Edinburgh hospital put man on controversial Liverpool Care Pathway

A widow has claimed doctors put her terminally ill husband on an 'end of life pathway' without telling her, denying her the chance to share his final days with him. Liz Watson, whose husband George was admitted to a Marie Curie Hospice for respite care, hit out at doctors after his condition deteriorated rapidly.

She says Mr Watson was the 'love of her life' and 'didn't deserve to die like he did' on the pathway, which sometimes involves depriving patients of food and water. Mr Watson was diagnosed with a brain tumour 17 months before he was admitted to the hospice. from which he never came home.

His family said the 64-year-old from Liberton in Edinburgh was going shopping and 'eating three-course meals' before he rapidly declined in the centre in Fairmilehead.Mrs Watson said she only realised George was on the controversial Liverpool Care Pathway - which involves withdrawal of medication, food and fluids - when her mother recognised the signs.

A later inspection by Healthcare Improvement Scotland upheld several complaints about care standards, including poor communication about his worsening condition, and made a list of recommendations...But following a recent unannounced inspection last month, it was found many improvements had still not been carried out. The watchdog made five requirements and 11 recommendations that must be addressed 'as a matter of priority'

A spokeswoman for NHS Lothian said: 'Like every health board in Scotland, NHS Lothian is following Scottish Government guidance on the Liverpool Care Pathway and phasing it out.'

Read more: http://www.dailymail.co.uk/health/article-2785401/Widow-claims-husband-s-days-stolen-doctors-banned-Liverpool-Care-Pathway-without-knowledge.html#ixzz3GtTPggfU

`Phasing it out` means it is still going on.

Doctors and nurses still using LCP

Some doctors and nurses are still using the Liverpool Care Pathway (LCP) for dying patients, an expert has claimed, despite an NHS decision to scrap the controversial care plan.

A major review recommended last year that the LCP should be phased out, following widespread criticism from the media and some patients.

The care plan, which gives doctors and nurses guidance on the management of terminally ill patients, was dubbed a "death pathway" amid allegations that patients were being placed on it without their families being told.

The Neuberger review said it should be abolished after finding many examples of poor implementation of the LCP’s guidance.

However, Dr Anthony Wrigley, a senior lecturer and specialist in medical ethics and palliative care at Keele University, said he was aware "certain institutions have gone back to relying on it"...

In June a group of leading nursing and end-of-life care organisations – the Leadership Alliance for Care of the Dying – proposed new guidelines, which placed greater emphasis on individual care plans.

http://www.independent.co.uk/life-style/health-and-families/health-news/controversial-care-plan-still-in-use-despite-nhs-decision-to-scrap-it-expert-claims-9768095.html

While the NHS is being dismantled and run down this type of abuse will continue.

The NHS is under threat

The National Health Service has provided world class care, free at the point of use, to the British people for 66 years. It was recently rated as the most effective and most efficient healthcare system in the developed world, outperforming 10 of the world’s richest countries, despite the UK spending only 9.6 per cent of GDP on health – much less than most of those countries.

Under the Coalition government, the health budget has been maintained in an era of unprecedented austerity. However, historic annual increases in the health budget, designed to keep pace with a growing and ageing population, have been severely reduced – meaning that our NHS has just been through the longest, and most damaging budget squeeze in its history.

Thousands of patients are facing longer and even unacceptable waits to find out whether or not they have cancer, because services are under extreme pressure and referral targets are being missed. In mental health, patients in need of emergency support are being moved to hospitals hundreds of miles away because there simply are not enough beds in their area.

http://www.independent.co.uk/life-style/health-and-families/health-news/the-nhs-timebomb-nhs-and-social-care-services-areat-breaking-point-it-cannot-go-on-9775928.html

More than 100 elderly a week are forced to give up their house

More than 100 homes a week are being seized from elderly people by councils to pay for their care home fees.

 

Families have been forced to hand over properties because local authorities are refusing to pay for the care.

 

The scale of the confiscations – revealed yesterday by a Freedom of Information request – will pile pressure on the Government to help the thousands of families forced to pay ruinous care fees.

 

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The Coalition promised a cap on care costs by 2016, but this will only apply to bills of £72,000 or more.

 

Up to that point, all those with assets of more than £23,250 are expected to pay their own way – even if that means selling the family home or agreeing to surrender it when their relative dies.

Read more: http://www.dailymail.co.uk/news/article-2770156/More-100-elderly-week-having-properties-seized-pay-care-home-fees.html#ixzz3FJvUflT5

Silver Line

 

The staggering volume of calls to 24-hour service The Silver Line reveals how a helpless army of the elderly has been suffering in silence. Now celebrity campaigner Esther Rantzen is demanding the shocking statistics act as a "wake-up call".

The veteran TV host, who set up the free and confidential line, has been stunned at the numbers phoning in, with roughly one pensioner every three minutes seeking someone to speak to.

Esther, 73, said: "This has to be a wake-up call because this is, and will continue to be, a huge ongoing issue. "I have unearthed a huge problem.

http://www.express.co.uk/life-style/retirement/478400/100-000-pensioners-flood-Esther-Rantzen-s-helpline-for-the-elderly

Childline has been accused of filtering out children making sexual abuse complaints against well known people. If that happens the children are ignored.

Those telephoning Silver Line for a chat had better take care. This phone-line could have been set up to gain access to vulnerable and solitary elderly people who might then have social workers knocking on their door, especially if they are living in their own home. Local authorities can always arrange a diagnosis of dementia and then ship an old person off to a care home.  The house will be sold off to pay for their care.

