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