Monday 31 December 2012

Liverpool Care Pathway – Saying It How It Is


Thankyou, Daily Mail, for saying it how it is -

   
Daily Mail COMMENT

A crass intervention


As new figures reveal 60,000 a year die on the Liverpool Care Pathway without their relatives even being told they have been put on it, Health Secretary Jeremy Hunt describes the controversial regime as ‘a fantastic step forward’ for the dying.

Given that its critics regard it as a ‘pathway to death’ and his own department is conducting an inquiry into its use, could he have been more crass?


In comments that appeared to prejudge an official inquiry into the LCP, the Health Secretary said ‘one or two’ mistakes should not be allowed to discredit the entire end-of-life system.

But Elspeth Chowdharay-Best of Alert, an anti-euthanasia group, said: ‘The Pathway is designed to finish people off double quick. It is a lethal pathway.
(Mail Online)


‘Mr Hunt has made a nonsense of the claim of his ministers that there is going to be an independent inquiry.’
(Mail Online)

Records from 178 hospitals also show that thousands of people on the pathway are left to die in pain because nurses do not do enough to keep them comfortable while drugs are administered.

An estimated 130,000 patients are put on the pathway each year.

Concerns have been raised that clinical judgments are being skewed by incentives for hospitals to use the pathway.
(Mail Online)


The national audit by Marie Curie and the RCP examined a representative sample of 7,058 deaths between April and June last year. The figures were scaled up to give a national picture.

It found that in 44 per cent of cases when conscious patients were placed on the pathway, there was no record that the decision had been discussed with them.
For 22 per cent, there was no evidence that comfort and safety had been maintained while medication was administered.

And it also revealed that one in three families did not receive a leaflet to explain the process. The LCP system was developed in a Liverpool hospital and has spread across the NHS over the past four years. The review is due to report in the new year.
(Mail Online)

Liverpool Care Pathway – The Court Has So Decided...

Why is the Telegraph so reticent these days to say it how it is?

The Telegraph was bold enough to point out that,
"A national audit recently disclosed that almost half of dying patients who were placed on the controversial pathway were not told that life-saving treatment had been withdrawn.
The study suggested that about 57,000 patients a year are dying in NHS hospitals without being told that efforts to keep them alive have been stopped.
It also revealed that thousands of dying patients were not given drugs to make them more comfortable.
Mr Hunt said patients and their families must always be fully informed. “What should never happen is that people should be put onto that care pathway without patients being fully in the loop and their families and relatives being fully in the loop as well,” he said..
But it was Mr. Hunt's outburst that the Liverpool Care Pathway is a "fantastic step forward"  that took the headline. To be fair to the Telegraph, perhaps Mr. Hunt's outburst took the headline precisely because it was so outrageous.

Norman Lamb, the care services minister, called for a review in November because, he said, there had been too many cases of families not being consulted.

Mr Hunt has said that patients and their families must always be fully informed. “What should never happen is that people should be put onto that care pathway without patients being fully in the loop and their families and relatives being fully in the loop as well.”

How does that fit with the appeal court ruling that David James may be put to death on the LCP? It would appear that 'being kept in the loop' as Mr. Hunt frivolously puts it does not really amount to anything if there is no possibility of raising objection or providing input to the situation. The doctors have no accountability to anyone.
"Local hospital have been allowed to put the retired musician on the Liverpool Care Pathway if his health deteriorates."  (Mail Online)
Does Mr. Hunt have any input on this? Both Mr. Hunt and Mr. Lamb are in agreement that patients and patients' kith and kin should not be kept in the dark about being placed on the Liverpool Care Pathway and, presumably, any of the other Death Pathways. What has Mr. lamb to say?

Mr. Lamb objects to families and their relatives not being consulted. It was for this reason he called his 'review'.

Mr. Lamb, neither Mr. David James nor his family wish for him to be put on the Liverpool Care pathway. Their wishes are being ignored and have been denied. They do not want Mr. James put on the Liverpool care pathway. The arrogance of doctors and the ignorance of judges have denied them their right of choice.

