Liverpool Care Pathway - Of Sense And Sensibility, Sense And Nonsense

When 'correctness' and political savoir faire reign supreme, then belief is beggared and the Emperor unclothed.



HSJ reports a legal challenge launched against a £126m contract awarded to Virgin Care...

The seven year contract was tendered by Swale and Dartford, Gravesham and Swanley CCGs last year.

Lesley Strong, Acting CEO at Kent Community Health NHS Foundation Trust, said:

“Our bid received excellent or good scores in every area, but we are disappointed it has been awarded to another provider. We scored slightly higher than Virgin Care on quality, but not on price. We have one of the lowest running costs of any NHS community provider in the country and the cost of our bid was within the budget set by the CCGs.

“We formed a strong alliance with Age UK, Maidstone and Tunbridge Wells NHS Trust, Ellenor Hospice Care and primary care provider DMC to present a plan for the future to deliver good value for money services without reducing the quality of care for our patients.

“Our patients and dedicated staff continue to be our highest priority and during the next three months we will be working with Virgin Care to ensure a smooth transition.”

The bottom line: They were beaten on price.

Assessing the Branson Empire by performance, Virgin will make an unbeatable offer to get their foot in the door and then, having signed you up, will forget all about you. Still, you pays your money and you makes your choice...

In September last year, an inquest heard how a non-medically trained Virgin Care receptionist at the Urgent Care Centre at Croydon University Hospital triaged Mrs Madhumita Mandal to see an in-house nurse as she was not seriously ill enough to see the A&E doctor.

Mrs Mandal died from multiple organ failure and sepsis.

This may have been a failure of Virgin Care.

It may not...

It was certainly a failure brought to light more recently in reports of NHS 111 calls (the second class 999 service) assessed by call handlers not properly experienced or qualified to do so.

This may have been a failure of the whole triage system which exists not to help patient or doctor or staff and not to save lives but to save money.

But they puts out to tender and they cuts their costs.

What is a matter of good sense that the gift horse offered should always be looked in the mouth and with a good dose of sagacity is become a debate of political sensibility and sense and nonsense, however, and a political savoir faire instead of just plain savvy.

Here's the Metro –

‘After a rigorous procurement process, we are awarding Virgin Care the contract to provide adult community health services in there,’ Patricia Davies, a spokeswoman for two selecting bodies NHS Swale and NHS Dartford, Gravesham and Swanley, said.

Virgin Care will take over health services at Gravesham and Livingstone community hospitals.

A spokesperson for the NHA Party told Metro.co.uk: ‘Virgin is very clever at putting together tender documents for public services and so far has won nearly 330 contracts for NHS services across the country. All operate under the NHS ‘logo’.

‘There are many other private health companies also operating as ‘the NHS’, behind the name. The change from a publicly provided NHS to a privately provided one is being done piece by piece and the extent of the change is being hidden by keeping the logo.

‘Breaking up services in this way is not only expensive but causes disruption and removes parts of the NHS from public scrutiny, as private companies have no obligations to answer Freedom of Information requests, as the public sector does. We need transparency and accountability in the NHS.'

Apparatchik or privateer, is the one likely to be any less or more 'transparent and accountable' than the other? The one may be actually opaque and more so than the other!

What 'wicked and low-down and ornery' Nazty was it working in the National-socialist Health Service (NHS) who desecrated Bella's grave...?

Further reading -

Liverpool Care Pathway - No More Is There A Moral Gravity To Provide Direction

 Liverpool Care Pathway - And Where Is Margherita...?

 Liverpool care Pathway - Another Stafford...?

The Metro continued –

However, Dr Hamed Khan, a GP and A&E doctor, told Metro.co.uk that many GP practises already operate in this way, ‘like small businesses’.

And that has long been the case. The GP practice, as a partnership and family partnership, operates like a 'small business', and more and more so. Gone are the days when the friendly face on reception could just pencil in your appointment.

Such GP practices are being further micro-managed and required to inform Mr. Hunt what they pay for Locums. This is a bid, presumably, to cut agency fees when, as small businesses, it is hardly in their interests to pay more than they need.

This is simply supply and demand driven by market forces. According to a report by NHS Professionals, costs spiral because of managerial workforce planning failures by Trusts.

NHS Professionals (NHSP) is the "leading provider of managed flexible worker services to the NHS".

