Liverpool Care Pathway - By Intrusion And By Stealth

By increment, our freedoms do they steal; by notch and by notch, they raise their banner high.





Just over a year ago, there was a police intrusion at our scheme which caused upset and concern to certain of our clients; dismay and alarm to others...

Liverpool Care Pathway - Data Is Power

Police have powers of entry to search a property without a warrant and this may be authorised by a senior officer. Whether those powers were crossed on this occasion by entering our client's room is a fine line.

By ruse and by subterfuge, the Kings men may make an entry by manipulation of the tools provided to them. The Barons must make good and renew their Great Charter.

Provision of support to our clients may extend to accompanying them in pursuit of claims.

Information is shared between departments at national and local level. The Local Government benefits department at a Council office near you has apparent full access to the DWP system.

Confidentiality was once respected as a matter of duty. It did not require laws to protect this. There were ways to behave and ways not to behave. Information provided was not passed on. It was in confidence.

Since the advent of laws to 'protect' personal information, this has broken down entirely. The Data Protection Act, for instance, acts only as a hurdle the legitimate user must jump, not as a protective device at all.

Recently, a client made a first claim for JSA (Job Seeker's Allowance). That is not such a simple thing these days. You have to prove who you say you are.

Our client took all the documents required of them and went upstairs for the interview. Twenty minutes later the client reappeared in a state of dismay. The interview could not proceed.

The photo ID, a passport, was three years out of date. It was the only photo ID they had. A barrage of 'security questions' had been thrown at them. Not normal things like date of birth but what was the last ESA payment that went into their account and when was it paid. They didn't remember; it isn't the thing you necessarily commit to memory.

They remembered the full amount of the benefit payment and that was the figure they gave. They were told this was wrong. This did cause consternation because the figure was correct. And they were being told it was incorrect.

Do they have a credit card? No, they have no credit card. Utility bills? No, they pay a service charge.

They were asked the name of their GP practice. They gave this. And before that? There was none, not that they knew. The practice had moved. Was this a trick question?

Protest was made on the client's behalf. We could verify who they said they were. No, the client would have to return at two o'clock with further requested documents and information.

The client ascertained that there was a prior GP practice. This was when they were barely old enough to remember anything at all. How would they know? How did the Job Centre know?

We returned, armed with what was required.

We challenged them directly. Do they have access to medical information on line? Only what the client provides. But the client could not and did not provide information which they were not aware of, that they had been too young to remember at the time.

Would we please permit the interview to proceed.

Just answer the question and we will retire. We said we would complain to Caldicott.

They have access only to what the client provides.

What is going on?

Benefit provision is integral in health and social care. It is inefficient not to share information. Information is power. Information is control.

Ask them their three main priorities, Number Six, and they will tell you: information, information, information.

Our part and complicity in this is integral. Once the information bucket is dipped into the temptation is going to be to dip into it some more.

Once permitted and left unchecked, this will slip and slide down a slippery slope, as all things inevitably do, and spread inexorably.

The way we manage and share information about people who are in contact with health and social care services plays a pivotal role in achieving higher quality care and improving outcomes for patients and service users.

The way we manage and share information about people who are in contact with health and social care services plays a pivotal role full stop.

The 10-year National Strategy for Information and Technology in Health and Social Care identifies significant financial benefits, including cost savings, efficiency and productivity improvements, as well as non-financial benefits from investment in appropriate information and technology.

ACDs are 'Good Practice'.

The National End of Life Care Programme (NEoLCP) sees the introduction of Electronic Palliative Care Coordination Systems (EPaCCS) as a key contribution to this wider strategic objective. The sort of benefits envisaged are, for example, demonstrated in a case study of an economy-wide electronic care record where improvements in diagnosis, reductions in unnecessary appointments and tests were demonstrated.

- Economic Evaluation of the Electronic Palliative Care Coordination System (EPaCCS) Early Implementer Sites

Is information sharing now dipping into the NHS dot Data bucket?

It is ‘okay to ask’...

The NHS is a data pot.

The potential of the NHS as a research platform is now being exploited and realised.

The National Institute for Health Research (NIHR) was created in April 2006 under the 2005 Government strategy for health research: Best Research for Best Health.

Achieving appropriate levels of participation has always been a significant hurdle to research.

This is Trials Journal –

In the United Kingdom, the overarching vision of the National Institute for Health Research (NIHR) is to see ‘more patients and health professionals participating in health research’

Significant resources continue to be invested into clinical trials and other high quality studies, but recruitment remains a significant challenge. Adoption of innovative methods to develop, test, and implement recruitment interventions are required.

We argue that insufficient focus has been placed on the development and testing of recruitment and retention interventions.

All trials which take place in the UK have to be authorised by the MHRA (Medicines & Healthcare products Regulatory Agency). The MHRA decides if they are scientifically valid and properly designed.

But, now, it's okay to ask.

