to her door.

May had helpers come in to see to her personal needs. She had a son who lived with her, who shopped and cooked, but was impatient of her...

May stopped eating. The son noted this. The helpers, if aware, did nothing.

The family stepped in. The son was turned out. May went into hospital in March this year.

To bring this story up to date, this witness statement fresh from the crime-scene follows:
"THIS IS WHAT THEY DO... and we're powerless to stop it... I am currently experiencing an act of neglect and as of today LCP application, in a family member.
Now, this particular side of the family are totally estranged, have been for years; however, my mum is a close relation of this person and I have been advising and informing her since this relative was first admitted to hospital - beginning March.
This is a classic case - elderly, being cared for at home when required, experiencing problems swallowing, dehydrated. Taken into hospital. Lots of tests, inconclusive. SALT team involved for a short time. Finally find a growth in throat, cancer query - patient refused biopsy (too scared) but Doctors conclude malignant growth. (Won't treat because diagnosis not confirmed)
Cannot take food orally (small teaspoons of yoghurt consistency only) - my Mum asked for PEG tube and Doctor refused because of "the risks" (sepsis/infection) but as I said, the greater risk is starving to death, which basically is what has happened. She is skeletal in appearance and has wasted away, the fluids that they were administering have started "skimming" the nurse said - basically infiltration has occurred, and they have let the fluid build up under the skin in the arms with no attempt to reduce swollen arms. They say "she's put on a stone in weight!" but as she has no food in her system this is surely the excess fluid!
Bedsores are blistering and oozing (treat with cream apparently). Originally on a urinary catheter, then allowed to just wet the bed and change sheets each time.
Not in pain, only discomfort when trying to swallow (a reason for PEG feeding?) but asked repeatedly if she'd like painkillers, she refused. However, this morning the family were informed that after they had left last night, she asked for pain relief? Hmmm.
This morning family were called in, she'd had a bad night (due to the drug administered last night? Not sure which analgesic used at this point).
Now they say she has mild pneumonia (hospital acquired, of course) and breathing problems. No antibacterial treatment suggested - simply told that she is showing all the signs of "dying" and if they were all happy, they would bring her into a side room and start end of life care, which includes the LCP.
My mum has made objections clear, she has fought for food for her, for continuing care at home, but today all other family members (with the "support" from the MacMillan nurse) have concluded that she must have peace... They have set up the syringe driver and have told the family the drugs are "very mild" - they are all falling for it, apart from my Mum, but her words and concerns are dismissed...
I am so angry. I feel like a failure. I did not go through this deceit and cover-up of mistakes with my darling Nan in 2007 for nothing; I want to make everyone aware and STOP it from happening; yet it's happening again to a relation, right now! 
"I spoke to my Mum at 6.30 pm and she was still on the ward with the curtains pulled round her, syringe driver working away with its death drugs... they say they are trying to arrange the side room asap..."
It is the weekend. This is the time of choice to proceed with the deed.The LCP tends to be the opportunists crime.

The victim refused a biopsy. Had this gone ahead, no curative treatment would have been offered. The doctors had already determined that starving their victim to death was preferable to inserting a peg...

A positive result would only have confirmed the LCP to have been commenced earlier than it was. According to the GSF Prognostic Indicator Guidance, a choice for no further active care is the second of the three triggers that suggests that patients are nearing the end of life. And the doctors would have dismissed treatment as 'futile' in any case...

The Soul Midwives had already moved in to ready the victim for induction and the family for indoctrination...

The victim had expressed verbally to family she was in no pain. After they had left, the Soul Midwives would have moved in to interpret a grunt or a nuance of voice to mean otherwise and administered accordingly. And did so.

The swelling of the arms to present as oedema would indicate infiltration...
"Just because it was soft at the insertion site DOES not mean you did not have an infiltrate. Fluid being pumped into the tissue will have to go somewhere and while it may appear as a classic lump above the site, it will often appear as generalized oedema of the arm and taut translucent skin. 
There is absolutely no point in keeping a IV in place that is NO good and especially one that is infiltrated. It does not matter how ill or unstable someone is..if the IV is BAD it's bad. If the patient needs another right away someone needs to restart it."
The victim was not only being starved of food, she was being starved of fluids.

