Wednesday, 4 September 2013

Liverpool Care Pathway - There Are Always Consequences

Life has many object lessons to teach. Failure to understand and to learn those object lessons will not keep the consequences from your door.

This is the NHS National Institute for Health Research
The Department of Health, through the National Institute for Health Research (NIHR) has announced the 15 NHS Trusts/Foundation Trusts that will host the local branches of the NIHR Clinical Research Network from April 2014.

The NIHR Local Clinical Research Networks will distribute £280 million of NIHR funding per year to hospitals and surgeries across England to, pay for research nurses, scans, x-rays and other costs associated with carrying out clinical research in the NHS. The Networks will help to increase the opportunities for patients to take part in clinical research, and will be responsible for making sure that studies are carried out efficiently. They will also support the Government’s Strategy for UK Life Sciences by improving the environment for life-sciences research in the NHS.

Clinical research provides evidence about “what works”, and on how the NHS can best use its resources to best provide better treatments for NHS patients across all areas of medicine. The promotion, conduct and use of clinical research is included in the NHS Constitution, which pledges that patients will be informed of research studies in which they may be eligible to participate.

Last year, more than 630,000 patients took part in clinical research studies supported by the NIHR Clinical Research Network.

Dr Daniel Poulter, Parliamentary Under Secretary of State for Health, said:

These changes will give patients around the country better access to clinical research. That means new treatments will be developed faster and available for patients earlier.

The UK’s position as a world leader in the field of research is something we are rightly proud of. The network provides a platform for exciting studies to take place and build on that reputation.”

The UK’s position as a world leader in the field of research is something we are rightly proud of. The network provides a platform for exciting studies to take place and build on that reputation.”The 15 NHS Trusts / Foundation Trusts are:
  • Barts Health NHS Trust
  • Central Manchester University Hospitals NHS Foundation Trust
  • Guys’ and St Thomas’ NHS Foundation Trust
  • Imperial College Healthcare NHS Trust
  • Norfolk and Norwich University Hospitals NHS Foundation Trust
  • Oxford University Hospitals NHS Trust
  • Royal Devon and Exeter NHS Foundation Trust
  • Royal Liverpool and Broadgreen University Hospitals NHS Foundation Trust
  • Royal Surrey County Hospital NHS Foundation Trust
  • Sheffield Teaching Hospitals NHS Foundation Trust
  • The Newcastle upon Tyne Hospitals NHS Foundation Trust
  • The Royal Wolverhampton NHS Foundation Trust
  • University Hospitals Bristol Foundation Trust
  • University Hospital Southampton NHS Foundation Trust
  • University Hospitals of Leicester NHS Trust 
4 September 2013
The National Institute of Health Research (NIHR) has awarded Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) - and involving the Universities of Cambridge and East Anglia (UEA) - nearly £10 million for research to “host” a Collaborations for Leadership in Applied Health Research and Care (CLAHRC).

CLAHRC East of England will begin operating in January 2014, replacing CLAHRC Cambridgeshire and Peterborough which was formed in 2008.

Stephen Barclay leads the CLAHRC End of Life Care Research Group, which is based in the Institute of Public Health. Dr. Barclay is a member of the General Practice Research Unit: the CLAHRC team are not members of the Unit.

This is the End of Life Care Team responsible for EoLC and HIEC (High Innovation and Education Cluster) training in Cambridgeshire and Peterborough -


HIEC End of Life Care Team members

Liz Mather, General Practitioner (community education):

Lesley Trout, Macmillan Nurse (care home education):

Anna Spathis, Consultant Palliative Medicine (hospital education):

Sally Thornton, End of Life Care Education Facilitator:

Stephen Barclay is also leading a second HIEC initiative to develop an electronic register “Share my Care” for patients approaching the end of life in Cambridgeshire. The local Clinical Commissioning Group have endorsed this service development project, for which a research evaluation is being developed.
Share my Care is an EoLC register. Three of these team members feature in the HIEC EoLC Newsletter dated 28.9.11 -

