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.”

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