Saturday, 25 April 2015

Liverpool Care Pathway - Dignity In Living

Such is the mettle of those who, lacking that courage themselves, deny and question that courage in others.

It is two years ago.

Jason Pitt spoke exclusively to Heart -
Walsall Hospital have replaced humanity with procedure and compassion for compliance.”
Jason’s Mum, Lynda, had her life taken on Mother’s Day, 2013.
“Despite the fact my mum was completely paralysed with limited ability to communicate we asked her the question did she want to go and she indicated strongly that she wanted to fight she wanted to be here and we also asked her if she felt let down by Walsall Hospital and she pressed her thumb to indicate 'yes she did'.”

Not everyone is just prepared to roll over and die. As inevitable as death may be, they don't plan on checking out just yet and certainly not without a fight.

The Quislings have taken over. When Death comes knocking, they will not fight for us but happily hand us over.

It is modern medical practice to always see the glass half-empty...

This is Heart West Midlands reporting on the Walsall Manor Hospital Review in 2013 -

Off the back of scandal-hit Stafford Hospital a 12 week independent review of death rates at Walsall Manor hospital is due out next month - with a brief update on the 12th March.
The Walsall Healthcare Trust was investigated over it's mortality rates which were almost 20% higher than expected between April 2011 and March 2012.

According to the Doctor Foster Hospital Guide into mortality rates at Hospital's across the country which came out in December 2012, Walsall Manor Hospital had 117 deaths between April 2011 and March 2012. The expected is 100.

Life is such a very precious gift and not to be readily surrendered.

Doctors gave Lady Campbell a year to live when she was born. Nine years ago, they put a DNR notice on her medical records, as if her life was not worth living.

Baroness Campbell of Surbiton, founder of Not Dead Yet, was once told by doctors that they “presumed” she would not want resuscitation if she experienced complications during treatment.

It is part of the human spirit to struggle to survive, to appreciate and understand life for the precious gift it is and not to be readily surrendered.

Further reading -
Liverpool Care Pathway - When Doctors Lack Capacity
- The Mott MacDonald Review
The following is taken from the Walsall Manor Hospital Review -
“All models are wrong but some are useful” –George Box
Hospital Standardised Mortality Ratio (HSMR) is an internationally recognised and used indicator to analyse the rate of inpatient mortality by comparing it to the national mortality rate, adjusting for various factors such as whether the patient was admitted for palliative care, how sick they were (number of comorbidities they had), and standardising for age, sex, deprivation and other population factors. It is shown as a ratio with a number higher than 100 representing higher than expected mortality and a number lower than 100 being lower than expected. 
Issues such as coding, variation in palliative care activity and reporting of comorbidities can all lead to high HSMRs. 
These issues are explored further in the contents of this report, with a particular focus on determining the sensitivity of key variables used within HSMR, and testing to see how Manor Hospital’s HSMR has been historically affected, and can be influenced in the future, when changes in practice, care provision and coding occur. 
In 2008 the Trust was identified, along with many other Trusts in England, as having a high rate of palliative care coding which can have the effect of lowering HSMR. In response to this the Trust brought its rate of palliative care coding back down to below the national average. 
The use of Palliative Care coding can have a significant effect on a hospital’s HSMR, as the addition of the ICD10 code Z515 “Other medical care –Palliative Care” significantly increases the risk, or probability of death for a patient, within the HSMR calculation.If enough patients are coded with a palliative care code, this has the effect of lowering the overall HSMR for a hospital by increasing the expected chance of death for these patients in the calculation. The sensitivity of HSMR to palliative care coding is a well-documented issue and is often a source of controversy as it can provide a mechanism for hospitals to artificially lower their HSMR by over using these codes. Over-coding of Z515 widely occurred throughout the NHS from 2006/07 to 2008/09, with the proportion of deaths coded with a Z515 code increasing by over 300% nationally over this time span. This relates to initial and then revised CFH coding clinic guidelines on the use of the palliative care (Z515), which is a known national issue. This was also a focus in the recent Mid Staffordshire mortality review. 
There is a clear inverse relationship between palliative care coding and HSMR. 
This could be interpreted as an attempt by Walsall to reduce itsHSMR artificially simply by increasing the level of palliative care coding in the hospital, however we do not believe this to be the case. 
We believe the current rate of palliative coding, despite being approximately 1.5 times that of the national average, is appropriate for Walsall NHS Trust as a high proportion of the population die in hospital as opposed to in the community in hospices or care homes. It would be expected that many of these ‘excess’ patient deaths in the Trust would be appropriately receiving palliative care and then coded as such. The addition of 2 new palliative care consultants in the Trust and wider local health economy seeing all end-of-life in patients as part of a palliative care team will also have direct causal effect on the increase in palliative care coding in the Trust. The Trust and CCG have also spent considerable effort assessing the issue of palliative care coding as evidenced by private board level reporting on the issue and a report by the CCG looking at coding from January to April 2012. Both concluded the level of coding was appropriate based on national coding guidelines and clinical best practice.
The Review says, unequivocally, that ‘excess’ patient deaths in the Trust would be appropriately receiving palliative care and then coded as such.

