Thursday, 28 April 2016

Liverpool Care Pathway - Tough Times And Difficult Questions

The sum of many parts does not make up a recognisable whole. When devolution is dismemberment then is it subservience.

These are tough times for Associations. There are mergers and more are afoot.

There are horror stories from surveyors. Roof repairs just patched up. Tenants up in arms.

There are horror stories from our own ALEC. Three project workers being let go at elderly supported housing. The residents have an alarm call, but they're on their own.

County provides Supported Housing projects with funding and the funding is put out to tender. The Commissioners are demanding 50% cuts. Existing Housing Related Support funding provides for three staff here and we have been a staff member down for a year or more. Where has that been siphoned off? Will it be refunded to the Commissioners...?

In addition to the funding, the Association receives an extraordinary income from rents and service charges.

The government forced a one per cent reduction on rents last year and Associations took a hit...

Social Housing

Rents were increased by 20% over the five years from 2010. This only further bloated the Associations’ coffers, further distorting the market rents and increasing the local tax burden to pay for the Housing Benefits to pay for the increased rents which the social housing sector tenants could not afford to pay.

'Supported' is reprieved until next April but our project is under threat. There is also the impact of welfare reform.

The Mental Health Act of 1983 closed down the institutions and along came Care in the Community. Many welcomed this; many lamented it. Those locked into the system needing structure despaired at it.

Supported housing works with other services - mental health, probation, local council - as a transition toward independent living. As such it is not a cost to the community but should be counted as an integral part of the overall cost of rehabilitation that is this salvage operation.

It is calculated that this saves the taxpayer £640m annually. How that figure is arrived at or if it is even possible to calculate at all is another matter; there are too many unknowns and too many assumptions, taken without context.

According to the House of Commons Briefing Paper –

“This is because the cost effectiveness of supported housing leads to reduced involvement in crime, reliance on the health system and other social services. With this in mind, supported housing services are not adding to the deficit but are rather a key component in reducing it.
Furthermore, organisations providing supported housing have already taken their fair share of the burden to reduce the deficit. According to the National Audit Office, funding for housing related support decreased by 45% between 2011-15. Added decreases in funding would only serve to undermine the financial viability of many services, placing the most vulnerable at increased risk.”
Services are not islands, separate and immune from the context in which they sit. Services have been co-opted into engaging clients in a Homeless Health Needs Audit to inform Commissioners to prioritise and target funding.

How this stands on the broader canvas of devolution proposals currently on the table, the European Structural and Investment Fund programmes and potential Brexit is not known.

See -
Liverpool Care Pathway - When Division Is The Rule
Here is Heart of the South West -

“We invite Government to begin formal negotiation with us on our proposals and the detail behind them with a view to signing a deal during the first half of 2016.”

Press Release issued by the Devolution Project Management Office - Thursday 3 March 2016:
Devo bid to boost prosperity for South West goes to Government

Council chiefs and business leaders in Devon and Somerset have submitted their ‘prospectus for productivity’ to the Government in a bid to win more powers to boost jobs and growth.

They say they want a ‘devolution revolution’ to improve the lives of people in Devon and Somerset.

The prospectus has been submitted to the Government after being separately endorsed by every local authority in the two counties.

They say the changes they propose would result in higher productivity and better-paid jobs, improved road, rail and broadband links and more homes for the region’s growing population.

There would be radical reforms to integrate health and social care to allow the ageing population to be better looked after, tailored support for growing businesses and the creation of a centre of excellence for skills development.

The submission of the bid follows months of concentrated work by council chiefs in Devon, Somerset, Plymouth and Torbay with 13 district councils, Dartmoor and Exmoor national parks, the local NHS and the Heart of the South West Local Enterprise Partnership.

They want more powers and finance devolved from Westminster to the region so they can close the productivity gap and allow local people to benefit from a thriving economy.
The integration of health and social care is already proceeding.

HSJ reports that Northern Devon Healthcare Trust is to become the first health service organisation to enter the home care market.
“Providing high quality, consistent care at home will also help us to prevent avoidable hospital admissions,”
All-sector leaders are co-opted in the devolution proposals and discussions that are proceeding. This is corporatism. This has not been a democratic lead from the electorate. This was echoed by EDDC Councillor, Jill Elson -
Councillor Jill Elson said she had concerns about the democratic value of the deal and how much input constituents would have. She added: “If you have 19 leaders for all the councils making the decisions, how is that going to be disseminated to the elected members of all the various councils and their residents?”

Cllr Elson said there was also an issue with the health budget, because nobody knew how much it was going to cost.

“Older populations need more and more care - whether they are at home or in homes, it is not going to be financially viable because at the moment there are not enough community care workers to actually have people in their own homes,” she added.
Midweek Herald

"Healthcare, bed-blocking in hospitals and education were the major concerns raised during the latest round of East Devon District Council’s (EDDC) talks over devolution."
What lead there has come from the electorate has been through published comments upon reports in the press. Predictably, these have drawn from traditional perspectives of right and left, Tory and Labour. The perspective of the Bard was up and down. Is this devolution or dismemberment and to what end and purpose?

