Saturday, 28 March 2015

Liverpool Care Pathway - Who Monitors The Monitors And The Monitors Of Monitors...?

What does it take to catch a fool? It matters not, only that he is an honest man...

The Kirkup Morecambe Bay Investigation reported finally on 3rd of March -

Clinical zealots come under fire. There are reported failures to communicate and to respond to opportunities. The regulatory bodies fall under repeated criticism for missed opportunities to intervene.

A specific watchdog has been accused of cover-ups and cover-ups of cover-ups in the press...
The Independent

and  this is discussed -
1.67 Ms Abraham was clear that in raising the matter she had conveyed the nature of her concerns that there were systemic problems...

1.68 Ms Bower’s recollection was less clear, but she was definite that the matter of systemic problems was not raised with her... 

1.69 Within the context of everything else that we heard from both PHSO and CQC interviewees, we believe that Ms Abraham’s account is distinctly more convincing; we were also disconcerted by the proviso in Ms Bower’s account (“… unless somebody can show me a memo…”75). It is clear that there was no shared understanding of the conversation.

1.71 We also considered carefully an email from Mr Halsall, the Chief Executive of the Trust, to his Chair, Mr Kane, around this time, which included the following odd phrase in relation to Mr Titcombe’s complaint: “… if I am right then the CQC can cover off the Ombudsman”. We received no satisfactory explanation of what this meant.
The remedial response of the Report findings is to propose yet another regulatory body; another monitor to monitor the monitors.

The Report discusses the confusion of responsibilities at this time…
1.53 Not only is this complex and changing picture difficult to follow on occasions, we believe as a result of what we heard from a range of interviewees that the organisational changes led to confusion of roles and responsibilities, loss of organisational memory as personnel changed and, in some cases, staff of new organisations struggling with responsibilities for which their previous experience had not equipped them.
Such was our experience in pursuing our complaint...
1.51 …From 1 April 2009, the Healthcare Commission was replaced by a new body, the Care Quality Commission (also responsible for the quality and regulation of social care providers), which had operated in shadow form from the preceding autumn....
Political interference only bedevilled what was already an arduous and soul-destroying process. There is an unmistakable culture to make little and less of what is seen as no more than just a much of a muchness with lessons to draw on to improve the service. And 'justice', in Ombudsman's language, is not justice at all.

The State should always step back. When the State steps in, it leads only to cronyship, cover-up and corruption.

Is it more monitors we need or just good, honest, decent folk like Will Powell. Mr. Powell’s campaigning spirit has been steadfast and unfailing in the face of all odds, at every twist and turn the establishment have ambushed him with.

‘Duty of Candour’: what does that mean? It means your doctor should be open and honest with you. Should you not expect that? Does there really have to be a law to enforce that?

The Independent
You take your car in for a service and all the Lords and Ladies in the land would not disagree that the mechanic should not rip you off with shoddy workmanship or charge for work done that has not been done. Is a car worth more than a human life that it demands such greater terms of service?
Speaking to The Independent on Sunday, Mr Powell of Ystradgynlais, Powys, said that a statutory duty of candour would represent "one of the biggest changes in patient safety since the inception of the NHS", but called for it to be extended to all individual health professionals, rather than to organisations.
Catch 22

That sounds strangely familiar...

Can that be the Catch 22 of all Catch 22s...?

When we responded to the Healthcare Commission Decision which had admitted failings – serious failings - but concluded that these had been addressed through ‘learnings’ undertaken by the Trust, Mr. Peter Pinto de Sa responded to us thus:
We are not empowered to undertake a general investigation into the performance or conduct of unnamed individuals at a particular institution or organisation where it is said that there have been general failings on the part of that institution or organisation or its staff in general.
We had assumed that meant we had to pursue a case against “that institution or organisation or its staff in general” and not against the individuals themselves. Re-reading it again, I'm not at all sure what it means.

Is it just gobbledegook or Newspeak for saying that, were you even able to pursue a duty of candour against individual health professionals, there could be no case to pursue in any case because their actions would constitute “general failings on the part of that institution or organisation or its staff in general”?