HIEC – End of Life Care Newsletter 28.9.11

HIEC – End of Life Care Newsletter

The Newsletter evaluates the 'changes in knowledge and behaviour of delegates, and use of the EOLC tools':
Our project aim is to improve end of life care (EOLC) for patients in community and hospital settings across Cambridgeshire and Peterborough, by providing education based on increasing the uptake of the three EOLC tools: Gold Standards Framework (GSF), Preferred Priorities of Care (PPC) and Liverpool Care Pathway (LCP). 
Key project features 
·         Multidisciplinary education for medical, nursing, social care and allied health professionals·         Close integration of education across community and hospital settings with shared learning materials·         Detailed evaluation of the impact of the initiative, including changes in knowledge and behaviour of delegates, and use of the EOLC tools.
HIEC End of Life Care team

Liz Mather General Practitioner (community education)(Wed): Trout Macmillan Nurse (care home education)(Wed/Thurs): lesley.trout@pbh-tr.nhs.ukAnna Spathis Consultant Palliative Medicine (hospital education)(Wed):

Clearly, this refers to introduction of the Mark 12 LCP at that time. 

Problems arose because, after the code of conduct accompanying the Mental Capacity Act 2005 became law (Oct 2007), it became a criminal offence to take consent without a test of the patients' competency to give it. However, this wasn't added to the LCP until version 12 was published in 2010.

Medical criminals have participated in a medical holocaust.

The NIHR news pages provide a link to a UN publication. The publication is the World Health Report 2013. It is entitled: Research for Universal Health Coverage. A modest review of this is supplied by Christine Hill -

Universal health coverage ensures everyone has access to the health services they need without suffering financial hardship as a result. In December 2012, a UN resolution was passed encouraging governments to move towards providing universal access to affordable and quality health care services. As countries move towards it, common challenges are emerging — challenges to which research can help provide answers.
The World health report: research for universal health coverage focuses on the importance of research in advancing progress towards universal health coverage. In addition, it identifies the benefits of increased investment in health research by low- and middle-income countries using case studies from around the world, and proposes ways to further strengthen this type of research.
The UN document promotes affordable, quality health services. This is the Mantra of Don and Zeke, with the NHS in the UK and the Affordable Care Act in the US.

Keeping costs down and improving quality is becoming a bigger and bigger concern for countries across the world as they face economic crises and increasing populations. It is about availability and affordability. It is what is available at the point of delivery and what is affordable at the point of supply.

This is a section on -
Aordable health care in ageing populations: forecasting changes in public health expenditure in five European countries
The need for research
As the average age of European populations becomes older, a larger number of people will suffer from chronic disease and disability as a result of cancers, cardiovascular diseases, fractures, dementia and other conditions. In addition, a growing number of people will suffer from several morbidities at the same time. These observations have generated concern that public spending on health care in ageing populations will become unaffordable.
The analysis was carried out for five countries of the European Union (EU) – the Czech Republic, Germany, Hungary, the Netherlands and SloveniaThe study design uses published data. However…

The Study maintains that,
If, with increases in life expectancy, the proportion of life in good health does not change, then public expenditure on health care is expected to increase by only 0.7%, to 7.4% of GDP.
“In the Netherlands, for example, the increase in spending per person is expected to peak between 2020 and 2025, resulting in an average yearly growth rate of 0.9% due to ageing, falling to zero between 2055 and 2060, when the population of the Netherlands is likely to become younger on average.”

Younger than average.

How can this be? Where will all the old ones have gone…?

Where are the missing people?

Fact: If you roll out a policy and not merely maintain that policy but expand and extend it over a decade and more, you are going to begin to see substantial results from the effects and outcomes of that policy.

The Study summarises -
Main conclusions 
Between 2010 and 2060, the estimated annual increases in health expenditure due to ageing are less than 1% and falling in five European countries. 
While the number of older people suffering chronic diseases and disability is expected to grow, the costs of health care become substantial only in the last year of life. 
Although ageing is not expected to incur large extra costs, systems for health care, long-term social care and welfare in European countries must adapt to population ageing.

