Monday, 4 May 2015

Liverpool Care Pathway - In Hope We Trust

When all you have left is hope, you hope. The alternative is defeat and despair.

Of Hollow Conviction, Falsity and Farce.

‘False hope’...

Come on, be realistic -

Mayur Lakhani on seeing the glass half empty:
Speaking on the Kelly Alexander Show, a popular Canadian podcast, Professor Lakhani, a practising GP of 30 years’ standing, said he felt “very strongly” about patients and their families being offered the “false hope” of CPR.

Dr Lakhani said research has shown that when a patient is very elderly or frail the chances of survival or recovery when CPR is administered are “so small as to be discounted and actually could leave someone very damaged”.
- NCPC - Dying Matters
But what is the alternative?

Claire Lomas on seeing the glass half full:
‘They didn’t work my legs,’ she says. ‘The view was the legs don’t work, so they’d only offer physiotherapy to the bits that do work that could improve.
‘I wanted to exercise the bits that didn't work and try to maintain my fitness in case research reaches a point to enable me to use them again. They don’t want to give you false hope – but I don’t think a bit of hope is a bad thing,’ she says.
- Metro
And some Life Café...

This is the Leicester Mercury –
Paralysed London Marathon heroine Claire Lomas has met the man who can walk again after pioneering surgery - thanks to the charity she champions.

Claire, 34, of Eye Kettleby, near Melton, met Darek Fidyka, who was paralysed from the chest down in a knife attack in 2010, who can now walk using a frame.

The therapy, carried out in Poland - thanks to funding by the Nicholls Spinal Injury Foundation (NSIF) - involved transplanting cells from the patient’s nasal cavity into his spinal cord.

Claire - who is heading towards the landmark figure of raising half a million pounds for the foundation - hopes one day it will help her realise her own dream of walking again.
There has been a cultural shift. With the acceptance of the idea of dying as a positive life choice, euthanasia or ‘assisted suicide’ has become popularised and entered the mainstream.

They have changed the way we think. A culture of death has cast its net wide to capture and ensnare opinion. A dark shadow is stalking our hospitals and care homes. The right to death is become paramount over the right to life.
Lomas wasn't awarded with a medal for completing the marathon as rules state entrants need to complete the course within 24 hours. However, 18 runners sent their own medals to her instead.

‘That meant a lot more than being awarded one of my own,’ Lomas says, adding that she’s surprised by the number of letters she gets from people thanking her for inspiring them to overcome challenges in their own lives.

She gives talks to schools and has a similar response from the students. ‘They say: “You’ve changed the way I think.” I just want to encourage them to get out there and do stuff. It’s strange. I’d never have had this opportunity if I was still on horses.

‘I sat and dwelt on the things I couldn't do for a long time after the accident and then stopped and turned it around. If I hadn't, I’d still be sitting there thinking “poor me”. That creates a miserable life. Thank goodness I stopped myself because I've had the best days of my life since the accident. Just amazing days. And I’d never have believed that was possible in the first year, ever.’
Is this false hope, but hollow conviction, to never give in, never give in, never, never, never?
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.

Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.

Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.

And you, my father, there on that sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.
- Dylan Thomas
No, it is not falsity...
How can I just let you walk away,
Just let you leave without a trace?
When I lie here clinging to every breath,
You're the only one who really knew me at all

I wish I could just make you turn around
Turn around and see me cry
There's so much I need to say to you
So many reasons why
You're the only one who really knew me at all

Help me stay the fight against all odds
It's the chance I've got to take
Take a look at me now

There are several times my life challenges me,
But I'm not yet past the post -
The last thing I want is for you to give up on me,
especially when I need you most.
With apologies,-  Phil Collins / Lady Jane, Baroness Campbell of Surbiton
And Claire Lomas continues to inspire...

itv NEWS
Claire Lomas from Leicestershire, who was paralysed after falling off a horse, is about to ride again - this time on a motorbike!

Claire who lives near Melton Mowbray is having a go at biking at Donington Park racetrack.

She became a paraplegic after a horse riding accident in 2007. She went on to make history when she completed the London Marathon in a robotic suit.

Today's challenge has been organised by the Bike Experience which gives disabled people the chance to go motorcycling.

Claire Lomas -motorbike

It is not falsity to strive in the face of adversity but, when the hospital is a university, then rage for here is farce.

This is HSJ reporting on the deaths of mothers and babies at the University Hospitals of Morecambe Bay NHS Foundation Trust 

The Health and Safety Executive has been criticised for not intervening over the deaths of mothers and babies at the University Hospitals of Morecambe Bay Foundation Trust.

James Titcombe, whose son Joshua died at the trust in October 2008, has criticised what he called an “arbitrary policy decision” by the HSE not to bring prosecutions over poor care at the trust’s Furness General Hospital between 2004 and 2013.