The Report discusses the confusion of responsibilities at this time...

Clearly, to all those concerned, those whom they would directly affect, the coming changes being steam-pressed by parliament were as clear as proverbial mud.

The Commission itself was doing a doggy-paddle in the mud and sent out this leaflet in the January of that year -
The information leaflet says:
From 1 April 2009 there will be a new regulator that will check on the quality of healthcare and adult social care services in England. The Care Quality Commission will take over the work currently done by the Commission for Social Care Inspection, the Healthcare Commission and the Mental Health Act Commission, “the three existing commissions”. 
We have sent you this leaflet because we are in correspondence with you about a process or matter that is not likely to be concluded before the Care Quality Commission takes over. This leaflet answers some of the questions you may have about the change.
The leaflet then demonstrates the level of misunderstanding in place. At Item 4, the leaflet asks: Will I have to start the process all over again on April 1st 2009? The leaflet responds with an answer:
No you won’t. The Care Quality Commission will continue the work of the three existing commissions after 31 March 2009. The Care Quality Commission will continue with the process as though no change had taken place. You won’t need to start again and you won’t need to contact them to tell them who you are or what process you are involved with. From April 1st 2009 you will simply begin to receive letters or information from the Care Quality Commission.
And goes further to compound the misinformation by asking: Will I still be dealing with the same person I was before? And answers:
This is very likely. Many of the staff working for the three existing commissions will be working for the Care Quality Commission and the person you are dealing with will carry on supporting you after 1 April 2009. If this isn’t possible a new person will take over and will be told about your case. They will  know how far you have got in the process we are currently writing to you about.
How many of those staff on that fateful April Fool’s Day 2009 just cleared  out their desks and found themselves without a job?

We had been in ongoing correspondence with the Healthcare Commission (HC) which had been shut down and so approached this regulatory body which had, so we had been informed, been set up in its place. Not so. They had made April Fools of us all.

This whole tier of appeal had been shut down. After the Primary Care Trust (PCT), the next port of call to take your complaint became the Parliamentary and Health Service Ombudsman (PHSO).

The PHSO replied that our papers had been archived. We had to supply duplicate copy of all correspondence or wait months to retrieve the archived content – if it could be retrieved. But what of the HC’s own record notes? What gems of information did they contain which was not made available to us and would not now be available to the PHSO? Such was our predicament.

The report explains correctly...
From 1 April 2009, the Healthcare Commission was replaced by a new body, the Care Quality Commission (also responsible for the quality and regulation of social care providers), which had operated in shadow form from the preceding autumn. Responsibility for the second stage of the NHS complaints procedure did not pass to the CQC, however, but to the Parliamentary and Health Service Ombudsman (PHSO), who had previously become involved only when the Healthcare Commission did not resolve a complaint. The regulator for Foundation Trusts, other than for the CQC’s responsibilities, was Monitor, which also ran the application process by which NHS Trusts were judged suitable or not to become Foundation Trusts.
Another monitor, by designation as well as by definition...

Looking at the record of reported subsequent failings by Foundation Trusts/University Hospitals, is Monitor really fit for purpose as a suitable arbiter to adjudge suitability?

Who shall monitor these monitors and these monitors of monitors?

This is from the Press Release –
The investigation report details 20 instances of significant failures of care in the FGH maternity unit which may have contributed to the deaths of 3 mothers and 16 babies. Different clinical care in these cases would have been expected to prevent the death of 1 mother and 11 babies. This is almost 4 times the frequency of such occurrences at the Trust’s other main maternity unit, at the Royal Lancaster Infirmary.
The report says the maternity department at FGH was dysfunctional with serious problems in 5 main areas:
  • Clinical competence of a proportion of staff fell significantly below the standard for a safe, effective service. Essential knowledge was lacking, guidelines not followed and warning signs in pregnancy were sometimes not recognised or acted on appropriately.
  • Poor working relationships between midwives, obstetricians and paediatricians. There was a ‘them and us’ culture and poor communication hampered clinical care.
  • Midwifery care became strongly influenced by a small number of dominant midwives whose ‘over-zealous’ pursuit of natural childbirth ‘at any cost’ led at times to unsafe care.
  • Failures of risk assessment and care planning resulted in inappropriate and unsafe care.
  • There was a grossly deficient response from unit clinicians to serious incidents with repeated failure to investigate properly and learn lessons.
The report says proper investigations into serious incidents as far back as 2004 would have raised the alarm. It was not until 5 serious incidents occurred in 2008 that the reality began to emerge.
Clinical zealots come under fire.

