Saturday, 23 August 2014

Liverpool Care Pathway - The 'Art' Of Good Grooming

Good grooming, the art of persuasion and the power to influence people.

Good 'grooming' is not to beg that their ears may be 'lent', but to bend them, grab them and to lead them by the sweet substance of what is being said that they may willingly take your medicine down.

Good grooming may capture the eye and win the heart, but what bends the ear is the power of the word. Every good and eloquent speaker will say as much: 'Tis the singer, not the song.

This is Mail Online –

The NHS has agreed to review controversial guidelines that instruct nurses to ask the elderly whether they would agree to a ‘do not resuscitate’ order.

The Mail revealed yesterday how patients are being visited at home by nurses they have never met before, and asked sensitive questions. These include where they want to die, and if they want doctors to try to resuscitate them should their hearts stop.

Following criticism of the initiative, the NHS’s Chief Nursing Officer for England, Jane Cummings, said yesterday: ‘We will review the [questions] again, with patients and clinical staff, in the light of the poor experiences described in the media, and make any changes that are needed.’
District nurses have been sent to the homes of patients aged over 75 and those with long-term conditions armed with a form about their medication and care which includes the controversial questions. 
Health policy analyst Roy Lilley – who was at his mother’s house when the nurse visited – described the policy as ‘callous’ and called for it to be banned.‘People will be frightened to death thinking the district nurses know something they don’t and will feel obliged to sign the form so as not to be thought a nuisance,’ he said.

Mr Lilley, a respected health commentator and former chair of an NHS trust, was at his mother’s home earlier this week when a district nurse arrived 45 minutes late for a scheduled visit. 
She began going through the form with his mother and within ten minutes of first meeting her asked where she would like to die and if she had agreed to a DNR or Do Not Resuscitate order.
Interviewing people for the Death Lists has been proceeding for some time. GPs are being paid to find their one per cent.

The End of Life Rights Advocacy Project has been pursuing these DNR interviews. It started out in the East End and has now gone nationwide.

The Advocacy page is slick and bears some prestigious logos. The Daily Mail, the National Lottery Fund, Age UK...

and, what's this?

Compassion in Dying? Well, that sounds like a nice thoughtful and concerned outfit. And the page is hosted by Compassion in Dying, too.

Mr. Lilley must know all about Compassion in Dying. The King's Fund published a Compassion in Dying report a while back.

My Wishes is another EoL Register. My Wishes is Invicta's provision of an Advanced Care Directive or 'Living Will'. You are persuaded and encouraged to make such wishes known with such 'fireside chat' language as, well, if you don't say now, when the time comes you may not get the treatment you would have wanted.

Making such hypothetical decisions out of the woods is vastly different from having to make them when you're actually lost in the woods and, yes, please do send out those search parties because I really don't plan on checking out just yet!

But DNACPR actually does mean don't even bother trying to save me.

This will affect such decisions as whether it is ‘appropriate’ to call an ambulance.

Of course, it really does matter how these things are put. That can make all the difference...

Some further reading -
Liverpool Care Pathway - It Ain’t What You Say, It’s The Way That You Say It
Liverpool Care Pathway - Moving In For The Kill
This is Roy Lilley's bio on The King's Fund –

Roy Lilley is an independent health policy analyst, writer, broadcaster and commentator on health and social issues. Previously, a Visiting Fellow at the Management School, Imperial College London, he was also formerly at the Centre for Health Services Management at the University of Nottingham.
Roy Lilley says these questionnaires are 'callous'.

Roy Lilley is a person 'in the know'. He really should know.

This is -
Liverpool Care Pathway - Changing Minds
Presentation is everything. Change the name; change the image; retain your goals but present yourself differently.

Compassion in Dying, a pro-euthanasia pressure group, is the charitable arm of Dignity in Dying.

The King's Fund and Age UK have both published a biased report released by the pro-euthanasia pressure group, Compassion in Dying.

What is Age UK doing publishing any report released by pro-euthanasia activists?
We are all really excited in Compassion in Dying to have put together some new promotional leaflets. Following a number of requests for materials for GPs surgeries, end-of-life events, community noticeboards and other charities' referral teams, we now have an Information Line leaflet and an Advance Decision leaflet.
Cutting costs means cutting care means downsizing care means downsizing care expectations, achieving the impossible by making it desirable.