NHS Professionals is wholly owned by the DoH, as Mr. Hunt should know. Perhaps he should start there.

But 'faire' takes precedence over 'savoir'.

- 6 C's NHS England

If Virgin run services in place of Kent Community Health, no matter how many 'C's there are, nurture may instil but nature will reveal and better training will not teach people who do not care to care.

The people working for Virgin Care will be TUPE'd over from Kent Community Health. They're the same people they always were.

At the Kent Community Health Council of Governors meeting in July last year...

Mr Flack informed the group of the state of current tenders. Dartford, Gravesham, Swanley (DGS) and Swale CCGs had given notice of the procurement process for adult community services. A timeline had been set out which meant a new provider could be in place by winter 2015. This tender represented approximately £26 million in terms of services. It did not represent the entire portfolio of services provided to the North Kent locality, but was a substantial part.

Mr Rogers queried what impact the loss of a £26 million service would have on the Trust, in terms of lost profit. Mr Flack explained that, whilst the Trust would not wish to lose it, this had been taken into account in the Trust’s financial model. Should the service be lost, the majority of staff would be transferred to the new provider. Reduction in income would be mitigated to some extent by reduction in expenditure.

The majority of staff will be transferred to the new provider.

The Kent County Council tender process relating to Sexual Health services was discussed. It was anticipated that the Trust would be successful and this would represent around £10 million worth of services. It was also reported that Kent County Council had an agenda to tender services out over a period of time including Smoking Cessation, Health Checks and Health Improvement programmes. There was an increasing indication that the commissioning of Health Visiting services would be transferred to Kent County Council from October 2015, but as yet there was no definitive timetable for this.

Kent has an agenda to tender services out.

Current policy in Devo Manc for CCGs and Councils to integrate their commissioning functions was already anticipated.

Here is The Commissioning Review –

European Union (EU) and international work

Kent is leading for the national pioneers on EU and international engagement and will feed back to the national integration pioneers assembly (an event to mark one year of pioneers). There are many opportunities to learn and get resources from the EU – Kent has many international partners as well as an international team based in Brussels and strong links with the International Health Alliance. Japan, USA and New Zealand are other countries that are increasingly working with Kent.

We have achieved a great deal in a short time, including setting up integrated discharge teams in hospitals, teams in the community to proactively work with patients most at risk of becoming ill, integrating computer systems to make it possible for hospitals and other clinicians treating a patient to see their GP record or care plan, and working with communities to understand their health and social care needs.

Across the county, a zero admissions policy for certain client groups has been adopted. 

What are we doing across the county?

One of the most successful projects has been the introduction of an integrated discharge team in Darent Valley Hospital. Datford, Gravesham and Swanley CCG commissioned team brings together primary care (GPs), acute, community, mental health and social care professionals who work together with the voluntary sector to help assess, treat and safely discharge the elderly, patients with mental health needs, and those with long-term conditions.

Darent Valley Hospital was one of the country’s best performing hospitals this winter in meeting the four-hour target. It is estimated that the integrated discharge team prevents up to 10 unnecessary emergency admissions to the hospital every day. Since January 2014, no patient has been admitted into long-term residential or nursing care from this trust and 95% of patients have been successfully discharged to their own place of residence.

HIOW showed them how to do it.

Here's The Commissioning Review again -

A bid for further devolution including healthcare in the South East was “like a bolt out of the blue” for a Hampshire CCG, who were cut out of the councils’ plans.

The councils of Portsmouth, Hampshire, West Sussex and Southampton have joined to put in a bid to NHS England for further devolution, and included health as an afterthought.

Dr Sarah Schofield, chair of West Hampshire CCG, said: “It was like a bolt out of the blue, we didn’t even know they were discussing it.”

The CCG has not been told how devolution will affect health, or been involved in the decision-making process, in fact the chair was “quite surprised that such a huge leap forward has occurred”.

“I think the big difficulty is around whose agenda this is. If this is entirely council-driven and health is invited that’s not the same as health and social care being equal partners, and all of that has to just be worked through,” she said.

Kent and Medway have published The Compelling Case For Change...

This is not so bold and forthright as HIOW, but equally compelling.

An economy of favours may well find favour and Smart Alecs may well do business. 