See also -

Liverpool Care Pathway - Of Sense And Sensibility, Sense And Nonsense
These are but brush-strokes upon the broad political canvas. Who is the painter? Is it all painting by numbers to some Grand Design?

Wait -

The 'devolution revolution' involves giving local authorities the power to retain their local taxes and spend them as they see fit, rather than have them funnelled up into Whitehall before being distributed back down again.


The devolution revolution involves giving local authorities governments the power to retain their local taxes and spend them as they see fit, rather than have them funnelled up into Whitehall Berlaymont before being distributed back down again.

Can this be? Do not the Berlaymont puppets in Whitehall want us to retain some essence of gratitude for the beneficence of EU largesse?

Demands for more transparency have made government ministers ever more secretive. The communities secretary, Greg Clark, has ignored parliamentary questions and Freedom of Information requests. Apparently, they're now all using Whatsapp to cloak their plans in further secrecy.

Whatsapp is one of the messaging services which Cameron plans to become subject to the new Investigatory Powers Bill. But not quite yet apparently.

The King of America who has ridden roughshod over American democratic process, bypassing Senate and Congress, and has backed the same EoLC Communitarian policies advised by the brothers Emanuel, Don Berwick et al is invited for a sleep over to shore up support for the Grand Design.

A Government and people which cannot speak with one voice, become a  dismembered disunity, is become a Divided Self.

Can the European concept of Subsidiarity explain this new tier of unitary authorities, each with its own Monseigneural Mayoral overseer?

The idea of 'subsidiarity' can be traced back to the 19th Century.

This notion was expounded more broadly in the Maastricht Treaty, reasserting the rights of member nation states through the subsidiarity principle and so it is not so incongruous after all.

Pertinent reading -
Liverpool Care Pathway - Murder On The NHS Express

Liverpool Care Pathway - Downsizing

Liverpool Care Pathway - Going Stateside

Liverpool Care Pathway - This Is Not 'Ageism'; It Is Communitarianism
There has never been a referendum of support for the Grand Design. What lead there came from the electorate was in support of a common market (EEC) in preference to a free trade association (EFTA).

Over time, a persistent force that is relentless in its purpose will accomplish subtle and irreversible changes in our perceptions.

How to change perceptions without really trying -
Liverpool Care Pathway - The Communitarian Nudge
Here they are, all pals together, supplying input here, across the pond and, via nudge, over on the mainland (EU)...
Behavioural Insights Team

Cass Sunstein, Don Berwick, Simon Stevens and Zeke Emanuel of the Tricky Trio Emanuel Bros.

The Sunstein groupies in the Cabinet Office BIT Team use a SMART mnemonic -
EAST (Easy, Attractive, Social, Timely).
They all love SMART. And they're all burning the midnight oil to get you to do the right thing.

Over time, a persistent force that is relentless in its purpose will accomplish subtle and irreversible changes in our perceptions.

This has happened with the creep to acceptance of euthanasia and using the body parts of the euthanased for organ harvest.

Doctors are impressed by the superior condition of lungs taken from people who are killed by lethal injection compared to those extracted from those killed in accidents.

Eurotransplant, a co-ordination group for transplants in Austria, Belgium, Croatia, Germany, Luxembourg, the Netherlands and Slovenia, has devised elaborate protocols for organ donation and transplantation after euthanasia.

Additional reading -
Liverpool Care Pathway - There Are Always Consequences

Liverpool Care Pathway - The Prequel

Liverpool Care Pathway - A Utilitarian Pathway

Liverpool Care Pathway – An Hideous Strength

Liverpool Care Pathway - The Good, The Bad, The Ugly And The Diabolical
Doctors heal, or alleviate what they cannot heal; they do not kill. That is the task of the Facilitator or Executioner.

No. That persistent force that is relentless in purpose has already accomplished much. The Assisted Dying Bill implementing the Supreme Court Ruling is before the Canadian Parliament...
"This enactment amends the Criminal Code to, among other things,

create exemptions from the offences of culpable homicide, of aiding suicide and of administering a noxious thing, in order to permit medical practitioners and nurse practitioners to provide medical assistance in dying and to permit pharmacists and other persons to assist in the process;

create new offences for failing to comply with the safeguards, for forging or destroying documents related to medical assistance in dying, for failing to provide the required information and for contravening the regulations."
Medical and Nurse Practitioners are to be the executioners and there is a new offence "for failing to provide the required information". They must make themselves complicit in the act even if they do not wish to perform the act.

A Canadian doctor pleads for the right of freedom of conscience...

This is Canadian Family Physician -
No provision in our Constitution ought to be dearer to man than that which protects the rights of conscience against the enterprises of the civil authority.
- Thomas Jefferson

A policy of regulators coercing medical professionals to jettison their moral compass, to defy their own conscience, to enact what they believe is unethical or harmful, and to abandon their lifelong values and standards to participate in care they deem destructive or unconscionable is another matter altogether.
The right of freedom of conscience is Article 18 of the 1948 Universal Declaration of Human Rights. Matthew Jones in The Guardian has called this "First among freedoms."