     Dying is a positive life choice.
     Let's talk about it...

Anything can be made to appear desirable if presented in the right way. The groomed have themselves become the groomers. In Scotland, they openly use psychometrics in the programme to limit life.

The Dundee Dignity Care Pathway is a psychometric questionnaire designed to groom the patient into accepting palliative care in place of curative options.

It is all about changing minds.

That's what Compassion in Dying are about. They're using the Daily Mail logo on their page...

The Daily Mail...?

Mail Online reported this three years ago -
A right-to-die pressure group has announced plans to sponsor the UK's first helpline aimed at speeding the terminally ill towards 'a good death'.
The free phone line, to be set up by a charity called Compassion in Dying, will 'promote greater patient choice and control where possible'.
The charity is an offshoot of euthanasia campaign Dignity in Dying and is led by the right-to-die group's chief executive.
Its plan to provide advice on the rights of the desperately sick sparked protests from antieuthanasia activists, who said the helpline would be used to shorten lives. The charity says it exists to highlight 'existing end-of-life rights' and will pass on information to callers.
However, it comes against a background of growing tolerance of assisted suicide by prosecution authorities, increasing political pressure for the legalisation of assisted dying, and a rising toll of Britons travelling to the Dignitas suicide clinic in Switzerland to end their lives.
Mr. Lilley is concerned for his mum. 

This is Nursing Times with a discussion on District nursing from August 2012 –

District nurses deliver a range of nursing care to adults in their own homes. However, practitioners have not effectively demonstrated the value of this care to primary care commissioners (Queen’s Nursing Institute, 2009). As a result, district nursing numbers continue to decline at a time when there is increasing demand from an ageing population for more care to be provided at home (Royal College of Nursing, 2012). If district nursing services are to receive the resources they need, practitioners must measure and communicate the impact of their care through “quality indicators” agreed with commissioners.
It is a statistical certainty that every person in their elder years is 'approaching the end of life'. Old age is a 'terminal condition'.
“District nurses discuss and record the needs of those approaching the end of life at dedicated multidisciplinary team meetings, preferably monthly but quarterly at a minimum”
If a person of elder years falls seriously ill, however, that does not mean that they are terminally ill; it means only that they require that much more care and attention to improve or to maintain their condition.

This is rather typical of modern science: having decided that something is so, they then seek the evidence to substantiate it is so. The decision to determine EoL and to 'diagnose' dying is a self-fulfilling prophecy.
“The team has a register of all patients for whom they are providing end-of-life care, which includes key information such as preferred place of care”
They have your card marked. Just when you need that extra TLC, they wind down the care and 'make you comfortable'.

The Lakhani Recommendations have rubbished CPR.

Are these the Byatt Recommendations to downsize treatment?
Writing in the journal Evidence Based Medicine, Dr Byatt said: “The data strongly suggests that we are over-treating many over-80s.  
“The largest trials of antihypertensive therapy and statins in this age group show at best a marginal clinical reduction in stroke and very modest clinical reduction in other cardiovascular end points.”  
Dr Byatt said studies have shown that: “these medications are greatly over-prescribed in the healthy elderly, and largely irrelevant in the frail elderly.”
“In my experience, it is not uncommon in the oldest of these often frail but relatively disease-free patients, to see death as the next natural event in their life, especially welcome if they have outlived their peers,” he added. 
“However this cohort is often deferential to the doctor, whom they frequently want to please or at least not upset. - The Telegraph
When someone visits the quack, it’s usually because they have a health issue they would like addressed. They may be happy or not happy with the treatment, but to extrapolate that dissatisfaction to demonstrate a preference to 'die naturally' is, frankly, bizarre.

The Telegraph article pleads:
'Stop medicating elderly and let them die naturally'
Whatever age you are there's many an illness, if it isn't medicated, will most certainly cause you to die 'naturally'. Are the rules determined by your positioning on the Complete Lives priority curve?

District Nursing, as a profession, must demonstrate that it is implementing the quality indicators such as EoLC required by Commissioners in order to attract the funding which will pay for the resources district nursing services so desperately need.

Quality indicators must be achieved and evidenced.

Signing up the punters is what it's all about, Mr Lilley.

Whether with faith or of no faith, you may yet have faith, Mr. Lilley.