There are three stages of drug testing in humans. Trials are approved by an ethics committee.

Phase one tests for safety. People, sometimes healthy and sometimes with a medical condition, are given a small dose of the drug, not to test if the drug works, but in order to check for any side effects.

Phase two tests the drug on a small scale.

Phase three involves larger scale studies.

Participants are often randomly allocated to either get the drug or a dummy version. In most cases neither the researchers nor the patients know who has got the real drug so that the results can't be skewed by expectations.

Commercial companies may offer a ‘generous payment for your time and inconvenience’.

The Association of the British Pharmaceutical Industry (ABPI) says people should not be given financial incentives to take part in research but they should be recompensed for the time they are giving up. The standard rate is between £150 and £200 a day.

Patients who agree to join trials are volunteers and may receive money ‘to cover expenses, loss of earnings or their time’. Doctors may be paid to recruit patients into trials.

When receiving payments, it might be handy to know that...

HMRC agrees that the amounts paid to those concerned are unlikely to fall within the definition of “earnings” for PAYE or NI purposes. No employment relationship exists and as such PAYE and NIC would be inappropriate.

Under Section 16, Taxes Management Act 1970, HMRC is entitled to ask for details of payments to non-employees at their discretion; but they would not routinely ask for details for small payments such as these.

There will be no tax or NIC liability arising on the individual if the sums received do no more than reimburse the individual’s reasonable costs of participating in the trial or research, including costs of travel and subsistence.

However should the sums paid exceed those reasonable expenses then the excess may fall to be chargeable to tax as Miscellaneous Income, potentially giving rise to personal tax liabilities of the individuals which should be notified to the Inland Revenue under Self Assessment.
- HMRC

Research may be carried out in the NHS, but some takes place in universities and research institutes, in social care services, or in the private sector.

Research that takes place in the NHS may be paid for by one of a number of different organisations, and often more than one organisation working in partnership - the Triple Alliance or Triple Entente of State, Third and Private Sectors.

They include: the NHS, through the National Institute for Health Research (NIHR); the Medical Research Council (MRC); the Department of Health and other government departments; medical research charities; pharmaceutical and other healthcare companies.

Everywhere, wherever, at every NHS facility, you will now be confronted with the comforting knowledge that it is...

Because their funding is dependent on that...

- NHIR

In future, our funding to providers of NHS services is becoming conditional on meeting benchmarks, including a 70-day benchmark to recruit first patients for trials. This was made a condition of new contracts from Autumn 2011 and performance affects funding from 2014.

NHS providers holding NIHR contracts issued after Autumn 2011 are required to provide, on a quarterly basis, information on recruitment to clinical trials, including commercial contract clinical trials.

Wherever there is a financial motivation can this be said to be either moral or safe?

The Healthcare and Life Sciences section of the Plan for Growth (in March 2011) sought ‘simpler’ regulation of health research at the national level, to remove ‘barriers to enterprise’ and stressed that health research has a key role in the national economy.

The Government combined and streamlined approvals under a health research regulatory agency, the NHS NIHR, working closely with the MHRA to create a unified approval process for clinical trials and promoting ‘proportionate’ standards for compliance and inspection.

Does 'simpler' mean less thorough?

Does 'proportionate' mean less stringent?

It's okay to ask...

Trials are approved by a streamlined ethics committee. Even so, north of the border, up Scotia way, in the circumstance of “Emergency” research...

Subject to the trial having been approved by an ethics committee such "emergency" research can proceed without ethics committee approval and without the consent of any guardian or welfare attorney, or the adult's nearest relative, if :-(i) it has not been practicable to contact any such person before the decision to enter the adult as a subject of the clinical trial is made, and(ii) consent has been obtained from a person, other than a person connected with the conduct of the trial, who is:-(a) the practitioner responsible for the medical treatment provided to the adult, or(b) a person nominated by the relevant health care provider.

- Incapacity (Scotland) Act 2000: Code of Practice

NHS England is enacting a policy of negative rights and 'presumed consent' in their Business Plan -

We will act as a facilitator of research – for example, we are planning to investigate a system of ‘presumed consent’ to take part in research studies for all patients treated in teaching hospitals.

- NHS England Business Plan

A 'teaching hospital' is a hospital affiliated to a university. And they are all become 'associated university hospitals'.

Further reading -

Liverpool Care Pathway - A Golden Opportunity

They are 'Health Partners'.

At SHP (Surrey Health Partners) -

SHP complements the University’s ‘One Health’ strategy and is one of several phases of strategic developments between the NHS and academia. The partnership will provide a strong platform for NHS and University to achieve their strategic ambitions of developing Surrey as a major ‘hub’ of excellence for clinical research and education.