There are many such zealots out there whose dedication to their cause borders on the obsessional and the irrational and binds them to it unswervingly, as were it holy writ. One such holy writ has perpetrated a medical holocaust but, with disdain, the ardent host has damned the evidence as anecdote.

There are many dedicated to their cause who pursue it faithfully but for whom duty also calls and know that you have to do the right thing.

Lawrence D Hills, a father-figure of modern organic gardening, became devoted to the cause of promoting the abundant uses of the comfrey plant, founding the Henry Doubleday Research Association (HDRA) in 1954. When Brussels started banning historic British vegetable varieties, he set up the HDRA seed library to ensure they would not be lost.

Devoted though he was, zealot he was not. When reports emerged in 1978 in Australia of links between comfrey, cancer and liver damage, Hills knew it was his duty to alert users and did so, going public with this in the national press. This caused him to become the subject of consternation, comment and criticism by fellow travellers.

Hills was one of those good, honest, decent folk and duty overrode dedication. He knew he had to do the right thing. 

Is it more monitors we need or just good, honest, decent folk at every level, doing their very level best to always do the right thing?

How many are they in public life who know that honesty is always the best policy and to always do the right thing?

In the Metro, following a 'grubby plot':
Charles Walker, the Tory MP who chairs the procedure committee, told the Commons he had been 'played the fool' after Mr Hague and Mr Gove failed to mention the motion when he met them this week.
'I will look in the mirror and see an honourable fool looking back at me, and I would much rather be an honourable fool in this and any other matter than a clever man,' Mr Walker said.
Perhaps so...


Dr Bill Kirkup will be joining the Gosport Independent Panel alongside geriatric medicine specialist Dr Colin Currie, investigative journalist David Hencke and former Scotland Yard Commander Duncan Jarrett.

At last, will some light be shone along those dark corridors of The War Memorial...

Additional reading –
Liverpool Care Pathway – The Audacity Of Hindsight

Liverpool Care Pathway - Ten Years In The Waiting

Liverpool Care Pathway - Blowing The Whistle On The Half Century

Liverpool Care Pathway – Corruption, Corruption, Corruption
 Liverpool Care Pathway - Have You Read the Olds Lately?

Saturday, 21 March 2015

Liverpool Care Pathway - Life Café Announces Living Matters Awareness Week 2015

Do you just give in...? If the 'black dog' should visit us, should we appease it? Or should we struggle on?

This is Life Café...

Martin Pistorious was 12 years old when, returning home from school, he complained of feeling sick. His condition progressively deteriorated, sleeping for much of the time.

His parents, Joan and Rodney, watched helplessly as his physical faculties began to shut down... 

Finally, a test came back positive. It was cryptococcal meningitis, something the doctors said that meant there was no hope for Martin.
They were told that he was a vegetable, with no more intelligence. They were advised to take Martin home, to provide him with love until his death.
This is Collective Evolution –

My mind was trapped inside a useless body, my arms and legs weren’t mine to control, and my voice was mute. I couldn’t make a sign or a sound to let anyone know I’d become aware again. I was invisible – the ghost boy.” - Martin Pistorious
Joan and Rodney despaired as they watched their son shut down. Joan’s despair would reach a point such that she thought death would be preferable for her son than this existence that he endured.
I was there, not from the very beginning, but about two years into my vegetative state, I began to wake up.”

“I suppose a good way to describe it is like an out-of-focus image. At first you have no idea what it is, but slowly it comes into focus until you can see it in crystal clarity.”

I’d have conversations with myself and other people in my head.”

