Liverpool Care Pathway - Death By Design

There is a Strategy in place and we are half way there. This is surely death by design and it is active killing.



Lilian Wilcock was admitted to Maelor Hospital in May 2012 with severe pain in her leg. Lilian's GP had prescribed paracetamol but was concerned there might be something more serious amiss such as  a clot or fracture.

This is the Daily Post –

X-rays showed that neither was evident but the pain continued, and she continued to receive paracetamol.

“Why they continued with that when it wasn’t doing any good at all we don’t know,” said her daughter Lynne Edwards.

She was diagnosed with arthritis in the hip and moved to a different ward.

This is not an untreatable condition.

However, Lilian was of an age that her care would be downsized... 

After six days Mrs Wilcock was transferred to Mold without the family being told and it was while she was there that she received an excessive amount of morphine.

She was rushed back to Wrexham and her condition deteriorated rapidly. She died two weeks later.

“She went from playing dominoes and chatting to being continually drowsy. She was a changed lady,” said another daughter, Maria Davies.

Dr Lee told the inquest that although Mrs Wilcock had kidney failure, “opiate toxicity” was also one of the problems and she was given medication to counteract it.

It is inconceivable that the coroner could record a conclusion of death by natural causes, but this was the outcome of the proceedings.

This was Active Killing. This was, at the very least, recordable as death by misadventure. The family have lodged a complaint...

“We are not after compensation but we want to know why our mother was overdosed,” said Mrs Davies.

In a prepared statement the family said: “We have lodged a complaint with the Health Board giving them a detailed catalogue of events and we expressed our concerns, but we fear our concerns will not result in any radical changes to improve the levels of care a patient can expect to receive in hospital.

“We hope no other family will be subjected to similar distressing events as we have been, but we are not hopeful.”

It has become custom to adopt the language of the Review and put it all down to 'miscommunication'...

After the hearing, Angela Hopkins, the health board’s director of nursing and midwifery, said: “We would like to express our deepest sympathies to the family of Mrs Wilcock for their loss.

“We accept that our communication with the family fell short of the high standards we would expect. Good, clear communication is vital to good care. We are working continuously to improve the ways we share information and communicate with patients and their families.”

How can this not be Active Killing...

This is the Mail Online –

Rohan Rhodes was born 14 weeks prematurely at Singleton Hospital in Swansea in August 2012.

Although he was very premature, he got through the critical first few weeks and was doing well in the hospital's neo-natal intensive care unit.

However, a heart duct which usually closes at birth remained open. Doctors said he needed to go to Bristol, which has a specialist children's heart surgery centre, for an operation.

Five weeks after birth he was transferred to St Michael's Hospital - which is in the same trust as Bristol Children's Hospital.

As he was so premature, he needed a ventilator to help fill his lungs with oxygen.

Rohan's parents allege a nurse practitioner looking after their son - who had no authority to withdraw the life-supporting device - turned off the ventilator.

It is understood the nurse who took Rohan off his ventilator received further training following her action - but remains working at the hospital.

She has not been disciplined or reported to the Nursing and Midwifery Council...

It has become custom to adopt the language of the Review and put it all down to miscommunication. Was this 'miscommunication'...?

An inquest will decide upon the circumstances of Rohan's death.

There is a Strategy in place. Are these but random events?

Is this allocation of care according to available resources...?

Harley Pascoe was deemed 'too healthy' for an immediate operation so doctors cancelled a life-saving heart operation five times in a week. Parents Danielle Gatehouse and partner Lee Pascoe, from Fraddon in Cornwall, are now considering legal action over the treatment Harley, who was born with half a heart, received on ward 32 of the hospital. - Mail Online

Allocation of scarce resources in the Communitarian view is not by the most needy or by the patient in front of the physician administering their care but by those who will most benefit. The most frail will have their needs sacrificed for those most viable.

Is this withdrawal of fluids and nutrition on a Care Pathway...?

Sean Turner, 4, was left so dehydrated after heart surgery he was forced to suck liquid from wet wipes.The boy's parents called for a full inquiry after their son died on Ward 32 of Bristol Children's Hospital last year. - Mail Online

From one end of life to the other is being adopted the Communitarian logic of the Complete Lives system. How may this not be otherwise than by design...?

However it is, it is still Active Killing.

Liverpool Care Pathway - Somewhere... Is There Erewhon?

Once that first step is taken, the next - and each successive step - becomes easier...