Controversial guidelines to be reviewed

Dr Peter Carter, general secretary of the Royal College of Nursing

 

The NHS has agreed to review controversial guidelines that instruct nurses to ask the elderly whether they would agree to a ‘do not resuscitate’ order.

The Mail revealed yesterday how patients are being visited at home by nurses they have never met before, and asked sensitive questions. These include where they want to die, and if they want doctors to try to resuscitate them should their hearts stop.

Following criticism of the initiative, the NHS’s Chief Nursing Officer for England, Jane Cummings, said yesterday: ‘We will review the [questions] again, with patients and clinical staff, in the light of the poor experiences described in the media, and make any changes that are needed.’

She added that the revised guidelines will make sure certain questions are only asked as ‘part of an ongoing discussion’ once a ‘meaningful relationship’ has been established between a nurse and patient. This could mean that nurses will only be allowed to discuss the do not resuscitate (DNR) orders if patients bring the topic up first.

The new guidelines on home interviews were introduced by NHS England in June as part of a drive to improve care of the elderly at home. District nurses have been sent to visit those aged over 75 and with long-term conditions, armed with a list of questions.

http://www.dailymail.co.uk/news/article-2730380/NHS-agrees-review-nurses-not-resuscitate-interviews-Nursing-chief-says-look-guidelines-criticism-initiative.html


The language is deceptive. The NHS keeps equating `allowing a patient to die` with `improved care`.  Whatever new guidelines are put forward, this topic is not going away because the elderly are viewed as a drain on the NHS.

What is an Advance Care Directive?

You fill out a form when you are competent so that should the time come when you are not competent you have a set of instructions about how you would wish to be treated. Advance directives can deal with health care, where you want to live, organ donation, cremation - a whole variety of things.

You can also have a proxy directive called a power of attorney. You nominate somebody else.to make decisions on your behalf when the time comes.

You don`t have to fill them out.

There may be advantages for some people in filling out advance directives and powers of attorney but there are also disadvantages.

If you are assessed as being incompetent you are not allowed to change your mind, although still having mind enough to know what you want. Your  power of attorney can stick you in a care home against your will and run away with your finances. Your house can be taken over by the local authority to pay for you being in the care home where you do not want to be. So there are lots of advantages for other people, but none for you.

Professor Molloy paints a rosy picture but it is only half of the story.

Then it is often the case that doctors and other professionals will make decisions on your behalf without informing your relatives and these days they tend not to want to prolong your life. See the post below.

One chance to get it right

The approach to replace the Liverpool Care Pathway was set out in the LACDP report, One Chance To Get It Right. The alliance accepted recommendations for a named GP to take overall responsibility for the care of patients nearing the end of their lives in the community.

Dr Maureen Baker, chairwoman of the RCGP, one of the LACDP bodies, said: 'Today’s announcement should provide much-needed clarity for doctors and, most importantly, much-needed reassurance for patients and their families and carers.

'By setting out clear principles of what is expected, it should increase the confidence of doctors, nurses and other health professionals in confronting sensitive issues around end-of-life care, as well as reducing the potential for confusion or misinterpretation.'

OK. What do they mean by `setting out clear principles of what is expected?`

For instance, why don`t they say who is supposed to be expecting what, and why? Using language in this vague way gives the strong impression that they are reluctant to come out clearly with what they mean.

Then we might wonder who has the potential for confusion or misinterpretation?  Is it the health professionals who lack confidence in confronting sensitive issues around end-of-life care, or the patients? It`s vital to know. Why don`t they say?

What are the sensitive issues around end-of-life care? Are they talking about the withholding of food and liquids? Get that wrong and you kill people. Isn`t that what all the scandals have been about and calling that a care plan an outrageous distortion of the truth?

Are we really expected to be reassured by another round of the same old gobbledygook that attempts to disguise the euthanising of our old folk?

I don`t think so.

http://www.gponline.com/liverpool-care-pathway-successor-clarifies-gp-role-says-rcgp/palliative-end-of-life-care/article/1300789

Palliative care. Has anything really changed?

Scotland`s Patient Association 





It is worth reflecting back on the following article from the Daily Record given that nothing much has changed and the current emphasis in the care of the elderly is still to encourage them to contemplate their decline and death:

A DRUG given to US Death Row prisoners is being used on dying old folk in Scotland's hospitals. Medics use the sedative midazolam as part of a highly controversial "pathway to death" care plan for people judged by doctors to be in the last hours of their lives.

But patients' leaders warned yesterday that the widespread use of the Liverpool Care Pathway (LCP) in Scotland's NHS is robbing pensioners of the chance of life. They claim that, for some old folk, being put on the LCP is effectively a death sentence.

And research has found that many doctors decided to put patients on the pathway WITHOUT the consent of their loved-ones. Margaret Watt, chairwoman of the Scotland Patients Association, told the Record: "The LCP can be used to bring patients' lives to a premature end.

"We have patients on our records who should be dead but are not. Their families had to fight to get them appropriate treatment. "If the relatives had not had power of attorney, it would have been 'ta ta' to the patients. And we're convinced this is only the tip of the iceberg.

"How many people's lives have been taken that should have been here today?" "We're concerned to hear about cases where patients have been given drugs used on Death Row without properly consulting the patient or their family. "Doctors are meant to save lives, not take them. If they do, that's murder."

http://www.dailyrecord.co.uk/news/health/death-row-drug-fed-to-dying-1093688

Planning for decline, dying and death

The Scottish Partnership for Palliative Care is a charitable company limited by guarantee, and is registered as a Scottish charity with the Office of the Scottish Charity Regulator.
You can download a copy of the Partnership's constitution here.