Patients receiving palliative care are on End of Life Care (EoLC) Pathways.

They are 'diagnosed' for palliative care.

Excess deaths...

The ACD, EoLC and the 1% Death Lists are all in place to wind down care; the glass is perceived to be half-empty,not half-full.

Just because the odds are that there is a less than best chance of a successful outcome, do you then give up?

But what is the alternative?

Walsall Council's response to the excess deaths at the Manor Hospital was to send them home to die. That is what the Review recommends.

This is the Walsall Council Health Scrutiny Panel –

Members were given a chance to  raise queries about the latest measures being put in place to ensure good quality care for those in the final stages of life at the latest health scrutiny panel meeting. 
At their meeting earlier this month members received the third in a series of updates on progress from Walsall NHS Healthcare Trust staff on their End of Life Care action plan. 
Plans to develop a local approach for end of life care, following national best practice guidance are progressing well. 
Key actions reported to the panel include arrangements to share information safely and appropriately with partners on patients' wishes for their end of life care, a roll out of a new training programme on palliative care for all relevant hospital staff and improvements to support for families dealing with bereavement. 
Further progress is also being made on working individually with each patient and their family to tailor support to their needs and wishes, such as help with equipment or care should they wish to spend their final days at home. 
Councillor Doug James, Vice Chair of the panel, said: "This is a good opportunity for the panel to reflect on the journey we've been on together with the hospital, social care and other partners. 
"The panel has been criticised in the past, for example on the Mott McDonald report into mortality rates at the Manor, but this highlighted the need for greater integration between agencies. 
"Since the report's publication the panel has seen a significant improvement and an ongoing commitment by all agencies that when people go through tough decisions they are responded to jointly by the whole health economy. 
"We have moved forward and we now have a much improved service to patients, but we will not become complacent, we will continue to improve. 
"This is an opportunity to move forward together and offer an improved service. 
"Thank you to all who have been involved." 
Question: How do you reduce the hospital (diagnosed) palliative excess death rate?

Answer: ‘Head ‘em up; move ‘em out’!

Further reading -
Liverpool Care Pathway - The State Rules, Okay?

Liverpool Care Pathway - Lamb's Move And Mate...

Liverpool Care Pathway - The Many Pathways To The Perdition That Awaits Us

Liverpool Care Pathway - The Micawber Principle

Liverpool Care Pathway - Back To A Way Forward
Post Note:

Even after the fallout from the LCP Review;

Sunday Post 
even after all the publicity...

Professor Julian Savulescu is pictured here posing on a window seat against the backdrop of the campus grounds on the pages of QUT Queensland University of Technology).

Professor Savulescu proposes Palliated Starvation as a legal and ethical form of assisted dying.

This is QUT -

People with terminal illness have the right to refuse to eat and drink and receive palliative care if they wish to die, argues world renowned ethicist Oxford University Professor Julian Savulescu.

Professor Savulescu will speak about the place of refusal of food and hydration as a legal and ethical form of assisted dying at QUT School of Law's 2014 Health Law Research Centre annual public lecture on March 31.

QUT Health Law Research Centre director Professor Ben White said euthanasia, and proposed legislation surrounding euthanasia and assisted dying had been a long-standing staple of debate in the health law and bioethics fields, and in the broader community.

