Saturday, 28 December 2013

Liverpool Care Pathway - A Negation Of Trust

When those placed in a position of trust to stand as impartial champions hold partial consort with those we challenge then they negate that trust.

Are these those we should trust?

In their own self-audit, they could find nothing wrong, only much to praise...

The Generic Report 2008/2009 was cited as gospel and clung to as the spoken and incontestable word of the Prophet, John Ellershaw.

The PHSO (Parliamentary and Health Service Ombudsman) is our last port of call in the complaints process. This is the PHSO Submission to the Independent Review –

And are these those we should trust?

The supposedly independent PHSO actually met with John Ellershaw of the Marie Curie Palliative Care Institute in Liverpool in 2012 to discuss how they should deal with complaints about EoLC and the application of the LCP!

In their submission, the PHSO reports that an increasing number of complaints they receive are in relation to EoLC.

Scenarios are discussed. One such is that the patient deteriorates and a decision is reached that their prognosis requires EoLC or a DNAR.

"As a result, some of the complaints we see in this area are about the deterioration in the patient’s condition which is seen by the families concerned as having been caused by poor care and treatment."
Such cases, apparently given such scant consideration, are actually well-founded as we know from the David James case and others mentioned in these pages!

The submission does mention cases where complaints were actually upheld. These were all where EoLC
“was not implemented soon enough and opportunities were lost to make patients more comfortable during their final hours.”
And the submission gives them particular mention...
 “We upheld one particular complaint in a community setting where a GP’s delay in considering palliative care meant that the patient and his wife did not have access to the full range of services which should have been available to support them at the end of his life. In another case palliative end of life care was not put in place as a result of delays in diagnosing terminal cancer.”
While the submission acknowledges complaints in regard to “patients being put inappropriately on the LCP by medical staff or against the wishes of the patient and their family” and that “the patient should not have been put on the LCP at all or that the patient was put on it at the wrong time, leading to an unnecessary or premature death”, it would seem that these cases were not taken seriously enough to pursue. There is good cause for this.

In such cases, where the LCP has been enacted and execution of death completed, there is only one charge to bring, and that is a charge of murder.

In such cases, where the LCP has been enacted and execution of death not completed, there is only one charge to bring, and that is a charge of attempted murder.

Hence, with all the clamour abroad in the press, notably the much maligned Daily Fail, it became necessary to meet with the Chairman himself in 2012.

Hence, with all the clamour abroad in the press, notably the much maligned Daily Fail, the trawl of data the PHSO undertook was from 2010 and covers only the period of the legal Version 12!

The submission concludes that all the complaints can really be put down to miscommunication and misapplication.


Who is going to be taken to task for that; anyone, anytime soon?

Any excommunications by the Prophet Ellershaw of those who perpetrated the misdeeds or of those whose provision of guidance and training was inadequate and wanting?

In 2012, The Mail reported that 5000 patient records were going missing every day. That is really quite extraordinary. This is the Mail Online

The Mail reports on records being dumped and even being posted on the internet. That is really quite scandalous. However, it is also all rather odd.

It could not be the case, but could it be, that there is something more sinister here and that these records are being LCPed for good reason?

Recent times have seen a fundamental revamping of the NHS with the creation of Commissioning bodies and so-called University Hospitals.

This has also facillitated misplacement of hospital records as we have found in chasing these down.

But what is the drive behind creating University Hospitals apart from the status this brings with it?

This is from the Surrey and East Sussex GP Newsletter
Associated University Hospital Status
This year we have developed a strategic and clinical partnership with Brighton and Sussex University Hospitals NHS Trust, which is one of the most oversubscribed medical schools in the country. It has a strong reputation for educating and training health professionals, teaching science and advancing research. It is also consistently highly regarded by its own students in annual university surveys.

The benefits to us of becoming an Associated University Hospital of Brighton and Sussex Medical School include gaining additional students and student resource, investment in our teaching facilities and a positive impact on our Research and Development opportunities. This is a significant building block for the future that makes us more attractive for medical staff and improves our clinical reputation.
And this is NHS England 
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...?

The Review says -
1.23 Formal, independent, prospective testing of the LCP has not yet been carried out after nearly 10 years of its dissemination, which is a major cause for concern. The National Care of the Dying Audit – Hospitals (NCADH)24 does provide some limited evaluation of the LCP.
That is to say, in effect, that the LCP has, for the past 10 years, been little more than a clinical trial and that The National Care of the Dying Audit was based on a clinical trial.