The ALECs and 'preferred providers' may find favour coincides well with the continental way of doing things but not at all favourable or conducive to transparency.

- Kent Business

Final thought:

"Since January 2014, no patient has been admitted into long-term residential or nursing care..."

Kent CCGs have enabled a Just In Case Box scheme for people identified as dying given a 6 month window of life.

This is based on GSF and SPICT (via NHS Lanarkshire) guidance and the National End of Life Care Strategy (2008).

Patient Information Form

This was launched on 15^th February.

The usual standbys of Morphine and Midazolam are included.

This is compelling...

This is Kent LPC –










Final reading -

Liverpool Care Pathway - When Division Is The Rule

Liverpool Care Pathway - On The Final Stretch

Liverpool Care Pathway - The Prequel

Liverpool Care Pathway - When Division Is The Rule

When the thread is unpicked the cloth frays and are we all undone. Yet, by means of that thread may we yet find our way back through the dark wood?


Are we witnessing not merely the break up of the United Kingdom into its constituent parts but the division of England into constituent parts?

And to what end and for what purpose might that be?

The Strategic Authority: To empower the people or to diminish democracy

Divided, they rule.

Not empowerment of the people, for the people, by the people but the impoverishment of parliament.

The nuts and bolts of division: Does it all add up?

Nomenclature des Unités Territoriales Statistiques (NUTS) -

- europarl.europa

A standard for referencing the subdivisions of EU member countries developed and regulated by the European Union. The NUTS is instrumental in delivery of the EU’s Structural Fund.

In the UK, nine regional development agencies (RDAs) were established for the purpose of development, primarily economic, of England's NUT Level 1 Government Office regions.

These were non-departmental public bodies (NDPBs), otherwise known as quangos, and worked as arms length external bodies.

Apart from the London Assembly which adopted a mayoral system, these were low profile and non-elected.

RDAs or RSGs?

Local enterprise partnerships (LEPs) between local authorities and businesses set up by the Department for Business, Innovation and Skills replaced the RDAs to carry out similar functions.

- LEP Network

European funding is being directed to the LEPs. Eric Pickles (Department for Communities and Local Government) announced last year that €3.6 billion (approximately £2.9 billion) has been allocated from the European Regional Development Fund Operational Programme by the Commission. This is to fund the England European Regional Development Fund Operational Programme for 2014 to 2020.

- EU ERDF

A single European Structural and Investment Funds Growth Programme for the 2014-2020 funding period has been set up to combine three separate European Funds. These are the European Regional Development Fund (ERDF), the European Social Fund (ESF) and part of the European Agricultural Fund for Rural Development (EAFRD). The total European Regional Development Fund for the 2014-2020 funding period is €3.6bn. This sum must be supplemented by national public and private funds.

Mr. Pickles said:

We have abolished unelected regional quangos that were previously in charge of the schemes and given an important role to local enterprise partnerships and other local partners to shape and influence how the money is spent.

We also believe local partners should have a direct role in decision-making outside of a formally delegated arrangement, to further increase local engagement. The European Commission ruled this out however, as not being compliant with European Union regulations.
- Written Statement

Breaches of the rules set by the European Commission resulted in £236million of financial liabilities in penalties when the fund was overseen by the RDAs.

- European Regional Growth Fund

The Department for Communities and Local Government (DCLG) also oversees the European Territorial Cooperation (INTERREG) programmes which funded the ‘Transmanche’ and renaming the English Channel ‘Le Pond’.

Funding follows a convoluted route, as UK contributions paid to the EU budget, allocated to the European Regional Development Fund to fund the Regional Growth Fund.

For the 21^st year in a row, the EU budget was approved even though irregularities showed up, this year some 4.4 per cent of the budget amounting to £102billion.

Information on the Regional Growth Fund (RGF), updated 4 December 2015 -

The Regional Growth Fund (RGF) has supported eligible projects and programmes raising private sector investment to create economic growth and lasting employment. Since its launch in 2010 it has invested £2.7 billion to help local businesses grow and take on more staff across England.

On average for every £1 invested through the RGF, the private sector has put in £5.50 with the total investment of private sector support expected to be £16 billion. 149,000 jobs have already been created and a total of 581,000 are expected by the mid-2020s.