God bless your dear mum and grant her long life.

May God take her when her time comes, Mr. Lilley, and not some vile priestess or 'soul midwife' bent on some Pathway. We who have had our dear mums taken thus would not wish her - or you - that.

Some additional reading -
Liverpool Care Pathway - In The Beginning Was The Pathway... 
Liverpool Care Pathway - The Shameless And The Brazen 
Liverpool Care Pathway - 'Newthanasia' 
Liverpool Care Pathway - Telling It More How It Is 

And some particular reading -
Liverpool Care Pathway - The Palliative-Medical Complex

Wednesday, 20 August 2014

Liverpool Care Pathway - Data Is Power

Do they care dot data? You bet they care dot data! But will they dare dot data?

This is The Bolton News –
A spokesman for the Bolton Clinical Commissioning Group said: “People should be reassured this is a national NHS programme, which will adhere to the highest standards of privacy and confidentiality.
"The information will be stored in a secure way and the HSCIC is bound by legislation to ensure confidential data is protected at all times.”
People were not reassured and the roll out was postponed.

The Mail claimed victory as theirs but MP, David Davis, urged caution and concern...
The NHS (National socialist Health Service) said the project would be postponed until the autumn while it runs an awareness campaign, but it would remain an opt-out rather than an opt-in scheme, just as organ harvesting has become and is becoming. Civil liberties are being trodden underfoot.
Lancaster Guardian

Well, here we are, half-way through the summer, and I don't see that anyone is any more aware than they were. What campaign has proceeded, if there has been one, has been on a par with the laughable but not funny Common Market misinformation campaign that had  co-opted everyone in and culminated in a referendum in 1975 in which everyone voted Yes or No to stay in without realising the significance of that.

The Times actually published a letter from some of the country’s most senior doctors and health executives in defence of and justification for the Dot Data plans.

From afar, Newspoint Africa reported –

After Dr. Gordon Gancz decided to opt out all his patients from a NHS scheme to extract their details, Health Service officials have threatened to shut down his GP surgery.
Dr. Gancz has been practicing medical services for almost 40 years and he accused the NHS of bullying doctors and patients to fall in line with their scheme. The scheme will automatically extract private medical information of patients until they opt out. Dr. Gancz has received a threatening email that if he breaches the contract, he will face a shutdown of his practice.
Some local GP surgeries made opt out leaflets available...

This is The Visitor –
Local GP surgeries in Morecambe and Lancaster are offering leaflets allowing patients to opt out of having their details uploaded. say the database will enable them to assess diseases, examine new drugs on the market and identify infection outbreaks, as well as monitor the performance of the NHS. But Lesley Archer, of Rhylstone Drive, Heysham, who cares for 88-year-old Robert Nightingale, is worried no-one knows about it. She said: “I had a leaflet put through my door but I don’t know anyone else who has had one.
“All your medical records will be sent from your GP to a giant central database and you have to actively opt out to prevent that happening, rather than consent to get involved.
“The delay is so that people can be brainwashed really.
“The NHS haven’t got a good record on keeping things confidential.”
NHS England agreed to delay the roll-out of by six months until the autumn amid criticism of how it has run the public information campaign about the project.

“The NHS haven’t got a good record on keeping things confidential.”

How's this for confidentiality, even if the records have been, supposedly, anonymised...?

This is HSJ –
The medical records of almost 50 million NHS hospital patients have been sold for insurance purposes, it has been reported.
The revelation comes less than a week after controversial plans to share medical records were delayed until later this year.
Both the British Medical Association and the Royal College of GPs have warned that patients are being kept in the dark about the plans.
Dot Data is an extension to a centralised database of what has already been proceeding at a local level. The Electronic Palliative Care Coordination System (EPaCCS), amongst others reported in these pages, is already synced with the Death Lists.

It all seems such reasonable and innocuous stuff, but perception is 99% of the law. When the Law comes knocking at your door, the composure of threat determines 99% of the response.

We are witnessing the coming together of a fascist regime and we are only half-way there.

We are witnessing the coming together of a fascist regime and nowhere is this being challenged.

This is -
Liverpool Care Pathway - Appointment With Death
This is HSJ –

What’s this? The police want greater access to confidential GP medical records without necessarily obtaining the prior consent of the individual concerned?