However, he praised Cumbria Constabulary for its decision to investigate poor care at the trust. He said: “Without the police investigating, other families would not have come forward and the wider pieces of the jigsaw would never have been put together. We are very grateful to the police.”

He told HSJ: “Under health and safety legislation, the HSE do have the power to investigate and prosecute NHS organisations that fail to take ‘reasonably practicable’ steps to prevent exposing patients to serious risks of harm. It’s a lower threshold than the police but the HSE have chosen not to apply it. They have taken an arbitrary policy decision not to apply the law. The HSE could have done a lot more, sooner, and events wouldn’t have cascaded into what happened.”
James Titcombe’s views are fully supported by Sir Robert Francis in the Mid Staffs Public Inquiry Report  –
13.143 The starting point must be that at the moment there is no criminal sanction available, other than that under the HSWA for failures of safety systems to protect patients, unless these follow failure to remedy a breach of certain regulations after issue of a warning notice by the CQC. Only the HSE has power to prosecute for an offence under the HSWA. The policy reasoning behind this may well be that adopted by Professor Sir Liam Donaldson: that it is generally undesirable to bring the criminal law into the clinical arena, as it inhibits openness and improvement. The alternative view is that in appropriate and serious cases it is in the public interest that those responsible for serious breaches of safety requirements should be held to account. Unless such an avenue is available, there is a serious danger that public confidence and trust in the health service will be undermined. No-one sitting through the two inquiries into the Trust can have been left in any doubt about the impact on public confidence of no individual or organisation having been brought to account for the failures in Stafford.

13.144 Given the current gap through which serious cases of safety breaches in a healthcare setting are likely to fall, the approach of the HSE is not calculated to maintain public confidence, even though such an agency is perfectly entitled, and indeed under a duty to take resource allocation into account in making decisions on what to investigate.143 The approach has the appearance of looking for reasons for not taking action rather than starting from a consideration of what is in the public interest. A concentration on the effect of a decision on resources has led to the unacceptable position where the more serious and widespread a failure is, the less likely it is that the HSE will decide to intervene, even where it is apparent that no other regulator is likely to do so.

13.145 Therefore, there is an unsatisfactory gap in the ability of regulators to enforce criminal sanctions in serious cases, in particular those involving death or serious harm to individuals where serious deficiencies in standards are involved. For understandable reasons, given the breadth of its responsibilities, its lack of specialist expertise in healthcare issues, and the existence of regulators apparently better equipped to make judgements on them, the HSE has been reluctant to take a less restrictive approach to healthcare cases. On the other hand, the CQC has relatively limited powers to prosecute. This restriction has, in part, been formed by reservations about the value of criminal enforcement in healthcare.
‘No individual or organisation was brought to account’.

The guilty escaped justice.

Moreover, the LCP which continues in use was a prime suspect involved in the deaths investigated at Mid Staffs -

The Telegraph
Figures disclosed by the hospital under the Freedom of Information Act show that use of the Liverpool Care Pathway (LCP) rose markedly in the wake of the introduction of targets promoting its use in 2009.

The system of care, intended to give patients greater dignity and less pain in the final hours of their lives, is under review after claims that medical staff across the UK had put people in it without proper safeguards.

It involves removing treatments deemed to be more harmful than helpful including, where appropriate, reducing food and fluids.

But a series of families have come forward to claim that their loved ones were placed on the treatment regime without any consultation or even when they were not imminently dying.

It emerged last year that almost two thirds of trusts using the system had been receiving payouts from the state for hitting targets linked to its use
The costs of the Inquiry up to November 2013 were approximately £13 million which amounts to some £100 thousand a day for every day the Inquiry sat. [Mid Staffs Inquiry]

And the chap in charge who overlooked this debacle walked off with a tidy lump sum and a pension thankyou very much.

No individual or organisation was brought to account.

The guilty continue to escape justice.

The regulators did not and do not investigate and bring to justice those responsible.

No, this is not farce but foul infamy.

And to some the Daily Mail continues to be the Daily Fail...

Supplemental reading -
Liverpool Care Pathway - A Rose By Any Other Name

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

Liverpool Care Pathway - A Failure Of Care

Liverpool Care Pathway - Have You Read the Olds Lately?

Post partum -
 North-West Evening Mail
CLINICAL negligence and legal costs totalling more than £45.3m have been paid out by the trust that runs Barrow’s hospital since 2003.

The stark figure includes a £12.5m bill to cover claims for failures within maternity services across Morecambe Bay between 2006 and 2013 – years in which shocking clinical failures resulted in the avoidable deaths of 11 babies and a mother at Furness General.

A breakdown of the individual claims and settlements was not provided by the University Hospitals of Morecambe Bay NHS Foundation Trust – despite a request submitted by the Evening Mail under the Freedom of Information Act.

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