Sunday, 25 October 2015

Liverpool Care Pathway - And Who Is The Victim?

Once you're the star of the show, it's hard to just step off the stage. You're in  the spotlight and the Super Troupers take charge.

She was a political activist. She was an advocate for the use of killing as a therapy and a treatment.

The solidarity of common cause reinforces resolve and commitment to the idea. She became the bandwagon advertising campaign success story which finally rolled out the California Act permitting people to be legally killed.

She is Brittany Maynard.

Compassion & Choices

The bandwagon was given its roll by Compassion & Choices.

They got the right PR people on board and made her the star of the show. There was no going back then.

The best response in any debate is the counter response which counters the argument, not with argument, but which uses that same argument to make a counter point.

They made her into a reality show with a spiritual, almost 'religious' quality about its presentation.

And pulled the rug from under the feet of the opposition.

They will take this to the very steps of the Capitol and milk it for the very last dreg of political capital they can make from it.

The man behind Compassion & Choices is ex-Brit Derek Humphrey who was a founder of The Hemlock Society.

The Hemlock Society was founded in 1980. This later became End-of-Life Choices. In 2005, it merged with Compassion in Dying to form Compassion & Choices headed up by Barbara Coombs Lee.

The Act affords the 'Right to Death'. This is, according to Barbara Coombs Lee and Compassion & Choices, a Right afforded by the US constitution.

The Constitution already affords and plainly states a Right to Life and Liberty but this ‘Right’ is a negative Right. It is the Right to not have life.

The President has already made the complaint that the Constitution is a constitution of negative liberties, stating what the State may not do...
Liverpool Care Pathway – Fur Das Wohl Des Staates
Liverpool Care Pathway - And The Right To Life
Is everything to be turned on its head such that it shall be a constitution of positive liberties and negative rights?
Declaration of Independence 

Then is America America no more.

If it is self-evident that all are born possessing certain rights, among these Life and Liberty, then these things may only be denied, not given.

Therefore, a 'right' to die is not a right at all except a right to not have life.

So, who is the Fool, the Hero and the Villain? And who is the victim? Are we all taken in?

Cultural attitudes have been chipped away, subtly but surely: unnoticed perhaps, and imperceptibly, but profoundly altered.

Compassion & Choices is a political bandwagon that has nothing to do with charity. It is still a US ‘trusted charity’, tax exempt and tax deductible.

There is need for charity reform. This is a mockery of charity, a crass caricature.

The video is a family celebration. It is joyous but we are applauding death.

There is an unsettling 'normality' about it all but we are watching the suicide on the ledge and tipping them over with our applause and approval.

When death stalks you and stares you in the face, do you capitulate and surrender, assist death in its work?

A ‘prognosis’: what is that? And if we say, "Six weeks, six months, what's the difference; she is going to die anyway," then what is nine months, a year, two?

is life so insignificant? Is it the highest common factor or the lowest common denominator?

Every day is a bonus; life is precious and living matters.

Should we determine when we die like Beverley Broadbent, live a ‘complete life’ of our own defining, end it at a high spot and go out with a bang?

They say:
“no one should have to uproot their life in the middle of a grave illness”
 Compassion & Choices
In the middle of a grave illness (Good choice of word there!) your life is already uprooted.

It is death which 'uproots' life. It is the Terminator, the final finality in life.

It takes our loved ones from us and removes us from our loved ones.

California has stepped through the Looking Glass.

The fire is in the grate, yes, but this is a different reality.The world may not appear at all different; what changes there are are almost imperceptible but will only become plain when we peer back through that glass darkly.
If all what is is what it isn’t
Would we know; could we tell?
And all that isn’t isn’t? Well...
I’m not so sure that you could tell
What is what and who is who
If I am I and you are you.
Killing is now both treatment and therapy.

Incidental reading...
Liverpool Care Pathway - So Readily Do Perceptions Change...
Death does ‘uproot’ life.

Euthanasia/Assisted Suicide is killing. Can killing become a cost-cutting exercise? It may be the cheaper option to put you down than keep you going.

The State is always in denial of its crimes. It may try to reach an accommodation but b
ecause the State says it is so, that does not make it so.

This world is more Orwellian than even Orwell could ever have imagined in any nightmarish vision of future past.

According to the LGA (Local Government Association) -
The failure to properly fund services for elderly and disabled people is already leaving councils having to severely strip back or axe other key services. It also means there is less money to properly recruit, train and keep the best staff and risks essential residential and home care providers going out of business if councils can't afford to pay the cost of the care being provided.
The current combined pressures of insufficient funding, growing demand and extra costs mean that adult social care is facing a funding gap that is growing by at least £700 million a year, estimated to reach £2.9 billion by the end of the decade, even before the cost of the National Living Wage is taken into account in full.
The LGC (Local Government Chronicle) says -

Care minister Alistair Burt has indicated social care will benefit from the additional £8bn funding promised to the NHS, despite NHS England arguing all the money is needed for the health service.