Somewhere, on a distant island off a far-off continent…A man, trained to protect and serve life, recalls and regrets how his moral perspective was turned to serve killing and death executed in the name of medical research, consent presumed and uninformed.

This is Japan Times –

Donning the crisp, Imperial Japanese Army khakis gave Ken Yuasa a sense of power, as a superior being on a mission to liberate China from Western colonialism.

“The uniform made me feel incredibly sharp.  Once I put it on, I was convinced Japan would triumph,” recalled the wartime surgeon, who was deployed to Changzhi (then Luan) in Shanxi Province in February 1942.

“I was in denial of the things I did in Luan until the war was over. It was because I had no sense of remorse while I was doing it,” Yuasa, 90, told The Japan Times in a recent interview.

“The atmosphere in which we cannot freely express our opinions and challenge government orders is eerily similar to that of my time. And back then, before we knew it, we were heading into a wrongful war,” the doctor warned.

They donned their white coats and willingly participated in what was clearly a trial as the LCP and, then, its legal version 12 was rolled out in the EoLC program which followed.

Confident in their arrogance, they do not question the roll-out of a Strategy to limit life through a policy of downsizing care. How may they when the nuance of language is subtly altered such that the withdrawal of care becomes 'care'.

The economic urgency to rationalise care distorts their moral perspective such that they are able to convince themselves and others of the correctness of what they do. Their literature - quoted in these pages - ever references the dire ecomomic projections of the demographics that threaten the continued viabilty of healthcare.

Zeke's Complete Lives system is coming into its own. Such is their zeal, they are moving the goalposts for escalation of treatment across the board.

Somewhere, on a distant island off a far-off continent…

This is the Japanese Finance Minister reported on Time Newsfeed –

Taro Aso, who also serves as the deputy prime minister, had been in office little more than a month when he insulted Japan’s elderly on Monday, calling those who can no longer feed themselves ”tube people,” and claiming that treatment for just one patient close to death can cost the government “tens of millions of yen” a month.

In a country where the elderly are shown the highest deference and respect, Aso’s comments go particularly against the grain. People over 60 make up more than a quarter of Japan’s population, making it especially surprising that a senior politician would speak out so bluntly.

Japan’s aging population does cost the country’s strained social services, and the number of elderly people is only expected to increase. In just 20 years, projections suggest that seniors will outnumber children 15 and younger by nearly 4 to 1. According to the Organization for Economic Cooperation and Development, Japan’s at-birth life expectancy is 83, one of the highest in the world. That imbalance means the ever-shrinking segment of people of working age will be burdened with the cost of paying to take care of their grandparents and great-grandparents.

Mr. Patrick Gordon Walker’s landmark observations echo down the years and, somewhere, on a distant island off a far-off continent…

This is the Guardian –

Jeremy Hunt's recent visit to Japan passed almost unnoticed in Britain. Yet the issues he discussed with Shinzo Abe, the Japanese prime minister, and the health minister, Norihisa Tamura, touched on a problem that is likely to dominate social policy in the next decade:dementia care. One in four of the Japanese population is over 65. By 2050, the proportion will be 40%. There are already 4.6 million people with dementia in Japan. Britain, with 10 million people over 65, has 800,000 people living with dementia, at an annual direct cost to the Treasury of more than £10.2bn pounds. By 2050, Britain is expected to have around 1.7 million dementia sufferers.

NHS England is enacting policies of '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

The NHS operates a policy of non-exclusion. To ensure that no-one shall be excluded from this 'presumed consent' system, hospitals are being given 'university hospital' status.

A university hospital is an institution which combines the services of a hospital with the education of medical students and with medical research. These hospitals are typically affiliated with a medical school or university.
- Wikipedia

Policies of 'presumed consent' are being echoed across the pond…

This is the New England Journal of Medicine –

"...in a learning health care system with ethically robust oversight policies, a streamlined consent process could replace formal written informed-consent procedures for many studies, and patient consent would not be required at all for some trials."

An NHS Scotland EoLC document references the Incapacity (Scotland) Act 2000: Code of Practice –

With various provisos,

Research on adults incapable of consenting is authorised under the Act...

and

4.2 One of the overriding conditions attached to involving adults with incapacity in research is that similar research cannot be done by involving adults who can consent. This condition is paramount. It is not sufficient to say there are no capable volunteers.

Even so, where there is “minimal” risk or discomfort this still is acceptable.