Saturday, 11 April 2015

Liverpool Care Pathway - Identification, Identification, Identification

On parade, the usual suspects and the LCP lives!

Mr. Patrick Gordon Walker's landmark observations still echo down the years...

The End of Life Baseline Report published in 2011 warned of a "Tsunami of need".

Just last year, Hartlepool Care Home Managers forum held a Study day, The Elderly and the Time Bomb Conference, to address EoLC following the phasing out (sic) of the LCP.
Liverpool Care Pathway - The Final Countdown... And Counting
The length and breadth of the land, the portent of a demographic debacle is the motivating raison d’ĂȘtre in implementation of every EoLC Strategy.

This is NHS Shetland –
The population of Shetland is ageing. Figure 1 below shows how we predict that this will continue, with the number of 75+ expected to more than double by 2035. A population who live longer are increasingly likely to be living with a range of long term and progressive conditions. Currently, on average 213 people in Shetland die each year. The majority of people who die are over the age of 65 (87% in 2011) and 80% of these deaths are preceded by a period of illness or increasing frailty.
The EoLC Strategy was published on 16 July 2008 under the 2005-2010 Labour Administration.

The Strategy was implemented and rolled out. It has since been continued with zeal by the Coalition.

The DoH invited the National Council for Palliative Care (NCPC) to groom the British public into accepting the idea of dying as a positive life choice. Out of this was formed the Dying Matters Coalition. The NCPC has led the Coalition since 2009. The EoLC Program was effectively outsourced to the NCPC.

In their own write: "The National Council for Palliative Care (NCPC) is the umbrella charity for all those involved in palliative, end of life and hospice care in England, Wales and Northern Ireland".

In 2009, the NCPC set up the Dying Matters Coalition to promote public awareness of dying, death and bereavement. It is chaired by Professor Mayur Lakhani, who is a practising GP and author of the Lakhani Recommendations. The Lakhani Recommendations are now protocol.

The work of the Coalition is supported by the NCPC’s Board of Trustees.

It has done its work well...

The New Statesman asked: Why are old people in Britain dying before their time?

The BBC asked: Where are the missing 90-year-olds?
Liverpool Care Pathway - Reports And Reports Of Reports
This does not moderate their zeal; on the contrary, it only excites their determination and their predictions remain steadfast and dire...

NHS Shetland –

And LCP lives...!
Priorities set in 2009
  • Implement a localised Integrated Care Pathway for the dying based on the "The Liverpool Care Pathway for the Dying Patient‟ (LCP) which facilitates regular re-assessments towards the end of life
  • Ensure that all professionals know how to access equipment for adults and children at the end of life and arrange for its delivery
  • Develop the skills of professionals to recognise when a patient might be nearing the end of life.
  • Develop and implement a Do Not Attempt Cardio-pulmonary Resuscitation (DNACPR) Policy to support the process of making resuscitation decisions.
     Current position (2013)

  • A localised Integrated Care Pathway for the dying based on the "The Liverpool Care Pathway for the Dying Patient‟ (LCP) was introduced in 2011 and is monitored on a regular basis
  • Training has been put in place to support the LCP and to ensure that there is a consistent approach when using the pathway and recognizing when someone might be nearing the end of life
  • Inventories of equipment have been put in place so all professionals know how to access and arrange delivery of equipment
  • The national DNACPR Policy has been implemented, with regular review of compliance with the DNACPR assessment process being undertaken by medical staff. Other policies with training for staff have also been implemented to support individuals to understand their rights and make decisions about their ongoing treatment e.g. through the Adults with Incapacity (Scotland) Act 2000 and the Resuscitation Planning Policy for Children and Young People (2010)
  • There has been an increase in the number of Non Medical Prescribers (e.g. nurses and pharmacists) who can independently prescribe medicines making it easier and quicker to provide appropriate medicines for people with long term conditions or palliative care needs. Symptom control has also been improved through the availability of the “Just in Case Boxes‟.
Going Forward (2013 - 2016)
  • Continue to implement integrated approaches to support people who are in the dying phase of their life, including the LCP or other structured, individualised care plans as appropriate.
  • Continue to implement systems to review and monitor the care standards set out in the integrated pathways so that improvement ideas can be identified 23 and implemented (e.g. quality of record keeping, undertaking case reviews in the primary care setting and the hospital, undertaking significant event analysis when needed, monitoring patient and family inclusion in care planning, monitoring the DNACPR assessment process etc).
  • Implementing all of the other recommendations and principles in this strategy which come together to make a holistic plan to support people at the end of their life.
Performance targets have to be met against National Indicators.

