Friday, 29 November 2013

Liverpool Care Pathway - A Cost Efficiency

When you're counting the pennies the patients will have to look after themselves.

The HSJ says –
The 2015 deadline to create £20bn in savings looms large.
NHS England predicts it will fall short of efficiency savings for 2012/13 and the latest King's Fund report shows few trust finance directors are confident they will meet 2013/14 targets.
With many easy efficiency wins now found, the NHS must now turn to the private sector.
Sir David Nicholson set the £20 Billion savings productivity target for 2015. This was - and is - the Nicholson Challenge.

Nicholson's challenging targets went toward creating the catastrophic failures at Mid Staffs. This is the Nicholson Legacy.

Nicholson's been sent away with a lubbly jubbly, thankyou very much £2 Million pension pot; we're left with a corner-cutting target and more catastrophic failures to come.

It's all a corner-cutting exercise; this is what the programme to limit life is all about.

This is The Telegraph

The fine balance between the right to live and the right to die is now tipped toward the latter.
They must allow the terminally ill to refuse food and water if the patient does not want treatment that prolongs their life and must abide by “living wills” in which patients specify in advance that they do not want to be resuscitated. 
Doctors must also follow the wishes of patients as communicated through a friend or relative who has been designated their “legal proxy”, says the GMC. 
Doctors who flouted the guidelines would be forced to attend a fitness to practise hearing before the GMC and would be struck off if the case against them were proved.
This is what the 1% 'last wishes' documents are all about.

Doctors MUST respect wishes of patients and those close to them...
Close relatives and partners, as well as paid and unpaid carers, will be involved in discussing issues.
Serious or persistent failure to follow this guidance will put your registration at risk. You must, therefore, be prepared to explain and justify your actions.
- GMC Guidance
...when that means refusing treatment.

May we expect clinicians to be brought to task and suffer similar ignominy when they have proceeded in the execution of EoLC against and in the absence of these wishes?

This is the Northumberland Gazette

In September of last year, the family, including daughter Louise Simpson, told the Gazette that they believed a series of errors throughout his ordeal meant that he endured a distressing and horrific time.
But shortly after our story, the family faced more trauma, after learning that Mr Fell had been placed on the Liverpool Care Pathway (LCP) at Newcastle Freeman Hospital.
And they only made the discovery after requesting his medical records.
Louise says the family is disgusted and horrified that nobody at the Freeman consulted them, nor asked for their consent. She says she has lost trust in the NHS and wonders how many families this has happened to.
Mrs. Audrey Peace was taken into the University Hospital, North Durham (UHND) after Christmas 2011 following a fall which caused her to fracture her arm. 

This is The Northern Echo 

THE family of an elderly woman who died after her bed sores became infected have expressed concerns over the medical care she received.
An inquest heard how Audrey Hannah Peace, of Perkinsville, near Chester-le-Street in County Durham, contracted septicaemia from multiple pressure sores she developed while recuperating from a fall.
She died at the University Hospital of North Durham (UHND)on March 25 last year after being placed on the controversial Liverpool End-of-Life Care Pathway, which was abolished this summer.
Will the Multidisciplinary Teams (MDTs) involved be sought out to appear before the GMC to explain their actions - and struck off?


They didn't strike off Dr. Jane Barton (author of the Barton Method, forerunner of the GSF 'Surprise Question'). She knew too much.

Sir David Nicholson set the £20 Billion savings productivity target for 2015. This was - and is - the Nicholson Challenge. Why £20 Billion?
With the number of deaths set to increase by 17% to 590,000 by 2030, we are facing a ticking time bomb when it comes to end of life care. A rapidly ageing population and increases in the number of people with complex long-term conditions will lead to greater demands on providers of end of life care and rocketing costs for the NHS predicted to rise from £20billion to £25billion by 2030. This issue is the subject of a series of fringe events Patient Choice V Care being held by Marie Curie is partnership with Sue Ryder and Help the Hospices, during the political party conference season.- Huffington Post
Doctors MUST respect wishes of patients and those close to them...
Failure to communicate some or all relevant  information can lead to inappropriate treatment being given (for example, DNACPR decisions not being known about) and failure to meet the patient’s needs (for example, their wish to remain at home not being taken into account).   - GMC Guidance
This is what the 1% 'last wishes' documents are all about: downsizing care expectations and shipping them off home for palliative care.

From The Mandate
"These priorities reflect the Government’s absolute commitment to high quality healthcare for all, while highlighting the important additional role the NHS can play in supporting economic recovery."

