Liverpool Care Pathway - One More Step Towards The Abyss

It's all about assessment of 'quality of life', of fair and equitable funding and affordability. That is the essence of Communitarian Healthcare theory.

Without sustained and unprecedented increases in health service productivity, funding for the NHS in England will need to increase in real terms between 2015 and 2022 to avoid reductions in the level or quality of services. However, this funding increase is looking increasingly unlikely 

Adam Roberts, Research Analyst, Nuffield Trust, and report co-author

The future is frightening.

This is Mail Online -

'Disabled children cost too much and should be put down': Calls for councillor to stand down after outrageous rant

• Cllr Collin Brewer refuses to quit and has apologised to Disability Cornwall

• Told BBC radio that the timing wasn't good because of upcoming elections

• Charity says his apology was an insult and he should quit his post

• Defended himself by saying he was 'hot under the collar' after a meeting

• Mr Brewer forced to write apology a year and a half after offensive remark

• 97 per cent of people in local paper poll say Mr Brewer should resign

• Katie Price tweeted 'How would you like to dispose of my son Harvey???'

• Cornwall Council distanced itself from Mr Brewer's 'ignorant' comment

By DAILY MAIL REPORTER

PUBLISHED: 09:42, 27 February 2013 | UPDATED: 08:40, 28 February 2013

A councillor told a charity worker who helps youngsters with special needs that 'disabled children cost the council too much money and should be put down'.

Collin Brewer, 68, an independent councillor at Cornwall Council, has refused to stand down after making the 'depraved' remark to the member of a charity during an information event.

What he said has received wide-spread condemnation including that of Katie Price whose son, Harvey, is severely disabled.

Mr Brewer admitted that he made the comment to 'provoke a reaction' and has now been forced to apologise in writing for the offensive remark.

However, he remains defiant and refuses to stand down saying: 'It is not something I would consider resigning over. I believe I am doing a good job.'

He said at his home yesterday: ‘We had had a difficult morning deciding on budget and job cuts. I listened to one of the ladies on the Disability Cornwall stall and came out with the comment. If only I had not said that.

The comment was made to Theresa Court, advice services manager of Disability Cornwall which complained to the council's standards committee.

Ms Court said: 'I was absolutely horrified anyone would make such a depraved comment, let alone a Cornwall councillor at a public event.

'As far as I was concerned, I had a duty to make a formal complaint against Councillor Brewer to seek appropriate justice.'

Her charity had a stand at an information event in Truro in October 2011. She was on hand to tell councillors about the issues they face and the work they do with parents of children with special needs.

Mr Brewer approached the stand, where there were parents of disabled children, and asked what the charity did. According to Ms Court he said that children with special needs cost too much money.

Fortunately, she added, none of the parents heard his comments.

She said: 'I couldn't believe it. It's taken a year and a half for him to be told that he has to write an apology. The apology was an insult.

'It came with a second class stamp and it was folded up into eight small bits. He might as well have screwed it up. I can't believe that the only thing he has had to to is write an apology. He needs to re-think his job.'

Katie Price tweeted her disgust at Mr Brewer's comments

The letter, sent by second class mail, is damning and serves as an indicator of the sincerity of its author!

More outrageous ideas are floated, to add to others reported in these pages. And where is all this leading us?

From Oregon to Belgium, each step towards the abyss has made each succeeding step that more certain.

This is Live Action News -

INTERNATIONAL

Belgium to legalize child euthanasia, because it’s going to be done anyway

• by Cassy Fiano
• February 27, 2013

Belgium’s euthanasia program is already out ofcontrol, but it might be getting even crazier. Euthanasia-friendly countries have a history of letting the programs go off the rails, and now Belgium might sanction one of the most horrible things they could:  allowing minors to be euthanized.  Their reasoning? Well, it’s being done anyway…

Licia Corbella  writes -

Black is white, white is black and wrong is right. Murder is merciful and compassionate care, cruel. Somewhere out there, George Orwell is saying, "I told you so."

So...

When will begin those European Directives that these Nazi policies be observed here in the UK?

When begins the cull of the 'useless eaters'?

Liverpool Care Pathway - The Last One Liner

Frank Carson is taken on the pathway.