The Mental Health Act permits compulsory medical treatment under certain circumstances. In the matter of communicable (contagious) diseases/infections, compulsory medical treatment may also be permitted. That is not the case here. How, then, may Mr. James, or anyone else in like circumstances, be treated under the Liverpool care Pathway against their expressed wishes?
"His family, who have fought the hospital in the courts every step of the way, believe David has been handed a barbaric death sentence. ‘It’s legalised murder,’ says Julie, a civil servant. "  (Mail Online)
The court has so decided, but is it actually 'legal'?


The Mental Capacity Act (2005) provides five key principles:

  • A presumption of capacity: every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise.
  • The right for individuals to be supported to make their own decisions: people must be given all appropriate help before anyone concludes that they cannot make their own decisions.
  • That individuals must retain the right to make what might be seen as eccentric or unwise decisions.
  • Best interests: anything done for or on behalf of people without capacity must be in their best interests.
  • Least restrictive intervention: anything done for or on behalf of people without capacity should be the least restrictive of their basic rights and freedoms.
So, what are 'Best Interests'?

A problem arises because the focus of the medical practitioner is no longer on the curative but the palliative, even in the circumstance where no terminal diagnosis has been reached. In fact, in Mr. James' case, no formal diagnosis has been reached...

Medical Protection. org gives the following definition:


Determining the patient’s best interests

The focus should be on what the patient would consider his/her best interests, not what the doctor would consider his/her best interests if he were in the same position
When a patient lacks the capacity to consent to, or refuse, medical treatment, the doctor concerned will have to decide what is in the patient’s best interests (see Box 8). In doing so, the focus should be on what the patient would consider his/her best interests, not what the doctor would consider his/her best interests if he were in the same position.

The guidance in Box 9 is taken from the Mental Capacity Act Code of Practice and should prove useful to anyone having to determine a patient’s best interests, regardless of whether the Act applies in their country.
In England and Wales, if a patient lacks capacity and has no-one (other than paid workers) to represent his/her interests, an Independent Mental Capacity Advocate (IMCA) must be consulted whenever serious medical treatment or a change of accommodation is being contemplated.
In Scotland, when non-emergency treatment is considered to be in the patient’s best interests, the doctor with overall responsibility for the patient’s care must certify that the patient is not capable of consenting to the proposed treatment. The certificate authorises the doctor to “do what is reasonable in the circumstances, in relation to the medical treatment, to safeguard or promote the physical or mental health of the adult”.10


Box 8: Treating patients who lack capacity

  1. Benefit (ie, your intervention must be necessary and must benefit the patient)
  2. Minimum intervention (ie, your intervention must be the minimum necessary to achieve the purpose)
  3. Take account of the wishes of the adult (ie, you must take account of the adult’s present and past wishes and feelings and you must try every possible means of communicating with the adult to find out what these are)
  4. Consultation with relevant others (ie, you must take into account the views of the adult’s nearest relative and primary carer, and of any other person with powers to intervene in the adult’s affairs or personal welfare, or with an interest in the adult, so far as it is reasonable and practicable to do so)
  5. Encourage the patient to use residual capacity (ie, you must encourage the adult to use any skills he or she has to participate in decision-making).
Adults with Incapacity (Scotland) Act 2000