When NHS England’s plans to collate GP metadata from us all for research - and commercial - purposes took a faltering step forward in February, it hit a wall of tabloid hysteria and stepped back to rethink devices for voter reassurance.

Big Brother
Professional and public suspicion - reflected in website analysis and comment - is a mixture of paranoia and concern that such data is open to abuse or exploitation, commercial or otherwise.
Edward Snowden’s revelations were fresh in the public mind, reminding us all just how invasive Big Brother technology now is, and not just at GCHQ level either.
Late for supper one night I phoned my son to say “we’re on our way”. “No you’re not, you’re still parked outside the house,” he replied. My iPhone tracker gave me away.
Back in February David Davis, the libertarian Tory MP, challenged health minister Dan Poulter.
He confirmed that police pursuing serious crime will have “backdoor” access - which was Mr Snowden’s complaint about spy agency dealings with Google - to the NHS’s new arm’s length database, even the records of patients who have opted out. Previously they would have had to trace a suspect’s GP.
Big Brother is a public guardian who knows better than we what is best for us and will take charge of us and our affairs for our own good. 1984 was 30 years off the mark and we are walking into Big Brother's world with a smile and a grin to welcome him with arms open wide.

God is watching us on a CCTV monitor.

How will police respect Care Dot Data? The same way they respect any and every opportunity that comes their way...?

At our scheme recently, a client, a vulnerable adult with mental health issues, became involved in a misunderstanding. An altercation ensued. Our client attempted to explain himself and, when this failed, he took it upon himself to phone 101 on his mobile phone. Just then, a police patrol car happened to pass by.

The two officers in the car arrested our client and he was taken to holding cells where he had all his possessions removed from him. A Solicitor and Appropriate Adult were appointed.

At first, our client chose to remain silent. The Appropriate Adult persuaded our client to explain what had happened and what his intentions had been. Our client did so.

Our client's mother phoned the following morning. She had been trying to phone her son and he was not answering. At her request and our joint concerns for his well-being, we used the master key to check his room.

At no time were we or his mental health team informed by police of what had happened to our client. We learnt from other clients that two uniformed officers had entered the house the previous evening, letting themselves in, and used a key to enter our client's room.

Our client returned later that morning to his home and began preparing himself a meal. He had not eaten.

He had just attended an appointment with his mental health team. He had not told them, he said, because he felt shamed by his arrest. No, he did not know police had come to his home. No, he had not given permission for them to use his keys.

Our Service Manager is looking into this reported intrusion and uninvited entry into the house and invasion of our client's room.

This is quite extraordinary. There was neither warrant obtained nor was there consent to enter supplied. This was an act of trespass for which explanation shall be sought.

At the end of the day, will it all be down to plausible deniability? Who is to be believed: a fine upstanding officer of the law, or a fruit and nut mental case? 


Lesley Archer said, “The NHS haven’t got a good record on keeping things confidential.”

The NHS haven’t got a good record on keeping things, full stop.

Reporting on Wirral Hospital, home of the Wirral Integrated End of Life Pathway, here is the Liverpool Echo –
More than 1,500 cancer patients’ medical records were mixed up in a computer bungle at a Wirral hospital, the ECHO can reveal.
The Clatterbridge Cancer Centre admits there was an error in the way they uploaded some data into a system they use called PACS (Picture Archiving and Communication System) which meant that as many as 1,598 medical records ended up containing some wrong information.

The hospital said there was no risk of patients being misdiagnosed – told they have cancer when they have not – as the affected scans and X-rays are for planning treatment only. Their patients have already had diagnostic scans.

The problem is said to mainly affect Clatterbridge, with a smaller number of records being affected at other trusts who have the same network.

These include the Royal Liverpool Hospital, Liverpool Women’s, Liverpool Heart and Chest, The Walton Centre, Fazakerley, Alder Hey, St Helen’s and Knowsley, Warrington and Halton and Southport and Ormskirk hospital.
And this is BBC News Berkshire – 
A woman who was wrongly told she had Alzheimer's and cancer when her medical notes were mixed up with those of her dead husband has received an apology.
Kathy Patient, 71, from Bracknell, Berkshire, went for a CT scan at Frimley Park Hospital last Friday due to heart problems and blood clots.