"The Partnership is a membership organisation, and criteria for membership are defined in the Memorandum and Articles of Association. The Partnership has around 54 member organisations, comprising NHS Boards, voluntary hospices, national charities and support organisations and professional associations" - in other words everybody who wants to push forward the palliative care agenda. So no conflict of interest there?

These unelected people have a vision for the rest of us. They want Scotland to be a place where:

Information is readily available on planning for decline, dying, death and bereavement.

People have access to legal, financial and spiritual support for end of life planning (including wills, Power of Attorney, funeral arrangements).

Families, communities and professions support and encourage each other to plan ahead for decline, death, dying and bereavement.

People have the opportunity to discuss and plan for their decline and death with health and social care professionals.

Health and social care professionals feel able to engage and initiate end of life care planning discussions with older people and their families.

People have anticipatory care plans.

As a result of planning and preparation people have fewer concerns about the practical, legal, financial and emotional aspects of decline, dying and death.

Do you get the feeling they are trying to push forward a particular agenda?
 

Data sharing partnership in Lanarkshire

Officials in Lanarkshire announced that their initiative to share patient/client information between agencies had been a success. That conclusion was reached after interviews with staff and key partner agencies.

Senior management encouraged the difficult changes and offered support, from fresh mindsets, to revised working procedures, to using technology. Staff realised that the sharing partnership was not about IT, it was about improving services
 
These extraordinary claims continue: 

At the heart of joined-up care are trusted professional relationships. Don’t even consider communicating complex patient/client contexts by electronic means. Pick up the phone to the colleague you know, or wait till the next team meeting  

If information sharing is in the interests of patient/clients and improved services, there has to be a good reason not to share. Which is a somewhat different mindset to security threats, confidentiality obstacles, silo ownership and sanctions.  

Lanarkshire Data Sharing Partnership (LDSP) was established in 2006 and tasked with Single Shared Assessment and Child Protection messaging. It replaced the Joint Working Across Care Agencies Group established in 2002. This group was responsible for the sharing of older people and adult information i.e. Joint future Agenda and Community Care Act requirements, sharing demographics, assessments/plans, contact and service provision details and service requests for homecare and aids and adaptations. The Children’s eCare Project was established in 2004. Its remit was sharing children’s information and creating and implementing the child protection messaging, linked child protection children and linked child protection adult messages. Annex 1 contains a summary of the Lanarkshire eCare journey (so far) 2002 to 2012.

http://ssrg.org.uk/wp-content/uploads/2012/02/Data_Sharing_Technologies_Board_-_8_May_2012_-_Lanarkshire_eCare_Review.pdf

John Kilbride did not know that this project was on the go when his mother was imprisoned in the care home but it explains a lot.

It was obvious to John Kilbride at the time that whilst Social Services refused to communicate with him regarding his mother`s care, they were communicating with all the other agencies involved in her case, including the Housing Department, care home manager and solicitor, as well as other members of his family. How easily joint working across care agencies becomes collusion - too easy in fact, and for that reason should be discouraged.

Draconian amendments to Scottish Mental Health Act (2003)

The Scottish Parliament is seeking to make draconian amendments to its proposed changes to the Scottish Mental Health Act (2003), allowing medical and legal professions tyrannical powers to detain individuals... The new proposals have very serious implications for the freedom of Scottish people, the changes would make it even easier for individuals to be detained in hospital and gives far too much power to psychiatrists who can, and do, subject their patients to unnecessary treatment.

Details of submissons and Petition:
http://www.scottish.parliament.uk/GettingInvolved/Petitions/mentalhealthlegislation

The consultation on the new Mental Health bill referred to contains proposals from the Scottish Government that appear aimed at drastically weakening the patient’s right of appeal.

In Paragraph II they suggest

1) removing the right of the Named Person to be involved in Tribunals (that will be up to the Trubunals), and also

2) removing the right of the Named Person to see papers relating to the evidence even at the patient’s behest. And

3) in Paragraph 13 they express a wish to allow MHO’s to indicate to Tribunals who the Named Person should be.
http://www.scotland.gov.uk/Resource/0044/00441187.pdf

These three proposals would appear to effectively permit the complete removal (at the discretion of the Sectioners) of the right of appeal from any patient who is unable to coherently and vigorously specify and insist on their own rights. As most are forced to take drugs before their first Tribunal, this could be the vast majority of patients.

The MHO can suggest a ‘Named Person’ to the Tribunal who they think is agreeable to the section, and the Tribunal can agree that the MHO is ‘best placed’ to judge. Should a Named Person be appointed that the MHO or the Tribunals believe might actually fight for the patients’ rights, they will no longer have to cook up a story about them being unsuitable, as the Named Person will apparently require permission to represent the patient at Tribunals. And if all else fails, they Named Person can be rendered unable to help the patient refute the evidence, by denying them permission to see the evidence even at the patient’s behest...

If all else fails, strong appeal cases (or those where there have been blatant breaches of the legislation or the guidelines) can simply be ‘vetoed’ by denying permission.

The proposals seems to be aimed at making the denial of the patient’s human rights appear to be legitimate.