Box 9: Best interests

Remember that the person who lacks the capacity to make the decision or act for themselves still has a right to keep their affairs private
A person trying to work out the best interests of a person who lacks capacity to make a particular decision … should:
  • Encourage the person to take part, or to improve their ability to take part, in making the decision 
  • Try to identify all the things that the person who lacks capacity would take into account if they were making the decision or acting for themselves
  • Try to find out the views of the person who lacks capacity, including: 
    • the person’s past and present wishes and feelings – these may have been expressed verbally, in writing or through behaviour or habits.
    • any beliefs and values (e.g. religious, cultural, moral or political) that would be likely to influence the decision in question.
    • any other factors the person themselves would be likely to consider if they were making the decision or acting for themselves.
  • Not make assumptions about someone’s best interests simply on the basis of the person’s age, appearance, condition or behaviour.
  • Consider whether the person is likely to regain capacity (e.g. after receiving medical treatment). If so, can the decision wait until then?
  • Not be motivated in any way by a desire to bring about the person’s death. They should not make assumptions about the person’s quality of life.
  • If it is practical and appropriate to do so, consult other people for their views about the person’s best interests and to see if they have any information about the person’s wishes and feelings, beliefs and values. In particular, try to consult:
    • anyone previously named by the person as someone to be consulted on either the decision in question or on similar issues
    • anyone engaged in caring for the person 
    • close relatives, friends or others who take an interest in the person’s welfare 
    • any attorney appointed under a Lasting Power of Attorney or Enduring Power of Attorney made by the person 
    • any deputy appointed by the Court of Protection to make decisions for the person.
  • For decisions about major medical treatment or where the person should live and where there is no-one who fits into any of the above categories, an Independent Mental Capacity Advocate (IMCA) must be consulted.
  • When consulting, remember that the person who lacks the capacity to make the decision or act for themselves still has a right to keep their affairs private – so it would not be right to share every piece of information with everyone.
  • See if there are other options that may be less restrictive of the person’s rights.
  • Weigh up all of these factors in order to work out what is in the person’s best interests.
MCA Code of Practice, pp. 65–6
The problem arises because the focus of the medical practitioner is no longer on the curative but the palliative, even in the circumstance where no terminal diagnosis has been reached. In fact, in Mr. James' case, no formal diagnosis has been reached!

How may the expressed wishes of Mr. James and his family be ignored and overturned?

The Liverpool Care Pathway is a medical treatment comprising a set protocol (which, in the non-hospice setting, is mostly ignored or not acted upon in any case) which expressed purpose is to ease the patient 'gently' into a state or condition of death. Is that in Mr. James' 'best interests'?

The court has so decided, but is it actually 'legal'?

In practice, the Mental Capacity Act, 2005, in what has been our experience,  is interpreted thus:

Those patients possessing capacity are the only persons considered able to consent for themselves; those lacking capacity are treated in their own "best interests" by the medical team in charge of their care. In such cases, family or next of kin are informed only at the discretion of the medical team in charge.

Many doctors treat this Act as a Carte Blanche to act without any consideration to consult with family, next of kin, which is considered but a nuisance and impediment to their charge.

Furthermore, in particular consideration to 'patient confidentiality', the Data Protection Act and 'protocol', the medical team in charge may decide against sharing any information.

The arrogant have been made more arrogant. But have the arrogant outdone themselves this time? Have medical practitioners not acted outside and beyond the remit of law as determined and delineated above?
‘It’s legalised murder,’ says Julie (Mail Online)
It is a bizarre world in which we live when if it was the case that Mr. James desired his own death, the court would have ruled against this. This is a Bradburian nightmare we walk. This is not dressed up, 'legalised' murder; it's murder, plain and simple!

Mr. Lamb, your adjudication is called for!

Sunday 30 December 2012

Liverpool Care Pathway – Just A 'B in the Sky' Review?

Mr. Hunt, shame on you, sir.