Businesses across all industrial sectors benefit from the funding with over £1.1 billion invested in manufacturing including:

• £364 million in the automotive industry

• £100 million in aerospace

• £104 million for low carbon enterprises

Following the 2015 Spending Review, no future rounds of the RGF are proposed.

From the LEPs have come devolution bids for the formation of combined strategic authorities.

The Greater Manchester Combined Authority ('Devo Manc') has powers over housing, skills and transport. It appears NHS England will remain responsible for many of the budgets being delegated to Greater Manchester under the devolution programme as it is employing the region’s new chief officer. That is not to say that the NHS could not be further devolved of itself.

Councils and clinical commissioning groups in Greater Manchester are being encouraged to integrate their commissioning functions, as part of the region’s devolution project and take control of the region’s £6 billion health and social care budget.

So-called 'Devo Manc' is not alone.

Here is Gosport Borough Council on the HIOW -

Hampshire and the Isle of Wight's devolution proposals have paved the way for what Chancellor George Osborne has called "the biggest transfer of power to our local government in living memory".

Of all the devolution bids submitted to government, the ambitious region led the way in pushing for full devolution of business rates. The concept has been well received as the Chancellor announced [5 October] it will be rolled out nationally, meaning councils across the country will benefit.

While many details remain to be confirmed by the Government, the announcement comes as an early endorsement for Hampshire and the Isle of Wight's devolution bid, and further increases optimism around the plans as negotiations with central government begin in earnest.

Full devolution of business rates is central to the proposals and would see councils giving up government grants in return, making them independent of Westminster and linking the prosperity of the public sector to the success of local business.

Following last week's announcement of a devolution deal for South Yorkshire, more successful areas’ bids are expected to be named in the coming days, while it is hoped the Hampshire and the Isle of Wight deal will be announced later this year.

The area's devolution proposals are set out in a prospectus submitted to central government on behalf of 15 councils, two local enterprise partnerships and two national park authorities. The bid has also received the support of Hampshire Constabulary, Hampshire Fire & Rescue and NHS England Wessex.

Should the proposals be successful, the ambitious nature of the devolution deal and number of partners involved mean it could become a blueprint for cities and regions across the country to follow.

This is the HIOW prospectus -

Dear Ministers

The 15 local authorities, two Local Enterprise Partnerships and two National Park Authorities in the Hampshire and Isle of Wight area, together with our many partners, have worked collaboratively and successfully over a long period.

We are now taking a momentous step together in seeking devolution, to gain greater control of the decisions that affect the residents and businesses whose interests and wellbeing we put first. We are doing so in order to increase the productivity of our economy and our public services.

This requires long-term planning and investment and sustained local commitment that is not dependent on changing national priorities – which is why we are asking to be entrusted by Government with a radical degree of freedom and responsibility.

This Prospectus is our offer for a devolution deal with Government. If we can reach agreement, we will see new powers and investment transferred from Whitehall to Hampshire and the Isle of Wight, so that we can manage our area’s affairs locally and engage our communities more closely. This will simplify our accountability, and give residents and businesses more control over the issues that matter to them. There will be no expensive reorganisation. We have agreed that new powers will be exercised transparently and through existing bodies as far as possible, with area-wide arrangements only used where this will promote strategic working or reduce bureaucracy and cost.

HIOW will forego Revenue Support Grant and other grants in exchange for retention of 100% business rates generated within the area, ensuring fair distribution locally and securing the financial sustainability of the Isle of Wight.This will deliver local jobs and homes and reduce the national welfare bill.

In return for sufficient commitment from Government on infrastructure and land release, HIOW will accelerate housing delivery, completing two years early our Local Plan commitment of 76,000 homes by 2026. As part of this deal we will also go further and increase delivery by an additional 500 homes a year in priority categories: rural affordable, low-cost starter, council new-build and extra care, making use of exception sites and prioritising redundant public land.

This is how HIOW looks -

HIOW has a complex economic geography. Substantial urban settlements, primarily in the south and north, contrast with large open areas interspersed with market towns and villages. This diversity gives our area great strength, but also means that there are variations in productivity, educational attainment, employment, housing and health; for example, between north/south, urban/rural and Island/mainland. Our two LEPs (Enterprise M3 and Solent) share the same goal of fostering growth, with different emphases reflecting the diversity of the area: specialisms such as aerospace and defence are shared while others such as marine and pharmaceutical are more locally clustered.