Somewhere along this process, Martin soon realized his immobility.
I stared at my arm, willing it to move. Every bit of me condensed into that moment.”
Martin recalled a moment when his father was helping him undress, and how badly Martin was trying to communicate, but nothing in his body would obey.
Everyone was so used to me not being there that they didn’t notice when I began to be present againThe stark reality hit me that I was going to spend the rest of my life like that – totally alone.”
Martin revealed how he spent countless hours wallowing in self-defeat, “You will never get out. You are pathetic, powerless, totally alone.”
Was this really how he was to spend the rest of his days alive?

By the time Martin was in his mid-20’s, something slowly began to shift. Martin was now able to squeeze someone’s hand, a remarkable advancement considering his history. Furthermore, he was getting better at holding himself upright in his wheelchair.
However, the doctors insisted that Martin still had the mind of a 3-year old. But one nurse, named Verna, was convinced that there was something there.
Verna’s belief and Joan’s dedication unlocked Martin from the confinement which had locked him in for half his life.

Today, Martin is in a wheelchair, he doesn’t speak, but his determination has forged him a life. From small beginnings, he has earned himself a degree, built himself a business and won for himself with an extraordinary personality the love of his life.
Martin’s story is indeed one of many mixed emotions -sadness, empathy, fear, agony, inspiration- yet it stands as an incredible account of the power of our will to live.
The power of our will to live!

That’s the theme for this year’s Living Matters Awareness Week…!

Because life is precious and living matters.

The Mail had this story on Wednesday -

A mother has described how she heard a doctor asking her husband about switching off her life-support as she lay in a medically-induced coma after collapsing from a rare condition.

Jenny Bone, who was feared to have catastrophic brain damage after going into cardiac arrest, lay listening to the life-or-death conversation but was paralysed and unable to intervene.

She recalls her husband John ruling out ending her life – despite a previous conversation when she said she wanted to die if incapacitated permanently. The 40-year-old later recovered and now says she is relieved he went against her wishes.
Dying Matters, along with a dodgy euthanasia ‘charity’ using entryist tactics to share Age UK’s toilet facilities, have been promoting ACDs to include DNRs and organ donation.

A culture of death and dying has been subtly sponsored such that it has insinuated itself into the mainstream.

Mrs Bone had had a previous discussion saying she would not want to be resuscitated or kept on life support.

The doctor spoke of being 'realistic'...
‘I was aware of conversations around me,’ she said. ‘The most frequent one was being turned in the bed. A familiar “ready, steady, turn” would come from the nurses.

‘The most alarming was between a doctor and my husband enquiring as to my wishes surrounding being kept alive on a ventilator and that they were unsure whether my mental ability had been impaired due to lack of oxygen while they were attempting to restart my heart.
Mrs Bone is so grateful now that her loving husband could not let her go so easily. But what if that ACD had been in place and the medics had had access to it? What then...?

The doctors had ignored a GP's referral letter that may have placed Mrs Bone in the dire situation she found herself in. A complaint is in process.

An ACD might be both convenient and welcome at such times.

An ACD might be used as a Death Warrant in such circumstances to escape awkward questions and to thwart consequences.

"Let's talk about it."

Another amazing story from The Mail this month. Sometimes, all you need is hugs...

Exhausted after a premature birth,Kate and David Ogg were given the devastating news that one of their twins had stopped breathing.
Doctors predicted that their tiny little boy would not survive, telling the first-time parents there was nothing they could do.
When a doctor says there is nothing to be done, there is nothing to be done. Medical science has advanced to such a stage that doctors, nurse practitioners, are able to diagnose dying.

But Kate Ogg was having none of that.
But his mother refused to give up on the son she had already named Jamie, and begged medics to allow her to cuddle him for his last moments.
She then asked her husband to climb into the hospital bed to embrace her and their cold, still baby.
And in the loving cradle of his parent's arms, little Jamie was brought back to life.
The most natural thing to do...

And a mother's instinct won through.
Doctors worked on Jamie for 20 minutes when the twins were born at 26 weeks on March 25, 2010. 'We looked over and everyone was crowding around him - there were about 20 people in the room. I saw him gasp but they said it was no use,' she said. 'He stopped breathing and his heart-beat was nearly gone. I took him off the doctor - he was cold and I just wanted him to be warm.'