Mr Burt’s comments came during his speech to the National Children’s and Adults Services Conference on Friday, in which he said he wanted social care to be afforded greater status by the NHS.

He said: “I am very keen to see social care have the same priority in [the] NHS as is given to hospitals and GPs and other things.”

The Health and Social Care Economy has arrived. Health is taking over social care, seamlessly, in a joint funding operation.

Background reading -
Liverpool Care Pathway - Transformation

Liverpool Care Pathway - When Justice Must Be Bought And Those Who Seek It Punished

Liverpool Care Pathway - Reports And Reports Of Reports
Care options and expectations have been downsized. They are hiring EoLC Facilitators at a Town Hall near you...
Liverpool Care Pathway - When The Funding Had To Stop
This is Halton Borough Council –
The Gold Standard Framework (GSF) is a system designed to support this process supported by GSF Prognostic Indicator Guidance. This guidance is to assist GP’s in identifying symptoms that would indicate a patient is approaching the last 12 months of life. Once this identification has been made they should then be added to an End of Life register within their GP Practice. By adding a patient to an End of Life register, this will allow regular multi-disciplinary discussions to take place to discuss that patients care. These discussions will ensure clarification of patient needs, the ability to provide pro-active support and act as a mechanism to prompt advanced care planning discussions.

The aim in Halton is for all GP’s to adopt GSF principles in order to provide seamless care at end of life.
Evidence suggests that most people, if given the choice would prefer to die at home. If a patient has been identified as approaching the end of life it is necessary for the team caring for the patient to initiate discussions to establish what the patient wishes are in relation to their care.

In order for this to happen, we need to ensure that staff and healthcare professionals feel comfortable in initiating these conversations with patients and families and feel confident in explaining the decisions that can be put in place to ensure patient wishes are adhered to.

To facilitate this, an Advanced Care Planning Team has been established within Halton, which includes an End of Life Care Facilitator and a Project Support Officer who are supported by the wider Palliative care network. The role of the Advanced Care Planning team is to provide staff within both health and social care settings with the skills and training to be able to initiate discussions and effectively communicate with patients and families.

To date, a number of initiatives have taken place to improve end of life skills across health and social care including;
• Bespoke training with GP Practices including all staff.
• Half day training events on end of life tools
• Commencement of the Six Steps training programme in 11 Care Homes
The Six Steps to Success is the North West End-of-life Care Model.

The GSF Prognostic Guidance includes the Barton Method to identify likely recruits for the Death Lists.

And we’re all looking back through the Looking Glass.
Beware the Jabberwock he says:
He’ll eye you up and down besides.
Watch out his Barton Method gaze,
the driver’s maw as in it slides!

The Jabberwock will size you up,
his eyes all sneaky beams.
And everything is what it isn't
For nothing's what it seems.

Once something is accepted in principle, that principle will creep with a certitude and inevitability.

Here, Jukka Varelius, writes in Bioethics -

Killing is being considered not because that has been sought nor because permission has been given but precisely because it hasn't.

Killing becomes an entirely physician determined decision.

Thus is the circle complete?

Of positive liberties, negative rights and negated decisions... thus through the Looking Glass do we tumble?

Further reading -
Liverpool Care Pathway - And "Rational" Suicide

Liverpool Care Pathway - A Perverse Symmetry

Sunday, 11 October 2015

Liverpool Care Pathway - Killing By Command

"They are a law unto themselves..." They are under financial constraint. And corners will be cut.

The financial cider apple press is putting the squeeze on the largesse.

The NICE recommendations on ACDs and EoLC are now 'good practice'.

The Policies and Procedures are written up; all the mechanisms are in place.

They want to hear how good they are and how well they are doing but it is all about window-dressing.

Regulation is not regulation. Regulatory bodies are there not to regulate but to ensure that regulation may be bypassed. The wheels will grind into motion to grind the petitioner down.

This is Orwell dosed up with a spoonful of Kafka.

This is the worst of both worlds; it is the sum of all fears.

When Left is Right and both are wrong, what's left?

Here, AOL reports on a fringe meeting at the Conservative Party conference in Manchester which heard that there are two reasons why the Government should cut benefits for the elderly now...

Alex Wild of the Taxpayers’ Alliance is speaking -
"The first of which will sound a little bit morbid - some of the people... won't be around to vote against you in the next election. So that's just a practical point, and the other point is they might have forgotten by then," he said.