Performance Indicators are a measure of ‘how well we are doing’.

Those who seek are sure to find and those ‘skilled’ to recognise when a patient might be nearing the end of life are sure to seek them out and find them.

  • There has been an increase in the number of Non Medical Prescribers (e.g. nurses and pharmacists) who can independently prescribe medicines making it easier and quicker to provide appropriate medicines for people with long term conditions or palliative care needs. Symptom control has also been improved through the availability of the “Just in Case Boxes‟.

Those who seek are sure to find and those ‘skilled’ Non-Medical Prescribers who 'recognise' that a patient might be nearing the end of life are sure to ease them into a 'good' death.

The BBC asked: Where are the missing 90-year-olds?

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?

They will (of course!) trawl in many who would not have formed part of the One Percent cohort they are exhorted to seek. By far the greater part of medical error consists of medical misdiagnosis. There will be excess deaths...
Palliative Care Performance Indicators
Palliative care performance indicators were published in 2013 by Healthcare Improvement Scotland, which provides a clear set of outcome measures for the provision of palliative and end of life care in Scotland. 
The intention is that the data to demonstrate performance against these outcome measures will be taken from routinely available information already provided to Information Statistics Division (ISD) and the results will be represented to Health Boards to be included in the clinical governance arrangements and future planning of services. 
The indicators are shown below and will form part of our local performance scorecard for palliative care and end of life care.
  • Indicator 1: Increase in the number of people with palliative and end of life care needs who are identified
  • Indicator 2: Increase in the number of people with palliative and end of life care needs who are assessed and have a care plan
  • Indicator 3: Increase in the number of electronic palliative care summaries accessed
  • Indicator 4: Place of death
Increase in the number of people with palliative and end of life care needs who are identified...

Indicators must and will be met and exceeded as marks of performance

and NHS Scotland has its own, home-grown version of the GSF (naturally).


This is the ‘tool’ they will use to ‘identify’ their 1%. Top of the list, at number one, is the Barton Method:
1. Ask
Would it be a surprise if this patient died in the next 6-12 months?
The ‘surprise question’.

Identification, identification, identification.

If this was a police identity parade, it would be called a 'stitch up'!


2013 was the halfway point of the 10-year 2008 End of Life Care Strategy. To mark that, the National Council for Palliative Care (NCPC) held a conference “Refreshing the strategy. The next five years for end of life care: what do we need to do?” 
Liverpool Care Pathway - What Is To Be Done...?
We are almost there but they are not quite finished yet.

With the acceptance of the idea of dying as a positive life choice, euthanasia or ‘assisted suicide’ has become popularised.

It is now in the main stream.

Additional reading -
Liverpool Care Pathway - Of CQuINs, Tipping Points And QUELCAs
Liverpool Care Pathway - The Werther Defectives
Liverpool Care Pathway - Time To Wise Up
Liverpool Care Pathway - When The Caring Had To Stop
Liverpool Care Pathway - Hard At Their Purpose
Liverpool Care Pathway - Recruiting And 'Transforming'!
Liverpool Care Pathway - The Three Options: A Post-modern Fairytale

Saturday, 4 April 2015

Liverpool Care Pathway - A Rose By Any Other Name

The timorous may lack the temerity to grasp the nettle by the stem but who will grasp the rose by the thorns...?

The much anticipated Rose report was submitted to ministers in December but has not surfaced into the public realm. It has been variously described as "damning" and a “totally shocking” report which has been put on “the back burner of the back burner” as the general election looms larger on the horizon.

This is Mail Online –

A report into the management of the NHS that is said to be damning is being sat on by ministers, it was claimed last night. 
Former Marks & Spencer boss Stuart Rose was asked a year ago by Health Secretary Jeremy Hunt to assess how NHS hospitals could keep ‘the very best leaders to help transform the culture in underperforming hospitals’. 
He handed his report to ministers on time at the end of last year, but it has not been given a publication date, according to the Financial Times.
HSJ has gained sight of a draft copy of the report.