This is The Telegraph -

Controversial Liverpool Care Pathway 'a fantastic step forward,' says Jeremy Hunt
The controversial Liverpool Care Pathway for patients who are dying is “a fantastic step forward” in the way hospitals support the terminally ill, Jeremy Hunt has said.
The controversial Liverpool Care Pathway for patients who are dying is “a fantastic step forward” in the way hospitals support the terminally ill, Jeremy Hunt has said.
The Health Secretary, Jeremy Hunt Photo: EDDIE MULHOLLAND
The pathway, designed to ease the suffering of patients in their last hours or days of life, has come under intense scrutiny in recent months.
It can involve the removal of drugs, nutrition and hydration if they are judged to be of no benefit to the patient.
But a number of families have complained that their loved ones were put on the pathway without their knowledge, while some doctors have claimed it can hasten death.
The Health Secretary insisted the protocol was far better than alternative arrangements and allowed those close to death to be comfortable and to spend their last hours with their families.
Mr Hunt told LBC radio: “It’s a fantastic step forward, the Liverpool care pathway, and we need to be unabashed about that.
“It’s basically designed to bring hospice-style care to terminally-ill people in hospitals. Inevitably people do die in hospital but they weren’t getting the quality of care in those final few hours.”
Mr Hunt said many patients did not want to die “with lots of tubes going in and out of their body” but would prefer their final moments with their families to be “dignified”
“The Liverpool care pathway was developed with Marie Curie, with Macmillan, with Age UK and a number of other charities, to try and bring that dignity to people in their last moments,” he said.
A national audit recently disclosed that almost half of dying patients who were placed on the controversial pathway were not told that life-saving treatment had been withdrawn.
The study suggested that about 57,000 patients a year are dying in NHS hospitals without being told that efforts to keep them alive have been stopped.
It also revealed that thousands of dying patients were not given drugs to make them more comfortable.
Mr Hunt said patients and their families must always be fully informed. “What should never happen is that people should be put onto that care pathway without patients being fully in the loop and their families and relatives being fully in the loop as well,” he said.
The minister confirmed that he was looking into reports of problems with the care pathway.
“I would be very sad if as a result of something that is a big step forward going wrong in one or two cases we discredited the concept that we need to do a lot better to give people dignity in their final few hours,” he said. “Most people would prefer to die at home – we need to do a lot better.”



















































Mr. Hunt, the review - if it isn't all just a stitch-up - is still ongoing. Should the outcome of the review be prejudged in this manner? You should not be offering any personal opinion you may have at this time.

Are you instructing the jury as to what the outcome of the review should be?

Is the outcome already decided and the review just an elaborate and cruel sham?

Mr. Hunt, a man in your position really should know better. Do you really hold us all in such contempt that you think these comments do not really matter? 

The Health Secretary should not be expressing an opinion at this time.

It is tantamount to the judge 
directing the court and finding for the defendant while the loaded jury is still out.

Just how 'far-reaching', how 'independent' is this far-reaching independent review? What is Mr. Lamb's commitment really worth when his colleagues undermine his credibility? 

Mr. Hunt, you were under pressure for your handling of the BSkyB takeover bid. Lord Justice Leveson said he had seen no "credible evidence of actual bias" in that case. We are trusting you, sir, that there is no "credible evidence of actual bias" in this case...
"In a hard-hitting speech last week Mr Hunt expressed concern about the culture of the NHS, warning that too many patients were forced to experience "coldness, resentment, indifference" and "even contempt". 
"He warned that in the worst institutions a "normalisation of cruelty" had been fostered."
(The Telegraph)
Can a failing health service be charged to operate the killing machine that is the Liverpool Care Pathway?

A disqualified driver in the driving seat of a faulty vehicle driving along a pot-holed Pathway will wreak devastation.
"Nearly 3,000 patients are dying a year because of needless hospital blunders, figures reveal.
Another 7,500 are severely harmed after being wrongly diagnosed, given incorrect drugs or poorly cared for.
Experts warn that such mistakes will increase because already overstretched staff will be unable to cope with the higher numbers of patients coming into hospitals.
Health Secretary Jeremy Hunt has admitted that there may still be ‘pockets’ of poor care like that revealed in Mid Staffordshire in 2008, where hundreds of patients died needlessly.
Figures obtained by Panorama in a BBC documentary to be aired tonight show that in 2011/12, a total of 2,864 patients died following mistakes by hospital staff.
This is up almost 5 per cent compared to the previous year when there were 2,726 deaths."
(MailOnline)
Mr. Hunt, you appear to be of the opinion that the problem lies not with the vehicle - the Liverpool Care Pathway - but with the drivers of the vehicle...

Mr. Hunt, there is a problem with the drivers, certainly...!

But the vehicle needs to be taken off-road immediately and consigned, straight way, to the breakers yard before it may do further damage and harm!

We may then consider what corporate liability there is for the taking of life that has ensued under this wicked regime...

Liverpool Care Pathway – When 'Caring' Is Not Caring

When the Doc tells you how it is, you tend to believe that's how it is.

