Liverpool Care Pathway - Ten Years In The Waiting

A report into the 81 deaths at Gosport is in the public domain, at last...




Deaths in custody are taken seriously (as they should be) by the lefty journalists in their lefty papers, and when there are riots and pillaging on our streets, they even excuse that.

Deaths in care are dismissed as propoganda or looked upon as an aberration or anomaly. Cops behave that way; carers don't, particularly those working in the holy cow that is the NHS which the holier than thou have seated on a pedestal and worship as a golden calf. Moses would slam his tablets to the ground at the sight of them!

And when there is a swell of protest and outcry of despair at what has happened, they will not be roused or rally to support that protest but, rather, stand side by side with puffed-up Tory Lords who chose to dismiss such claims of wrong-doing as 'anecdotal'!

But deaths in care are and continue to be reported. "Excess deaths" continue to be the indicator that something has happened, is happening.

The Review has slammed the use of the LCP, but still reserves some good thoughts for the LCP itself. There are other ‘last days’ pathways, though, and these are all still up and running.

As mentioned in these pages, the Welsh Collaborative Care Pathway, for instance, had a 'fundamental rewrite' and was relaunched­­­ because of 'adverse publicity'. Now, the same is happening to the LCP? These should not be looked to to replace the LCP; rather, they should be subjected to scrutiny and review themselves.

The Review recommends:

More use of evidence based prognostic tools and education and training in them is needed.

This is the GSF Prognostic Indicator Guidance –

It was Dr. Barton's claim that she could look at someone and tell that they were dying.

The 'Surprise Question' recommends to GPs that they do just that in their hunt for their 1%.

This quote is in the Review. They are all quite, quite arrogant:

And this is the SPICT –

SPICT is a trademark of the University of Edinburgh and NHS Lothian but it was not found to be registered at the Intellectual Property Office.

The SPICT^TM  is sometimes used in combination with the "Surprise Question":
Would you be surprised if this patient died within 12 months? [See the GSF Prognostic Guide]

Way back in the 90s, the Barton Care Pathway was in full swing at Gosport War Memorial. Hers was but one more of many that have a long tradition in the NHS of doctors 'playing God'.

The Shipman care pathway and the Grigg-Booth protocol, for instance...

Further reading -

Liverpool Care Pathway - The Trailblazers

Liverpool Care Pathway – And Other End Of Life Care Pathways
Liverpool Care Pathway – CQUIN-gate!

They may pretend or deny any personal allegiance to a god-head but - inapproprate yet fitting - always possess the 'god complex'.

A government blockbuster just released by the DoH Studios, ten years in the making - but no box office blockbuster this, it is hoped - has just been slipped out quietly to get lost in the weekend news and buried beneath the LCP sham review.

This is a report, for all intents and purposes, into a Care Pathway - the Barton Care Pathway - that might as well be the Liverpool Care Pathway.

This is  Portsmouth News –

Ian Wilson, 53, of Beryton Road, Gosport, has been one of many families waiting for the Baker report to be published.

It looked into 81 deaths at the Gosport War Memorial Hospital (GWMH) during the 90s, after concerns were raised about patient care under Dr Jane Barton.

And after a 10-year wait, the Department of Health published the report yesterday.

It revealed an over-prescription, and in some cases use, of opiates, and note-taking had been poor.

Mr Wilson’s father Robert, 74, had been to Queen Alexandra Hospital, in Cosham, for a shoulder injury.

He was transferred to GWMH, to wait to be put into a nursing home.

But he died in October 1998, and the cause of death was put down to bronchopneumonia.

Mr Wilson said: ‘I can see why the report has been kept back for so long.

‘It shows a consistent over-prescription of opiates to an inappropriately wide group of patients.

‘A high proportion of deaths were because of bronchopneumonia, that is a side affect of diamorphine, and that was my dad.

‘He was in for respite, they were trying to find a nursing home for him. He wasn’t on any painkillers at QA.

‘This is a damning report and I can see why they kept it from us.

‘I’m glad it has come out now, it’s taken a long time, but gives us more of an angle.’

