Saturday, 1 November 2014

Liverpool Care Pathway - Boiling Frogs, Sans Everything

In the beginning was the word.

Ten Months that shook the NHS

Almost fifty years ago, a book was published that shook the NHS and fired a blast that caused a stir of debate in the House.

The book: "Sans Everything" by Barbara Robb.

This recounted what was seen at the time as an unbelievable and extraordinary catalogue of abuse that, today, only appears frighteningly mundane. Like the boiling frogs, we have been slowly parboiled and conditioned into acceptance of the unacceptable and to walk in thrall, blind to suffering.

They waited long enough until they thought it was safe to act. Culture and attitudes have been doctored and groomed. It seems they can now get away with anything, even referring to a dementia sufferer as 'Mickey Mouse'.

The Mail has been running articles on the state of the NHS in Wales. According to the Mail, NHS Wales is dying on its legs. The Mail lays the pall of this appalling state of affairs at the door of the Reds in the person of ‘Red Ed’ and an NHS in the charge of Labour.

Mail Online published a damning report of error and mishap that is horrifying to read. Patients...
have been forced to wait months for vital cancer treatment.

Around half of Welsh cancer sufferers must wait six weeks or more for many scans and tests. Yet, across the border in England, less than a mile from my home town of Monmouth, the comparable figure is less than 6 per cent.Little wonder that 15,000 Welsh patients every year decide to travel to English hospitals for cancer treatment they are denied at home.

Or that thousands more are going private or even moving to rented accommodation in England to bypass long waiting lists for heart scans or hip operations.
What are statistics and what do they show? There are always techniques. In finance, it is called creative accounting.

There are methods, procedures and practices put in place, to massage and manipulate statistics and present reality in a more favourable light.

These are all box-ticking exercises, from sending out single paramedics in response vehicles to cut call-out response times and the creation of the Acute Medical Units to cut waiting times in A&E - and we all have our own tales to tell in those regards.

But this is policy, not politics. There is selection and exclusion, also, that is not extraordinary or particular at all and has been reported by the Mail.

This is Mail Online in November 2012 –
Doctors are withholding treatment from dying cancer patients because they do not think it worthwhile, a report warns.
They are refusing to send them to intensive care or offer life extending drugs as they believe such measures are ‘futile’. 
In some cases, patients have been put on the controversial Liverpool Care Pathway - where fluids and food are withdrawn - rather than on life support machines.
A report by the Royal College of Physicians today warns that the hospital care for some terminally-ill cancer patients is inadequate.
It blames a lack of communication between GPs, nurses, cancer specialists and doctors in A&E for causing delays in treatment that can result in unnecessary suffering.
But it also warns that some doctors are too fatalistic and refuse to provide life-extending drugs or even help patients with their breathing as they believe it pointless.
Some of these ‘delays’ are actually part of the box-ticking exercise. The focus of Trusts, the CCGs, is to be seen to be complying. Compliance is the new buzz word. The reality comes second place.

The Mail's focus is NHS Wales. They have picked up the ball and ran with it, not because it is 'news' but in response to the Labour leader's recent comments and to make political capital out of it.

This 'news' is not even new. The Times reported earlier this year -

The Times

Elsewhere in the UK -

The Scotsman
And the Guardian entered stage left -

The Guardian

"It's the same the UK over
For every patient it's the same;
It's the Docs what gets the pleasure;
It's the patients gets the blame..."

The Mail Online report continues -
Over the coming days, this series about the Welsh NHS will tell the stories of patients who have been failed by the service and it will expose the shocking extent of the crisis — one that shames the Labour politicians who control the health service in Wales.

