Friday, 21 March 2014

Liverpool Care Pathway - What Is To Be Done...?

A coherent and controlled programme, comrades, is the only way forward!

One crucial problem is a chronic shortage of beds.
"The central issue the NHS faces – demand for healthcare outstripping its supply – is by no means unique to this country.
"The ageing of the population and constant, expensive, technological progress means the NHS will always be in a state of crisis.”
- Neurosurgeon, Henry Marsh 
What is to be done...? (Vladimir Ilyich)
In the past, I would jump up and down and shout when we had no beds and we would start anyway.
A bed was always found because one had to be found.
- Neurosurgeon, Henry Marsh
That was when doctors were motivated by urgency and heroic deeds, and saving lives was at the top of the agenda...

The apparatchiks have stormed the Winter Palace and the world has been turned on its head. Power grows out the needle of a syringe driver. The State has taken charge; a new political class has arisen and seized the vanguard to form a triumvirate with the Third Sector to persuade us what is in our best interests. Their managerial minions now set the agenda.

What is to be done...? (Vladimir Ilyich)

Downsize care by downsizing care expectations. Initiate a programme of ‘identifying’ the One Percent who statistically die via a protocol of assessment involving statistical probability and intuitive judgement and earmark them for EoLC.

This will (of course!) trawl in many who would not have formed part of that One Percent cohort. By far the greater part of medical error consists of medical misdiagnosis. There will be excess deaths...
The number of older adults is increasing 
• The absolute number of older adults and their proportion in the population is significantly increasing. From 1983–2008, the proportion of the total population aged 75 years and over in England increased by a third from 6% (2.9 million people) to 8% (4.0 million people). The population aged 75 and over is projected to increase to 7.2 million in 2033, and the number of people aged 90 and over is projected to increase from 0.4 million in 2008 to 1.2 million in 2033.(Office for National Statistics).
• Increases in the ‘oldest’ population have resulted from falling mortality rates in the second half of the 20th Century and increased birth rates at the beginning of the 20th Century (Dini & Goldring, 2008). In the UK, from 1968–2008 mortality rates declined by 51% in males and 43% in females (Office for National Statistics, 2009).
• In England, life expectancy (period expectation of life at birth) increased by over 6 years in males from 1980–82 to 2006–08, from 71.1 years to 77.7 years, and by over 4 years in females, from 77.0 years to 81.9 years (Office for National Statistics) 
National End of Life Care Intelligence Network
Mr. Patrick Gordon Walker’s landmark observations echo down the years...

There are always consequences. A programme or strategy promoted and rolled out by government will multiply those consequences. There have been "excess deaths". There are "missing" older adults. Where are those missing ninety year-olds?

A crisis programme of life limitation has been rolled out and implemented. It is the EoLC Strategy. It is still only 'half way there'. 

Yippee! More freed up beds. Keeping people alive is a costly business. We shall fill this pension black hole with the corpses and cadavers of those deemed old and useless and only making this black hole larger still.

We shall call this providing dignity and care and compassion!

The language of Newspeak is rife and the frail elderly are assessed according to the Lakhani Recommendations. These recommendations promote a policy of passive euthanasia through non-action. This is said to preserve ‘dignity’.

A pro-euthanasia group associated with The Voluntary Euthanasia Society Dignity in Dying has conned the Gambling Commission National Lottery to provide the funding and groomed Age UK to provide the means to sign up the frail elderly to contracts to deny them treatment. This is said to advocate their ‘rights’.

Keeping people alive is a costly business

The National Lottery has provided funding to a pro-death euthanasia group to 'advocate' for the rights of the vulnerable elderly. Shall it, then, provide funding to a pro-life group advocating for the rights of the unborn child?

The euthanasia lobby has found growing support on both sides of the House and in both Houses. This isn't just about 'dignity in dying'; it is about digging the economy out of the pensions and benefits black hole into which it is plunging by filling it with the corpses of the most frail and the most vulnerable members of the community.

Diagnosing dying and putting patients on a pathway sounds like death with dignity but it's going to save governments, and the taxpayers who fund them £Billions.

Of course it's not about killing people, but it's still cheaper to kill the seriously ill than to keep them alive in hospitals, nursing homes or hospices.