The family, appropriately groomed by the Soul Midwives, agreed to the LCP.

The Soul Midwives were seen to confer with the doctor. The driver was set up, screens pulled round the bed. The one lone family member who had objected to LCP was heard to remark, "We won't see any more of them."

The Soul Midwives had done their job. They had instigated the LCP, advised the ward doctor, and they left to groom the next family...

News has come. She has been taken from this place and consigned to a side room to await her death...

The LCP is not about care; it is about a convenient solution. It is death on the dot. Death by induction. It is about a convenient outcome. No stress.

The victim, this lady, has a name; she is a person, not a category or a statistic. To protect the innocent, we have called her May.

If May dies, and it is certain now she must, she will not have died from her cancer, but of the prolonged and debilitating effects of starvation and dehydration.

It is not unheard of to have 'malnutrition' put on the death certificate. 
The Department of Health has increased the number of unannounced inspections by the Care Quality Commission, saying it is “unacceptable” for patients to go hungry or be malnourished in hospitals.
The announcement was made after it was reported that 1,165 people have starved to death in NHS hospitals over the last four years.
The Sunday Express said that figures from the Office for National Statistics revealed that for every patient who dies from malnutrition, four more have dehydration mentioned on their death certificate.
This is not mal-nourishment, however; this is non-nourishment. That is an assault.

And what will show on May's death certificate? What will they admit to?

EPILOGUE Saturday 27th April:

The results follow -

May slipped away after 9am this morning. A nurse initially declared her dead, but then found a pulse. May yet clung to life...

Moments later, her passing was once more announced. This time, it was authoritive and sure. May had left this world.

May had consented to the continuing care offered her. May had confided her belief they were all "a bunch of crooks" in there, meaning they weren't to be trusted...

May, may you find peace; may we yet triumph and bring an end to this monstrous caricature of care that is the Liverpool Care Pathway.

The NHS is beyond repair; it cannot be 'cured'...

Thursday, 25 April 2013

Liverpool Care Pathway - The Dispassionate And The Merciless

This is surreal... Hospitals give us infections. Doctors fight to end our lives. And take our lives. And our loved ones who rush to our defence are imprisoned.

In Ray Bradbury's surreal world, the firemen came to set fire to your books.

In this 21st century, this is Mail Online -

The State, the dispassionate and the merciless...

Doctors may take us to court to impose their decisions upon us. The court may not only enforce those decisions but throw us in prison should we attempt to disregard them.

The Mental Capacity Act and the so-called Court of Protection...
...the terrifying fact is that we already have a whole swathe of secret courts in this country, where judges are allowed to exclude the public and the Press.  All the normal principles of British justice can be turned on their heads. The rules, which in criminal courts require evidence to be put to a proper test, can be routinely ignored.

This is Labour's imperious legacy.

Miss Maddocks, who served six weeks of her sentence, was jailed because she ignored the court’s orders not to try to remove her father John from Park Hall care home in Bentilee, a suburb of Stoke on Trent.

She was condemned for incidents including taking the 80-year-old dementia sufferer to a court hearing and to see a solicitor.

She was also censured for producing a leaflet to try to publicise details of the case and giving her father a wooden cross ‘to ward off evil’ in the care home.

Her family said Mr Maddocks, a retired painter and decorator from Stoke-on-Trent, had been held ‘like a prisoner’ on the orders of a local council.

Miss Maddocks was initially not allowed to be named after the hearing and was identified only by her initials WM.

And the court’s ruling containing details of her sentence was not published.
The Court of Protection is a branch of the High Court and its hearings are always conducted in private.

Judge Martin Cardinal merely went through the motions of observing open justice when he handed down his sentence.

He ordered the doors of his courtroom in Birmingham to be unlocked and told ushers to announce in the corridor that members of the public were free to come in.

How gracious...