Their testimonies detail a system in turmoil, where dreadful oversights in care, institutional neglect and instances of botched treatment have become routine. 
They also lay bare a woefully politicised culture of official cover-ups, where it has become common practice to smear critics and gag whistle-blowers. As well as the BMA’s damning assessment, there have been several other highly critical reports, from highly regarded bodies such as the Royal College of Surgeons and the College of Emergency Medicine (who warned last year, incidentally, that Wales’s A&E departments were ‘at the point of meltdown’). 
Official figures, too, show the Welsh NHS lagging behind England’s on a host of key indicators, most notably waiting times, and reveal that the Welsh Government has until recently been cutting NHS funding by 1 per cent a year, even as the rest of Britain increases it by the same amount.

Typically, the Welsh Government refuses to acknowledge the crisis and dismisses its critics irresponsibly as purveyors of Right-wing propaganda. But what else can you expect from what is effectively a one-party state?

For ever since devolution in 1999, when responsibility for health- care was given to the Welsh Assembly, voters in the Principality have elected only Labour administrations (albeit never with an overall majority).

As a result, the Welsh NHS has been controlled, without exception, by the Labour Party for 15 years. Its supporters also dominate every regional Health Board.

Despite these gross failings, Ed Miliband says that only Labour — under him as prime minister — can be ‘trusted’ to safeguard the British health service.
The Mail is intent on politicising the debate and continues -
Almost invariably, the whistle- blowers and aggrieved families of victims of the Welsh NHS find themselves facing a mixture of attacks and obfuscation.

For example, the children of Malcolm Green, a businessman who died at Withybush Hospital in Haverfordwest in 2012 after waiting five hours to be operated on while he was bleeding internally, have been refused access to a report detailing his final hours.
Despite learning that staff lied about his treatment and that a consultant chose to attend a meeting rather than operate immediately on the 82-year-old patient, they have yet to receive a proper apology.

A supposedly contrite letter from Trevor Purt, chief executive of the local Hywel Dda health board, had not even been signed by the health boss. When they tried to contact the Welsh Health Minister, Mark Drakeford, they were told to complain via a website.

Malcolm’s son John says: ‘The complaints process is deliberately fitted with barriers to stop people pursuing complaints and to make them give up. In the Welsh NHS, there is a disgraceful culture to try to cover up complaints.’Thankfully, there are those such as Labour MP Ann Clwyd who are prepared to speak out. She has suffered personally — her husband Owen, she says, died ‘like a battery hen’ after being kept on a trolley in a corridor at the University Hospital of Wales in Cardiff.

Her reward for highlighting an issue of grave public concern? She has been smeared by the Welsh ruling class.Though the hospital’s health board apologised ‘unreservedly’ about her husband’s care and said his treatment was ‘unacceptable’, Mrs Clwyd was publicly told to shut up and stop complaining by Labour Assembly member Lynne Neagle.

‘We have all had cases of problems with poor care, but I do not believe that it gives Ann Clwyd the right to denigrate the entire Welsh NHS and I wish that she would stop it,’ Miss Neagle remarked.

Miss Neagle’s attitude speaks volumes for the sense of entitlement and inscrutability that has been allowed to take root in a health service that many believe puts point-scoring over patient care.
The Mail claims that -
Things are very different in England, where health boards (often run by party political apparatchiks) were replaced many years ago by trusts in an attempt to get a degree of independence from Whitehall.

Though their performance varies, they are designed to be protected from party politics and are typically run by an eclectic mixture of local people, business leaders, medical staff and NHS employees. 
We are all well aware that the truth is otherwise. Waiting times are targets. 

We are all well aware from the outcome of the Mid Staffs inquiry that the English NHS (National-socialist Health Service) are pretty proficient with the magic mirrors and ‘re-coding’ figures.

We are all well aware of these 'apparatchiks' as the Mail appropriately describes them. The LKP Tweets on Twitter and Facebook chirping and chattering, actually pointing the finger that opponents of the LCP are part of some right-wing Catholic conspiracy theory.

No, Daily Mail, you’re right but you’re wrong: it’s not about politics; it’s all about policy.

The rush to be rid of the LCP is itself rescinded and the Pathway is revived and vindicated just as the apologists for Stalin seek to revive his memory for the glory days of the Soviet holocaust.