"He was described as "one of the nicest people in showbiz" and was one of a generation of comedians that included Eric Morecambe, Bernard Manning and Tommy Cooper." [Belfast Telegraph]

Opportunity knocked and he rocked the world with a torrent of one liners.

He cracked us up the way he told 'em, but the man who gave us tears of laughter leaves us with tears of heartache...

And the tears of laughter are all dried up.

This is News Letter -

Frank Carson’s daughter reveals heartache

Frank Carson

Published on Wednesday 27 February 2013 11:14

THE daughter of one of Ulster’s best-known comedians has spoken of her father’s final days and how the family helped hasten his end.

Majella Carson, daughter of Belfast funnyman Frank, said she was “upset” at being faced with the nightmare scenario, but felt the Liverpool Pathway method of easing his distress was more humane.

Recalling the day her family faced the heartbreaking decision, Majella said the doctors told them to “start making preparations”.

She said: “We didn’t want to start planning the funeral; that would have been accepting it was over.

“Da had been distressed during the day so they’d [doctors] put him on the Liverpool Pathway and injected him with morphine; it’s very controversial at the moment as some patients are put on it without their families’ consent and it means no more water or food is given to them.

“I was very upset about it but they said it was the best care plan for him, the most humane way for him to go.

“There was no way he could have come back.”

Frank Carson was born in north Belfast and starred in local clubs before moving to England where his television career took off in the mid 1960s.

He suffered from cancer and was buried from St Patrick’s Church in his native city last February.

In an interview with the Belfast Telegraph this week, Majella said her father died, aged 85, just two days after beginning the Liverpool Pathway programme in a Blackpool hospital.

“At least we all had a chance to say goodbye. He died two days later on Pancake Tuesday – we said it was so he wouldn’t have to go off anything for Lent, not that he would’ve,” she added.

The family are taken aside by members of the care team, coerced by gentle persuasion and by authoritative argument, and finally submit to the power of medical opinion and the temerity of arrogance that underlies it:

"Before the decision is made, there needs to be discussions with the patient’s family and there needs to be an acceptance that the patient is dying. The Liverpool Care Pathway only comes in when that recognition has been made." [Graeme Hendry]

We are all of us faced with personal choices we have no choice but to make. We can only ever hope and pray the choices we make are the right ones and act accordingly.

Liverpool Care Pathway - The LCP Review: All Sewn Up!

Submissions for the 'impartial review' receive an acknowledgement from Tessa Ing. Tessa is Head of the End of Life Care Programme at the Department of Health, and an Observer to the Board of Trustees of the National Council for Palliative Care (NCPC). 

Tessa supports End of Life Care Pathways. A presentation given by Tessa is here - End of Life Care, Liberating the NHS, and QIPP.

Tessa is listed in this Generic Report (National Care of the Dying Audit 2008/2009) as a National LCP Reference Group Member. The Group is thanked in the acknowledgements by Marie Curie for their valuable support and advice throughout the project.She has also been involved on the Policy Team in rolling out the LCP -

   End of Life Care Strategy 'Almost one year on’ -

   Professor Mike Richards, June 2009
    

Tessa is screening the submissions....

Is this an impartial review?

Is Tessa really the right person for the job?

Once the 'review' has been completed, the panel will submit its report to the NHS Commissioning Board...

Are the Commissioners impartial? Ciaran Devane, for instance, joined Macmillan Cancer Support as Chief Executive in May 2007, co-chairs the National Cancer Survivorship Initiative, sits on the board of the National Cancer Intelligence Network and is a trustee of The Makaton Charity..

The review is not into the Liverpool Care Pathway (LCP); it is into the implementation of the LCP. But which version? We are now on version 12.

The LCP (mark 12) complies with provisions of the Mental Capacity Act in the regard of capacity and informed consent. LCP (mark 11) was current until 2010 when version 12 was published.

Communication is supposed to be a priority goal, but the recommendation to confirm the ability to communicate in English is made at goal 4 after the syringe drivers are already set up, if appropriate, at goal 1 and within 4 hours of doctor's order at goal three. This version may be read hear -

Care of the dying Pathway (lcp) (Hospital)

Liverpool Care Pathway - The LKP Can Deliver.

In the beginning was the Find Your One Percent Campaign...