Additional reading -
Liverpool Care Pathway - Of Terminal Rights And Indeterminable Wrongs 
Liverpool Care Pathway - A Dying Scandal
The right of freedom of conscience is no longer politically correct.

Personal choice may not be respected or even tolerated if it does not coincide with that of the politically correct.

Thus therapy to realign sexual orientation has been outlawed in two US States. Feelings of sexual orientation are promoted positively and objectively, free of repressive moral considerations.

They are entitled to have "their sexual needs accepted and respected".

But see -
Liverpool Care Pathway - It STILL Ain't Over!

Liverpool Care Pathway - Telling It More How It Is
We are seeing more and more young people enter the mental health system, most if not all from broken or dysfunctional homes. Cameron made a call to action in child mental health. Is this another one per cent they seek?

Politicians set targets which then must be met. We have already seen where that leads...
Liverpool Care Pathway - Of Terminal Rights And Indeterminable Wrongs
A child is medicated and labelled with Emotional Conduct Disorder (ECD), a diagnosis the young man now feels no longer fits. His mother, become a single parent, became his ‘carer’, a role she reluctantly relinquishes. The young man is in limbo, without diagnosis, then is redesignated 'Personality Traits'.

There are diagnoses of Attention-Deficit Hyperactivity Disorder (ADHD) addressed with drugs instead of diet and complicated by non-compliance, cannabis or alcohol.

In the broader social context there are demands for autonomy of action but these translate into denial of responsibility of action with diagnoses such as Anti-Social Personality Disorder (ASPD).

Social issues have become medical issues.

People like James Churchill have expressed concerns about health taking social care into its fold. This has been discussed in these pages.

See, for instance -
Liverpool Care Pathway - 'Joined Up' Services
This is now policy.

In a different world, youngsters with too much energy needing a lot more time and attention, focus and direction to channel that energy were not sidled into the doctor's surgery for diagnosis and medication.

Young people in need of some guidance to make the right choices did not have money thrown at them in benefits to make the wrong choices.

Whatever you feel there is a diagnosis and a drug to deal with what you feel.

A young man who can't cope with his feelings is 'self-medicating' with alcohol. The mental health professionals refuse to deal while he continues to deal but he must stop dealing for a period of six weeks before they will deal the appropriate drug to deal with what he feels. It is an alcohol issue and they will not engage until this ceases and so he continues dealing. This is a common Catch 22 situation.

These are wasted generations.

What is today dealt with by diagnosis and containment was once, in a time of more moral certainty, given direction and expression.

Brixton, early to mid1950s: There were no drugs, except those prescribed by the doctor. Lots of kids had knives and they took them to school freely; they were penknives to sharpen a pencil, not to stick in a classmate. I could get my dad's cigarettes and the tobacconist was happy to serve me but none of the kids at school smoked. Come bonfire night kids could safely collect pennies for the guy well into evening with no harm coming to them. The police were just bobbies and respected not robocops all tooled up to tackle an invading army. It grieves me to hear places I grew up in mentioned in the news in the context of shootings and violent crime. What happened?

My dad ran the Anchor Boys and the Life Boys for the local Methodist Church. The kids looked up to him. He was in the 8th Army in the Desert Rats in the war. That's the Second World War for those too young to remember and that still meant something even then. The other kids didn't believe me when I said he was my dad. They just scoffed as if it was some childish fantasy. But I didn't mind.

In an amoral society that has surrendered traditional mores for autonomy of action and sown the seeds of confusion there is much to lament and more to regret. Inappropriate role models will provide inappropriate direction and expression.

Unformed minds do need guidance and direction, understanding and certainty. Else,they will become flotsam jettisoned onto a sea of confusion.

This is not simply a matter of parental failure. No child is an island. Children are assaulted on all sides by doubt and uncertainty. The certainty of the ‘straight and narrow’ is become a broad-trodden track. A generation gone under the hammer of new think have themselves raised another generation. The expectations that provided boundaries are gone. The gate posts have been moved or have rotted away and not been replaced.

- Daily Mail
Psychological interventions are costly in time and not measurable to determine effectiveness in practice and this is what attracts funding.

A medicated nation on mood control drugs to regulate emotion: this is the Final Destination, then, that looms large? It is not natural to not feel.

The Equilibrium of Lucas’ Electronic Labyrinth, of induced birth and induced death, controlled, tidy, and the 'complete life' between. Is this the prospect that faces us?

A Big State with Big Data and the power of the graph database to know all and see all? There is no money for the NHS but there is £1.8bn to go paperless by 2020.

New money to replace old money, an economy without money? Plastic transactions are also data that reveal to those who wish to know not merely our purchasing habits and preferences but also our movements and much more besides.

In an economy that is hungry for debt and more debt and negative interest, the only way the banks can effectively shut their doors is to go cashless. As the leader of the world's biggest debtor nation, the King of America, will tell you, the only way to keep raising that debt ceiling and prevent a run on the bank to call in all those $ Bills is to go cashless.

Tough times and difficult questions. Decisions, decisions...

Blog supplemental -
Liverpool Care Pathway - When The Funding Had To Stop

Liverpool Care Pathway - Blowing The Whistle On The Half Century

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