And

Where no direct benefit to the adult exists

4.5 The first of the conditions set out above is that the research must be of real and direct benefit to the adult involved. However, subsection 51(4) of the Act provides exceptionally for the possibility that research may be carried out even where it is not likely to produce real and direct benefit to the adult. This is where the research is likely to improve the scientific understanding of the adult's condition and in the long term contribute to the attainment of real and direct benefit to persons suffering from the same form of incapacity.

Furthermore, 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.

Further pertinent reading -

Liverpool Care Pathway - A Golden Opportunity

One step at a time and the next becomes easier and, when it is down a slippery slope we tread, each step becomes a rush toward the next.

The Social Architects are hard at their Labours.

Additional reading -

Liverpool Care Pathway - It Cast Its Shadow Long


Liverpool Care Pathway - Nice One!

Liverpool Care Pathway - Telling It How It Is

The GSF summarises how to recognise the one percent to line them up for EoLC.

Eyeballing - The GSF

How do you make the unacceptable acceptable? You redefine it and adopt terminology that grants it an apparent scholarliness which academia will rush readily to discuss. 

You retreat from defensiveness and go on the attack; you challenge and question. You repeatedly raise the issue such that what was once shocking becomes ‘daring’ and slips almost imperceptibly into the window of respectability. 

You use slander or slur to diminish and demean those who oppose you such that they are placed in ridicule and their views are mocked as ‘outdated’ and ‘old-fashioned’. You are ‘advanced’, your views are ‘modern’ and it is time for change. 

It is ‘cool’ to denounce the Hippocratic Oath and traditional mores. It is trendy to challenge long held beliefs of right and wrong. 

Those who have raised issue with the LCP and EoLC Pathways have been denounced in online forums and in newspaper comments columns as right wing, Christian (particularly Catholic) crackpots. 

In 1935, the inaugural meeting of the Voluntary Euthanasia Legalisation Society was hosted at the BMA in London. Fifty years later, it still hadn’t gained widespread support. Its fortunes changed in 2005 when it became Dignity in Dying. Also, at this time, the LCP was being trialled and, in 2008, the DoH and NCPC joined their resources to roll out the EoLC Strategy and the version12 LCP.

Having learned the merits of Newspeak, Dignity in Dying started up a charitable wing calling itself Compassion in Dying. Bang! Age UK actually partnered up with them in a project in East London which gained National Lottery funding. Political or what...? That wasn't given national exposure on the Saturday night lottery draw!

Euthanasia was always espoused as 'advanced', as 'modern', as 'forward thinking'; hence, from the beginning, it found support with public figures who viewed themselves as being such. However, give yourself an appropriate and suitable name and - particularly if you may demonstrate yourself to be part of a persecuted minority - you will find more ready and widespread support from such people.

The post war years saw a rising tide of diverse groups, competing, but united against the common enemy of the establishment. The CND Easter March of pilgrimage and the Spies for Peace became the weekly anti-Viet Nam War demos of the late 60s. Agit Prop (Agitational Propaganda) readily lent its resources for their purpose. Collets was a frequent haunt in Charing Cross Road in London to sell the radical journal. This was the Left or the New Left. Only the Bard had the vision to sing of the Upwing and the Downwing. 

I have mentioned, in passing comment in these pages, training I have been sent on at work. One such course was on sex offenders. The trainer had academic terms she used not just for 'paedophiles' but for specific kinds of offending. There is, for instance, a specific kind of paedophile who will latch onto a single mum with young child and wait for the child to grow to a particular age of his liking, all the while gaining the child's trust and grooming them for his purpose.

I objected that the use of such terms was a cop-out. What do you mean, she responded indignantly, defensively. It's all abuse, I replied. Giving them the dignity of an academic term to describe what they do is to make excuses for the abuser, to give him dignity at the expense of the victim of the abuse, the child. I then raised with her the Paedophile Information Exchange which actually published a magazine called Magpie (Magazine of the Paedophile Information Exchange). To my disbelief, this trainer had never heard of the Paedophile Information Exchange! 

A long, long time ago, a news item came up on the tele. I pricked up my ears because Bromley was mentioned. I had lived on the Downham Estate by Grove Park in my teens. This was just down the road from Bromley. Bromley was also home to one of these woolbrained diverse groups. Arrests had been made. The PIE and their magazine, Magpie, was mentioned. It is incredible, but true, that child abuse really took off in the 1980s in just the manner already discussed here by gaining sympathy and support from such woolbrained intellectuals. 