And the LEPs -

HIOW is seeking Intermediary Body (IB) status for the EU (ERDF, ESF and EAFRD) programme for 2021-2028, giving HIOW control of the EU programme.

An Intermediate Body as defined in art. 2(6) and as referred to in art. 59(2) of the Council Regulation (EC) No 1083/2006 is eligible to submit a proposal, provided that it is an authority and is in charge of ESF evaluation. It would be advisable that the Intermediate Body inform the Managing Authority about its application,
- ec.europa.eu

HIOW has its focus set to:

Align local funding including working with Managing
Authorities on focus on EU programmes across HIOW.

Consider innovative business investment initiatives requiring critical mass across the HIOW area - e.g. a Regional Investment Bank or through an expansion and Equity Fund.

Align Local Growth Fund, European Regional Development Fund (ERDF) and European Agriculture Fund for Rural Development (EAFRD) focussed on key sectors, innovationand export support.

Intermediary Body (IB) status for the EU (ERDF, European Social Fund (ESF) and European Agricultural Fund for Rural Development (EAFRD) programme for 2021-2028,giving HIOW control of the EU programme.

This will allow us to align local resources and partner organisations, EU Structural and Investment Funds (ESIF) available for R&D,sector development and export support.

Access EU and other energy efficiency funding

Mr. Osborne has his focus also set.

In Europe, the transition of power has always been to the centre.

Any apparent support for autonomy of the regions/nationalities is subordinate to this project.

HIOW will complete the health and social care project.

HIOW will share core capacity to reduce the cost of service outcomes; develop transformative digital platforms; reimagine public services; deliver a single adoption service; and pursue innovative approaches to health and social care integration and ‘blue light’ collaboration.

Our strong tradition of collaboration brings together many high-performing bodies as well as our extended public sector family, including Health bodies, Hampshire Constabulary and Hampshire and Isle of Wight Fire and Rescue Services.This broad and capable partnership provides a platform for the successful delivery of our devolution proposals.

The HIOW partners will undertake a full governance review, exploring all options including a Combined Authority with a directly elected mayor as well as other forms of democratic governance, such as committee governance and executive arrangements, to determine the most appropriate, robust and cost-effective governance solution for the HIOW area.

This will be developed on the basis of partners’ agreement to support proposals for a HIOW Combined Authority, building on partners’ existing powers, responsibilities and boundaries, and the outcome of our negotiations with Government.

The role of the LEPs in the governance arrangements will be considered as part of the governance review on the basis of the LEPs’ agreement to support proposals for a HIOW Combined Authority, building on the LEPs’ existing powers, responsibilities and boundaries. The LEPs will rightly play a key role in influencing proposals and funding related to theeconomic prosperity of HIOW.

We are committed to engaging the public and all relevant local partners in our governance review, including our eight Clinical Commissioning Groups and wider health partners, Hampshire Constabulary and the Police and Crime Commissioner, Fire and Rescue services, parish and town councils and the voluntary and community sector. Should our proposals be agreed as part of Spending Review 2015 we would expect to conduct a full public consultation in the spring of 2016.

We will maximise our productivity potential and make a direct contribution to the £22 billion NHS gap by accelerating innovative approaches to health and social care integration. Our devolution proposals build on our existing Vanguard pilots and relate to expenditure of £2.7 billion per annum.

The Vanguard pilots:

Isle of Wight’s ‘My Life a Full Life’ vanguard, Hampshire County Council’s Integrated Personal Commissioning vanguard, Southern Health NHS Foundation Trust’s Better Local Care Multi-speciality Community Provider vanguard and North East Hampshire and Farnham CCG’s vanguard.

This is My life a full life –

The HIOW focus on the increasing pressure of a ‘large and growing elderly and ageing population’ on health care resources:

HIOW is home to large and growing elderly and ageing populations and this cohort is increasing pressure on health, care and other services. The demographics for the area will present further challenges in the years ahead, particularly to meet an increasing population with multiple morbidities and the demand for locally-based community health and social care services.

As part of a devolved approach the local authorities and other agencies and Trusts will work with NHS England and the relevant Clinical Commissioning Groups will work together to address these problems.