Original article at Namaste Publishing http://namastepublishing.co.uk/tyranical-powers-sought-by-scottish-government-to-change-mental-health-act/

Prisoners of care homes

Mrs Kilbride is not the only person who has been kept in a care home against her will as the following article reveals:

Seldom does a parliamentary inquiry manage to uncover a national scandal on the terrifying scale of the one blazoned across yesterday’s Daily Mail front page under the headline ‘Prisoners of Care Homes’.

Astonishingly, this report by a House of Lords committee on the workings of the Blair government’s 2005 Mental Capacity Act found that ‘thousands, if not tens of thousands’ of old people have been forcibly incarcerated in care homes or hospitals against their wishes and are being ‘de facto detained unlawfully’.

At the heart of the scandal is the ultra-secretive Court of Protection, set up under the Act, which rules every year that thousands of people are deemed to ‘lack mental capacity’ — so that control of their lives and property can be handed over to social workers and other state officials.

http://www.dailymail.co.uk/news/article-2580636/Read-stories-secret-courts-imprison-elderly-care-homes-against-weep.html

10 days in hospital without food

A frail hospital patient was left without food for ten days after several failed attempts by medical staff to insert a feeding tube.

The revelations came to light in a report into Victoria Hospital in Kirkcaldy, Fife, after an unannounced inspection.

The report by Healthcare Improvement Scotland revealed that in one ward the elderly patient "had lost a significant amount of their body weight" as a result of not being fed.

A nurse was observed bringing the patient a meal despite the patient being assessed as unsafe to swallow food or drink.

The same report stated that in a different ward a dementia sufferer also received "little or no" food or fluid intake for five days in a row.


http://news.stv.tv/east-central/268274-elderly-patient-left-without-food-for-ten-days-at-victoria-hospital/

NHS Scotland too slow to deal with problems

Duncan McNeil MSP for Greenock and Inverclyde

Critics last night warned patients are suffering while the NHS is too slow to deal with the problems identified. Labour MSP Duncan McNeil, convenor of the health committee, said: "The Scottish government has been singing loudly about its dementia strategy but these figures show the reality is very different.

"The majority in hospitals are older people and deserve much better. What is particularly damning about this is the health boards are being judged by the inspectors on their own guidelines, the inspectors are simply trying to get them to keep to their own agreed standards and it is not working in so many respects.

"My concern is the health boards are more worried about the cycle of inspections than the root problems and what is happening in the months or years between a failing being identified and then fixed."

HIS figures released under freedom of information show that a total of 303 "areas of improvement" have been identified in its 24 hospital inspection reports since 2012.

Just over a third of the failings relate to "care planning for dementia" with every single HIS report warning that screening for the condition on admission to hospital is "not routinely being carried out".

http://www.sundaypost.com/news-views/scotland/hospitals-slow-to-act-on-elderly-care-failings-1.271302

The Eugenics movement

The buzz word these days is SUSTAINABILITY. Now we are expected to be concerned about unsustainable pressures like the young having to plug the gap in the care budget which has been reduced by austerity. No mention of getting rid of austerity which is making things worse.

Then we are informed that the gap in the care budget has actually been plugged by tightening the eligibility rules for the elderly. So why mention unsustainble pressures on the young at all?

But I think we will be hearing a lot more propaganda like that. The young are supposed to feel aggrieved and hard done by because of the elderly and their care needs.

Families and the NHS are being placed under "unsustainable pressure" to plug the gap created by major cuts to care for elderly and disabled people, the public spending watchdog has warned.

The National Audit Office found that despite a Government pledge to protect social care from the impact of austerity, spending on help for older people in England plunged by 12 per cent in just two years in real terms.

While councils have spoken of protecting services by focusing on other cost-saving measures, the NAO concluded that the vast majority of the reduction had been achieved by cutting the amount of care provided by tightening the eligibility rules.

http://www.telegraph.co.uk/health/healthnews/10693548/Even-Government-does-not-know-how-long-care-system-can-cope-with-cuts-spending-watchdog.html

Annette Bruton CEO of Care Inspectorate explains her role

Guest blogger Annette Bruton, Chief Executive of the Care Inspectorate, explains how the organisation is developing its approach.  www.careinspectorate.com. 

Almost everyone in Scotland will use a care service at some point in their lives. That simple fact means everyone in the country has an interest in the quality of services provided across Scotland right now, from nurseries to care homes, and it means the question of what standards we expect will become an ever more important one in the future.

Care standards are always important..

As Scotland’s regulator for care services we have a duty to ensure everyone receives the best possible care; which means care that is safe, compassionate, meet people’s needs and respects their rights..

Talking about a duty is one thing. Putting it into practice is another.

But there’s more to our role than that, because not only do we have a duty to inspect and regulate, we also have a duty to inform people about the work we do.  Fundamental to the principle of respecting a person’s rights is respecting their right to choose.

Is that why an elderly person was taken into care against her will, perhaps?

And people can only make informed decisions if they have all the information they need. 

Is that why Mrs Kilbride was provided with no information, perhaps?

That’s why we have now embarked on a new way of highlighting some of the things we find out through our rigorous inspections.

GOOD. But you only have rigorous inspections for the situations you are prepared to inspect. Your department was certainly not willing to inspect the abuse of a Power of Attorney in Mrs Kilbride`s case, were they?  How many times has that happened?

On top of that we have just launched an innovative new way to communicate some of the other information we gather. The Hub is our new online resource aimed at Scotland’s 200,000 care workers.

Dare I tell you that the information you gather at the Hub is only as good as the people supplying the information?

Put simply our inspectors who are experts in early years provision inspect nurseries, and those with corresponding experience of care services for the elderly inspect care homes for the elderly...And that’s why we recently launched a bid to recruit more inspection volunteers.

