Wednesday, 8 January 2014

Liverpool Care Pathway - Living Wishes

The rights of the living to live must also be respected...

This is the HSJ 
End of life care
Sir Malcolm Grant said “the question of death” had become an “inherent part” of the consideration of future NHS strategy.
The NHS England chair said death and end of life care involved “discussions which are quite difficult to have” but indicated they should be considered as “part of a big public debate about the way in which we provide healthcare, the right of patients not to be treated if they choose that, and to have a dignified death”.
Death is now “an inherent part” of the NHS...

This is the World Health Organisation 
WHO definition of Health 
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

That definition was formulated in 1948 and has not been amended. There has been criticism over the years from medical professionals -
Limitations of WHO definition 
Most criticism of the WHO definition concerns the absoluteness of the word “complete” in relation to wellbeing. The first problem is that it unintentionally contributes to the medicalisation of society. The requirement for complete health “would leave most of us unhealthy most of the time.”4 It therefore supports the tendencies of the medical technology and drug industries, in association with professional organisations, to redefine diseases, expanding the scope of the healthcare system.
At the Ottawa Charter for Health Promotion in 1986, the WHO defined health as -
"a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities."
A definition of health that might serve would be an ability to perform the functions of life to whatever degree our condition of health permits and best serves us. Thus, whilst the WHO promotes health in its absolute definition of the word, it is reasonable to say that such an absolute condition is not feasible for much of the time. Even so, that is not to say that for much of the time we are denied the ability to function as living beings. Health is a relative scale, therefore, that we constantly attempt to optimise.

Where are we going with this...?

The letters NHS are the initial letters of the three words National Health Service. It is reasonable to infer that this 'NHS' is a national organisation intended to serve, to promote and to optimise that relative scale. It is reasonable to state that, whilst the WHO absolute definition of health might not be achievable for all for some of the time or for some for all of the time, the NHS should promote good health for all for all of the time!

Grant says that Simon Stevens will take this 'NHS' into the "next phase" of its transformation; that "next phase" is that death is now its essential concern. Our definitions are morphed into something completely unrecognisable. Where are these people taking us?

Simon Stevens is part of the Transatlantic Unholy Communion. Read further here -
Liverpool Care Pathway - What Prospect Does This Bode...?
Simon Stevens is already the second most powerful man in healthcare according to the HSJ 
The HSJ100 – now in its eighth year – measures influence for the next 12 months. Mr Stevens was only pipped to the number one position by health secretary Jeremy Hunt, whose interventionist approach has resulted in a jump from fourth place.
Simon Stevens is already the second most powerful man in healthcare and he's not even in the job yet. Like his reputation, his influence precedes him!

Do not doctors serve the living and promote or, at least, maintain them on that relative scale; do not coroners serve the dead...?

Grant proclaims 
"the right of patients not to be treated if they choose that, and to have a dignified death."

And does Grant also defend the right of patients to be treated if they choose that and to continue to be maintained on that relative scale?

This is the Bath Chronicle 
A woman whose elderly mother was being treated at the Royal United Hospital was shocked to discover staff had decided she should not be revived if she lost consciousness.
Sue Henderson moved to Bath from Newcastle for a few months, so that she could visit her 83-year-old mother, who was being treated at the RUH for a urine infection, every day. 
Her mother was in the RUH for two months after developing an abscess on her liver, spending a week in the intensive care unit. 
During this time a Do Not Attempt Resuscitation (DNAR) order was placed on her, without her or Mrs Henderson being aware. 
Mrs Henderson found out only when she saw it written on a paramedic's notes when her mother was being transferred to Bristol. 
She said: "At no point did the consultant making this decision make any attempt to discuss this with my mother, or with me, her next of kin. 
"I discussed this with my mother, who was extremely distressed by this, and made it clear that this was not her wish at all. I think this is disgusting, they are playing with patients' lives."

This is not an exceptional occurrence by any means.

Grant demands that patients' wishes be respected. Well, only when it is their wish not to fight for their life.

This is a man who would have fought for his life, just as he served in the skies to defend this land...