Richard Baker, a professor of clinical governance, who worked on the Harold Shipman inquiry, started his review in 2002.

The government would not publish the report until the final inquest into deaths from that period took place.

The report found the use of opiates ‘almost certainly shortened the lives of some patients, and it cannot be ruled out a small number of these would otherwise have been eventually discharged from hospital alive.’

It said opiates were often prescribed before needed.

Dr Barton had a higher percentage of patients whose cause of death was put down to bronchopneumonia, and prescribed a higher number of opiates before a patient’s death.

It also found there ‘were no clear clusters of deaths’, but the ‘proportion of patients at Gosport who did receive opiates before death is remarkably high’.

Gosport MP says report makes ‘sobering reading’

FOR the past three years, Gosport MP Caroline Dinenage has been asking for the results of the Baker report to be published.

The report, which was revealed yesterday, looks into the deaths of 81 patients at the Gosport War Memorial Hospital (GWMH), from the 90s.

Ms Dinenage said: ‘It’s sobering reading. I’m pleased we can finally look at the reports, and the families that have been waiting 10 years can look at it.

‘It makes troubling statements about the anticipatory prescription of medicine, and of inadequate note-making.

‘But the comfort we can take is changes have been made at GWMH.’

Why it’s taken 10 years for report to come out

THE government called for a review in to the deaths of patients at Gosport War Memorial Hospital.

Dr Jane Barton, who used to practise at the Forton Medical Centre in Gosport, was also a clinical assistant in the former Dryad and Daedalus wards at the hospital in Bury Road.

Between 1996 and 1999, 12 patients died in her care, instead of recovering.

Gladys Richards, 91, was one of the patients who died in Dr Barton’s care, and her daughter Gillian Mackenzie approached police with concerns, which prompted an investigation by Hampshire Constabulary.

In 2002, Richard Baker, a professor of clinical governance, who worked on the Harold Shipman inquiry, was appointed to look into 81 deaths at the hospital.

The government said the report would not be published until inquests in to all of the deaths had taken place.

In April 2009, an inquest was held in Portsmouth into the deaths of five patients under the care of Dr Barton.

A jury ruled drugs prescribed by the GP contributed to the deaths their deaths.

Following the inquest, the General Medical Council (GMC) held a hearing into Dr Barton’s fitness to practise.

She was found guilty of ‘multiple instances of serious professional misconduct’ relating to 12 patients who died at the hospital, but was not struck off.

In 2011, Dr Barton, applied to the GMC to have her name removed from the register.

The inquest of Mrs Richards took place in April, and yesterday the Department of Health released the report.

Ten years down the line, will there be a Baker report into the LKP that reveals it, at last, for the medical holocaust it has been?

Liverpool Care Pathway - Curiouser And Curiouser And Curiouser

'Curiouser and curiouser!' cried Alice. 'Dear, dear! How queer everything is to-day! And yesterday things went on just as usual.' 
Or did they?


The following article is published by Guardian Professional. According to The Guardian,

Guardian Professional Networks are community-focused sites, where we bring together advice, best practice and insight from a wide range of professional communities.All editorial content is independent of any sponsorship, unless otherwise clearly stated.

The Guardian report included an interview with Elaine Stevens of the Independent Association of Nurses in Palliative Care.

What is the Independent Association of Nurses in Palliative Care?

According to the link supplied on The Guardian page, Elaine Stevens, is one of five committee members and is Chair of the group.

There is a Treasurer, Carol O'Leary, and two undesignated members, Celia Manson and Mary Holland.

The fifth member, the Secretary, is Margaret Kendall.

The Guardian article is written by Debbie Andalo.

Guardian journalists tend to be lefty, prim and proper types, politically correct and, mostly, woolly-brained. Debbie...

you want to be careful who you brush shoulders with. There are a lot of Arthur Daley types about, you know, who may be not at all who or what they make themselves out to be with delusions of grandeur and self-importance.

This is the IANPC website -

As you can see, they have obtained CME Medical sponsorship. CME Medical is the fastest growing specialist infusion company in the UK.