Volunteers (?) who want to get close to vulnerable children and the elderly? I shudder to think ...and you are crowing about this?  How about stopping the banning of relatives from visiting their loved ones? That would be an even more robust system I assure you. How about dealing with complaints about it.

 To find out more about the work we do, (or less, as the case may be) and to get involved as a volunteer inspector, log on to our website www.careinspectorate.com

 

 

Care of elderly is not sustainable

Audit Scotland warns that: "Caring for older people in Scotland’s hospitals and care homes at a cost of billions of pounds a year is not sustainable as the elderly population continues to grow.

Audit Scotland said the Scottish Government has estimated that spending on health and social care for over-65s will have to increase from £4.5 billion to £8bn by 2031 unless there are changes to people’s wellbeing and how services are provided.
But Audit Scotland concluded that overall progress in delivering better services had so far been slow. It also found spending did not appear to be moving away from emergency and residential care and into local initiatives.

And it said the current way that services were delivered was "unsustainable". 

Their answer is to keep the elderly out of hospitals and care homes and to provide support closer to home but it does not say how emergencies can be dealt with in this way. This proposal is cunningly equated with improvement in delivering services.

But we have to ask what kind of services? Without the equipment and specialist medical knowledge available in hospitals anything on offer is going to be substandard for those who require emergency treatment.

http://www.scotsman.com/news/health/elderly-care-costs-unsustainable-says-watchdog-1-3295977

Division between age groups

Here is another report which divides young and old. According to the study `The State of Living Standards` by the think-tank  Resolution Foundation, young people and working families have seen their incomes fall in real terms compared with a decade ago while average pensioner households have enjoyed an 18% rise.  The trend is set to continue, as further cuts to working-age benefits come into force in the next few years, while pensions are protected.

The findings will highlight how falling real wages combined with political decisions about who should benefit from public spending have created a sharp divide across age groups, with the young faring worst and pensioners the best.

The RF report – the first of its type to look at inter-generational income patterns across the last decade – finds that the typical income of pensioner households grew from £313 a week in 2001-2 (at 2011-12 prices) to £370 in 2011-12, representing an 18% rise. By contrast, the weekly income of a couple without children in a median working-age household fell slightly from £453 (in 2001-2) to £445 in 2011-12, despite GDP growth of almost 10% over the decade.

For young people, the fall in real wages was even more acute. Between 2001 and 2011, median weekly wages for 18-21 year olds fell by 21.7%, and for 22-29 year olds by 7.6%

James Plunkett, director of policy at the RF, said that while many pensioners were still hard up, and their incomes remained on average below those of working-age families, they had enjoyed a recent good run that looked set to continue.

The report goes on to remind us that further cuts and more austerity is on its way. But isn`t that the problem, and the fact that there is no real recovery in terms of jobs which offer a living wage for young people and families?

http://www.theguardian.com/politics/2014/feb/09/pensioners-thrive-while-working-families-and-young-suffer

The LACDP

Following the review of the Liverpool Care Pathway we have this:

The Leadership Alliance (constituents listed at the end of this statement) has issued an update to its work on Care of Dying People (LACDP) following the report of the independent panel on the Liverpool Care Pathway (LCP). The LACDP is a coalition of the national organisations to which the panel addressed its recommendations, joined by charities with a strong interest in care for dying people.

The words in bold are the first that jumped out at me. We are referring to the care of very sick people - so sick, they are dying - so why is the panel joined by charities?  It would be more reassuring to know that the panel were joined by senior doctors.

LACDP members are committed not only to taking forward the panel’s recommendations, but also to implementing a consistent approach to caring for dying people across England, to ensure that everyone who is in the last days and hours of life, and their families, receive high quality care, tailored to their needs and wishes and delivered with compassion and competence.

What are they saying here? They are committed to implementing a consistent approach. What, in place of an inconsistent approach? Does this really require saying?  High quality care? What, in place of low quality care? More rubbish. So what is high quality care for the dying? Tell us. Tailored to their needs and wishes? What kind of needs and wishes is a dying person supposed to have then? There`s an awful reluctance to come out and say anything, isn`t there? This is waffle.

The alliance believes that the starting point for ensuring excellent care for everyone in the last days and hours of life should be a common understanding, between professionals, dying people and their families and between professionals themselves, about what such care should look like. The alliance aspires to a shared vision for care and is currently engaging with families, and professionals and organisations on draft outcomes and guiding principles, which would help create that shared vision.

I would have thought the starting point should be attending to the patient. But No. The starting point should be a common understanding between professionals, the dying and their families. Common understanding of what? Oh, about what excellent care should look like? You mean you don`t have that shared vision? But you are confident about getting it and drafting the outcomes and guiding principles anyway. The obfuscation and arrogance here is frightening.

The alliance recognises the continuing challenges faced by those caring for dying people, including following the review panel’s report. We understand that professionals are looking for further guidance and direction..

Patients did not fare well with the last lot of guidance and direction did they? But let`s brush that aside.

The independent review panel concluded that many of the issues around the LCP were that it had come to be regarded and used as a generic protocol – and sometimes as a tick box exercise - which is the wrong approach.

A tick box approach is the wrong approach. Yes indeed. I would have thought the right approach to the care of the dying would occur around the bedside not in the office.

The alliance will not produce a replacement for the LCP. Instead, we want to see the way in which a dying person is cared for, including the goals and other key aspects of their care, focused around the individual, in line with their needs and preferences; and developed and delivered in consultation with them, wherever possible and/or their family, and in line with the final version of the outcomes and guiding principles.

