Saturday, 15 February 2014

Liverpool Care Pathway - Time To Wise Up

When it's time to wise up, it's time to own up. The bald, stark statistics staring you in the face aren't going to go away.

The kissing has to stop. You can’t all continue to treat this as a political football to kick around. You can’t all keep batting back the ping-pong ball; it’s not a game you’re playing. You have enacted policies and they are taking effect. It’s as simple as that and the killing has to stop.

The EoLC Strategy was published by the Centre for Policy on Ageing on 16th July 2008. The EoLC Programme was born.

The LCP version 12 was rolled out. When a national policy is rolled out and begins to bite, there are outcomes consequent upon that policy. That is, surely, self-evident. It goes without saying.

This is the
 New Statesman 

Danny Dorling opens his piece with this...
People may look back at the huge increase in deaths among the elderly and be amazed that the authorities initially just blamed the cold weather. It should soon become clear that a very large number of the additional deaths of people aged over 85 were in residential care homes that were adequately heated.
There are excess deaths. What is going on?

Danny Dorling concludes his piece with this...
The government said that it would look after pensioners. It brought in the so-called triple lock on state pensions and protected the free bus pass, but it has not looked after all pensioners equally. It will be those who were poorer and lived in poorer areas who will have made up the majority of the prematurely dead, and who will make up the majority of the thousands more who will die between now and May 2015, should the situation not improve. These are the last of all those people who, in their millions, voted for Labour in that landslide election victory of 1945.

These statements stand as diametric opposites. How does Dorling reconcile this? He does not. He wishes to make a political point and that is his focus.

Back in the 50s, there were excess deaths...
He [Macmillan] ordered that an official government report be conducted; it conveniently proposed the hypothesis that influenza had caused all the excess winter deaths. Many MPs and the public remained suspicious.
Influenza, ah yes...

In the doctor's surgery, in the High Street pharmacy, we are urged not to forget to have our flu jab, especially us oldies. Well, I am drawing my pension so, although I hate to say so, I must be an oldie.

Wait a minute, though. Us oldies are prone to dementia, aren't we? Is it a good idea, then, to encourage us to have a flu jab when the vaccine contains a neurotoxin in the form of a mercury-based preservative? Then again, perhaps that's the idea.

- Healthcare Analysis & Forecasting (HCAF)
This paper documents a recurring series of infectious-like out breaks -

Excess deaths are mainly for those aged 85+ although the effect can be discerned above age 65, more amongst the female than the male population.

The increase in deaths is associated with a parallel increase in emergency admissions and emergency department attendances.

The New Statesman continues –
Again the deaths are taking place at a time of austerity and again the government of the day would prefer to be able to point the finger at some “influenza-like illness” – blame the cold when it wasn’t that cold – rather than a cause that it could tackle. This time it is austerity itself that is being blamed, but no one is quite sure whether more people are dying now because they cannot afford to heat their homes or because they are getting worse care when elderly. There might even be an unrecognised “time bomb” suddenly reducing the generation’s life expectancy, as cigarettes did in the past and obesity might do in future; but it seems unlikely. All we do know is that more people were dying in 2012 and 2013 than in previous years.
The Health Service Journal explained to its readers, mostly health-service workers and researchers, that as a result of the increase in deaths among elderly people 2012 had been the first year in which overall all-age mortality had increased since 2003. Back then, the rise had been followed by a very steep reduction in deaths the following year, which rebalanced the long-term trend back towards a steady fall in mortality and a rise in life expectancy. The 2003 increase was a quickly reversed blip. The 2012-2013 rise appeared to be more of a trend.
According to the leaked Public Health England report, by mid-2013 there had been, “if anything, a further deterioration in mortality compared with that observed [in the same period in 2012]”. The number of excess deaths in England in 2012-2013 had been 23,400 (5 per cent) above Office for National Statistics (ONS) expectations. However, and seemingly unperturbed, an anonymous official reacting to the story told the Health Service Journal that “if increased mortality continues through 2013 and into 2014, there will have to be more detailed consideration”.
The recent increase in deaths among the elderly in England has been so great that, by winter 2013, the ONS announced an overall decline in life expectancy over age 65 as measured against previous expectations. The Guardian reported this as a drop of 2 per cent in post-retirement UK life expectancy compared with the 2010-2011 projections, and raised the idea that this coincides very closely with the roll-out of the incoming 2010 Conservative-led coalition government’s unprecedented programme of cuts to local authorities as well as cuts to numerous social support schemes, housing and welfare payments.
What has taken place in Britain recently has few precedents. To find sustained absolute rises in mortality for specific age groups in Britain nationally (outside of wartime), you have to look back to the 1930s. To discover the reasons why there might be a fall in life expectancy among the elderly in England now, the best idea is to look for where in the rich world a similar fall has occurred in the past. The closest precedent to what is happening in the UK can be found in what happened in the United States under the last Republican regime. It was in the final year of George W Bush’s welfare-cutting presidency, during 2008, that Americans’ life expectancy fell for the first time in 15 years. The very elderly (85-plus) were worst affected.
The Guardian attempts to kick a political broadside across the Coalition’s starboard bow. As Danny Dorling has pointed out, however, additional deaths occurred in well-heated residential homes.