CME Medical is into sponsorship -

CME Medical Supports Sue Ryder Charity Conference on Palliative Care

CME Medical is proud to be sponsoring an annual conference organised by the Sue Ryder charity at its Thorpe Hall Hospice.

The charity uses the T34 Ambulatory Syringe Pumps to help support patients at the hospice in Peterborough which offers respite care, palliative care and end of life care for patients with active, progressive and advanced illness

So, who is, what is the Independent Association of Nurses in Palliative Care? Where have they suddenly appeared from?

Well, according to the IANPC, they have been around for some time. This is a Letter from the Chair -

Hello and Welcome to our first electronic newsletter. My name is Elaine Stevens. I am a lecturer in cancer and palliative care in Scotland and the chair of IANPC.

The IANPC was developed by a group of experienced palliative care nurses to promote high quality palliative care to all dying people regardless of diagnosis or place of care. We had our inaugural meeting at Palliative Care Congress in March 2010 but due to work and other commitments did not really begin to advertise the Association more widely until the end of 2010.

We have our 1st National Conference coming up in May and we look forward to seeing any members who can manage to come along. Information about the conference can be found later in the newsletter.

Our first AGM will be held at the beginning of the conference and we are seeking two new executive committee members. So if you feel you have the time to give to our Association please contact me for further information. Elaine.stevens@uws.ac.uk

We would also be delighted to receive information about palliative care initiatives for inclusion in our next newsletter or to post on our website. Information on who to send items to is listed at the end of the newsletter. I do hope you enjoy this first newsletter.

Yours

Elaine provides here her University of West Scotland email where she is a lecturer.

Scroll down to the bottom of this page and you reach an
announcement for the 1st Annual Conference incorporating the AGM.

There is a list of links at left on the main site, one of which goes to Annual General Meeting. Clicking on this link, you are taken specifically to a summary disclosure of the 1st Annual General Meeting -

The First Annual General Meeting of the Independent Association of Nurses in Palliative Care was held at the Lancaster House Hotel, Green Lane, Lancaster  LA1 4GU on Thursday 26th May 2011 the AGM was held as part of a full day conference The full programme is available here The minutes of the AGM are available here

It is confirmed that the above all day conference booking, made at the The Lancaster House Hotel, for Thursday 26th May 2011 was made in the name of NHS Cumbria. 

NHS Cumbria.

According to Elaine, by this time, they were "advertising the Association more widely", so it seems strange the booking wasn't made in the Association's name. It does seem odd. This is a booking for the the 1st Annual Conference of the Association, incorporating the AGM, and it wasn't made in the Association's name. 

Any other members of the Association apart from these five committee members declared to be present would surely have expected that to be the case, and heard that to be the case when the accounts were being declared at the meeting.

At the AGM, the Treasurer -

Carol O’Leary (CO’L) gave an overview of the year’s accounts and these were approved as accurate by Celia Manson (CM) and seconded by Mary Holland (MH).

Was the conference booking paid for out of Association funds?

Readers of these pages will know of the controversy of Margaret Kendall and 'The Group that never was'.

Further reading here -

Liverpool Care Pathway - Of Deception And Infamy

Liverpool Care Pathway - Of Deception And Infamy (Part II)

Margaret Kendall's emails -

I can confirm that the groups mentioned in 1-5 below are the same group of which I am chair. Our terms of reference are as follows:

Our purpose as a group of nurse consultants is to promote palliative care nursing within a multi-professional context 

AS NURSES IN PALLIATIVE & END OF LIFE CARE WHAT DO WE DO?

Our terms of reference are as follows:

· To provide a critical body of expert nursing opinion
· To influence nursing practice at local, network & national levels
· To articulate nursing practice to influence policy
· To identify areas of nursing practice in need of further development by research and education
· To contribute a nursing voice to debate affecting delivery of palliative and end of life care
· To provide diverse nursing knowledge and expertise supporting service development

I hope this clarifies.

Margaret

Margaret Kendall

Consultant Nurse In Palliative Care / End of Life Care Lead


The group is made up of 26 consultant nurse in palliative care who are employed either by acute trusts, primary care trusts or independent hospices.