They want the goals and other key aspects of their care to be focused around the individual. Do these people know how ridiculous they sound? Why shouldn`t care of the individual focus on the individual?
 
That`s the problem when you try to hide the true intentions of what you are doing with your outcomes and guiding principles. It does not come across as sensible, never mind convincing.

The Leadership Alliance for the Care of Dying People is comprised of: Care Quality Commission (CQC); College of Healthcare Chaplains (CHCC); Department of Health (DH); General Medical Council (GMC); General Pharmaceutical Council (GPhC); Health and Care Professions Council (HCPC); Health Education England (HEE); Macmillan Cancer Support (also representing the Richmond Group of Charities); Marie Curie Cancer Care (also representing Help the Hospices and the National Council for Palliative Care); Monitor; National Institute for Health Research (NIHR); NICE (National Institute for Health and Care Excellence); NHS England; NHS Trust Development Authority (NTDA); NHS Improving Quality (NHS IQ); Nursing and Midwifery Council (NMC); Public Health England (PHE); Royal College of GPs; Royal College of Nursing (RCN); Royal College of Physicians (RCP); and Sue Ryder (also representing the National Care Forum and the Voluntary Organisations Disability Group).


http://www.bgs.org.uk/index.php/readingsubjectlist/155-eolc/2703-care-of-dying-leadership

Power of attorney advertising campaign

Martha Wardrop, Green Party councillor, Hillhead, wrote the following in her blog:

On 11th December 2013, I received a briefing about the Power of Attorney TV Advertising Campaign at a meeting of the Dementia Working Group established by Glasgow City Council.

The need for this campaign arose from the delayed discharges from hospital when a person is lacking the capacity to make the decision to return home, be taken in to care or seeking an alternative option. This can result in the person being forced to remain in hospital leading to an increased risk of infection or complications. If the power of attorney is held by a third party or relative, this decision can be made promptly and the person returned to safe and comfortable surroundings within the community in line with their wishes.

Without the power of attorney, the State has to apply for guardianship and this is a time consuming and costly process, of on average 256 days.

There is a need to encourage discussion on the process to apply for a Power of Attorney and the option to apply prior to the loss of capacity.  

http://marthawardrop.blogspot.co.uk/2014/01/start-conversation.html

　
If the person without capacity (whatever that really means) can be returned to the community promptly via a third party `power of attorney` why can`t they be returned promptly without one? I mean all parties should know where the old person lives, surely?
But I don`t think this is about returning the old person home is it? It`s about putting the old person in a care home and getting a third party to deal with their finances - including covering the costs of the care home and selling off, or taking over, the old person`s house.
　

This is an abusive system set up by the state and there are no safeguards that actually work - no matter what the law says. The Office of the Public Guardian is another body like the Ombudsman working for the Government, as the true story in this blog reveals.  All that office does effectively is collects the registration fees for those power of attorneys it advertises for, whilst batting away the complaints for its lack of proper regulation.

Glittering UK award

News from NHS Lanarkshire informs us that the Integrated Community Support Team (ICST), made up of staff from NHS Lanarkshire and South Lanarkshire Council, has won a glittering UK award which was presented to them at the Patient Experience Network (PEN) National Awards in Birmingham on Wednesday.

The Integrated Community Support Team aims to prevent the elderly being subjected to unnecessary hospital or care home admissions and has been successful in nine out of ten cases. They operate in East Kilbride and Strathaven. 
http://www.nhslanarkshire.org.uk/news/news/Pages/powerofpartner.aspx


So NHS Lanarkshire and South Lanarkshire Council have won a glittering award for keeping elderly people out of hospital or care homes.

No curative treatments for this group then !  So what actually happens to them ? Perhaps the next post gives us a clue ..
 

The Missing 90 year olds

Thousands of elderly people are missing. The last UK census found far fewer people in their 90s than expected, and the same thing happened in the US with people over 100. Could this be an early sign that gains in life expectancy made in recent decades will not be repeated in future?

We've seen amazing improvements in life expectancy over the past few decades. Six years have been added to global average life expectancy at birth, over the past two decades. Much of this increase has been down to improvements in child mortality in low- and middle- income countries.

But in countries like the UK, post-retirement life expectancy has also increased rapidly.

"Life expectancy of a man aged 65 has increased from 14 years in the early 1980s to 21 years now - so that's a 50% jump in just three decades," says Richard Willets, director of longevity at insurance company Partnership.

Which is why, when the 2011 census was published, he went straight to the statistics about elderly populations.

And there the data revealed a surprise.

"There were 30,000 fewer people aged in their 90s than previously believed," he says - 429,000 instead of 457,000.

http://www.bbc.co.uk/news/magazine-23126814

Does this not reveal how the Liverpool Care Pathway has been successfully giving the elderly a `dignified death`?

Contradictory messages

 

According to NHS Lanarkshire the Liverpool Care Pathway is "a document which should be used to facilitate best practice and improve care of the dying patient. Adapted from the hospice model of care the LCP is a holistic, multidisciplinary and evidence based tool which focuses on the physical, psychological and spiritual needs of the dying patient (and their families) in the last few days of life.  The LCP allows health care practitioners to identify the dying phase and initiates appropriate comfort measures required at this phase of a person’s life. The LCP is a legal document, replacing all other documentation at this time. It aims to standardise and improve end of life care throughout Lanarkshire."

