Friday, 9 January 2015

Liverpool Care Pathway - So This Is New Year...

Another year over,
And a new one just begun...

So this is New Year...

This is Ely Standard –

Chief executive Dr Keith McNeil said that the hospital has been under “extreme pressure” since New Year’s Eve and “for the past two days we have been in critical internal incident mode”

He said that as of 7pm last night the hospital had declared “a major incident due to unprecedented levels of demand on our services.”

The hospital was dealing with especially high numbers of frail elderly patients combined with a record level of patients whose medical care is finished and whose discharge is delayed.
“As part of our plans to manage high demand on our services, we have cancelled all non- emergency surgery and procedures. Right across the country the situation is similar. Ambulance and community services are also under pressure and this has put additional pressure onto acute hospitals.”
Aiming for the DIUPRs...

EPaCCS are essential and integral to the final solution.

The report describes “The quantitative analysis undertaken as part of the evaluation, focusing on national data for deaths in usual place of residence (DIUPR), local information on EPaCCS costs, and data extracts from EPaCCS and Hospital Episode Statistics.”
Because of the progress made in Locality D, as well as it being the location with the longest development path, it is worth describing more of the local context as an indication of the potential extent of the whole system changes necessary to realise the benefit seen there. The elements of development that support the high score against the critical success factors include:
-  Advanced Care Planning was made mandatory training before users of the system received their login details and was also rolled out in care homes;  
-  There is automatic flagging to 111, 999 and GP OOH for all 24/7 services;
-  Nursing home training has been prioritised with a number of routes to training, including provision by the hospice;
-  EoLC facilitator roles are in place and working with acute hospital discharge teams;
-  Extensive training continues to be provided on a ‘train the trainer’ basis across the locality.
This location is also now progressing to implement a new LES scheme and recently introduced two CQUINs in both the community and the hospital sectors. These will not have had an impact on the progress reflected  in this evaluation but demonstrate the ongoing progress that needs to be made as they enter their third year of EPaCCS.
So this is New Year...

This is Ely Standard again –
The CQC, which inspected the hospital in September, released its report into standards at the Huntingdon hospital today (Friday).

Inspectors say that three of the five categories – are services safe, caring and well-led – were inadequate and the remaining two – are services effective and responsive – required improvement.

As a result, the CQC has recommended Hinchingbrooke be put in special measures and its breaches monitored by the Trust Development Authority (TDA).
Concerns are raised about drinks being placed out of patients’ reach and the response to call balls on a number of wards that, in some cases, was so bad that two patients said they were told to soil themselves, and another soiled themselves waiting for a nurse to come.
Well, sadly, that sounds depressingly all too familiar.
Ely Standard continues –
Other key findings were:

• Many instances of staff wishing to care for patients in the best way, but unable to raise concerns or prevent service demands from severely impinging on the quality and kindness of care for patients. In both maternity and critical care we noted good care, focused on patients’ needs, meeting national standards.

• There was a lack of paediatric cover within the A&E department and theatres that meant that the care of children in these departments was, at times,increasing potential risks to patient safety.

• There was a lack of knowledge around Adult Safeguarding procedures, Mental Capacity Act and Deprivation of Liberty processes.

• Infection control practices were not always complied with in A&E Apple Tree ward, Cherry Tree ward, Walnut ward and in the Treatment Centre.

• Medicines, including controlled drugs, were not always stored or administered appropriately in A&E, Juniper ward, Apple Tree ward or Cherry Tree ward.

However there was some praise for the maternity and critical care wards, with staff focused on patients’ needs and inspectors singled out the paediatric specialist nurse in the emergency department and the chaplaincy staff for their work.

The inspectors raised 21 areas of poor practice the hospital needs to make improvements and a further 12 recommendations.
In this election New Year, this is going to be kicked around as a political football by all engaging parties.

In this election New Year, this is going to be a game of ping-pong to allocate blame...
Liverpool Care Pathway - Time To Wise Up
In this election New Year, this is Ely Standard yet again with Circle Chief Exec, Steve Melton –

Can I start by thanking the staff for their professionalism and dedication.

Since we took on Hinchingbrooke in early 2012, the hospital has been transformed. Hinchingbrooke faced closure. It was described as a ‘basket case’. We invested in the quality of care, in staff and in facilities. Now, it has won a number of awards. We consistently hit the most important outcome measures, including low mortality rates, excellent patient feedback, and meet all major waiting time targets. In the first two years of the franchise, we made financial savings significantly above the NHS average. We have saved the taxpayer around £23million in total.
So, what happened and why is Melton running away? Is this the criminal escaping the scene of the crime?

The business model has been criticised and the Union has condemned private involvement.

Is the Trust trustworthy?

On record, in their own words...

Or was it all their Master's Voice...?

Melton and Circle will be accused of walking away with a nice stash.

So, what about Nicholson...?

According to Hinchingbrooke –
Our executive board is made up of nine practicing clinicians, elected by their peers and supported by four managers. These clinical leads are each responsible for a clinical divisional unit and are accountable for their own budget and their team, reducing the gap between our Board and our frontline staff.

Not only this, our organisation’s vision was written by our people, and it was our people that set our goal to become a top ten district general hospital – in fact they wanted us to be number one. To make their vision a reality, 1200 of our staff came together to shape our business plan and we captured their ideas under four simple headings: clinical outcomes, patient experience, value for money and engaged staff. And so, our 16 point plan was born, a simple pocket-sized guide to realising our goals. You can read it here.
We're part of something new, a unique franchise with a private sector company. Find out more about our partnership with Circle here.
Just down the road at Addenbrookes they're dealing with
especially high numbers of frail elderly patients combined with a record level of patients whose medical care is finished and whose discharge is delayed.
The End of Life Baseline Report published in 2011 warned of a "Tsunami of need" -
Our population is getting older and sicker. Currently there are around 1.5 million people with long term conditions living in the North West; it is estimated this figure will be 3 million by 2030. In tandem with this, population statistics estimate that the people over the age of 65 will increase by 252% by 2050; described by Sir John Oldham as “a Tsunami of need”.
Is the "Tsunami of need" breaching the gates?
Liverpool Care Pathway - Appointment With Death

Liverpool Care Pathway - Back To A Way Forward
Is the Final Solution the only solution? A medical holocaust has proceeded...
Liverpool Care Pathway - As If We Didn't Know

Liverpool Care Pathway - Persons, Personhood And Non-persons
So this is New Year, just barely begun...

Concluding reading -
Liverpool Care Pathway – The Nuremberg Pathway

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