And GPs have a surfeit of guides available now to assist them in their search to hunt down their 1%...

Macmillan Quick Guide

There's the EoLC 1% GP Pack Folder full of useful weblinks; an EoLC One Percent 'Top Tips' guide which shares the Dying Matters logo.

There's the Six Steps To Success, of course.

Even Macmillan have got in on the act with a 'Quick Guide'.

Who needs euthanasia booths when you can keep them grinning on a fast-track to the grave?

The British public have been groomed to accept death and dying as a positive life choice for many years now. This shows up in many of the comments posted on newspaper columns.

The 'Six Steps' is the North West end of life Care Model. GPs are advised -

Ask yourself

• Can you identify those in your care who are approaching the end of life?

• Have you noted triggers that might indicate it is an appropriate time for discussion?

Your role

• Recognise when a patient’s signs and symptoms have increased or his or her condition has deteriorated

• Ask yourself: “Would I be surprised if this patient were to die in the near future?”
• Identify those who need to be receiving end of life supportive care
• Remember to take into account triggers such as recent changes in circumstances.

Triggers could be the death of a spouse, increase in hospital admissions or a change in care setting, e.g. a move from a residential to a nursing home.

Support

Care Home staff, GP practices, those in the community, will be supported by an End of Life Care Facilitator from the local area who will deliver the Six Steps to Success workshops and provide support and education to all staff.

Psychometric Testing 

There's even psychometric testing on hand via the Dignity Care Pathway (DCP).

The DCP "was acceptable to the community nurses, helped them identify when patients were at the end of life..." [Evaluation of the Dignity Care Pathway for community nurses caring for people at the end of life]

"Nurses identified that using the DCP allowed them to reconsider which patients required palliative care. In line with Scottish Government (Scottish Government 2008) policy, this study encouraged nurses to consider approaching any patient who the nurse considered was in the last months of their illness, regardless of diagnosis, and including the frail elderly."[PAGE 12 - QNIS Project Report]

"The community nurse makes a prognostic, clinical judgment to decide when to start a patient on the DCP..." [Dignity in End-of-Life Care]

Martin Amis has said previously (The Telegraph) that euthanasia is 'an evolutionary inevitability' and that the 'primitive' Christian notion of the 'sanctity of life' is holding back debate on assisted suicide.

And now, lo and behold, having found their 1% who have less than a year to live, it is proposed that GPs have an additional option to offer (on top of the LKP)...

This is the Telegraph -

Allow assisted suicide for those with less than a year to live

Doctors should be allowed to help terminally ill patients kill themselves – but only if they have less than a year to live, under proposals published in a major report today.

By Martin Beckford, Social Affairs Editor

7:30AM GMT 05 Jan 2012

The independent Commission on Assisted Dying, whose members include several prominent peers and medics, wants GPs to be able to prescribe lethal doses of medication for dying people to take themselves.

The report, published today, calls for the “inadequate and incoherent” law against assisted suicide to be scrapped following a series of high profile cases where patients have used the Dignitas suicide clinic to take their own lives.

Although helping someone to die is punishable by up to 14 years’ imprisonment and police still investigate all cases, there have been no prosecutions since landmark guidelines were set out almost two years ago.

The Commission says the situation is “very distressing” for families, “uncertain” for health workers and place a “deeply challenging burden” on police and prosecutors.

Under its plans, doctors would be allowed to prescribe drugs to end the lives of terminally ill patients who have fewer than 12 months to live provided they are judged to have the mental capacity and clear desire to die.

If implemented, it could mean more than 1,000 people a year being helped to die in England and Wales.

The year-long inquiry admits legalisation would create a “real risk” of pressure on vulnerable people to end their lives, either from family members or a sense that they were a burden on society.

It says that to safeguard the vulnerable, disabled people and those suffering from dementia or depression would not qualify for help in killing themselves.

It also recommends that two independent doctors’ opinions are required before deciding that a patient should be entitled to assisted suicide, and that they should have a “cooling off” period of up to two weeks before being given the drugs that they must take themselves.

In addition, the report calls for better end-of-life care in hospitals and hospices across the country, as well as more open discussion about death.

The final report of the Commission, chaired by the former Labour minister Lord Falconer, concludes: “There is a strong case for providing the choice of assisted dying for terminally ill people.