Research and trials in SHP are supported by the Surrey Clinical Research Centre (CRC). The Surrey CRC is a MHRA Phase I supplementary accredited experimental medicine facility that is part of the Faculty of Health & Medical Sciences at the University of Surrey. It is adjacent to the Royal Surrey County Hospital and is a specialist clinical pharmacology unit with over 12 years’ experience of undertaking clinical trials in both volunteer and patient populations.

They are all part of NIHR Big Data –

Developments in clinical technology have had a revolutionary impact on healthcare over the last 30 years, and the arrival of the electronic patient records more than 20 years ago has delivered enormous benefits, to patients, clinical practice and research.

Such as EPaCCS...

The health data held in GP surgeries, NHS Trusts as well as by the Health and Social Care Information Centre (HSCIC), Public Health England and the Clinical Practice Research Datalink service, is world class and is recognised internationally as a major research asset for the UK.

They are 'delivering clinical research'.

They are committed to ‘ensuring faster and easier clinical research, increase the number of patients who have the opportunity to participate in research, and enhance the attractiveness of the UK as a host for commercially sponsored research’.

It is 'good practice'.

And down at a local CMHRS (Community Mental Health Recovery Service) near you they’re promoting OK to Ask, inviting you to visit NIHRC on line and to like them on their Facebook page.

It used to be CMHT (Community Mental Health Team), but that's just politics.

And a new breed of health professional has come on board - the Facilitator.

No, these are not the now familiar EoLC Facilitators; these are Research Facilitators. And they know how to 'deliver NIHR portfolio studies to time and target'.

They recruit health professionals, patients and collect actual patient data.

They promote initiatives such as the Research Site Initiative (RSI) scheme to GP practices to take part in primary care research...

Funding is available for your GP Practice to cover research infrastructure costs in addition to the usual SSCs paid to cover all agreed study activity related to specific research projects undertaken by the practice. In return for this additional funding, your practice will need to meet specific research related requirements such as Good Clinical Practice (GCP) Training and RCGP Research Ready accreditation.

There are two levels of RSI to match your practice’s research experience and these are summarised below:

Level 1 (£1000)
Level 2 (£2000)

Medical professionals have received payment and been trained to recruit for the death lists; they are now receiving payment and being trained to recruit for clinical studies.

It is all 'good practice'.

The pool of Data is 'world class' and provides a vast pool of opportunity. All that is necessary is engagement.

How to broach the subject and approach the punter requires coaching and that is part of the Facilitator's role.

A client has recently informed us they will be participating in a trial. They will be paid "ten or fifteen pounds a day".

This is an Orwellian world in which we live. Like Alice, we have, well and truly, stepped blithely Through the Looking Glass.

Is this 'good practice' or malpractice?

'Rights' are not given or granted. They are yours. The Life that is yours was not given or granted; it may only be denied or taken away.

That is the principle and uniqueness of the US Constitution. It is, indeed, a document of negative liberties and positive rights.

We have proceeded to a world of opposites.

We have absorbed the Europa model that Kafka would have so readily recognised. Permission is not sought; it is assumed. Be that Organ Donation, DNR or dot Data.

We challenged them directly. Do they have access to medical information on line? Only what the client provides. But the client could not and did not provide information which they were not aware of, that they had been too young to remember at the time.

Would we please permit the interview to proceed.

Just answer the question and we will retire. We said we would complain to Caldicott.

They have access only to what the client provides.

What is going on?

Our client did not give permission because they did not need to; it was assumed. They did not need to know: it was recorded.

This is Big Data, a pool of opportunity.

Further reading -

Liverpool Care Pathway - Twenty Four

Liverpool Care Pathway - So This Is New Year...

Liverpool Care Pathway - A Cost Efficiency

An Afterword –

Our clients have, and regularly have to endure, 'side effects'. A common one is lumps appearing at the site the depot is given. The medication is suspended in oil to slowly release the drug until the next depot is due. Clients have been told they are 'too skinny'; the oil does not disperse. A previous client's arm was "full of lumps".

Medication commonly has side effects for which 'side-effect' medication may be given which, itself, may be problematical.

There has always been recommendation and facility to report side effects. The BNF (British National Formulary) - the ‘Doctors’ Bible’ - recommended it; the Yellow Card provided means...

There has always been the ‘blame game’ and these have gone unreported, unadmitted and denied.

My dear mum, just months before her life was taken, fell victim to a rare condition. This resulted from a topical application. The condition appeared upon application; the one followed from the other but this was denied. Our own research showed that the condition did result from allergic reaction to medication. It was still denied. It was the ‘blame game’.

Will the 'blame game', which is endemic in the NHS, also 'skew' results...

Things can, and have, gone wrong...

- BBC News

Six men remain in intensive care after being taken ill during a clinical drugs trial in north-west London.

The healthy volunteers were testing an anti-inflammatory drug at a research unit based at Northwick Park Hospital when they suffered a reaction.

Relatives are with the patients, who suffered multiple organ failure. Two men are said to be critically ill.

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 because 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

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