We are all highly experienced nurses who have worked In the field of palliative care for many years prior to assuming these roles.

The name of the group as you can tell has been under many guises, but the final agreement on a definitive name will be debated at our next meeting March.

As we are all clinical nurses there is no board formulation. We have a chair and a secretary for administrative purposes only. We meet to debate and support palliative care initiatives and to initiate best practice models where none may currently exist.

Neither the DoH or NHS commission work from the group but we work alongside the National End of life Care team to provide the clinical voice for new developments and reviews. Occasionally the DoH ask for a representative from the group to sit on working parties or review panels to provide the clinical nursing input.

We receive no funding whatsoever either for work that we do or for our meetings.
Regards,

Margaret

Margaret Kendall
Consultant Nurse In Palliative Care / End of Life Care Lead

Were any individual to award themselves any number of diverse aliases in like fashion as has/have this/these body/bodies, they would likely be suspected of wishing to perpetrate some fraud and the police would likely be called in to deal with it.

Why use diverse aliases in like fashion, unless it is thereby to deceive and mislead that the body of opinion supported and promulgated has wider, broader support than is actually the case, and to provide additional sources for citation?

Margaret, you had already awarded yourself/selves five august sounding titles. Margaret, you then responded to my email with a sixth!

Thus, it is established that the six groups named here –

1.     The National Nurse Consultant Group (Palliative Care) 

2.     The Consultant Nurses in Palliative Care Reference Group 

3.     The National Palliative Care Nurse Consultant Group

4.     The National Group of Palliative Care Nurse Consultants

5.     The National Group of Palliative Care Nurse Consultant

6.     The nurse consultant group

are one and the same group chaired by Margaret Kendall. 

It is now established that these six  named groups did not exist officially under any name at all as that matter was to be decided at their next meeting last March, 2013.

It is now established that this group chaired by Margaret Kendall has had many names and yet has had none.

It is now established that this anonymous anomality of non-persona have had authored and co-authored work published, given evidence to a House of Lords Select Committee, submitted expert opinion, and been cited in reference.

According to Dr. Lofthouse:

1. In 2005, a group claimed to represent "all palliative care nurse
consultants in England ".- "The National Group of Palliative Care
Nurse Consultants"-, in their written evidence to the House of
Lords Select Committee on Assisted Dying in 2005 (see:
http://www.publications.parliament.uk/pa...).
2. A statement by another group called the"Consultant Nurses in
Palliative Care Reference Group" in 2012 (signed by an M Kendall
MSc BSc RGN RSCN NDN on behalf of this group on 25/10/12 ) is
currently being displayed on the NHS National End of Life Care
Programme web portal at
<http://www.endoflifecareforadults.nhs.uk...> 

in support of the Liverpool Care Pathway, and what they describe
as 'their colleagues at the Association of Palliative Medicine'.
They do not appear to exist.
3. Yet another group calling themselves the "National Nurse
Consultant Group (Palliative Care)" appear to have actually written
the Guidance on nursing the dying for the DoH/NHS in 2011. (see:
http://www.endoflifecareforadults.nhs.uk...)
, and M. Kendall appears to have been the only named author of this
document. They do not appear to exist either.

This 'group', this bunch of somebody/nobody nurses, representing no-one but themselves, have had profound influence far beyond their stature and their reach.

Now, Margaret turns up as Secretary of the Independent Association of Nurses in Palliative Care. Is this actually a seventh incarnation of the previous six?

Who can tell...?

The booking at the Lancaster House Hotel was not made by the Independent Association of Nurses in Palliative Care; it was made by NHS Cumbria.

Was the conference booking paid for out of NHS funds? Was there corruption involved?

Was this an actual NHS Cumbria conference and are this 'gang of five' of the IANPC doing a Ministry of Truth to rewrite its history to give it some historical credence?

How can we tell...?

You spun us some terrible yarns,

Oh, Maggie
I couldn't have tried
                    anymore...

Just to conclude...

At the AGM, "special reference was made to Napp Pharmaceuticals and CME McKinley for their sponsorship towards the Association."