She said before the procedure the nurse was insistent she had a number of other conditions.

Mrs Patient said: "The nurse said you've had [a CT scan] done before. I said, 'no I haven't'; she said, 'yes you have'.
'Started crying'
"She asked me to confirm my date of birth and name. She left me for few minutes, then came back and said, 'you've got Alzheimer's and cancer'. I said, 'no I haven't'; she said, 'yes you have'."
Yes, you have; you have Alzheimer’s and you can’t remember, poor dear...
The nurse later returned and admitted she had mixed up Mrs Patient's records with those of her 80-year-old husband - who died 18 months ago.
The hospital, which sent a bouquet of flowers, said it was "extremely sorry" and was taking the matter "very seriously".
"We are currently investigating how Mrs Patient's late husband's history became attached to hers on our electronic radiology record," it said.
At a centralised level, on a national scale, the ‘Big Guardian’ element aside, this has ponderous considerations and worrying implications of consequence and consequences.

Some further things to ponder upon -
Liverpool Care Pathway - The DES
Liverpool Care Pathway - A Land Of Confusion
Liverpool Care Pathway - When The Funding Had To Stop
Liverpool Care Pathway - The Palliative Option And Downsizing Care
Liverpool Care Pathway - After The Review, After Everything, They're STILL Killing People
The fact is that if the designs behind the Common Market are carried out, we are bound to be affected in every phase of our national life. There would be no national planning, except under the guidance of Continental planning—we shall not be able to deal with our own problems; we shall not be able to build up the country in the way we want to do, so far as I can see. I think we shall be subject to overall control and planning by others. That is my objection.
Earl Attlee, 1962

Sunday, 10 August 2014

Liverpool Care Pathway - The Final Countdown... And Counting

If we view our old ones as a “time bomb”, what does that say about us?

In May of this year, Hartlepool Care Home Managers forum ran a Local Study Day for Carers working in the area. Attendees of the study day, at the Borough Hall in Middlegate, were awarded a certificate of attendance to file in their training portfolios.

This is Care Industry News –

Course features included - managing continence issues in EOLC, implementing EoLC pathways and a Syringe Pump tutorial.

The major focal point of the day is to address the End of Life Care Pathways that change this year following the phasing out of the Liverpool Care Pathway. The Conference will have a two pronged approach, taking the opportunity to address the issues of Dementia in Elderly Care and looking towards agreeing an assessment tool that covers EOLC for people suffering dementing illness.
This is...
a time bomb that is in its final stages of countdown.
The "focal point" of the Study day was ringing the changes in EoLC brought about by the Neuberger Review. A year ago, it was announced that the LCP was to be 'phased out'... 

One year later, the LCP has not been phased out; there is no moratorium on its use and the sin city users are still hooked on its use.

They've re-branded. There are 'legal highs' like The Wirral -

Wirral Community EoLC Team
 At Wirral, they’re not going to get their fingers mucky...
What does the End of Life Care Team do?
We work with health and social care professionals
NHS and Care Home staff are encouraged to contact the team on the number below if you require support, education or guidance regarding implementation of any of the End of Life Care Tools.
Please note: Our staff do not have direct contact with patients

In June, the Wee Bee Long Leadership Alliance 'Gang of 21' published One Chance To Get It Right –

The Wirral Team have responded –
One Chance to Get it Right

The National Alliance has produced its report in response to the phasing out of the Liverpool Care Pathway. The report called One Chance to Get it Right identifies five Priorities for care of the Dying Person.

A task and Finish Group is being established on Wirral to look at how these five Priorities for care of the Dying Person can be incorporated into individualised care plans for patients. In the interim period the Wirral End of Life Care Quality Group has identified the need to adapt the current PACA (Patient and Carer Assessment) document to incorporate elements of the five Priorities for care of the Dying Person
The Wirral tools are the Gold Standards Framework, the Preferred Priorities for Care and the Wirral Integrated End of Life Pathway, which is, essentially, the LCP...