Danny, quite rightly, attempts to look for a historical precedent. He has found the final year of George Dubblya's tenure and compared the cuts in welfare. But Danny has already pointed out -
People may look back at the huge increase in deaths among the elderly and be amazed that the authorities initially just blamed the cold weather. It should soon become clear that a very large number of the additional deaths of people aged over 85 were in residential care homes that were adequately heated.
Is what has happened, actually, quite unprecedented? Never before has a policy been pursued by government to actively seek out people to recruit them for EoLC in a cool and calculated long-term strategy. Never before has the Hippocratic Oath been pilloried and put to ridicule. Never before has government partnered with the Third Sector to fundamentally alter cultural perception and to downsize care expectations.

The New Statesman –

What does this graph tell us? It tells us that the EoLC Programme has worked; the EoLC Strategy is working; and that, for the first time since Mr. Patrick Gordon Walker’s landmark speech, the demographics are going in the ‘right’ direction.

Dorling attempts to link one set of statistics with another to provide causal effect...

This graph is provided by Care & Support Alliance -

"But councils are forced to ration care. Care providers say it’s becoming impossible to work on the ground. Ultimately older and disabled people are left without the support they need to get up, get washed, get dressed and get out of the house. Without that support they become isolated, more likely to slip into crisis and end up in A&E." - Care & Support Alliance

And what happens when the old, the frail and disabled are rushed into A&E in hospitals where an EoLC pathway is CQUINed in place...?

Furthermore, the graph dips from 2008 (when the Strategy commenced); this predates the assumption of power by the Coalition to whom Dorling wishes to attribute the increased deaths.

This is confirmed here -
The number of people getting social care support in England has fallen by a quarter in four years, figures show. - BBC News UK
This is all playing a game of semantics with statistics. Statistics don't lie but their interpretation may provide proofs for those whose opinions are diverse and diametrically opposed.

From 2008, the number of social care recipients falls. Over the latter half of the period the statistics cover (Note: this may or may not be attributable or related to these figures) the mortality rate rises sufficiently to affect projections of the trajectory of life expectancy.

This is the Al Gore graph gaf. The core data demonstrated a correlation between CO2 and temperature rise and fall and Al drew his own conclusion. But the temperature rise and fall preceded that of CO2 and so, if the one was the driving dynamic of the other and there was not a third, unknown causal factor in play, Al really put the cart before the horse.

This graph depicts a steady drop in the number of social care recipients from 2008. Over much of this period, life expectancy continues to rise. Dorling wishes to make a political point that doesn't quite fit. He makes the same graph gaf as does Gore.

Does the mortality rate rise over this period - such that it ultimately affects projections of life expectancy - as a result of the fall in the number of social care recipients, or does the number of social care recipients fall because they are dying before their time?

The majority of people in my brother’s Care Home have a DNR on file. The Care Home is well- heated; he is well cared for; the Care Home operates the Gold Standards Framework.

Late last year my brother had an arrest and was given CPR. He was rushed into hospital, returning home after a couple of days.

If my brother had that DNR on file which they wanted me to sign a couple of years ago, he would now be dead. Instead of celebrating our Christmas, we would have been mourning his passing.

These policies really do have consequences. Who knows – I do know! – this was why, in recent weeks, I was pressed, once again, to sign that DNR.

This is “Active Killing”. It cannot be said that this is otherwise. And this is policy. This is the ongoing Strategy. And we are only halfway there.

It’s time for us to wise up. And it’s time for them to own up.

Further reading -
Liverpool Care Pathway - The Palliative Option

Liverpool Care Pathway - So What's The News?

Liverpool Care Pathway - All Change!

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