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

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