Furthermore, Elaine Stevens said that "Approach has been made to [her] by Grunenthal who wish to discuss possible joint working and sponsorship of the Association."

Grünenthal is a German pharmaceutical company headquartered in Aachen. It was founded in 1946.

In regard to Napp, NCPC (National Council for Palliative Care) offers 'Corporate Partnerships'.

One of these partners is Napp Pharmaceuticals -

A partnership in the true sense of the word...

The so-called third sector is a profitable business to be in, on all sides, not least because they have money being generously thrown at them by an unsuspecting public.

Charity used to be charity and everything was as it was. Or was it? How queer everything is today.

Liverpool Care Pathway - Horrific And Costly In Lives

A policy of convenience, at once deadly and effective, promoted by government and by its network of proxies.



The great liberal reformers of the 19th century would have proclaimed: "How well we care for the poor, the vulnerable, the sick, reflects how we care as a society"

This is e-Hospice in the 21st century -

"How well we care for our dying reflects how we care as a society"

What Jeremy Hunt described as a fantastic step forward has been more in line with another gentleman's great leap forward, both horrific and costly in lives.

This is NCPC:

End of life care accounts for a high proportion of NHS spending. The Demos think tank has estimated it as at least a fifth of NHS costs and a total of about £20 billion

There is considerable scope for improvement using interventions such as early identification triggers, advance care planning, co-ordination of care and effective multi disciplinary team (MDT) working.

[Commissioning End of Life Care]

The emphasis in this statement is on a concern that costs are as much as one fifth of the total budget, amounting to some £20 billion.

According to e-Hospice, hospices in Wales are to get £2.4 million as part of a £6.5 million funding package for specialist palliative care services. This ties in with the Welsh government's dangerous presumed-consent policy on human organ harvesting.

"The Welsh Government has declared that hospices play an essential part in its aims to reduce 'inequalities' in end of life care and to maintain the dignity of an individual in their last days of life, as set out in the Delivering End of Life Care Plan, published in April 2013."

How do you spend money to save money?

Science Business says -

A £3.2 million grant has been made to establish a Palliative and EoLC Chair at University College London (UCL). 

How do you spend money to save money? 

Cutting costs means cutting care means downsizing care means downsizing care expectations, achieving the impossible by making it desirable. 

THINK:
Dying is a positive life choice.
Let's talk about it...

To promote this concept costs money but, to achieve such an outcome, spending money to save money really does make sense.

The Government published its NHS National End of Life Care Program in 2008 and invited the NCPC to groom the British public into accepting the idea of dying as a positive life choice. Out of this was formed the Dying Matters Coalition. The NCPC has led the Coalition since 2009. The EoLC Program was effectively outsourced to the NCPC.

The Department of Health committed to investing 286 million pounds over the two years to 2011 to support implementation of its National End of Life Care Strategy.

"We are investing £286 million over the two years to 2011 to support implementation of the End of Life Care Strategy to help improve end of life care for all adults, regardless of where they live.”- The Telegraph

Best interests...

   It is not in their best interests to 'keep them going'.

   It was 'for the best' that the patient should have died.

   It was better that 'she should not suffer'.

   The patient would not have wanted to 'live in a wheelchair',

   or 'be a vegetable',

   or have to stay in hospital 'with wires coming out of her',

   or 'be a burden to her family'.

   If they were animals, they would be put down.

That last comment about 'they would be put down' might appear overly blunt or insensitive, but it is one that has been commonly expressed by respondents on the subject in on-line comments columns.

Are these sentiments, then, not worthy and in accordance with the humanitarian and enlightened approach espoused by the proponents of euthanasia and assisted suicide? Lord Faulkner might even applaud.

The really worrying thing is that such 'best interests' decisions may be used by some physicians and medical practitioners to bury their misdemeanours.

These sentiments are, in fact, those expressed by Dr.Harold Shipman.

The Independent reported -

The caring killers: Death by night shift

For years, nurses illegally administered morphine and other powerful drugs. Hospital patients died. Now the story can be told. Nina Lakhani reports

The report reveals that night nurses at the hospital in Keighley, West Yorkshire, openly gave patients drugs such as morphine intravenously for many years, despite the practice being illegal.