See -
Liverpool Care Pathway - There Are Many Pathways...
-  Wirrall Community EoLC Facilitators
The Wirral Integrated End of Life pathway incorporates the patient journey from diagnosis through to death and should be used so that prognostic indicators enable health & social care staff to anticipate care.
End of Life Care Facilitators 
The End of Life Care Facilitators are based within the Clinical Education and Development Team as part of Clinical Excellence. The role is to work within the framework of the Wirral End of Life Care Model. Ensuring best practice for End of Life Care for all conditions for patients and their loved ones.
The role of the facilitator involves the implementation and promotion of the End of Life Tools that are recommended within the Department of Health EOLC strategy (2008).

These 'legal highs' are a cape beneath which they conceal the uniform of their true loyalties.

To Stephen Barclay, who has his fingers in many an EoLC honey pot, the CAPE is a mapping tool...

Stephen is always looking out for that next cutting edge tool that will identify candidates for EoLC.

This is CAPE: Community cAre Pathways at the End of life: mapping the pathways to improve care.

Further reading -
Liverpool Care Pathway - There Are Always Consequences
Liverpool Care Pathway - On Pint-sizing Perceptions of Care And The Betrayal Of Trust

At Greenwich & Bexley Community Hospice, they're still openly using –

The use of the Liverpool Care Pathway helps to ensure unnecessary or inappropriate care is discontinued.

When the pathway is started, the dying person’s medication will be reviewed and any that is no longer helpful may be stopped or substituted for another form, sometimes new medicines may be prescribed just in case to help if a new symptom should occur and to prevent unnecessary delays.

Meanwhile, KNMG says morphine should not be used in palliative sedation –

Morphine and palliative sedation: Directive should be followed 
Morphine is not suitable to accelerate death or to sedate patients. The KNMG Guideline for Palliative Sedation classifies this as bad practice. The report-Danner makes the importance of compliance with this Directive insistently clear, according to the KNMG.
The Danner report was convened in response to the high mortalities reported at the Ruwaard van Putten Hospital.

The article suggests that Midazolam should be used in place of Morphine.

The article cautions that, if not sufficiently sedated, the patient could become confused and suffer myoclonic jerks.

The Netherlands Times reported that –
Smaller hospitals can have a lower mortality rate if doctors monitor each other better, and the medical staff follows national guidelines, and keeps better track of patient records. The Danner committee draws this conclusion after examining the deaths of nearly 800 patients in the Ruwaard van Putten Hospital in Spijkenisse.The Ruwaard van Putten Hospital made the news frequently the past few years because of many deaths in the cardiology department. The affair eventually led to closure of the hospital.
A committee headed by Professor Sven Danner was commissioned to examine the files of patients who died in the hospital between 2010 and 2012. The death of 1 out of every 11 patients proved to be partly caused by the treatment.
Much went wrong in care around the end of life of patients. One example cited the use of incomplete treatment methods, such as the use of morphine as a means to keep people asleep. Records in the files were also inaccurate.
Yet the health damage that patients in this hospital were subjected to is not different from the national average, the commission found.

At Hadamar, they used Morphine to kill 'Defectives'...

Hadamar Nurses

Don't think it can't happen here because it couldn't.

1200 people perish every year on the NHS...
These appalling figures are reported by Mencap -
The principle investigator of the confidential inquiry, Pauline Heslop of Bristol University, also cautioned that the seriousness of the issues raised by her report required "more immediate actions … which are largely missing from the Department of Health commitments".
She said: "We cannot allow the situation to continue in which people with learning disabilities are dying from causes of death amenable to good quality healthcare. That needs tackling with some urgency, and urgency of action appears to be lacking in the Department of Health response.
"In particular, we are disappointed that the Department of Health has not agreed to a national mortality review body to review future deaths of people with learning disabilities."
Jan Tregelles has said this is: “A scandal of avoidable deaths on the scale of Mid-Staffs.” 
The government’s reluctance to set up an investigative body to look into this scandal is on a par with Gosport.
This is The Danish Centre for Holocaust Studies -

Hitler's authorisation of the Euthanasia
Programme (Operation T4)
Euthanasia – the ‘mercy killing’ of disabled people in Germany 


After Hitler had received a letter from the father of a handicapped child, whom the father wished to be put to death as a mercy killing, the Fuehrer approved the Euthanasia Programme. The idea of the Programme was to “remove” the seriously disabled on a national basis.

They have already shifted perceptions. And we are only half way there.

Additional reading -
Liverpool Care Pathway - The Final Countdown
Liverpool Care Pathway - There's Life In The Old Dog Yet