This is Wales Online -

Elderly and terminally ill to be given support to die at home



A new plan sets out how NHS Wales will improve inequalities in
end-of-life care

Elderly and terminally-ill people wanting to die at home will have the same support and care as those in a hospital, care home or hospice under plans published today.
The Welsh Government’s Together for Health – Delivering End of Life Care plan sets out how NHS Wales will improve inequalities in end-of-life care up to 2016.
It is hoped the plan will improve the options available to terminally-ill patients and their families by combining compassion with high quality care.
The strategy was last night welcomed by the Older People’s Commissioner for Wales and by charity Age Cymru.


When the Doc tells you how it is, you tend to believe that's how it is. No more. 

Doctors are guided by the National End of Life Care criteria drawn up the NCPC led Dying Matters Coalition and the LCP guidelines.
This is Mail Online -


Sentenced to death for being old: The NHS denies life-saving treatment to the elderly, as one man's chilling story reveals


When Kenneth Warden was diagnosed with terminal bladder cancer, his hospital consultant sent him home to die, ruling that at 78 he was too old to treat.

Even the palliative surgery or chemotherapy that could have eased his distressing symptoms were declared off-limits because of his age.

His distraught daughter Michele Halligan accepted the sad prognosis but was determined her father would spend his last months in comfort. So she paid for him to seen privately by a second doctor to discover what could be done to ease his symptoms.

Sentenced to death: Michele Halligan fought to get treatment for her father Kenneth Warden after a specialist told her nothing could be done
Sentenced to death: Michele Halligan fought to get treatment for her father Kenneth Warden after a specialist told her nothing could be done

Thanks to her tenacity, Kenneth got the drugs and surgery he needed — and as a result his cancer was actually cured. Four years on, he is a sprightly 82-year-old who works out at the gym, drives a sports car and competes in a rowing team.

‘You could call his recovery amazing,’ says Michele, 51. ‘It is certainly a gift. But the fact is that he was written off because of his age. He was left to suffer so much, and so unnecessarily.’

Sadly, Kenneth’s story is symptomatic of a dreadful truth. According to shocking new research by Macmillan Cancer Support, every year many thousands of older people are routinely denied life-saving NHS treatments because their doctors write them off as too old to treat.

It is often left to close family members to fight for their rights. But although it is now British law that patients must never be discriminated against on the basis of age, such battles often prove futile. 

Michele’s fight began in September 2008, when her father noticed blood in his urine. His GP sent him to a consultant urologist at a hospital in the north-west of England and a large tumour was found in his bladder.

An MRI scan showed that the tumour was advanced and went through his bladder wall and muscle. 

A minor operation enabled Kenneth to pass urine, but left him needing to do so every 20 minutes, day and night.

Still fit and active: Kenneth Warden is now cancer free after his daughter Michelle fought to get him treatment
Still fit and active: Kenneth Warden is now cancer free after his daughter Michelle fought to get him treatment

‘He was exhausted by lack of sleep,’ says Michele. ‘It was making him more ill than the tumour was. The pain was like having permanent cystitis.

‘But when I asked for Dad to be given help for this, the consultant said there was no treatment available.’

Michele, who lives in Chester and is married with two children, was not satisfied. As a former midwife, she was more confident than most about attempting her own medical research on the internet. 

She read on one site that radiotherapy could shrink the tumour and give her father relief from his terrible symptoms. Further surgery on the bladder might help even more.

‘I was not looking for a cure, just a way to give my father some quality of life for the time he had remaining,’ she says. 
‘We went back to the urologist and asked about radiotherapy. I also wanted to know why my father could not have an operation to relieve his urinary symptoms.

‘The doctor said that as my father was 78, these treatments would not be appropriate because he was “too old”.
‘But my father was very fit and muscular. He regularly went running and worked out at the gym. He was also a lifelong rower who held competition records. But all the consultant would say was: “You have to accept that your father is dying.”

‘I had no issue with the hospital — it is a very good hospital — but I could not believe the surgeon. 

‘We went back to our GP, but they believed the consultant. I got the impression that I was considered an “interfering woman”.’

In desperation, the family found nearly £3,000 to pay for private tests and a second opinion from a consultant in Birmingham. 