 

So the LCP we are told is a legal document which allows practitioners to identify the `dying phase`? Never mind that identifying the `dying phase` is not an exact science and doctors are not always able to diagnose dying - this legal document can do it. Then we can suppose that health professionals can rush in with their `anticipatory` comfort syringes thus ensuring that death results.
http://www.nhslanarkshire.org.uk/Services/PalliativeCare/Pages/Palliativecareliverpoolcarepathway.aspx

There is an update on the same website: 18 December 2013

Press reports and feedback from families indicated that not everyone was getting the high quality care that the public has a right to expect.

In July 2013 the findings from an independent review, led by Baroness Neuberger, into the Liverpool Care Pathway (LCP) were published. The report highlighted failings in the implementation of the LCP and recommended that the Government replaces it with individual care plans over the following 12 months.

More Care, Less Pathway: A review of the Liverpool Care Path found that although when used well, by well-trained staff, the LCP did enable people to have a comfortable and dignified death, too often it was used inappropriately, by poorly trained staff, resulting in a breakdown in communication and poor end of life experience for not just the patient but also those close to them and their carers...

Isn`t it about time that NHS Lanarkshire stopped singing the praises of the Liverpool Care Pathway and removed the first post from their website?  Find out more about the Leadership Alliance for the Care of Dying People

New pharmacy service is first of its kind in UK

The drive to keep the elderly out of hospital, (with the risk that they might be provided with curative treatments), continues unabated. We are told that people living in the Glasgow and Clyde area can now benefit from an innovative new service, co-ordinated from their local pharmacy – the first of its kind in the UK. It means patients and their carers will have improved access to the medications for end-of-life care - (those which assist the `dying process`, or should we call it a journey? - even for those with `life limiting` conditions who are not actually dying.)

It will ... support patients, should they choose to die peacefully at home rather than spending their final days in hospital.

Yes I`m sure it will. It will also support carers who make decisions on behalf of their patients. This is the care plan for which ten new Macmillan pharmacy facilitators will be working with existing community pharmacies.

http://www.nhsggc.org.uk/content/default.asp?page=s1192_3&newsid=17420&back=home

The OptCare study

A number of people in Sussex have been invited to take part in what is called a research project to test a new palliative care service for frail older people living at home or in a care home. 900 people who registered the death of a relative, friend or cared for person are being contacted to give their views on a questionnaire. The purpose is to be able to analyse why some people received care which met their needs and preferences, while others did not.

Your views are very important and will greatly help to provide better care for patients and families in Sussex and across the United Kingdom in the future.

Can this possibly be true? The important thing to notice is that the needs and preferences of the 900 dead people are being requested from third parties, some of them with conflicts of interest regarding any assessment of the dead person`s care or preferences.
http://www.csi.kcl.ac.uk/files/Link%20to%20patient%20information%20sheet.pdf

So what drives this kind of nonsense research which no doubt will find in favour of keeping the elderly out of hospitals with `Do not resuscitate notices`?

 

 

The demographics of an aging population is, again, the core concern and driver. The UK’s ageing population has “considerable consequences” for public services as is discussed in UK Parliament –

The pensioner population is expected to rise despite the increase in the women’s state pension age to 65 between 2010 and 2020 and the increase for both men and women from 65 to 68 between 2024 and 2046. In 2008 there were 3.2 people of working age for every person of pensionable age. This ratio is projected to fall to 2.8 by 2033.

 http://liverpool-care-pathway-a-national-sc.blogspot.co.uk/2014/01/liverpool-care-pathway-trials-and.html

Monklands nurse helps to improve the care of patients with dementia

A Monklands nurse is helping to improve the care of patients with dementia, after graduating as part of a recent cohort of dementia champions.

Alison Tedford (centre) is pictured with Sandra Shafii AHP Consultant in Dementia (left) and Maureen Taggart, Alzheimer Scotland Dementia Nurse Consultant (right) Senior charge nurse Alison Tedford, who works in an orthopaedic trauma ward at Monklands Hospital, completed the National Dementia Champions programme and is now helping to support improvements to the care provided in acute hospitals across Lanarkshire.

 

We are told in the article that one in four patients occupying a bed in hospital is over 65 - well, that is to be expected. What is extraordinary is the claim being made that this same group of patients have the symptoms of dementia or a diagnosis of dementia. I believe that figure is an over-estimation and deliberately alarmist.

Alison has been expertly trained by the University of the West of Scotland and Alzheimer’s Scotland.

 

This probably accounts for the fact that dementia is being over-estimated. Alzheimer`s Scotland also put forward the notion that dementia is a life limiting illness [progressing slowly, my emphasis] and one in three people who died had dementia. This does not mean that the people died of dementia and Alzheimer`s Scotland are misleading the public. But if you want to introduce palliative care to this group of patients it would help to build this kind of confusion.

Alison said:  “Dementia Champions provide specialist advice to staff on patients who have a diagnosis of Dementia or have cognitive impairment. They can provide support in relation to assessment of needs in relation to eating and drinking, the patient’s environment and indentifying whether the patient is in pain.

It`s a disgrace that it has had to come to this. Surely nursing staff should already know that all patients need to eat and drink and might require assistance, and pain relief is not just for the dying. 

http://www.nhslanarkshire.org.uk/news/news/Pages/Monklandsnursehelpstoimprovethecareofpatientswithdementia.aspx

Paul Gray visits Greenhills, East Kilbride

Paul Gray, new head of NHS Scotland, visited Greenhills East Kilbride where he met the care team looking after people in their homes and so reducing hospital admissions.