A showcase hospital that won the Government's highest three-star rating allowed nurses to prescribe illegally and administer powerful drugs which police believe killed three patients and injured many more.

A damning report into "systemic failures" at the Airedale NHS Trust reveals that night nurses at the hospital in Keighley, West Yorkshire, openly gave patients drugs such as morphine intravenously for many years, despite the practice being illegal and against hospital rules.

Nobody has ever faced trial or been struck off as a result. One nurse at the heart of the inquiry, Sister Anne Grigg-Booth, was charged with three murders, one attempted murder and more than a dozen lesser, related charges but died of an overdose in 2005 before the case came to trial. Her death meant the allegations against her were never tested. No motive has ever been suggested for her actions.

NNPs took verbal orders for medicines from doctors over the phone to save them coming to the ward. They also administered morphine and other opiates intravenously. Neither was allowed under hospital or professional regulations. Grigg-Booth, and at times other NNPs, also prescribed opiates such as pethidine and diamorphine for patients. This was risky and unlawful as they can hasten or cause death.

The doctors were complicit also; the Night Nurse Practitioners (NNPs) took verbal orders over the phone...

It was the NNPs who were charged.

These are the caring killers of the LCP...

Mail Online

This is Mail Online -

This was why the LCP had to be rolled out. This was how Shipman got away with it for so long.

'Best interests'

...to withhold hydration?

From the BMJ archives -

"... It matters not whether we discuss continuous deep sedation or a lesser degree of sedation. Any level of sedation, even a small dose of morphine in the frail elderly, can result in dehydration that may prove fatal if left untreated for days. Unfortunately palliative carers tend to overlook this basic fact. They prefer to discuss sedation and hydration as separate issues without linking the two in their minds. In doing so they are in danger of missing or evading the point, which is that sedation without hydration kills."

They have downsized care expectations. The policy of determining care to be 'futile' and downsizing care expectations has worked. A system has been rolled out. It is in place. It is working.

- Mail Online

All policies, ultimately, have consequences. These are now apparent and plain for all to see.

Result? Excess deaths...!

- Healthcare Analysis & Forecasting (HCAF)

The BBC reports -

"Missing..."

130,000 LCP deaths a year...

How many of those 130,000 would have lived on to make up the missing numbers?

The policy is a global policy.

The right to die is a right to 'self-determination'.

Yonhap News Agency reports -

S. Korea asked to legislate on patients' right to self-determination

By Kim Kwang-tae
SEOUL, July 31 (Yonhap) -- 

A presidential bioethics committee on Wednesday called for a special bill that would allow patients in the final hours or days of their lives to determine whether to receive treatment that could prolong their lives. 

The move represents growing calls in South Korea for patients nearing the end of their lives to be well-informed of their exact conditions and to be able to decide whether to sustain their lives through equipment or treatments such as respirators, hemodialysis, cardiopulmonary resuscitation and anti-cancer drugs.

The patient is determined to be in their "final hours or days of life". How is that determined? What does that mean?

Any patient, without receipt of appropriate medical treatment to remedy their situation, might be considered to be in their "final hours or days of life".

What criteria determines that such appropriate medical treatment in this case is 'futile' but, in that case, is not futile?

It is determined by the physician's subjective  perception of a life considered worthy of life and of a life not so adjudged worthy of life. It is to do with health care rationing and the intrusion of the Communitarian ethos into the mainstream.

It is doctors abandoning traditional ethics.

It was once unthinkable to permit an action that would cause or permit death. Today, doctors don death caps and sit in judgement of their patients worthiness to live. The right to life, the right to live, has been submerged beneath a tidal wave that demands the right to die.

With the LCP, this has gone further. Patients, diagnosed not with a life-limiting or terminal illness but to be 'dying', have had their lives taken, terminated abruptly. The so-called review did not 'review' these deaths. The so-called review did not 'review' those deaths on the LCP not recorded as such because the the Trusts do not know and the documentation  is not there.

The review is a shambles and a cover-up to bury the truth.