"If you did it now, chances are that in 2020 someone who has had their winter fuel cut might be thinking, 'Oh I can't remember, was it this government or was it the last one? I'm not quite sure.'"
And this is City Wire –
‘All policies which appear to give special advantages to older people as a category should be reviewed, because in financial terms alone, older people are no longer special.'
Sorry Alex, you were pipped to the post.

Andrew Harrop recommended the government review all policies that ‘appear to give special advantages to older people’ 2½  years ago.

Who’s Andrew Harrop?

One-time Labour Party candidate, Andrew Harrop was appointed General Secretary of the Fabian Society in September 2011. He was previously Director of Policy and Public Affairs for Age UK.

Well there’s a turn-up. Anything to do with becoming bed mates with that pro-euthanasia group purporting to be a charity?

What contempt they have. This is not at all 'morbid'; it is reprehensible. Out come the ACDs. This is killing by command.

Our documents now reference ACDs. Policies and Procedures reference all the the pertinent legislation such as the Mental Capacity act 2005.

Where there is financial constraint, in whose 'best interest' might best interest be? 

We are still dealing with the outcomes of the flood at our project. Yes, 'still'.

Two  months and they are now agreeing a consensus on what will not be done.

A works programme commenced to take up and replace all sub-floor, but this was halted to treat the bare boards with Halophen. Well, you might expect mould after flood water off the street engulfs the ground floor, dehumidifiers are brought in but it's left two months.

We need charity reform. We need a shake up in social housing.

I have had it said to me that "They are a law unto themselves!"

We all follow the road we follow, so shame on them and shame will come.

Pertinent reading -
Liverpool Care Pathway - Litigating The Litigants
A fire fighter who attended our flood observed the surge of water beneath the fire doors. She queried the gap and we confirmed that we are not in compliance.

Next day, we had a phone call from the local paper writing up a story. The voice said they had been informed our clients had been evacuated.

We followed policy and referred her to the press office.

She persisted. They had got the story from the fire service, she said.

We didn't take the bait.

"Whistleblowing". It's become the new buzzword of 'best practice'. But it is just that and is not what it is.

They want to hear how good they are and how well they are doing and it's just window-dressing.

They close ranks and squeeze you out.

When Left is Right and both are wrong, what's left?

Am I losing my memory in a fog of years?

There is only upwing and downwing and I know where I stand.

We are all dying; we are all on the road on that journey to our demise, our final destination. But while we are dying, first and foremost, we are living.

And life is precious… Living matters.

Additional reading -
Liverpool Care Pathway - The Sum Of All Fears

Liverpool Care Pathway - Telling It How It Is

Saturday, 3 October 2015

Liverpool Care pathway - Killing On Demand

Deficient and wanting, or just different?

They wanted them to kill their child; they chose to let him live.

“Terminate.” That's the word they used. It sounds like Dr. Who and the Daleks.

It’s actually killing. Say it how it is. Killing is become both a therapy and a treatment.

Sky News

This is Jaxon Emmett Buell. He was diagnosed with anencephaly and was born with most of his skull missing. He was given days to live.

Jaxon has confounded the predictions and lived to see his first birthday. In that year, he has both given and experienced the joys of living, something he might never have known.

Jaxon has been dubbed 'Jaxon Strong' and has his very own Facebook page.

Life has its highs and lows but that is life. There are peaks and there are troughs.

Without the hard climb, how else may we go freewheeling down the other side?

That is life's lesson.

Killing is become both a therapy and a treatment. It’s still killing, whatever else you call it. Say it how it is.

Another kind of killing is here discussed. It is called Euthanasia.

This is News.Com Australia –

FIVE minutes after Simona de Moor heard her daughter had died from a heart attack, she decided she wanted to end her life, too.

The 85-year-old mother, who was considered healthy by doctors and was not taking any medication, made arrangements to be quietly put to death.

More than 8000 people, probably more, have been euthanised in Belgium, where assisted suicide has been legal for 13 years. Patients don’t have to be terminally ill, just deemed to be suffering “incurable, unbearable pain” by a doctor.

The country has faced controversy over the soaring numbers of cases in which people with psychological problems, from depression to dementia, are asking to die. With the rest of the world moving towards bringing in euthanasia laws, some people are asking where and how you draw the line.
Journalist Brett Mason went to Belgium to film Simona being killed for a ‘Dateline’ special that aired September 15 on Australia's SBS (Special Broadcasting Service) network.
We could be looking at Australia’s future. In July, the Victorian parliamentary inquiry into end of life choices began hearing from medical professionals and palliative care providers about possible changes to Australia’s legislative framework. The inquiry will report back on 31 May 2016.