'If we had let the doctor walk out of the room with him, Jamie would have been  dead,' said Mrs Ogg, who lives in Queensland, Australia. 'It's astounding. This whole experience makes you cherish them more.'
The Hippocratic Oath that once taught humility has fallen into disrepute.

Does Pride blind them, then, that they think they may not commit error?

Those whom the Gods offend shall be taught wrath for their hubris.

All doctors were once seen as a heroic breed who would not give up on you easily and who would fight with every ounce of their strength and purpose to preserve life. And so they were. And many still are...

The Metro had this -

Little Joeseph Flint arrived 16 weeks too soon, so eager was he to come into the world. Weighing only 1lb 5oz and with a hole in his little heart, he was given only a 40% chance of survival.

Nevertheless, the good doctors plunged in –
In a pioneering approach,doctors used paracetamol rather than life-threatening surgery to seal the hole.

'He's our little comeback kid and it is great to be celebrating his first birthday after the year we have had,' said Mrs Flint.
That is the power of our will to live!

This is the power of the will to live...

This is Pennlive –

MIFFLINBURG -- The 22-month-old boy who fell and was swept away by a swollen stream last Wednesday may have been in the 34-degree water for as much as half an hour.

Doctors know that when he was found, he had no pulse and no respiration. For one hour and 41 minutes, rescuers administered CPR in a desperate effort to revive him.

That's why those same rescuers are using words like "amazing" and "miracle" to describe young Gardell Martin's return home five days later. He is healthy and giggling and playing again with his siblings.

"I've never experienced anything like this," Dr. Richard Lambert, a pediatric critical care specialist at Geisinger's Janet Weiss Children's Hospital near Danville, said of the resuscitation efforts.

The Union County toddler suffered no apparent neurological damage and was discharged Sunday.

You don't just give in, roll over and die.

Wednesday, 18 March 2015

Liverpool Care Pathway - The wake-up call...?

Is this the clarion call so long-awaited? Or does the sleeper, woken, only sleep-walk to the rousing tones of the alarm...?

Tucked away on page 22 of Saturday’s Mail was the following article...

NHS still using Death Pathway despite 'ban' –

The discredited Liverpool Care Pathway is still being used in some hospitals despite having been scrapped, a Commons report will reveal.

A cancer charity warns that despite an NHS ban, the controversial end-of-life programme is still in use under ‘a different name’.
How many times has that been said in these pages...?

In January 2013 -
Liverpool Care Pathway - Rebranding
And the caution call has been sounded in the national press. The Telegraph reported in December 2013 on rebranding.

A 'cancer charity' now, in written evidence to the said Commons inquiry, cautions us. So, the mail says, and who is this 'cancer charity'? Why, the very same Macmillan Cancer Support, among the staunchest of its supporters to the very end and in the face of all the evidence dismissed as anecdotal to the contrary!

The embarrassing Consensus Statement backing the Liverpool Care Pathway for the Dying Patient has been ‘disappeared’…

But the document may still be found. It lists the infamous gang of 22 who put their names to it. It includes the very same ‘cancer charity’...

The Mail refers to the ‘discredited treatment method’. Of course, it was always insisted that the Pathway is not a ‘treatment’ at all but a ‘document’. It was a classic response to the accuser's pointing finger of accusation to flick through the wad of LCP documents and to ask how might this innocuous operandi kill? This was also to sidestep the illegal use of Version 11 following the 2005 Mental Capacity Act.

On a forum in Runner's WorldGhostrider, a hospice nurse, here blogs contemptuously about reports in the Mail -
There was a report about 60,000 people being put on the dying pathway, also known as the Liverpool Care Pathway (LCP). For those not in the know, it is a document that nurses and doctors use when the patient in a hospice / hospital are deemed to be very poorly, and have not got long to live.
In real terms, and as a hospice nurse, all it means is that we are condensing down all the care plans we have to write, into one document. If we put someone on the LCP, it is after families have been spoken too, where we have told them, that their loved one is less well, and time is short. We dont always tell them we are putting the patient on the LCP, since in real terms, it means nothing. The care, the treatment, doesnt change. It is just a document for us, that also allows future nurses looking at the care notes, to be able to access certain information quicker, and acts as a guide, that this particular patient will need more observation than others.
The LCP is a document; that's all...