There’s no fool like an April Fool and this story published April 1 in the Journal may not only add to but confound all the speculation -

A draft of the report, seen by HSJ, contains a number of measures which would be profoundly challenging to NHS culture.
The report is called NHS Plan A, an echo of the highly successful environmental strategy Sir Stuart introduced at Marks & Spencer and whose name highlighted the lack of alternatives.
He recommends the health service introduces a system-wide bonus scheme, modelled on those used by FTSE100 companies. Under the scheme the most outstanding NHS board executives could potentially earn up to 10 times their base salary in a given year.
The bonuses would be linked to a suite of “completely ungameable” metrics, including performance against accident and emergency targets, continuity of service risk ratings, the friends and family test, Care Quality Commission ratings and efficiency gains.
Bonuses which could be worth up to £1m...

Is this report, far from being the skeleton in the closet, the big gun held in reserve to give the broadside?

Bonuses for bosses will be funded by 'putting a high street in every hospital'.

Moreover, the rank and file need ‘motivating’ according to Mr. Rose.
He notes that “quality, service, cleanliness, and operational excellence” are a challenge in many NHS trusts and that these are exactly the same goals which the McDonald’s “gold star” scheme has been so successful in tackling for the fast food chain.

Proposing the introduction of a similar scheme in the NHS, he recommends that NHS support staff gaining gold stars would receive small financial rewards such as retail vouchers. Achieving all four stars would automatically mean receiving the next Agenda for Change pay increment the individual was eligible for.
One Morecambe Bay laid to rest...

Another Morecambe Bay in the making...?

Hackney Gazette reports –

Another mother-to-be has died at Homerton Hospital, becoming the fifth in a string of deaths which had already prompted an investigation.

NHS England (NHSE) was called in last summer to assist an internal review into how four mothers under the care of the maternity unit at the Homerton Row university hospital died within the space of eight months. In the whole of England and Wales in 2013 there were just 47 maternal deaths during pregnancy, childbirth and the six-week period following birth.

The hospital had already undergone one internal review, another from the Care Quality Commission and a further from the City and Hackney Commissioning Care Group following persistent allegations from an anonymous group of whistleblowers about “avoidable” deaths of mothers and babies there.

The deaths at the maternity unit occurred in July and October 2013, and January and April 2014, with the latter believed to have followed an elective caesarean section.

The latest expectant mother died on January 17, and a spokesman for Homerton said the matter was “in the hands of the coroner”, adding the case would not be included in its internal review, which is not yet complete.
One, two, more Morecambe Bays...?

Is any regulator really worth their salt?

Here's the Manchester Evening News –

The M.E.N. understands the 10 deaths took place between December 2013 and July last year – with four babies and two mums dying at Oldham, and three babies and one mother dying at North Manchester.

We learned Pennine Acute Trust, which manages both hospitals, commissioned the external review in July last year and received the findings back at the start of this year.

A summary of the review, obtained by M.E.N. from the Trust, reveals how investigators found there was a ‘notable absence of clinical leadership in both medical and midwifery teams’ which resulted in a ‘failure to adequately plan care’ in a number of cases involving babies.

They also found risk management was ‘below standard’ in some cases – although there were no apparent ‘deficiencies in care’ in the deaths of the three mums.

The families of the babies and mums were not told about the external review until the M.E.N. approached Pennine Acute Trust about it.
Hey, but who’s complaining, anyway? Funding provision for complaints advocacy is not being funneled through...

According to the Local Government Chronicle –

According to data collected by Healthwatch England under the Freedom of Information Act, shared with LGC’s sister title Health Service Journal, 13 councils failed to hand on more than £50,000 each to their advocacy provider and three failed to pass on more than £100,000.

Collectively, councils were awarded £14.2m a year through the local reform and community voices grant to fund independent NHS complaints advocacy services, which help patients and families navigate a complex complaints system. Local Healthwatch provide these services in some areas.

Katherine Rake, chief executive of Healthwatch England, urged councils to rethink the amount they spent on complaints advocacy.