“Even with skilled end of life care, the Commission finds that a comparatively small number of people who are terminally ill experience a degree of suffering towards the end of their life that they consider can only be relieved either by ending their own life, or by the knowledge that they can end their life at a time of their own choosing.”

Its recommendations are likely to be discussed in Parliament, with one of the commissioners, the Tory MP Penny Mordaunt, calling for a Westminster Hall debate rather than a Commons vote.

She added: “I think if it was a motion asking the Government to consider the Commission’s report and was limited to terminally ill people who met the criteria, I think you would get a much more positive response.”

No political leaders have publicly backed scrapping the law, not least because it would prompt claims that the Government wanted to kill off the elderly and ill at a time of cutbacks in health and social care.

Yet polls suggest that public opinion is moving towards a change, particularly among those who have watched loved ones suffer in their final days. A new survey highlighted by Dignity in Dying found that 61 per cent of people questioned would want Parliament to debate “the issue of Britons travelling abroad for help to die”.

There is also widespread agreement that the current regime in England and Wales, under which assisted suicide is illegal but perpetrators are not prosecuted if they act out of compassion, is unfair.

It favours those people with the money or practical support to travel to places where the practice is allowed, such as the “suicide clinic” Dignitas in Switzerland, while the poor or physically disabled are often reduced to botched suicide attempts at home.

Grieving relatives, and health workers who may have discussed suicide with patients, must deal with the threat of arrest and prosecution.

The new 415-page report, published on Thursday, represents the first detailed model of how a relaxed system could work.

It would allow assisted suicide to over-18s with less than 12 months to live, who have the mental capacity to decide to die and who have not been coerced into it.

This would mean that Debbie Purdy, the right-to-die campaigner who has Multiple Sclerosis but is not terminally ill, would not qualify for help, nor would Daniel James, the paralysed teenage rugby player who chose to end his life at Dignitas rather than live a “second-class existence”.

Sir Edward Downes, the former BBC Philharmonic conductor who died at Dignitas, would not have been given help to end his life but his wife, who had terminal cancer, would have been.

It would mean a regime more like that of Oregon, where “physician-assisted suicide” is allowed for those who have less than six months to live, than the Netherlands, where children as young as 12 are eligible for euthanasia, as are those experiencing “unbearable suffering” rather than a terminal disease.

Police would still be able to investigate cases where the criteria were not met.

The new proposals place much of the responsibility on doctors. They would have to check that a patient was eligible, tell them about possible treatment for their condition, ensure the lethal prescription was delivered safely, be “on hand” during the death, provide bereavement services to relatives, co-operate with police and give data to a national monitoring service.

But many medics fear it would compromise their relationships with patients and their duty to preserve life, with one expert telling the Commission: “The health service is not the environment for a death service.”

A spokesman for the British Medical Association, the leading doctors’ union, said: “"While there is a spectrum of views on assisted dying within the medical profession, the BMA believes that the majority of doctors do not want to legalise assisted dying.”

The Commission itself has faced accusations of bias as it was funded by Sir Terry Pratchett and chaired by Lord Falconer, both long-standing supporters of assisted suicide.

Several organisations, including the BMA, declined to attend its evidence hearings.

Dr Peter Saunders, Campaign Director of Care Not Killing said: “These recommendations if implemented will place vulnerable people under increased pressure to end their lives so as not to be a burden on others. This pressure can be especially intense at a time of economic recession when families and the health service are already feeling the pinch. The so-called right to die can so easily become the duty to die.”

No, nothing so crass, surely; after all, with all the EoLC Pathway options available, it is just not necessary:

"Euthanasia is rightly illegal, and not necessary with good end of life care that we hope to deliver across Swindon in 2012 and into the future." - Dr Eric Holliday GP at Eldene Surgery. [swindon link]

It's "not necessary..." The LKP can deliver.

Liverpool Care Pathway - When A Crime Is Not A Crime

The police are pursuing other matters with rigour, but the killing wards that are our hospitals go, apparently, unaddressed and best forgotten.