The Mail refers to the 'discredited Liverpool Care Pathway'.

Of course, it is not ‘discredited’ at all and its praise is still sung both far and wide, as readers of these pages know only too well. In point of fact, the Review itself was not a review into the 'protocol' but into its use and into Version 12 of the 'protocol' only.

The Mail continues –
The report comes as police are investigating the death of a second ‘healthy’ pensioner at a hospital in Cheshire. The family of Margaret ‘Nellie’ Smart, 93, lodged a formal complaint against Warrington and Halton Hospitals NHS Foundation Trust, saying they were convinced the mother of 12 died after being dehydrated.
The complaint’s focus is on the patient being dehydrated to death. The Review, also, concentrated on the ‘misuse’ of the Pathway. The LCP apologists shouted from the mountain tops that the LCP does not say to do this. This appears to be a focal point of the Commons inquiry also.

They are expected to say that, in far too many cases, it is unclear whether proper discussions have been held with patients and their families.

They are also set to call for social care for the terminally ill to be free, to ensure people are not forced to suffer bad deaths because of money worries.
Labour MP Rosie Cooper said that if the pathway was still in use, how can we know whether the ‘abuses, misunderstandings and lack of education isn’t going on under our noses now?’ 
Macmillan told the MPs too many doctors and nurses do not know how to talk to patients and their families about death. 
Proper discussions did take place in the case of Mrs Kathleen Vine...
Liverpool Care Pathway - The Three Options: A Post-modern Fairytale
Only she wasn't actually dying!

But for an accident of circumstance, she would have perished. That would have been murder.

They would have murdered Mrs. Margaret Kibble, a grandmother in her 90s...
Liverpool Care Pathway - Recruiting And 'Transforming'!
Margaret would have joined the ranks of the 'missing' 90 year-olds!

The BBC reports -

Where are the missing 90-year-olds?

“ Sadly, they've already died. They just didn't live as long as statisticians had predicted.
The issue is in the actual ‘diagnosis’ of dying and this being a self-fulfilling prophesy...

Back to that Mail report -
An initial police inquiry into the death of an elderly patient has now been expanded after Mrs Smart’s family complained about alleged neglect at the same hospital. She died after the NHS ban on the controversial pathway was imposed.

Her family believe that the great-grandmother would still be alive if she had not been admitted to Warrington General Hospital for checks following a suspected minor stroke.
Mrs Smart is described as a ‘healthy pensioner’. She was 93 years young. The police investigation should not focus on 'neglect' but become a general inquiry into acting upon a 'diagnosis' of dying which then predetermines an outcome that places the patient on these death protocols.

The patient may be healthy or not healthy; the patient may be 93, 83 or 73. The fact is that they have died before their time...

Pertinent reading –

- Mail Online
Health chiefs are studying trends in life expectancy amid fears that it is falling among the elderly.
Concerns come as it is reported that in Blackburn and Darwen, in north-west England, there have been reductions in life expectancy at 85 for both men and women, as well as some signs of a reduction in life expectancy for men at 65.

An email from Blackburn with Darwen Council's director of public health Dominic Harrison, sent to regional colleagues and to Public Health England (PHE), said the council had seen a "sustained reduction" in life expectancy at 85 in its area. "Actual sustained cohort reductions in life expectancy such as this are now extremely unusual," it says.
Mrs Smart is described as a ‘healthy pensioner’.

She has died before her time...

ITV News 
Health officials are investigating a "statistically significant, sustained" decline in life expectancy among elderly people in some parts of England, amid warnings that cuts to social care and pressures on the NHS may be contributing to earlier deaths.
PHE issued a statement last night from Professor John Newton, its chief knowledge officer, which said: "Although there was a fall in life expectancy at age 85 in 2012, preliminary analysis shows there was no further drop in 2013.
"Life expectancy at age 85 will be influenced by many factors and has fluctuated from year to year in the past. However, PHE is currently conducting further analysis of these trends and we hope to make the findings available in the near future."
The fact is that they have died before their time...