She said as many as 250,000 incidents of poor care could go unreported every year due to the “complexities of the complaints system and the level of fear amongst patients”.
Two-thirds of patients Healthwatch surveyed who had a bad experience but did not report it said they would be more likely to in future if they were offered support, she said.

Ms Rake said: “Considering the relatively modest amounts being invested in complaints support nation-wide, Healthwatch England is calling on commissioners to ensure they fully consider the resourcing necessary for a well publicised and easy to use complaints support service.”
- Pulse
Nice guidelines are becoming more and more nonsensical according to Pulse, actually depicting the Institute as being a bunch of braying asses...

NICE has been clamping down on prescription of antibiotics -
GPs will be given annual reports on their antibiotic prescribing and local resistance patterns under draft plans to curb the use of the drugs in primary care released by NICE today.

The draft NICE guidance says local ‘antimicrobial stewardship teams’ should review GP antibiotic prescribing and target areas where inappropriate prescribing may be driving the development of drug resistance
 - Pulse
However, the renowned Peverley column in Pulse reports as follows…
There are two wonderful advances in modern medicine; antibiotics and vaccines. Without them, we GPs would not be all that far from our 18th- century colleagues’ position of only being able to offer placebos, laudanum, bark, quinine, the blue pill and the black pill, leeches and a slime bolus (whatever that was). OK, to be fair, we are still big on offering placebos. 
But now, apparently, we are no longer supposed to prescribe antibiotics. Never mind that more than half the antibiotics in the world are poured down the necks of poultry and cattle to make them bigger, more quickly. Never mind that these drugs are available over the counter across most of Europe to anyone with a scratchy throat and five euros to spare. Never mind that the French, the Greeks and the Americans have an antibiotic ingestion rate thrice that of the UK population. We, the GPs of Great Britain, are apparently responsible for all the woes of antibiotic resistance, and must be forced to change.
Without antibiotics, Factory Farming wouldn’t work. Antibiotics keep the animals alive and healthy for long enough to get them to market.

If GPs are responsible for microbial resistance it is exactly through following those guidelines to under-prescribe. The punters go away and come back to report the symptoms haven’t. GP prescribes a different antibiotic, not because the first didn’t work, but because the dose has given the bugs immunity.

Peverley continues...
Technology is the answer to many of the world’s ills. No new antibiotics have been developed for decades, and the reason is obvious. Drug companies are interested in developing drugs patients will take for decades on end - statins, for example. A drug taken for five days at the most does not hold the same commercial attraction. Fix that problem and we have solved the antibiotic resistance problem.
But in the meantime, don’t blame GPs for using the best tools we have to hand.
Big Pharma, bad. Big Government, bad. Together, disaster.

A Medical-Pharmaceutical Complex...

Further reading -
Liverpool Care Pathway - The Morphine Ruger 
Liverpool Care Pathway - The Sneak In The Waiting Room 
Liverpool Care Pathway - The Three Options: A Post-modern Fairytale

Friday, 3 April 2015

Liverpool Care Pathway - Just Ticking The Boxes

It's a NICE turn of events when the QOF is more important than the cough...

Did anyone ask the punters?

Is this a case of the Monitor demonstrating it is adequately monitoring by chasing the ‘box-ticking’...?

This is Pulse –

Dr Khan said: ‘I am disappointed by the decision of the tribunal, but I am grateful that it acknowledged my practice had run for 33 years, “without incident” and with very few complaints. I have been with the NHS for 45 years.
‘This is after all a decision by the CQC based largely on issues such as the keeping of records, fire risk assessments, extension cables and hypothetical scenarios. The decision to close my surgery did not relate to any actual treatment of my patients, for which no criticism has ever been made by either the GMC or the CQC.’
He added: ‘Those who have lost most are my patients who have been forced, against their will, to find alternative surgeries to care for them, breaking the doctor/patient relationship which was in many cases, over 30 years old.’

Back in the day, family doctors knew their ‘manner’ was as important as their medicine and the patient was not an island in isolation but a part of a family unit that had consequences and outcomes.

Back in the day, there was always an appointment at the desk and the receptionist was a facilitator to get you the appointment, not a wall you had to go through to get one.