This is In The Loop -

Feb 11, 2013

Parents sue hospital over chronic neglect of children with heart conditions

The NHS has been hit by new legal action just days after the findings of the Francis report were published. In a landmark case which raises fresh questions over the NHS’s treatment of patients, University Hospitals Bristol Foundation is being sued by a group of families over its care of infants and children with heart conditions who either died or suffered debilitating complications while under its care.

The case reveals a catalogue of failings and severe neglect by nurses at the hospital, including an accusation that nurses turned down or switched off alarms that are meant to alert them that a child’s condition is deteriorating. In some cases, nursing care was so lacking at the hospital that the parents of children who had undergone heart operations were left to perform aftercare including administering medication and monitoring heart oxygen levels themselves.

This is more than gross neglect; it is a wanton disregard for life that, in any other field, would attract the tireless scrutiny of senior officers and incur certain police prosecution. In its stead, a private prosecution is being pursued by families.

The Mail Online reports -

Assisted suicide 'is legalised' by police: Secret new guidelines from senior officers mean deaths are not investigated
By MARTIN BECKFORD

PUBLISHED: 00:27, 24 February 2013 | UPDATED: 00:33, 24 February 2013

Campaigners fear assisted  suicide is being legalised by the back door as record numbers of Britons end their lives at Dignitas  – while their relatives escape investigation for helping them.

The law is, clearly, not the law. And, if the law is not the law, then a crime is not a crime.

One step towards the abyss makes each proceeding step that more certain. The weak, the frail, the elderly and the vulnerable are put at risk.

The following is posted on Facebook:

"Euthanasia will come into our society at some point, though we will fight against it at every step, and after it is legal too. It is typical to have such a biased, unprofessional and evidence-ignoring report be held up and used on this sort of issue, by the culture of death. Meanwhile, in the Netherlands hundreds of people have been euthanased against their will (used to be called murder); in the UK many critically ill or palliative patients are being put on the Liverpool "care" pathway and subsequently starved and dehydrated to death, often without their or even their family's consent or knowledge. The same things will likely happen here. Look these things up, they are fairly common knowledge, but of course don't get mention in this "report"."

In a letter to The Daily Telegraph, Julie Bailey of Cure the NHS (which helped bring about the Francis Inquiry) called for the resignation of Sir David Nicholson, the chief executive of the NHS.

Mrs Bailey said she feared a new review could prove to be a “PR exercise” by the police.

According to The Telegraph,

Police and prosecutors are examining new evidence about the Stafford Hospital scandal that could lead to criminal charges

Matthew Ellis, the Police and Crime Commissioner for Staffordshire, disclosed that detectives were examining “information not in the public domain” relating to deaths at the hospital.

“There is more information that is not in the public domain that is going to be used to identify individuals who should be looked at,” he said.

“They will use every single piece of information — published and not published. The police are going to look at absolutely everything, every piece of information it is possible to get.”

He added: “They will be looking at new information — information they have not looked at before.

“This is a serious exercise led by a very determined and talented senior investigator, not just a paper-based review.”

It is understood that some of the information being considered comes from coroners’ inquests into deaths at the hospital. The police have also made clear they will consider fresh evidence submitted by families, campaigners and former NHS staff.

Mr Ellis insisted that “operational decisions would always be made by the police”, but said that he “There is more information that is not in the public domain that is going to be used to identify individuals who should be looked at,” he said.

“They will use every single piece of information — published and not published. The police are going to look at absolutely everything, every piece of information it is possible to get.”

He added: “They will be looking at new information — information they have not looked at before.

“This is a serious exercise led by a very determined and talented senior investigator, not just a paper-based review.”

It is understood that some of the information being considered comes from coroners’ inquests into deaths at the hospital. The police have also made clear they will consider fresh evidence submitted by families, campaigners and former NHS staff.

Mr Ellis insisted that “operational decisions would always be made by the police”, but said that he would ensure officers take account of public concern that no individuals have been held accountable for the scandal.

He said: “I want people who are responsible for this to be held responsible.”

Officials from Mr Ellis’ office will be part of the police-CPS review team. There is no fixed timetable for the work, but officers will brief Mr Ellis and the force’s chief constable on their progress in two weeks.

Mr Ellis said he had told the force to move swiftly. “There needs to be pace. They need to get on with this – the longer it takes, the more scepticism there will be,” he said. The review team will this week meet campaigners including Julie Bailey of Cure the NHS, which helped bring about the Francis Inquiry.

