This is Des Spence in the BMJ –
Spence supports the LCP and has commented that the pathway
"must be used with full explanation and the consent of all involved. If it has not been used in this way, then a review is welcome if only to reassure the public."The public were not reassured. The sheer weight of evidence forced the Review to suspend the LCP in England. It is also now being withdrawn in Scotland. Even so, Spence must be fully aware that the pathways are legion and live on.
Will Spence act on promoting the prosecution of those responsible for 'misapplying' the LCP? Will he act with immediate determination, for instance, to get Dr. Alison Coackley removed from the Medical Register and seek a charge of murder - at the very least, manslaughter - against her?
Read further here -
The BMJ’s own Dr. Tessa Richards also writes -
Ten years ago a friend suggested that I write up my experience of weathering emergency thoraco-abdominal surgery for adrenal cancer. “It will be a useful cathartic exercise,” she said. So I did, and maybe it was, but I didn’t share the story. Skilled care saved my life. Might any critical comment be seen as carping rather than constructive?
Now the value of collecting and learning from patients’ accounts of their experience of illness and care is well established and enshrined in policy, notably the UK Health and Social Care Act 2012. It’s widely seen as an essential tool to monitor and drive up the quality of care and to improve the delivery of services and the experience of patients who use them.
The PROMs are just a box-ticking exercise that means little or nothing but cited as documented consultation. And as for the Patients on the death pathways, they cannot respond upon their experience for they are dead.
Yet despite “patient-centric” policy commitments and an obligation stemming from the Francis report into failings at Mid Staffordshire to listen, learn, and respond to the view of patients and carers, the gap between policy and practice still yawns. Swathes of information are being collected from patients, but most is not being systematically analysed in a timely way and used to inform change. And the patients who supply it get little feedback. Experts in patient experience data argue that substantive investment is needed in the science of gathering and using it.
|"Hell - I sound like a Daily|
Mail reader...!"- NHS Forums
Compartmentalised care is tough on patients
I remembered a debate held at the Royal College of Nursing on whether washing patients is part of a nurse’s duty or not. The majority concluded it was. But the fact that it was questioned had surprised me. Recognising different skill sets is important, but for a patient the idea that personal care should be compartmentalised, with the less desirable bits delegated to the lowest in the pecking order, seemed odd.
But compartmentalisation is where we are at. In my last clinical job in a rheumatology department I saw many elderly patients with multiple intractable problems being passed like parcels between different specialists. The difficulty of seeing the whole picture, especially when notes and x ray pictures are missing, is huge. Patients get frustrated, upset, and confused, not least about who “their” doctor is.
It’s hard to quantify the effect of continuity of care, holistic management, and the simple interventions and humane acts that make being a patient tolerable, but we should surely appreciate their value more and reward those who provide it. The kindness of two medical students who sat on my bed and talked to me as if I was a sentient being will long stay with me.
|- Mail Omline|
Although I am personally familiar with Dr Richard's struggle through the illness she describes, this is a remarkable chronicle of personal experience through the healthcare system. As a GP I am sad so little of her experience came from primary care where I am situated in NZ. Her journey should have started earlier and in a kinder place so that she could return and be supported by those who knew her well. I see my own patients suffering similarly and I realise that I must make a greater effort to attend them - and spend a little time - when they are incarcerated in such institutions and traumatised by their interventions. This week 2 patients of mine died in extremis and I was too busy to attend them in hospital.
Sadly, I also see the demise of 'real' nursing - Tessa does not address this head on in fear of offending - where the ownership of qualifications and ability to put in iv lines out trumps the caring that patients need. I see this space occupied by carers, usually nurses qualified from overseas who cannot get employment due to the regulations we create. It is the carers now who wash one's private parts, comfort the distressed elderly lady with a wet nightie, tell them not to worry, feed people who can barely swallow, pray for them (they are often religious) and generally attend to their needs. They do what nurses used to do. Where are our own people and where is our caring? Of course, doing other jobs because of better pay. Somehow the price of compassion has been lost in the NHS and probably across many other healthcare systems in a morass of targets, pathways and deliverables.
This article should be given to every medical students and trainee nurse to help them understand why we are here. Giving it to politicians, could be also be productive but likely to end up, alas, in the too are basket. Small compensation to me that I get a huge 15 minutes in primary care to see my NZ patients but I still struggle to keep on time knowing that everyone really needs to talk, be cared for, reveal something they didn't attend to discuss, and get to know me so one day they might pour out their hearts like the doctor friend I should be, but rarely am.