"The NHS Commissioning Board’s objective is to ensure that the new commissioning system promotes and supports participation by NHS organisations and NHS patients in research funded by both commercial and non-commercial organisations, most importantly to improve patient outcomes, but also to contribute to economic growth. This includes ensuring payment of treatment costs for NHS patients taking part in research funded by Government and Research Charity partner organisations."
The important additional role the NHS can play in supporting economic recovery...

Contribute to economic growth...

NHS patients taking part in research...

The focus of any health provider is to restore the patient to a condition of health. A healthy population is constructive to maintaining and encouraging a healthy economy but that is an entirely incidental consequence.

Alarm bells are already ringing. This could lead to significant conflicts of interest. Are permissions to be sought...?
NHS England Business Plan
We will act as a facilitator of research – for example, we are planning to investigate a system of ‘presumed consent’ to take part in research studies for all patients treated in teaching hospitals.
NHS England Business Plan

Presumed consent...?

Evidently not.

Commercial exploitation of patients...?

Privacy violations through access to patient data, medical records and genetic information?

There have been no study results posted as yet to this inquiry into The Effectiveness of the Liverpool Care Pathway (LCP) posted to Clinical Trials, a service of the US National Institutes of Health -

The Independent reported -
The Belgian study is recruiting 600 dying patients, half of whom will get usual palliative care, while the others will be cared for using the LCP.
As at June of this year, the sponsors, End-of-Life Research Group, were still recruiting volunteers.

Volunteers? A policy of presumed consent? Is it possible such trials may be run in these teaching hospitals? Don't say, "No; it's impossible". They've been killing people, cutting lives short, for years and no-one has batted an eyelid.

Presumed consent...

This is Barts Health NHS Trust
Our hospitals 
With a turnover of £1.25 billion and a workforce of 15,000, Barts Health is the largest NHS trust in the country, and one of Britain’s leading healthcare providers.
We have six hospitals which deliver high quality compassionate care to the 2.5 million people of east London and beyond.
Presumed consent...

Barts Health has been given a leading role in clinical research.

Barts, Royal London, leading London teaching hospitals.
We are based in leading teaching hospitals, and continually push the boundaries of medical research to ensure that we are able to provide the most advanced and successful technologies and treatments.Barts Health NHS Trust
Presumed consent...
Barts Health NHS Trust
Barts Health has been chosen as the lead organization for clinical research across north central and north east London, Essex and Hertfordshire, underlining the Trust’s wealth of experience in recruiting patients onto pioneering clinical research trials.

Barts Health is one of 15 NHS Trusts and Foundation Trusts across England that will host local branches of the National Institute for Health Research (NIHR) Clinical Research Network from April 2014.

The NIHR Clinical Research Network is the clinical research delivery arm of the NHS. It provides funding to hospitals and surgeries to pay for research nurses, scans, x-rays and other costs associated with carrying out clinical research in the NHS.

Commenting on the appointment, Professor Jo Martin Barts Health NHS Trust Director of Academic Health Sciences said: “We are delighted to be asked to play such a pivotal role in bringing the opportunity to participate in trials to patients.”

Professor Nick Lemoine, Director of Barts Cancer Institute, who has led the programme to speed up approval of trials across the network said: “With more time available to recruit, more patients will be recruited. Thus these ‘extra’ patients will be able to access the therapies being tested in the trials, which are potentially life-saving or life-changing.”

The Chair of the selection panel, Dr Jonathan Sheffield, Chief Executive of the NIHR Clinical Research Network, said: “The host organisations will help to set the level of ambition for clinical research delivery locally, and assist us in making sure that clinical research occupies the place it deserves in the day-to-day work of the NHS”.Clinical research provides evidence about “what works” and on how the NHS can best use its resources to provide better treatments for NHS patients across all areas of medicine.

The Clinical Research Network, supported by UCLPartners*, will develop the capability of all the hospitals in the region to increase the opportunities for patients to take part in clinical research, ensure that studies are carried out effectively and to collaborate in vital research into potential new life-saving treatments and diagnostics.

With half of the country’s clinical trials taking place in north east and north central London, partners in the network are well placed to take advantage of the announcement to improve the health outcomes for their patients.

As the chosen Trust for North Thames, Barts Health NHS Trust will be awarded a five year contract from the Department of Health through the NIHR, and will take responsibility for distributing £29m worth of funding per year, to support clinical research across the parts of London, Essex, Hertfordshire and Bedfordshire.

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

The National Institute for Health Research (NIHR) is a member organisation of Bee Wee's Leadership Alliance for the Care of Dying People.

Say no more.

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