Wednesday, 31 December 2014

Liverpool Care Pathway - A New Year Life Café

What does 2015 have in store...?







2015 - The deadline to create £20 bn in savings.

Sir David Nicholson set the £20 Billion savings productivity target for 2015. This was - and is - the Nicholson Challenge. Why £20 Billion?
With the number of deaths set to increase by 17% to 590,000 by 2030, we are facing a ticking time bomb when it comes to end of life care. A rapidly ageing population and increases in the number of people with complex long-term conditions will lead to greater demands on providers of end of life care and rocketing costs for the NHS predicted to rise from £20billion to £25billion by 2030. This issue is the subject of a series of fringe events Patient Choice V Care being held by Marie Curie is partnership with Sue Ryder and Help the Hospices, during the political party conference season. 
-
 Huffington Post
From The Mandate (April 2014 to March 2015) -
"These priorities reflect the Government’s absolute commitment to high quality healthcare for all, while highlighting the important additional role the NHS can play in supporting economic recovery."

"The NHS Commissioning Board’s objective is to ensure that the new commissioning system promotes and supports participation by NHS organisations and NHS patients in research funded by both commercial and non-commercial organisations, most importantly to improve patient outcomes, but also to contribute to economic growth. This includes ensuring payment of treatment costs for NHS patients taking part in research funded by Government and Research Charity partner organisations."
The important additional role the NHS can play is in supporting economic recovery and contributing to economic growth.

The Third Sector will continue to work hand-in-glove with government.

Lord Shawcross has said that some charities risk becoming too dependent on the State. Actually, some charities, possessing a valuable branding, behave less and less as you would expect charities to behave and more and more like for-profit corporate entities.

NHS patients will be taking part in research...

According to the NHS England Business Plan 2015/16 -
We will act as a facilitator of research – for example, we are planning to investigate a system of ‘presumed consent’ to take part in research studies for all patients treated in teaching hospitals.
NHS England Business Plan 
...a policy of presumed consent is being investigated.

The focus of any health provider is to restore the patient to a condition of health. A healthy population is constructive to maintaining and encouraging a healthy economy but that is an entirely incidental consequence.
Liverpool Care Pathway - A Cost Efficiency
From April 2015...

This is the South Warwickshire CCG Commissioning Intentions 2014/2015 
By November 2013 we will have commissioned an Admission Avoidance Programme (Phase 1) to keep people at home. This willprovide patients with access to specialist opinion and/or diagnosticswithin 24-48 hours for patients. In November 2013 we will start the more comprehensive Admission Avoidance Programme (Phase 2). This will impact on services outsideof the hospital and is anticipated to significantly change the number and type of contracts we have with providers from April 2015.
If The Facts Fit...?
On the basis that each year 1% of our population dies, we want our end of life registers to reflect this.By March 2016 we want 0.8% of our population on an End of Life Register.
"On the basis that each year 1% of our population dies, we want our end of life registers to reflect this. By March 2016 we want 0.8% of our population on an End of Life Register" (irrespective of whether these 0.8% selected for the Death Lists would have been part of the actual statistical cohort or not?).

The DoH raised a national alert in 2010 after a number of errors occurred in syringe driver use.

This is the Rapid Response Report –

 Ambulatory syringe drivers are widely used for palliative care and long term therapy in all clinical settings and at home. Some ambulatory syringe drivers have rate settings in millimetres (mm) of syringe plunger travel. The use of millimetres rather than millilitres (ml) as a basis for medication calculation is unique to ambulatory syringe drivers. This is not intuitive for many users and not easy to check. Errors include the wrong rate of infusion caused by inaccurate measurement of fluid length or miscalculation or incorrect rate setting of the device. Errors can also be made through confusion between models calibrated for mm per hour or mm per 24 hours. Syringes in some of these devices can become dislodged in use. Some have inadequate alarms and no internal memory (which makes establishing the reason for any over or under-infusion difficult). Because ambulatory syringe drivers are often used to deliver opioids and other palliative care medication, over-infusion can cause death through respiratory depression while under-infusion can cause pain and distress.

Changes must be implemented by 2015...

EDP24
The national programme to replace this type of syringe driver was piloted at the James Paget University Hospital where Michael Shuckford had his life ended.

Norfolk Coroner, William Armstrong expressed concern that the Trust had until 2015 to implement changes to replace it. Mr. Armstrong said this was a too generous time scale.

2015 - Chasing the 1% and chasing the EPACCs...

According to Community Care -

Norman Lamb has said that NHS England wants to expand the use of electronic palliative care co-ordination systems (EPACCs) to increase national coverage form 30% to 70% by 2015.