2012 was at the peak of the LKP Programme killing spree...

Mail Online 

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?

The New Statesman –

What does this graph tell us? It tells us that the EoLC Programme has worked; the EoLC Strategy is working; and that, for the first time since Mr. Patrick Gordon Walker’s landmark speech, the demographics are going in the ‘right’ direction.
An email from Blackburn with Darwen Council’s director of public health, Dominic Harrison, sent to regional colleagues and to Public Health England, said the council had seen a “sustained reduction” in life expectancy at 85 in its area. “Actual sustained cohort reductions in life expectancy such as this are now extremely unusual,” the email says.
The Independent 
The fact is that they have died before their time...

Dr Foster -

The report highlights Dr Foster’s concerns that current palliative coding encompasses a wide variety of palliative pathways. Patients admitted to hospital specifically for specialist palliative care cannot currently be distinguished from those who were admitted for treatment and whose subsequent deterioration in health led to them receiving palliative care.
The figures show that at London’s Guy’s and St Thomas’, home of Amber, the percentage of patients recorded as ‘palliative’ increased from 1 per cent in 2008 to 32 per cent in 2012.

There have been excess deaths. Amber is working.

The fact is that they have died before their time...
Liverpool Care Pathway - Time To Wise Up
Dr Cliff Richards, local GP and Chair of the NHS Halton CCG (Clinical Commissioning Group) –
"The decision to replace the LCP will not change the fundamental principles of how we deliver end of life care"
'Find your 1%' proceeds; the tools, the advice - the GSF, the SPICT, the 'Surprise Question' and other DoH recommendations - stand. Amber, the Wirral and other LCP scions abound...
Liverpool Care Pathway - Catch Up EoLC
The Project has a long history.

The GSF was originally commissioned from the GSF Centre in June 2006 to support GPs include appropriate patients on their QOF.

For years, the British public has been softened up to accept dying as a positive life option.
‘Earlier identification of people nearing the end of their life and inclusion on the register leads to earlier planning and better co-ordinated care’(GSF National Primary Care Snapshot Audit 2010 )
Care expectations have been downsized.

ACDs are being promoted by a dodgy euthanasia ‘charity’.

The Route to Success -
The route to success in end of life care - achieving quality in ambulance services
28 February 2012 - National End of Life Care Programme
This guide sets out the key role and contribution of ambulance services in achieving high quality care at each step along the end of life care

Whilst highlighting the crucial role of ambulance services, the guide also acknowledges the unique set of challenges and barriers that need to be addressed and overcome.
Healthcare Analysis & Forecasting (HCAF)
"Excess deaths"...

This paper documents a recurring series of infectious-like outbreaks -

Excess deaths are mainly for those aged 85+ although the effect can be discerned above age 65, more amongst the female than the male population.

The increase in deaths is associated with a parallel increase in emergency admissions and emergency department attendances.

There have been excess deaths.

The fact is that they have died before their time...

For years, the British public has been softened up to accept dying as a positive life option.

The Government published its NHS National End of Life Care Program in 2008.

The NCPC has been running the EoLC programme since 2009. They have downsized care expectations. 

A system has been rolled out. It is in place.

A system has been rolled out. It is working.

There have been excess deaths.

They have died before their time...

The Telegraph reported life expectancy is falling among the elderly.

In days, The Telegraph reported here -
Living beyond 100 will become the norm for children born within the next generation, official projections show.

According to estimates published by the Office for National Statistics the average life expectancy for newborn girls in the UK is on course to reach just under 97 years and four months within just over two decades.

Baby boys born in 2037 will expect to live until 94 years and four months on average – with many living much longer.

But the ONS pointed out that people living longer will further add to the pressure on the NHS and care services.

“With life expectancy increasing, the UK’s population will age,” it explained in a commentary.

“This will affect a number of policy areas, including pensions and the health service – particularly because healthy life expectancy is not increasing as quickly.”