This is the Caerphilly Observer -

Roy Bushen, 75, was diagnosed with terminal liver cancer in June this year and was told he had to pay £18,000 for treatment that could prolong his life.
His widow Sandra told Caerphilly Observer that her husband of 52 years was brave to the end but blamed the NHS for not offering treatment sooner.
She said: “I feel disgusted and really let down.”
Caerphilly Observer first reported on Mr Bushen’s case in October this year when he was faced with spending his life savings on the treatment.
At the time he said: “I feel totally let down. I feel they’ve got all that they can out of me and they’ve pushed me to the sidelines. I feel bitterness as there is so much money wasted in the NHS.”
In the end, this health 'service' failed to serve him. Mr. Bushen is correct; they are throwing £Billions at their pet strategies, they slipped a couple of £million into Nicholson's waistcoat pocket, but they couldn't find 18 grand to keep an RAF veteran soldiering on for a little longer...

Well, that wouldn't make Communitarian sense, now would it?

BBC News

11 Dec 2013 - Merseyside hospital bosses are issued with a formal warning after failing to meet three of seven national standards in an unannounced raid by regulators...

This is the Liverpool Echo –
New figures revealed two hospital trusts in the region have significantly higher than expected death rates for patients.In the case of Fazakerley hospital, the “observed” figure was 2,062 deaths, compared with an “expected” figure of 1,778.At Warrington and Halton Hospitals NHS Foundation Trust the “observed” figure was 1,700, compared with the “expected” figure of 1,506.The figures from the Health and Social Care Information Centre cover the period from April last year  to March this year.
This is the Trust that betrayed the trust of the James family whom they took to court to permit them to kill beloved husband, father and grandfather, David James.
Whither, then, the right of patients to be treated if they or their families so choose...?
There are always consequences. And there are consequences to operating a death pathway, whatever you intend to call it. The Fazakerley figures quoted above cover the period during which David James' life was taken.
Excess deaths...
There are always consequences.
The HSJ reports -
The Call to Action strategy review began in July and is due to publish primary and specialised services frameworks by March. 
Local commissioners have been told to write five-year strategies for late June, so Mr Stevens’ April arrival will be close to the end of the process. 
However, Sir Malcolm insisted the current UnitedHealth president of global health would “have an impact the whole way through”, and said he was “in regular discussion” with him. 
“He identifies the Call to Action as the platform on which we can start to make the transformative changes we all understand are needed,” Sir Malcolm said. 
“We should see his incoming leadership as part of the transformation. I see him as the person who will take us through to the next phase of the NHS. 
“[Current chief executive Sir] David [Nicholson] has laid the foundations − had somebody not got a grip on [making savings] we would be in desperate straits now. The next stage is ensuring we can go beyond the transactional changes into the truly transformational.” 
Sir Malcolm said NHS England was not “coming up with a blueprint” for the service but “signalling our change of direction”.
The Call to Action Strategy says -
The ‘Call to Action’ was published by NHS England on 11 July. We have the support of Monitor, Trust Development Agency, NICE, PHE, HSCIC and the Local Government Association in this undertaking. 
The analysis is clear:
 The NHS is loved, respected and benchmarks well against other health systems.
 The core values and commitments set out in the NHS Constitution are essential for the wellbeing of patients and communities.
 But the challenges of aiming for excellent outcomes, coping with technological and demographic trends, and living in an age of austerity are unprecedented in the NHS’ 65-year history.
 NHS England cannot expect the taxpayer to bridge a potential £30bn funding
gap between 2013/2014 and 2020/2021, rising to a possible £60bn gap by 2024/2025; will not concede on standards, scope or funding regimes; and so must work with patients, partners and local communities to accelerate beneficial change.

 This will require new relationships between citizens and services: active citizens owning their NHS.

 And much greater integration of public services around the needs of patients and local communities.
The Call to Action Strategy says that, despite all setbacks, the NHS is still a viable brand. However, a solution will have to be sought to cope with the unprecedented deficits and demographics that stand in the way of securing the NHS for now and for future generations.

This will entail working with communities at all levels to groom groomer and groomed to enact a final solution.
In their houses are many mansions, but one agenda. If that were not so, they would have told you. And, even now, they go to prepare a place for you...
It's all falling into place this year...

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