Our proposal, while recognising the need to reduce pressure on A&E admissions, and the speed of and requirement for improved hospital discharge arrangements, will be the mechanism and plan around which NHS England, our Clinical Commissioning Groups (CCGs) and local authorities would pool resources across the area. It will provide the basis for the development of a shift of health and social care resources towards locally-based community services and early intervention and prevention strategies.

Ultimately we believe that our plan will require greater local control of existing social care and health budgets in return for improved health and wellbeing outcomes across the area.

My life, a complete life...?

HIOW, like Devo Manc and others, is pinning its future on EU funding provision and assuming control of the EU budget.

Have they nailed their colours to the mast...?

There is ample provision for the Smart Alec and an economy of favours not at all favourable to transparency.

Additional reading -

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

Liverpool Care Pathway - When Creep Comes To Slide

Liverpool Care Pathway - A Renegade State

Liverpool Care Pathway - Litigating The Litigants

And, yes, this is a ‘grey old island’... of mist and mellow fruitfulness and close bosom-friend of the maturing sun!

Liverpool Care Pathway - A Renegade State

When the law is but lip service then is democracy not served but made mockery and betrayed.





May was was talking to her family. May remonstrated with the physician not to pull her about. The physician ignored her and spoke directly to the family instead.

“She has pneumonia,” he said.

The physician departed and returned to say he had consulted with his LCP team. He informed the family that May was dying.

The driver was set up. In 18 hours, she was gone.

May was not asked.

Lord Carlisle called for doctors who put patients on the LCP without their permission to be struck off.

Due process is observed and they do nothing.

Nothing is all they have to do for we are nothing and everything is dismissed as anecdote.

They do nothing because they know they can.

There were voices that had cautioned restraint...

This is the BMJ from 2008, eight years ago –

A recent study has shown that health care professionals in a hospice setting are wrong 50% of the time when predicting patient survival. Such is the pressure to roll out the LCP nationwide that many patients, especially the frail elderly, are at risk of having their lives shortened prematurely. That may suit economists and politicians with eyes on the balance sheet rather than the patient, and it may suit those who resent having elderly bed-blockers on their wards, but it is not good medicine. Poor end of life care undermines the trust between doctors and their patients. 

It is surely time to put the LCP on hold until all the concerns that have been raised online at http://www.bmj.com and elsewhere have been carefully considered. It is time for those who advocate sedation without hydration at the end of life to examine their motives. It is time for the medical profession to take collective responsibility for end of life care, for this topic is far too important to be left to palliative carers and the Department of Health. We must not allow ourselves to be driven by individuals or organisations with vested interests or by quasi- governmental committees meeting behind closed doors. It is time to say enough is enough! 

Yours truly, 

Dr Gillian M Craig.
E mail: craig.gm@clara.co.uk.

The years rolled on and Version 12 was rolled out and the LCP and other Pathways continued to take their toll.

A medical holocaust proceeded as EoLC went into overdrive...

Liverpool Care Pathway - The Voice In The Wilderness

Whatever happened to plain and simple life care...?

Liverpool Care Pathway - The Killing Wards

There was a Review that achieved much little than it took place and only took place because the groundswell of what had been dismissed as 'anecdote' in parliament was seized upon by Denise Charlesworth-Smith and held aloft as a battle standard  to demand justice for her own father.

Then, in a Government Press Release dated 26 June 2014, it stated:

When the Review was published last year, the Minister for Care and Support announced that people who have a complaint – even where a complaint had already been pursued – about the care given to a dying patient on the Liverpool Care Pathway should have access to an independent assessment of their case should they want it. That message is reinforced today.

New approach to care for the dying published - Press releases - GOV.UK New Priorities for Care launched as the new basis for caring for someone at the end of their life. Read more...

Plain and clear, the words: “even where a complaint had already been pursued”.

May's daughter, Jane, took May's case to her MP.

The Under Secretary of State for Care Quality has responded to the MP, but not within the spirit of the intentions of the wording of the government Press Release.

Surprise, surprise.

Mr. Gummer is fully aware that, in pursuing a complaint, the complainant will be invited to take the matter further to the PHSO. That is all part of the NHS complaints process.

Mr. Gummer knows this full well, or should do. It is wholly unacceptable but he has responded thus that, firstly, the complaint was resolved locally and, secondly, because the PHSO is an ‘independent’ body this constitutes the ‘independent assessment’.