This isn't just about pensions and benefits. Hospitals under financial pressures and bound by targets don’t want bed-blockers clogging the wards eating up finite resources.

What is to be done...? (Vladimir Ilyich)

Ship them out...?

This is the Southern Daily Echo –
A FRAIL 88-year-old woman who is blind in one eye and vulnerable to falls was discharged from a Hampshire hospital – at 11.30pm.
Today a Hampshire MP has demanded answers after dementia sufferer Rose Sweetman was asked to take a taxi home late at night – despite having no cash on her.
Her 93-year-old husband Leonard, a Second World War veteran, was asked to arrange the journey home – even though he had been under the impression she was being kept in for the night.
Now he has hit out at the Royal Hampshire County Hospital over the care of his wife, even claiming staff had once sent her home “more or less stripped to the waist” in a taxi.
This is not exceptional or at all anomalous.

Pertinent reading -
Transportation belongs to the 19th century. These are not society's dregs; these are our venerable elders, those whom we should value!

Over the border, this is the Sunday Post –
Hundreds of failings in elderly care provided by Scotland's hospitals have still to be put right - nearly two years after many were first identified.
What is to be done...? (Vladimir Ilyich)
The fact the majority of failings identified by inspectors relate to dementia care was no surprise to Peter Tulloch.
The 56-year-old launched a legal action against the NHS last year amid claims his mum starved to death in an Edinburgh hospital. 
Jean Tulloch, 83, was given just one day’s calorie intake in the space of three weeks after being admitted for a urinary tract infection. While Jean’s death certificate officially listed “end-stage dementia” as killing her, she was on the controversial Liverpool Care Pathway (LCP) which Peter describes as the “starvation diet” and the certificate also notes her diet “materially contributed” to the former nurse’s death. 
Peter said: “These new figures are shocking but sadly they are not surprising. I have little confidence that lessons are being learned from these failings. 
“The hospital where my mother died, the Western General in Edinburgh, was inspected by HIS just two weeks after her death. They reported a shortage of beds, so in my mind it is not a coincidence that she was on the LCP.”
The Post fails to note that there is an ongoing Scottish EoLC programme to tackle this problem which sets out to downsize care expectations and collar the elderly for palliative care, reducing those hospital admissions, culling the elderly hospital population and the high cost of unsustainable, curative options - a veritable Scottish Mint! - AND tackling these 'failings' all in one fell swoop...
"What! all my pretty chickens and their dam
At one fell swoop?"
- Will Shakespeare (Macbeth: act IV, scene 3)
Further reading -
Liverpool Care Pathway - And Where Is Margherita...?
Liverpool Care Pathway - Fallen Unto Iniquity
What is to be done...? (Vladimir Ilyich)

The NCPC held an exclusive Subscribers Forum on Wednesday 19th March. The big names in attendance included Wee Beelong. We are at a crucial stage. We are at the halfway point -

2013/14 has been a crucial year for end of life care as well as NCPC & the Dying Matters coalition. It has marked the halfway point of the 10-year End of Life Care Strategy; NHS England has launched a process to “refresh” the strategy; we have had the report of Neuberger review of the Liverpool Care Pathway, as well as other landmark reports such as the Francis report; and the Government has said it will hold a review into the feasibility of a “national choice offer” to enable people to die at home.
Simon Chapman, Director for Public & Parliamentary Engagement at NCPC has spoken at the ICO Conference Centre on the LKP and 'what went wrong'.

The Director is expanding his empire.

NCPC/Dying Matters have recruited a Public & Parliamentary Engagement Manager -

NCPC/Dying Matters are recruiting a Public & Parliamentary Engagement Officer -

What is to be done...? (Vladimir Ilyich)

Expand the EoLC programme...

This is NHS Jobs advertising for a Band 6 Amber EoLC Facilitator -

It is not possible to identify with confidence and ‘diagnose’ dying, but...
The clinical facilitator will use their experience and expertise to influence and change practice in wards to improve end of life care, staff confidence to identify, assess, manage and implement best practice for patients whose recovery is uncertain. This will include developing and running education and training programmes for all staff, collecting data and measuring the effectiveness of the care bundle. The main focus will be working clinically with ward staff to ensure staff are competent to use the AMBER Care Bundle.
The arrogant will gain confidence and certainty they may do so!

Thy will be done...?

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