An Assisted Dying Bill was debated in the UK parliament this month, but did not pass its second reading debate on 11 September and will make no further progress.

It’s clear that giving people the right to die is not a simple decision.

“Most of us have reached a low in our lives where we’ve lost a loved one or suffered a trauma,” said Brett.

“The challenge for doctors — many with no psychological training — is being able to make that call and know when someone’s pain isn’t going to heal. I’m not sure I could. For me, there will always be a ‘what if” with Simona’s euthanasia.”

Killing is both a therapy and a treatment.

Killing as policy

HSJ has published an investigation which purports to show an ‘unwarranted and unfair’ disparity in elective surgery.

Knee Replacements
Hip Replacements
In the regard of both knee and hip replacements, that is something which is commanded by demographics.

As an example, Tower Hamlets has a more youthful and diverse population than does Guildford.

Professor Stephen Page, from Bournemouth University, has said there will be a growing polarisation by age of local populations. This will distort the uptake figures.

The borough of Tower Hamlets, for instance, has the lowest median age in the country at 29 along with Newham, compared to the London average median age of 33.

Guildford and Waverley by contrast has the largest 5 year cohort aged 45-49 reflecting the baby boom of the early 1960s. The fastest growing cohort since 2001 is the 60-64 age group which has increased by 35%.

As older people become more dominant in the local economy, young people often go away to university and get jobs in bigger cities and don't come back, further distorting the local age profile.

What the researcher wishes to demonstrate will depend on how the statistics are presented as readers of these pages will know.

This 'disparity in elective surgery' is not even new news.

Read the 'olds' in this paper dated 26 November 2010 from Public Health Wales Observatory -

The Daily Mail has picked up an investigation published by Pulse -

Perhaps, we are all selective in what we present and the manner in which it is presented but, again, as readers of these pages will know, GP incentives are not new.

The report says:
GP practices are being offered thousands of pounds to refer fewer patients for specialist care, including those with suspected cancer, finds a Pulse investigation.

Pulse has learnt that in at least nine CCGs, practices are being offered payment for keeping within targets for outpatient referrals and follow-ups. And some of these schemes even count two-week cancer wait referrals towards the target.

Payments of between £6K and in excess of £11K are being offerred. The payments come following on from recommendations just a year ago to double cancer referrals.

This is BBC News –

GPs got beavering away and, before anyone knew it, Pulse had a banner headline in January of this year proclaiming: "Urgent GP cancer referrals increased by 50%"

Pulse reported –
There has been a 51% increase in the number of GP urgent referrals for suspected cancer cases in the last five years, a major audit of cancer outcomes has found. The National Audit Office’s ‘Progress in improving cancer services and outcomes in England report’, released today, lists improvements ‘across a range of indicators’, including GP urgent referrals, five-year survival rates and a drop in overall mortality rates. The report states: ‘Urgent GP referrals for suspected cancer increased by 51% between 2009-10 and 2013-14 from 0.90 million referrals a year to 1.36 million referrals a year.’


Reports, reports and more reviews, the fact is that command control distorts and does not address issues.

The fact is that killing as policy has been proceeding for a long, long time via EoLC policies imposed by a grand alliance of State, Third and Private Sector interventions and strategies, in downsizing care expectations and designing programmes, death lists and pathways.

There is  crisis.

The news is dire: Addenbrooke’s recovery ‘could take years’; Shelford Group Trust and West Herts are in special measures; more than one in ten Trust chief posts are unfilled; a third of CCGs may ration services; bailouts have ‘rocketed' to £1.2bn; GP practices may get a £1m emergency assistance fund after one in six practices have closed their lists…

GPs have been asked by commissioners to not refer to a local acute trust for at least three months to allow the hospital to clear up its backlog of operations.

The chair of NHS Redditch and Bromsgrove CCG, Dr Jonathan Wells, shared the letter online which asked GPs ‘to refer patients to another NHS or independent sector provider other than Worcestershire Acute Trust for an initial period of three months’.
Just a year ago The telegraph reported on a 'debt timebomb' –

A Westminster think tank, the Institute of Economic Affairs called for ‘radical measures, including a smaller NHS’, to deal with the ‘debt mountain’.

Time bombs, silver-haired tsunami...

We have heard all this before -
Liverpool Care Pathway - Of CQuINs, Tipping Points And QUELCAs
Further reading - 
Liverpool Care pathway - A Life Less Perfect, Or Just Different...?

Liverpool Care Pathway - 'Informed Consent'

Liverpool Care Pathway - A Perverse Symmetry