That being said, this does not resolve the whole fundamental principle of obtaining consent to treatment.

They cherry-pick what they wish to respond to and ignore or overlook what they do not wish to respond to.

If you persist, they deny everything.

Mr. Gummer, as Under Secretary of State for Care Quality, is fully aware that consent is a fundamental principle and that this was a major issue raised in the LCP Review that permissions were not obtained.

May had capacity to be asked. This is stated to be so and admitted in correspondence with the Trust. Why, then, was she not asked her permission to be placed on the Liverpool Care Pathway?

The MP has responded with an apology to Jane that this is not the answer she wanted but that is that.

Your Member of Parliament is your representative. To whom else are you to turn to if your MP turns away?

The official guidelines do clearly state that permission must be sought. The Trust, the PHSO, an anonymous 'very experienced medical professional' and adviser to the Ombudsman, the Under Secretary of State, the MP, all have disregarded this authoritative opinion and official NHS guidance. They are not prepared to comment on this nor permit May's daughter to challenge.

The fact is, if facts need repeating and evidently they do, that May was put on the LCP without her permission.

What have they to say to that?

Nothing.

They Do Nothing because they know they can.

This is the continental model, the omnipotent and anonymous authority Kafka confronted in works such as "The Castle" and "The Trial".

May's daughter is suffering her own trials.

Jane has not gone onto the optimum regime for her CLL TP53 aberation because of conditions for funding imposed by the CDF (Cancer Drugs Fund).

The CDF has recently come under scrutiny from MPs...

This is ABPI –

“What is needed is a wholesale reform of NICE, which, along with NHS England, needs to develop a longer-term sustainable solution to the evaluation and commissioning of cancer medicines. We therefore look forward to the upcoming consultation on the Cancer Drugs Fund and remain committed to working with all parties to achieve a more joined-up system which allows many more NHS patients to benefit from life-enhancing medicines.”

The BBC has asked: How do we pay for innovative drugs?

As if in answer, the HSJ has headlined: Fifteen trusts asked to pay executives more than prime minister.

HMOs have also had considerable scrutiny of late in the corridors of power.

A Houses in Multiple Occupation Bill is currently in debate in Northern Ireland.

HMOs have attracted debate at Westminster.

Debating Clause 85 of the Housing and Planning Bill in a Public Bill Committee on 26th November 2015 concerned Licences for HMO and other rented accommodation.

Here is Brandon Lewis Minister of State (Communities and Local Government) - As I have outlined, we want to ensure that the licence [HMO] is granted only to a landlord who can demonstrate that they are a fit and proper person to operate a house in multiple occupation.

More recently, the Planning (Community Right of Appeal) debate was heard in Westminster Hall on 20th January 2015 also concerning HMOs and predatory landlords who are disregarding the planning rules.

Social landlords, for whom no prerequisite of licence is required but must still adhere to HMO Management Regulations, are granted leave from having to jump through the hoops...

Liverpool Care Pathway - Litigating The Litigants

Liverpool Care Pathway - No Confidence In Confidentiality

Social Landlords are registered charities. They present a shop window of window dressing which conceals not a pretty picture.

When are these so-called charities to be brought to account?

The Metro reported on Friday...

We have read about LATCs (Local Authority Trading Companies)

The  Smart Alecs at Age UK have set up Age UK Enterprises Limited as the "commercial arm" of Age UK. Essentially, it’s a smart ALEC (Arms Length External Company)...

See -

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

and

Liverpool Care Pathway - When Creep Comes To Slide

This is 'partnership working'. Slip is come to slide and creep is come to spread and mutual profit is the justification of reason.

Where will all this lead?

You scratch my back; I'll scratch yours.

This is Age UK –

Commercial partnership with E.ON

Age UK has a longstanding commercial partnership with E.ON.

When customers contact us, they are signposted to E.ON and offered a choice of all four E.ON tariffs and many choose the one year tariff or variable option, however many prefer the reassurance of a fixed tariff for two years.

The long term Commercial partnership includes a typical commission to Age UK of £10 for each customer.

Is this within the remit of a charity to muscle elderly vulnerable people into signing up with companies with which it has a commercially beneficial relationship?

AGE UK has partnered with another 'charity', a pro-euthanasia outfit, the 'charitable arm' of the Voluntary Euthanasia Society which re-branded as Dignity in Dying.