I had never before heard the word paedophile. It seemed obviously an academic term with Greek roots. As with bibliophile, someone who loves books, it must mean someone who loves children, I thought. What was going on? How could child abusers call themselves paedophiles when, clearly, they just wanted to exploit children for their own selfish purpose and rob them forever of their dignity and self-worth? And yet I had recalled brief reference in a left wing journal of 'misunderstandings' in regard to child sexuality. The Reichians in particular had made note of this.

These child abusers actually perceived - perceive - themselves to be 'advanced' and 'forward thinking'. They did not - do not - view themselves as 'sick' or in any manner doing wrong. This is their moral perspective. Call pornography erotica and it immediately becomes an acceptable topic to discuss over the After Eight Mints once the dinner table is cleared.

The Right and the forces of reaction; Christian (particularly Catholic) crackpots and their concept of family; the hypocrites in religious office who clearly tolerated if not upheld child abuse themselves were clearly opposed to this radical political minority which challenged their beliefs. And the academia - these woolbrains - actually reinforced this 'radical' challenge and those who promoted it. They upheld their world-view, and gave them sense of purpose by themselves adopting their terms to describe them and what they stood for. This was another cause celebre to fight! The academia leapt on the bandwagon. One Dutch psychologist of the time actually suggested a child might benefit from such a relationship.

The woolbrains of the time readily fell over backwards to provide them and their cause support. The worse thing in the world would be to be denounced as a reactionary. Is this why Esther never denounced Jim? Was she, too, part of this trendy set who didn't want to be denounced by their fellows as reactionaries and 'chauvinists'? How on earth could Jim 'fix it' and get away with it for so long such that never, in his lifetime, did justice ever catch up with him? 

This is how it was in these groups. I can personally remember a 'comradely act' of sharing an umbrella in the pouring rain being denounced as an act of male chauvinism. Today, Esther has jumped on the EoLC bandwagon. The person who started Childline has started Silverline. Note, I say 'person' rather than 'woman' as it would be sexist to draw attention to such an insignificant detail. This political correctness proceeds to this day. You're just not allowed to say it how it is and, for that reason, do so many injustices continue and is the initiative passed to the Nasties on the Right.

It is time to say it how it is. When journalists report abuse they must not use the terminology of the abusers. The philatelist, the bibliophile may be enthusiasts and devote much time to their pastime. Others might just dabble. This is exactly the language of the 'paedophile'. The 'paedophile' might throw themselves into their pursuit; others might dabble in a small image collection on their laptop. They 'dabble'. You permit them to say that by using their terminology. But use the word abuse; speak only in terms of abuse; could they then say they 'dabble'...?

We have seen our latter-day New Left deny the facts of the killing that has proceeded. They refer to the right-wing press and the 'Daily Fail' and a submission to the BMJ has actually resorted to calling this an assault on the Pathway. There is a Strategy in place. It is taking effect.

Nearly fifty years ago Mr. Patrick Gordon Walker made his landmark observations in parliament. Just twenty years prior to this, as a BBC journalist, he reported on the liberation of the Bergen-Belsen Concentration Camp. The good old Beeb paused in disbelief. We had seen this sort of propaganda fifty years previously to that in the Great War of 1914-18. The Hun were bayoneting babes in Belgium...

One hundred years later, and they're euthanasing babes in Belgium!

Let us get away from the political language of the abusers. Let us start saying it how it is. Let us all wise up and make them own up...

This is ACTIVE KILLING that is proceeding as policy; it is not care!

Further pertinent reading -

Liverpool Care Pathway - No-one Answered

Liverpool Care Pathway - When The Funding Had To Stop

The socialising of death continues at a pace. We wait with bated breath to see to what extent is its outcome.




They're hiring EoLC Facilitators at a Town Hall near you.

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. To facilitate this, a Cancer and End of Life forum with a representative from each GP practice in Halton has been established to identify any gaps and provide an opportunity to share best practice. 

Advanced Care Planning 

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 document makes pointed reference to the EoLC Strategy, 2008. It recognises that it is "inherently difficult" to identify when a patient is approaching end of life and recommends taking guidance from the GSF Prognostic Indicator and working in partnership with Macmillan. It also recommends the infamous Six Steps.

Eyeballing...

This EoLC Team of Social Storm Troopers will be going out into the community giving their caseload the eyeball and asking themselves the 'Surprise Question' aka the Barton Method...

This is Community Care -

Care minister Norman Lamb has given his personal backing to free end-of-life social care, but said he could not yet commit the government to the measure.