The EoLC strategies have concentrated on that last year of life, of singling out the 'failing runts' amongst the aged for the 1% - the one in one hundred - death lists, much as the one in three hundred of Sparta singled out their failing children for termination.

On the NIHR pages, Christine Hill reports further on this matter -

       Dementia Rate Is Found to Drop Sharply

1:10 pm in CLAHRC CP NewsCLAHRC CP News and Events by Christine Hill
Results from two major cohort studies, led by the University of Cambridge and supported by the Medical Research Council, reveal that the number of people with dementia in the UK is substantially lower than expected because overall prevalence in the 65 and over age group has dropped.

The two studies provide the first estimate of the change in the number of people live with dementia in the UK, and the new figures give a more accurate picture for those developing policies and planning healthcare services for dementia patients. -

The study was led by Professor Carol Brayne from the Cambridge Institute of Public Health at Cambridge University. She said: “This study provides compelling evidence of a reduction in the prevalence of dementia in the older population over two decades. Whether or not these gains for the current older population will be borne out in later generations would seem to depend on whether further improvements in primary prevention and effective health care for conditions which increase dementia risk can be achieved, including addressing inequalities.”
Read more from Cambridge University news
Download the paper published in the Lancet: Matthews, Fiona E., et al. “A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II.” The Lancet (2013).
The Telegraph reports -
Previous estimates had put the number of people with dementia at about 800,000, but new research using more recent health data suggests the true figure is about 670,000. 
It means that while the total number of dementia sufferers has increased slightly over the past two decades, from about 664,000 in 1991, the proportion of over-65s with the condition has dropped from 8.3 per cent to 6.5 per cent among a much greater elderly population.
The drop in the projected figures is attributed to better public health and education -
Better public health and education have made the condition almost 25 per cent less common among over-65s today than it was in the early 1990s, a new study suggests.
The Study focuses on the drop in the projected figures. The Telegraph actually headlines: Dementia rates fall as public health improves. This is a classic demonstration of how to put a different spin on the figures to reach an alternative conclusion.

Actual figures over this period show an increase in the total number of dementia sufferers. There has not been a drop in the number of sufferers. What requires to be explained is how the projected figures could prove to be so inaccurate.
Maria Carrillo, vice president of medical and scientific relations at the Alzheimer's Association, an advocacy group, was not convinced that the trends were real or that they held for the United States.- New York Times
The figures show a drop in the prevalence of the condition amongst the over 65's in an elder population that is steadily growing. The actual number of sufferers has also grown. What is happening?

Across Europe, the Death Cult has raised its voice and been busy about its work. Euthanasia is common place and become 'normalised'.

Organ harvesting of euthanased patients is well organised, almost to a factory precision, across europe via Eurotransplant -


In the UK and across Europe the EoL Pathways have been rolled out.

Rolling out any policy with the determination and thoroughness that has proceeded with these Death Pathways will have ramifications.

29 per cent of NHS deaths on the Pathway -

That is a figure which suggests around 130,000 deaths a year.

The BBC reports -

"Life expectancy of a man aged 65 has increased from 14 years in the early 1980s to 21 years now - so that's a 50% jump in just three decades," says Richard Willets, director of longevity at insurance company Partnership.
Which is why, when the 2011 census was published, he went straight to the statistics about elderly populations.
And there the data revealed a surprise.
"There were 30,000 fewer people aged in their 90s than previously believed," he says - 429,000 instead of 457,000.
"That was about 15% fewer men; 5% fewer females. There were also fewer centenarians than previously believed - the number of female centenarians was [out] by about 10%."

How can this be?

Where have all the old ones gone…?

Where are the missing people?

Where are the missing 90-year-olds?

“ Sadly, they've already died. They just didn't live as long as statisticians had predicted.

 In other words, the mortality and life expectancy calculations actuaries and statisticians rely on have been too optimistic.

The story is a consistent one. The same story comes via different and diverse sources, each one providing only confirmation of the other.

Sadly, they have fallen victim to government programs and strategies and the determined efforts of those who have promoted them.

For further reading -

         Liverpool Care Pathway

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