Come to us all it must and, asked where you would prefer to die, it is almost certain that the response will be in your own home with loved ones at your side. Mr. Lamb is determined to grant that wish. An ACD might well include that wish...

But that doesn't mean you want them to give up on any chance to save your life.

The Health and Wellbeing Boards have been productive in developing EoLC provision and the move to ‘respecting and acting upon’ EoL wishes - code for Advance Care Directives.

According to the The King's Fund, the Better Care Fund has been implemented in the context of an ageing population. This is spending money not to provide for demand but to reduce that demand. This is spending money to save money.

The National Audit Office announced that the Better Care Fund will pool £5.3 bn of existing NHS and local authority funding and will run from April 2015.
End-of-Life documents include not merely attitudes to refusal of treatment but to such things as organ donation.

2015 - The coming of presumed consent.

In Wales, from December 2015, there will proceed organ harvesting. New legislation will require people to opt out of donating their organs when they die, rather than opting in by signing the donor register.

And has this been properly and appropriately risk assessed...?


BBC News Wales
Danny Dorling writes in the New Statesman 
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.
Where have all the old ones gone, long time passing...?

Why are old people in Britain dying before their time?

Excess deaths!


National Audit Office
The headlined report, 'Securing the future financial sustainability of the NHS', maintains that the NHS delivered a £2.1 billion surplus in 2011-12 but that there is some 'financial distress' in NHS Trusts with some very large deficits.

On target, perhaps. Much has been achieved already, then.

There is still much more to achieve, however. The pensions black hole still gapes its maw ready to gulp down the careless or unwary economist and politician.

Essential reading -
Liverpool Care Pathway - Time To Wise Up
A Trial in Flanders' killing wards, where they euthanase patients without their prior permission, hosted on a US dot Gov website, is approaching its Estimated Primary Completion Date in March 2015.

The Independent reports -
The Belgian study is recruiting 600 dying patients, half of whom will get usual palliative care, while the others will be cared for using the LCP.

"Although the LCP has been adopted in 21 countries outside the UK and has been recognised to be the gold standard for practice, the evidence supporting such practice is insufficient," say the researchers leading the new trial. "Due to the scarcity of available evidence, recommendations for the use of end-of-life pathways in caring for the dying cannot be made at the present time. Randomised clinical trials or other well designed studies are needed to obtain additional evidence about [its] effectiveness."
Further reading -
Liverpool Care Pathway - Over Here, Over There, And Coming Your Way Soon
2015 - Another new year, fresh start, off with the old, on with the new...

And the new year begins with the ED in need of some emergency resus.

This report began the new year 15 years ago in The Guardian -

The Guardian
Britain's accident and emergency wards are so overstretched that seriously ill elderly patients are being left on trolleys for more than two days, and patients waiting to be seen are left lying on the floor, according to a shocking new survey.

The full scale of the chaos in casualty departments will be revealed in a report this week by the Association of Community Health Councils, based on spot checks on most A&E departments in the country. One recent check found a 71-year-old woman with angina who was left on a trolley at East Surrey Hospital, near Gatwick, for 49 hours. Government guidelines say no one should be left on a trolley for more than four hours.
2015 – Is Gosport War Memorial finally, finally to open its cobwebbed doors and permit the light of truth to penetrate each last nook and cranny of deceit, deception and dishonesty?

The Portsmouth News reports -




Bishop James Jones, who previously chaired the Hillsborough Independent Panel will chair the independent investigation and today Mr Lamb confirmed four additional members.

They are geriatric medicine specialist Dr Colin Currie, investigative journalist David Hencke and former Scotland Yard Commander Duncan Jarrett will join the Gosport Independent Panel immediately, whilst pathology and medical records expert Dr Bill Kirkup will join after his work with the Morecombe Bay investigation concludes.

The stepson of Arthur ‘Brian’ Cunningham, who died at the hospital in 1998, aged 79, believes that it is long overdue.

Charles Farthing, said: ‘There’s been a blatant cover-up from the beginning.

‘There may have been investigations, but someone has been controlling what’s coming out and what information is not.

‘This has all been dreadful and an investigation like this should have happened 10 years ago.

‘But the system has been covering things up for whatever reason, and now I hope this investigation will get to the bottom of it all.’
Will the Morecombe Bay Investigation chaired by Dr Bill Kirkup finally penetrate the smog of obfuscation that has cloaked the awful truth for so long, too long?

This is the Morecombe Bay Investigation (last updated 19 December 2014) -



It is expected that the interview programme will conclude during the week commencing 5 January 2015...

But let's end the old year with some wholesome Life Café with this report from the Metro...



...What's yours, an Americano or a latte?









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