The Times
When neglect, ongoing and systemic, continues and has continued it is arguable that this may, indeed, be policy. The offence of wilful neglect appears ineffective and inadequate as either a castigatory or corrective measure. Is this neglect reckless and wanton or wilful and contrived, as in some vile intent and purpose?

Should those who perform these acts alone be castigated or should those who oversee their wickedness also be rebuked and receive just chastisement? Do these foot soldiers of abuse receive their just deserts or are they permitted to continue their pursuits in the vile treatment of those who exposed them?

Sir David Nicholson’s admission of failings was expressed with a regret that was so ‘bitter’ that he threw a £12K celebratory do to see himself off to bathe in the sunset of a £110K pension.

And the mail reports the boiling frogs are become senseless to sans everything -

Mail Online

Mail Online

 Mail Online picked up the ball on the NHS black hole in June -

 Mail Online is still running with the ball -

Is it all a case of I see no ships? Has life just been downgraded as an optional extra?

This is The Express -
A whistle-blower claimed 32-year-old James Harrison should have been taken to a hospital mortuary but he was instead left on the ground next to some bins.

The insider said the body was left until the next team of paramedics arrived for the following shift and blasted the incident as "totally wrong".

The source said: "Standard practice would be for paramedics to transport the body to the mortuary.

"But on the day the body was left on the station floor next to the bins for more than an hour, which raises serious issues of dignity and decency. 

"I have never experienced anything like this in my career, it was totally wrong."
Already, the cuts are biting hard -

The Telegraph
And the troops are up in arms over pay -

The Telegraph
What is to be done...?

We were only “half way there” but this is all coming together and, piece by piece, the jigsaw is being completed. Already, the DPP has relaxed the guidelines on ‘assisted dying’ and the Falconer’s Bill is ready to snatch up his prey.

Oh ye whose lot it is to be adjudged to have life of insufficient quality, beware. If there is a cost-cutting advantage to seize, an inheritance to gain, then your days may well be numbered.

Release the hounds CRITters!

In July, Greater Manchester Fire and Rescue Authority published a document proposing formation of a pilot Community Risk Intervention Team.

This is The Telegraph -

A plan to send fire crews and former soldiers to deal with medical call-outs has been criticised as “emergency services on the cheap” that could cost lives.Greater Manchester fire service is to recruit 30 people to provide assistance on two types of “low priority” calls, which it is claimed take police officers and paramedics off the road for several hours.The brigade has received an extra £3.67 million in government funding for the project. If successful, the pilot will be extended across the county next year.

What is to be done...?
Liverpool Care Pathway - What Is To Be Done...?

They are cutting corners to help fill that black hole.

For what shall it profit a man...?

This is the power of the word.

They used to call it price fixing; they now call it price matching. Another name for it would be a Cartel.

A scam no less outrageous are the deals presented by online comparison sites. There is no such thing as a ‘deal’. It is all about presentation. It costs what it costs. It’s all about profit margins that maintain profitability. Why won’t you get this ‘deal’ elsewhere? Come on, where does their profit come from?

It is all in the presentation.

When 'choice' becomes the promoters' selling point, it's likely the wreath is being dressed up as a garland. Beware what you wish for...

Footnote reading -
Liverpool Care Pathway - A Cost Efficiency
Liverpool Care Pathway - Hard At Their Purpose
Liverpool Care Pathway - Active Killing...
Liverpool Care Pathway - Whatever Happened To The Family Doctor...?
Liverpool Care Pathway - The Prequel
Some further reading -
Liverpool Care Pathway - The Werther Defectives
Liverpool Care Pathway - When The Caring Had To Stop  
Liverpool Care Pathway - NICE One!
And some additional reading -

The book: “Semantography (Blissymbolics)” by Charles K. Bliss

This is the Power Of The Word

The most powerful weapon in their armoury is the power of language to motivate and to move. This realisation has been exploited by dictator and despot, by praetor and potentate to muster armies to their cause.

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