 

You have to ask yourself, why is he smiling about downsizing the care of the elderly? My 95 year old father was put out of hospital in October 2013 and has seen his carer twice in the past three months. Both times she flew in for a few minutes to deliver his medical aids before flying out again. Home care is actually the minimum of care. 

Successful end of life care extended ?

Not good news for patients with heart conditions. The Liverpool Care Pathway was first developed for cancer patients and to begin with it was considered inappropriate to apply the procedures to patients with other kinds of health problems. Although the Liverpool Care Pathway is being `phased out`, palliative care and other similar pathways are still firmly on the agenda and the net is widening to include more patients.

If we remember that palliative care involves `Do not resuscitate notices`, no antibiotics or other treatments, no food or water, syringe drivers, a chat with the family and ultimate death the language used below is astounding. Why should this be called helping heart patients? Why should the project be called a fantastic example? How can dead patients show they appreciate anything? Isn`t the use of hyperbole actually covering up what is really going on?

A unique partnership between Marie Curie Cancer Care, British Heart Foundation (BHF) Scotland and NHS Greater Glasgow & Clyde has been extended after helping more than 230 patients in the advanced stages of heart failure. 

"Caring Together is a fantastic example of what can be done to improve end of life care for those patients with more complex care requirements."

The Caring Together programme, which aims to improve the quality and access to palliative care for any patients in the advanced stages of heart failure, is set to continue for a further 18 months.

Since launching in March 2011, the programme has helped more than 230 patients and their families and has been key in allowing these patients to stay in their preferred place of care and avoid hospital admissions where possible.

Every patient referred to the programme receives a comprehensive assessment of their palliative care needs, a review of their cardiological management, and the allocation of a care manager who coordinates and manages the care for these patients.

The programme makes sure that heart failure patients with supportive care needs have access to advice, support and services, including benefits and hospice day services, at an appropriate time in the progression and deterioration of their illness.

Marjory Burns, Director of BHF Scotland, added: "Caring Together is an innovative programme for patients with advanced heart failure that supports the Scottish Government's action plan for palliative care services, Living and Dying Well, which calls for a more equitable provision of end of life care services for patients with any advanced, progressive or incurable condition across all care settings. This partnership is showing the way in terms of a service that patients and their families really appreciate."

http://www.ehospice.com/uk/en-gb/home.aspx

The Francis Inquiry

Government provided financial incentives so that hospitals would put patients on the Liverpool Care Pathway and this happened at the Mid-Staffordshire NHS Foundation Trust too which has been accused now of substandard care. HERE  The discusssion following the inquiry below fails to mention the Liverpool Care Pathway which has also been the subject of another inquiry. It hardly inspires confidence for it was the misuse of the LCP which caused most of the problems.

CLICK HERE FOR THE DISCUSSION

 

The following is the announcement of a conference to be held in regard to the safeguarding of elderly patients. Obviously when they say things like: "We must get it right," they know they have been getting it wrong. So much talk,  conference after conference, and so little action.

Implementing the new statutory framework for Adult Safeguarding under the Care Bill

Wednesday 12 March, Hallam Conference Centre,. London

"We must get care right for the most vulnerable group, who are often the most challenging to treat: frail older people. The challenge is to embed the experience of this group in hospital care – getting it right for them is our first benchmark." 

Many of the instances of substandard care at Mid-Staffordshire NHS Foundation Trust took place in medical wards caring for our most vulnerable patients: frail older people with complex comorbidities. Achieving "gold standard" care for this group must be the priority. 

The Health Secretary has announced he is seeking views on a set of proposals to radically improve care for vulnerable older people. Safeguarding vulnerable older people is a key element within this improvement programme and is critical following the recent events at Mid Staffordshire and the recommendations from the Francis Inquiry. 

http://www.healthcareconferencesuk.co.uk/safeguarding-vulnerable-older-adults

NHS Lanarkshire Palliative Care Strategy

Here`s a nice example of carespeak/doublespeak:

NHS Lanarkshire (2012) made palliative care one of its four strategic priorities for A Healthier Future.

What kind of future does a patient have who is being provided with palliative care, when this is end-of-life care? The rest of the document outlining their strategy for palliative care is depressingly full of the same management spin.

What it amounts to is encouraging practitioners to have those `senstivie` conversations with patients and family about preferred place of dying (home/care-home). Document and share the anticipated responses after they have had those `sensitive conversations`. (Wasn`t our fault - it was their choice) Assist the target population to remain in their home/care-home. Avoid hospital admissions, emergency and curative treatments and REDUCE COSTS.

http://www.nhslanarkshire.org.uk/boards/2013-board-papers/Documents/August/Palliative-Care-Strategy-2013--August-2013-Board.pdf

Please note that hospitals are not always safe places for the elderly, but where is?

Care not killing

Care not Killing Scotland rejects the proposed assisted suicide bill recently launched in the Scottish Parliament by Margo Macdonald MSP. They are hopeful that the bill will be rejected as was her previous attempt.

http://www.carenotkilling.org.uk/news/scottish-bill-launched/

I say we do not need to legislate to allow 16 year olds to have the right to assist in the suicide of their grandparents or great-grandparents. We do not need the medical profession to be turned into `killers` and we do not need the trust that has been established between doctors and their patients over hundreds of years to be smashed by this selfish bill.

Anybody who wants to commit suicide is free to do so. That is their choice. Just do not involve the rest of us in a slippery slope to Bedlam.