The good doctor was shut down not because he failed his patients but because he failed his QI.

It's election time come round again and the politicians are anxiously making promises which others will have to keep. Dr. Sarah Wollaston, House of Commons Health Committee Chair, comments in Pulse –
‘It’s easy for politicians to introduce these kinds of targets and directives without remembering there are unintended consequences’
Yes, there are always consequences...

GPs are resolutely fishing for their 1% but there is no ‘patient safety’ concern at the potential for the misdiagnosis of dying.

A medical holocaust has proceeded and there is no thought for the consequences or outcomes.

It’s not the cough that carries you off but the QOF may size you up for the coffin...

Accreditation, accreditation, accreditation is the one and only driving factor to demonstrate patient safety.

The devil is always in the detail but, in ticking off the detail, do you overlook the bigger picture?

Fifteen years it is and yet a further investigation begins...

Portsmouth News
A police investigation was held into the deaths of 92 patients at the Gosport War Memorial between 1988  and 2000 but no criminal prosecutions were ever brought. A review into the deaths was 10 years in the making.

They connived to release that review, the Baker Report, buried underneath the hype of the publication of the flawed LCP Review and the weekend news. Did anyone really notice?

The Barton legacy lives on.

The Wessex Guidelines became the LCP. The Barton Method became the Surprise Question and installed as part of the Gold Standards Framework (GSF). The GSF is employed by GPs to determine their 1%.

In December, the Gosport Independent Panel sat, chaired by Bishop James Jones.

Gosport Independent Panel
The Gosport Independent Panel has been set up to address concerns raised by families over a number of years about the initial care of their relatives in Gosport War Memorial Hospital and the subsequent investigations into their deaths. The Panel will oversee the maximum possible public disclosure of all relevant documentary information.
The maximum possible disclosure...

Pertinent reading -
Liverpool Care Pathway - Ten Years In The Waiting  
The maximum possible disclosure?

Why not full disclosure? What is there to hide? People have died before their time. Their lives were taken. After 15 years, isn't it time to tell the truth?

Was it all a testing ground for what has happened since? A programme has been rolled out which continues to this day. Lives have been taken. They have died before their time.

Where are the missing 90-year-olds? Were the projections wrong...?

BBC News
“ Sadly, they've already died. They just didn't live as long as statisticians had predicted.
Thousands of elderly people are missing. The last UK census found far fewer people in their 90s than expected, and the same thing happened in the US with people over 100. Could this be an early sign that gains in life expectancy made in recent decades will not be repeated in future?
There were 30,000 fewer people aged in their 90s than were projected should be the case...

A programme has been rolled out. GPs are sizing up the usual suspects for their 1%.

They can eye you up and by intuitive assessment 'know' you are going to die. That is the essence of the GSF Surprise Question; that is the Barton Method. They interpret that nuance of tone, that expression. We have come a long way.

Lives have been cut short. That is murder.

The Gosport Independent Panel is now joined by Dr. Bill Kirkup.

Dr. Kirkup has been chairing an inquiry into infant deaths at Morcambe Bay and now joins the inquiry into elder deaths at Gosport.

This is the North-West Evening Mail reporting on the Barrow Hospital Inquiry –

THE chairman of the inquiry into poor maternity care and deaths in Barrow’s Furness General Hospital has said he was “disappointed” by the response of professional bodies to his report.

Dr Bill Kirkup, who lead the investigation into University Hospitals of Morecambe Bay Foundation Trust has said he wanted to see more “professional leadership” from bodies such as the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives.

Dr Kirkup told the Health Service Journal: “I am disappointed that there wasn’t a stronger response from the professions, particularly the medical profession. There just hasn’t been any attention given to it at all."
There have been "avoidable deaths". Lives have been lost and lives have been taken.

In anyone's language, morally, that is murder; at the very least, it is manslaughter.

And the good doctor is shut down, not because he failed his patients, but because he failed his QI...

It's a NICE turn of events when the QOF is more important than the cough.

Further reading -
Liverpool Care Pathway – 'The End Of The Line'

Liverpool Care Pathway - The Three Options: A Post-modern Fairytale

Liverpool Care Pathway - Twenty Four

Liverpool Care Pathway - There Are Always Consequences