Wednesday, 24 April 2013

Liverpool Care Pathway - A Pattern Of Circumstance

There is a pattern of circumstance, here repeated, in other cases reported on these pages that cannot be just circumstantial...

Please sign the petition, also listed opposite: South London Healthcare trust: Independent external Enquiry URGENT.

Emrys Robe went into Princess Royal Hospital in Farnborough last February following a fall at his home in Eltham. Three weeks later, he was dead.

According to the GSF Prognostic Indicator Guidance, a Sentinel Event (e.g. a serious fall) is classed as a Step 2 General Indicator of decline and suitability for consideration for LCP.

If shortcomings have led to an avoidable death it may be hard to prove for precisely the reason that any 'care' regime which promotes and directs to a terminal outcome is going to have precisely that effect!

The PAG (Patient Action Group) says:

"From going in he should have been discharged five hours later. Instead, he started on a conveyor belt towards the death ward."

After a blood test, doctors said he had an infection and kept him in overnight. He was then confined to a bed, received no physiotherapy and was left with a blocked catheter three times which lead to septicaemia developing.

Treatment was then stopped and Mr. Robe was put on the Liverpool Care Pathway.

His daughter, Helen Ellis, says:

"Three weeks he was in hospital as they continued to make mistake after mistake. A dignified and proud ex-Navy gentleman went from being a happy go lucky man to basically a vegetable.

"He fought for this country to end up treated like an experiment animal. He fought and struggled to breathe for over three days. They have taken away all my wonderful memories.

"All I can remember is his cries for his mum as he struggled and struggled."

This is News Shopper 

While there, Ms Ellis says other patients were treated "appallingly", with one elderly man left sitting in the same chair for nine hours, and others left with bulging catheters or face down in a plate of food.
Following her father's death Ms Ellis met outgoing trust administrator Matthew Kershaw to discuss it, during which he promised a review into 42 different issues she raised.
But Ms Ellis, who says hospital staff are too scared to speak out about their concerns, claims he also agreed to an external review of the whole trust, something the trust denies.
She said: "They need to have an external review. I don't want to see people going through what we did.
"I haven't been able to sleep since. Everytime I think of those old people who hadn't been seen and all they wanted was a drink."
To contact the group, email or sign the petition calling for an external inquiry at

Tuesday, 23 April 2013

Liverpool Care Pathway - The Cult Culture

Like the secret society, this cult culture that works to protect the wrong-doer and excuse the wrong, singles out for reprisal those who raise objection.

West London Branch Motion brought at  CWU Retired Members Conference -

  "Anonymity for relatives and care home workers, who wish to make a 
  complaint, to do so without fear of reprisal. "

"This Conference notes that the Care Quality Commission (CQC) in relation to care for the elderly is not fit for purpose. The CQC Board and the organisation need to be restructured so that there are no Board members with any financial interest in the provision of care for the elderly, including Board members of Private Care providers, preventing any conflict of interest. 
This conference further notes that the Inspectorate Service should be given powers to issue improvement notices to be complied with within 30 days; the next stage being able to instigate closure of the home with all costs incurred, including movement of patients, to be borne by the provider. There should be, additionally, a provision for anonymity for relatives and care home workers, who wish to make a complaint, to do so without fear of reprisal. 
This conference therefore instructs the Retired Members Advisory Committee, with the assistance of the NEC, to organise a mass campaign within the Trade Union and wider Labour movement to obtain these objectives."
The motion was carried and selected to be submitted to the Union's General Conference. [CWU]

The Guardian reported -

"In all, 5,277 (64%) of the 8,262 nurses surveyed by pollsters ICM for the RCN had raised a concern, mostly about unsafe staffing (48%) or patient safety (21%). But 24% said they were discouraged or warned off taking any further action by managers or colleagues. 
Almost half (45%) of those who had voiced disquiet said their employer took no action as a result, while 44% said fears about being victimised or suffering reprisals had made them think twice about speaking out again in case they were seen as troublemakers."

This culture that persists in the NHS and elsewhere is fostered and encouraged by both N&MC and the GMC.