Mrs Bailey, who in a letter to The Daily Telegraph calls for the resignation of Sir David Nicholson, the chief executive of the NHS, said she feared the new review could prove to be a “PR exercise” by the police, but said she would co-operate with officers.

To be truly credible, she said, the police and prosecutors would have to consider charges against people who worked for the Strategic Health Authority and other public bodies that oversaw Stafford hospital.

“If the police are going to look at people in the SHA and other regulatory bodies, that would give us some satisfaction,” she said. “They knew what was going on, they are the ones that put pressure on the hospital to reduce staffing.”

The focus on the oversight of Stafford hospital will add to the pressure on Sir David. He was running the Mid Staffs hospital trust in 2005, and has already faced calls for his resignation over the scandal.

Sean Worth, a former Downing Street adviser on health policy also called for health executives to face greater scrutiny over the scandal. Writing for telegraph.co.uk, Mr Worth says: “It is indeed astonishing that none of the management overseeing Mid Stafford has yet been held accountable.

He adds: “If specific allegations are brought forward of wilful neglect on the ward floor, especially any amounting to manslaughter, there should absolutely be a police inquiry. Anything less would let down the victims.”

This man, Gary Walker, as chief executive at the United Lincolnshire Hospitals trust (ULHT), raised concerns for patient safety. He was dismissed and paid £500,000 from the public purse for his silence. This was public money being used for corrupt purposes.

When Mr. Walker broke his silence, he was threatened with legal action and told by the NHS he faced paying back the money and any extra legal costs.

"I stand to lose everything if they sue," he told the Daily Mail.

Gary Walker, who was chief executive of United Lincolnshire Hospitals  Trust (ULHT) before he was dismissed in 2010 claims he may “lose everything” after speaking out against the “culture of fear” in the NHS. Mr Walker alleges that the trust, which is now being investigated about high death rates, has threatened to sue him for the return of £500,000 it paid him to keep quiet.

He said: “Now I risk having to repay even more than the settlement because I could be liable for the trust’s legal fees. I face ruin. It has got to the stage where thousands of patients are dying needlessly in NHS hospitals and the government says no one’s to blame, someone needs to stand up and be counted.”

This man, NHS boss, Sir David Nicholson, participated in Mr. Walker's dismissal. Mr Walker said Sir David was warned about problems in Lincolnshire in 2009 but was ‘not interested in patient safety’. Instead, he ordered that whistleblowers on the trust’s board who had raised concerns should be sacked.

Sir David Nicholson, is now head of the NHS Commissioning Board. So, what does he know that keeps him in his job...?

 According to The Mirror,

Mr Cameron said: "David Nicholson, first of all I think he does a very good job.

"I've worked with him at close quarters since becoming Prime Minister.

"I'm impressed at the grip and grasp he has over the NHS and his knowledge, understanding and love for it and what he helps to deliver in terms of results.

"It seemed to me that he had properly apologised and acknowledged the mistakes the regional health authority had made when he ran it for that short period of time as these events unfolded.

"I would point you towards what the report said - which is that we should not be seeking scapegoats.

"And I think to highlight David Nicholson in that way would be seeking a scapegoat.

"I don't think he should be made a scapegoat."

Hang on. What's going on here? Sir David Nicholson 'apologised and acknowledged the mistakes the regional health authority had made when he ran it ', and that's good enough, and now he's running the new Commissioning Board.

Mr. Gary Walker, however, under threat of being sued by the NHS which Nicholson is running, stands to 'lose everything if they sue'. It was Mr. Walker who blew the whistle, for heaven's sake.

DoH ministers claim they cannot intervene to get the police off their butts to pursue a case at Mid Staffs.

DoH ministers can, surely, intervene to stop a case being brought against Mr. Walker. So, why don't they?

According to The Telegraph A further 2,800 patients may have died needlessly as nine more hospitals were identified as having worrying mortality rates over the last two years.

That would bring the total to nearly 4000 deaths....

That's mind-boggling.

It is reported that up to 50% of deaths at Mid-Staffs were on the LCP. Extrapolation produces a figure close to 2000 possible deaths on the LCP that need investigating.

That's devastating.