Speaking in a debate on the Care Bill last Thursday, Lamb said although he was “not in a position to commit the government” to free end-of-life social care, he said that “I want us to do this” and was “determined that we achieve that objective”. He added that as the responsible minister he had “some degree of influence over decision-making”.

He made the comments in response to an amendment from Conservative MP Sarah Wollaston proposing that terminally-ill people be exempted from social care charges to allow them to die in their preferred place.

This recommendation was made by the government-commissioned Palliative Care Funding Review, which reported in 2012. On the review’s recommendation, the government set up eight pilot projects to test its proposed funding model. The pilots last two years and are ending in March.

Lamb added that NHS England wanted to expand the use of electronic palliative care co-ordination systems (EPACs)—which allow people to register their end of life wishes—to increase national coverage form 30% to 70% by 2015. He said in places where EPACs were established, 80% of people died in the place of their choice. Wollaston said she was “absolutely delighted with the minister’s assurance” on free end-of-life social care and would not press the issue to a vote.

Backing from charity

Macmillan Cancer Support, which has long campaigned for free end-of-life social care, welcomed Lamb’s comments.

- Community Care

“We are very encouraged by Norman Lamb’s comments during last week’s Care Bill debate and his assurance that he’s determined to introduce free social care at the end of life,” said Gus Baldwin, head of public affairs at Macmillan Cancer Support.

“We look forward to discussing this further with the minister with the aim of making quick progress as soon as the Palliative Care Funding Review pilots looking at this issue have ended in March.”

They're hiring EoLC Facilitators at a Town Hall near you...

This is North East Jobs –

Durham County Council, Children and Adults Services in partnership with McMillan Cancer Support

Temporary for 2 years

A great opportunity has arisen for a short term project worker to undertake a role in leading Adult Social Care’s development of a new and exciting pathway for supporting people on the End of Life pathway.

The project is to scope the current inter-agency network and develop a joined up pathway for people who need both health and social care support. It will also involve the development and rollout of training to Adult Social Care staff.

The post holder will work alongside Adult Social Care Practice Development and Support Team in addition to accessing advice, and expertise from the McMillan Cancer Support service. The post holder will be expected to work with partners at a strategic and operational level and the project will be reliant of the candidate’s experience of this type of work to succeed.

The successful applicant for this post will be required to apply for a Disclosure and Barring Service Enhanced Disclosure.

Required Qualifications:
Degree or Diploma in Social Work and registered with HCPC.Evidence of relevant and recent Continuous Professional Development (CPD).

Interviews will be held on Tuesday 11/03/2014 (p.m.)

For further information please contact: Geraldine Waugh, Operations Manager (OP/PDSI) on 03000 268253. E-mailGeraldine.waugh@durham.gov.uk

Apply on-line via the jobs portal or for further assistance contact the HR Resourcing Team on telephone no. 0191 383 3081 (24 hour answer-phone) or email hrresourcing@durham.gov.uk

They're holding interviews on Tuesday 11th March, my mum's birthday. Happy birthday, mum! They're taking the Strategy out into the community to the punters; we are only halfway there and those care expectations have to be downsized.

- Mail Online

- Mail Online

- The Express

They're signing up Local Government Facilitators to co-ordinate borough-wide EoLC programmes. Applicants might do well to read up on the above documents and the wealth of reference work put out by NCPC/Dying Matters. This would stand them in good stead to get the job offers.

The successful applicant will demonstrate...

Will they offer incentive payments and bonuses in recognition for innovative EoLC?

This will save the ratepayers a bomb. Both local and national exchequers are going to breathe a long sigh of relief. There are going to be consequences, of course. The demographics are going to take a plunge as these measures begin to bite. We are only "halfway there", as we have been reminded.

Excess deaths...

This is the new Front Line. They are recruiting now for Social Service.

Your NHS needs you to secure affordable and sustainable healthcare - now and for future generations.

These policies really do have consequences.

This is “Active Killing”. It cannot be said otherwise than that. And this is policy.

It’s time for us to wise up. And it’s time for them to own up.

Further reading -

Liverpool Care Pathway - The Many Pathways To The Perdition That Awaits Us

Liverpool Care Pathway - The Reaper At the Town Hall Door

Liverpool Care Pathway - The Micawber Principle

Liverpool Care Pathway – The Attractive Option?

Liverpool Care Pathway - The State Rules, Okay?

Liverpool Care Pathway - The Good, The Bad, The Ugly And The Diabolical

Liverpool Care Pathway - The Dust Has Settled. All Change! Nothing's Changed.