Only recently has a randomised clinical trial of the LCP proceeded. Another is under way in Flanders. Whatever succeeds the LCP in a hospital setting may now proceed, openly, as a clinical trial. 
Clinical Trial Agreements
The Trust supports the use of the DH Model Clinical Trials Agreement. This was developed by the DH and the Association of the British Pharmaceutical Industry and is a standard contractual framework for commercial trials involving NHS patients.

The model covers the legal and financial issues raised by NHS participation in contract research sponsored by pharmaceutical companies. Leeds Teaching Hospitals
The Department of Health Model Agreements (2011) provide for clarification of indemnity and bring US and UK bribery legislation into line.

However, there is no indemnity for what has proceeded for the past ten years. May we now see some prosecutions, please?

Further reading - 
Liverpool Care Pathway - A Cost Efficiency
In regard to hospital records we have chased down, these serve to demonstrate that both the Healthcare Commission and the PHSO lied to us by omission in not revealing certain facts.

My dear mum was admitted to what was described to her as an old-fashioned Cottage Hospital for rehabilitative care. She was joking with the ambulance crew on the way there, saying, "You won't drop me, will you?" She was alert enough that evening after I left her in their care to ask the nurse if I had safely gone upon my way.

In the Healthcare Commission report, the nursing adviser refers to poor nursing practice and there is an admission that the medical notes kept are inexact and slapdash, not to be trusted and not to be relied upon for their accuracy. It must be significant therefore that, following the Healthcare Commission report and the PCT’s review, recommendations were made in respect to the administration of analgesia that Caterham Dene were required to put in place!
The Commission’s GP advisor expressed concerns about “undated entries being entered on to the wrong notes” and cast doubt upon the accuracy of blood pressure readings. These are damning words which cast into actual doubt the validity of the medical evidence! Lack of care and attention to properly and accurately maintain the written record constitutes a negligence which directly threatens the well-being and safety of the patient.

They also permitted mum to present cyanose and did nothing but stand by and watch her condition deteriorate - because this is what they are trained to do; they are trained to let them go and help them on their way.

The notes we have obtained reveal that, upon arrival, she was 'whimpering constantly' (not true) and that, over the following 24 hours, her repeat medication removed, mum was dosed with a cocktail of Temazepam, Tramadol and Oramorph (of which we knew nothing and the HC and the PHSO kept from us) and reduced her (small wonder) to a state of total incoherence and confusion.

The nursing notes appear 'doctored' with two leaves added and written in a careful hand in the Multiprofessional Progress & Communication Sheet and with the wrong dob at the foot of the page. It is noted carefully that I have said I want it "documented that we are killing his mother with morphine."

A report in 2009 (prior to the PHSO and Marie Curie trawl) by BBC News notes that -
Research suggests use of CDS in Britain is particularly high - accounting for about one in six of all deaths.

There are fears that CDS is being used inappropriately.

Father's death
Dr Philip Harrison, a GP now based in New Zealand, set out his concerns recently in the British Medical Journal, following the death of his father in Doncaster Royal Infirmary. 
He was put under continuous deep sedation without being consulted, and so had no chance to say goodbye to his family. 
Dr Harrison reached the hospital two hours before his father died. 
"I'm 100% certain he would have been horrified to know that he would never see us even though we were coming," he said. 
"There was no reason on earth why he would have wished to have been put to sleep, unless he was obviously distressed or agitated or in pain. 
"But there was no evidence he was in pain at any stage during his admission." 
Dr Harrison, who has long experience in palliative care, decided not to sue the trust - but he did try to get reassurance that it couldn't happen again. 
Despite an apology he is still not satisfied. 
"I don't know what the legal term is but to me it was as near to a form of murder that I had come across," he said. 
"I have never seen that in my medical practice before. I've seen euthanasia once, but I've never seen anybody being put to death without consent." 
Dr Harrison said he is concerned about what could be going on across the NHS in the name of caring and terminal sedation. The truth is, no one knows.
Further pertinent reading -
Liverpool Care Pathway - The Report

Liverpool Care Pathway - Cast Iron Protection

Liverpool Care Pathway - It Is MURDER!

Liverpool Care Pathway - After The Review, After Everything, They're STILL Killing People

Liverpool Care Pathway - A Medical Mischief at Work.

Liverpool Care Pathway - A Right Carry On Up The Pathway

Liverpool Care Pathway - The Early Years

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