See, for instance -

Liverpool Care Pathway - Doing The Addition

AGE UK Enterprises Ltd also sells branded Insurance provided by Ageas Insurance Ltd.

Ageas brands include Castle Cover, Express Insurance, Kwik Fit Insurance, RIAS, and Tesco Underwriting Ltd. Tesco Underwriting Ltd is jointly owned by Aegas and Tesco Bank.

This is a tangled web. Is this but an appearance of competition?

It is likely a mutually lucrative relationship.

According to Third Sector, Age UK income is currently £159m. This ranks 9th in the tables and Age UK pays 38 staff in excess of £60k. Tom Wright, Age UK CEO, earns up to £190k.

"Charities want dynamic, superb chief executives to drive and fulfil their missions," he says. [David Fielding] "If you're too restrictive and sanctimonious on salaries, you will struggle to recruit and retain the best possible leaders."
- Third Sector

This is 'justified' to recruit and retain the best possible leaders who have come up with ideas for innovative income generation such as badgering donors and driving them to suicide and employing crews of chuggers to aggressively accost passers by in the street.

And what happens to all that information you give when they sign you up as a donor? If you don't opt out, will you be opted in?

Positive liberties; negative rights.

This is Collaborate –

Collaborate is a new data source of prospective donors for UK charities. Collaborate is part of the Abacus Alliance database, the largest single source of transaction data in the UK. Actual transactional histories are modelled to predict future behaviour. There are two solutions available: non-contribute and contribute.

Concerned about sharing your donor data? This solution allows charities to access a sub-set of the Abacus Alliance in order to:

acquire new donors

reactivate lapsed donors

£130 per thousand

By contributing your shareable donor records you can:

gain access to the full Abacus Alliance universe

acquire new donors

reactivate lapsed donors

gain donor insight

£70 per thousand

With over 17 years’ experience, Abacus has become the standard for high-level consumer targeting in the UK.

Medialab is an industry leading direct response media agency, with a track record for delivering market beating results within the charity sector with a core focus on new supporter acquisition through data driven media planning and innovation solutions. They work with more than 30 charity clients directly and many others through long-standing agency relationships, including Macmillan, Age UK and Save the Children.

In 2012, Lord Shawcross took over the helm at the Charity Commission and was very critical of the fundraising tactics being employed in the Third Sector...

Liverpool Care Pathway - The Likely Customers

The Express carried a report on excessive and exorbitant remuneration...

Nine executives at Cancer Research UK earn more than the Prime Minister, including chief executive Harpal Kumar, who pockets up to £240,000 a year.

Kumar, 50, lives in a luxury £1.6m home in north-west London and does not have a mortgage.

Peter Wanless, CEO of the NSPCC, earns a staggering £162,000 per year – £40,000 more than his predecessor Andrew Flanagan.

Last year he pictured sipping champagne, and boasted on Facebook: "This was taken while I was 'working' on a visit to Jersey."

The NSPCC was among the charities that asked Olive Cooke, 92, for money before she killed herself last month.

Cooke, a poppy seller, was inundated with requests from charities she felt were "taking advantage" of her generosity.

The mother-of-three was struggling with her finances after being diagnosed with cancer.

A spokesman for the NSPCC said: "We have thousands of long-term supporters, who are committed to helping end child abuse, of which Olive Cooke was one."

Other high earners include Amnesty International's Salil Shetty, who pockets a salary of up to £210,000, and Tom Wright of Age UK, who earns up to £190,000 a year.

Where will all this lead?

Sir Stephen Bubb, chief executive of Acevo (Association of Chief Executives of Voluntary Organisations), has accused William Shawcross, the chair of the Charity Commission, of being out of touch when he criticised charities that rely on state funding...

Liverpool Care Pathway - Either, Or... Else

Are these the makings of the Corporate State...?

Liverpool Care Pathway - The Palliative-Medical Complex

Supplemental  reading -

Liverpool Care Pathway - A True Story

Liverpool Care Pathway - Responses Will Be Answered

Liverpool Care Pathway - A True Story Supplemental

Liverpool Care Pathway - A True Story: The Next Generation

Liverpool Care Pathway - Jane's Story

Liverpool Care Pathway - Don't Call The Ambulance! 

Liverpool Care Pathway - Bringing It On Home