‘The private consultant agreed with me that Dad should be given chemotherapy to shrink the tumour prior to a radical cystectomy.’

After being told there was nothing anyone can do Kenneth Warden was sent to The Queen Elizabeth Hospital, Birmingham and is now cancer free
After being told there was nothing anyone can do Kenneth Warden was sent to The Queen Elizabeth Hospital, Birmingham and is now cancer free 

This operation involves removing the bladder, surrounding lymph nodes and the prostate gland. Though neither Michele nor her father had private medical insurance, the new consultant arranged for Kenneth to have the operation on the NHS at the Queen Elizabeth Hospital, Birmingham. 

‘The treatment there was superb,’ says Michele. ‘Dad went for chemotherapy every week for nine weeks, followed by one month off. Then he went back in March 2009 and had the radical cystectomy.

‘The operation went well. We felt it would relieve so much of Dad’s anguish during the time he had left.’

But as it turned out, the chemotherapy and surgery did not just relieve his symptoms: they also banished his cancer. Now, four years after the operation, a total body scan shows Kenneth to be completely free of the disease.

Michele says: ‘He is back rowing and working out at the gym. He has enjoyed seven holidays abroad and bought himself a sports car.’

She feels strongly that her father’s case proves that elderly people are still discriminated against by the NHS, and she even reported the first consultant to the General Medical Council. ‘I said his actions constituted “pure ageism”. But they said he hadn’t acted wrongly as it was a “matter of professional opinion”.’

This kind of ‘professional opinion’ appears to be costing more than 14,000 lives each year, thanks to routine discrimination by doctors who assume older patients are too frail for surgery, chemotherapy or radiotherapy.  

This is according to experts at Macmillan Cancer Support, who warned last week that every day up to 40 elderly cancer sufferers are dying needlessly because they are being denied the best treatments. This is particularly true, it says, for patients over the age of 70.

The charity estimates that if the treatment of older patients matched that on offer in the U.S., as many as 14,000 lives could be saved every year.

Ciaran Devane, chief executive of Macmillan, points out that despite major advances in diagnosis and treatment, the survival chances for patients over the age of 75 have grown only by a fraction.

Mr Devane says: ‘Writing people off as too old for treatment is utterly shameful. We have a moral duty to treat people as individuals and give them the best chance of beating cancer, regardless of their age.’

Discrimination against the elderly affects not only cancer treatment but goes right across the board, according to another new report.


Discrimination against the elderly affects not only cancer treatment but goes right across the board, according to another new report. 

'They told me I had to accept my father was dying'

Last week, the respected health research charity, the King’s Fund, warned that prejudice about older people means they often go without treatment for conditions such as depression, and are not even tested for illnesses such as heart disease. 

This is despite huge advances in medical care which mean that patients can now successfully undergo major surgery at ages where they would not previously be expected to survive.


In America, doctors pioneering the field of ‘geriatric surgery’ regularly perform open-heart surgery on people in their 90s.
In Britain, the leading cardiac specialist unit at Papworth Hospital in Cambridge has now achieved a mortality rate of less than 1 per cent for coronary artery bypass operations, despite the fact that the average age of its patients is in the late 60s. 

The Papworth patients are, however, a fortunate minority. The King’s Fund report, based on patient surveys and evidence from staff, is only the latest in a series of critical reports on elderly care.

The Patients Association and Care Quality Commission have both recently published studies detailing ‘shocking’ standards.

According to Nat Lievesley, an expert researcher into older people’s care, such attitudes should by now have been banished from the NHS because they are in fact illegal. He explains that the 2010 Equality Act outlawed age discrimination, such as age limits for treatment, in all official NHS policies.

But Lievesley, an investigator for the Centre for Policy on Ageing, says that while official rules have changed, the attitudes of individual doctors and nurses has not.

Leading cardiac specialist: Elderly patients at Papworth Hospital, Cambridgeshire, are among a minority of over 60s who are afforded specialist care
Leading cardiac specialist: Elderly patients at Papworth Hospital, Cambridgeshire, are among a minority of over 60s who are afforded specialist care

He points out that when the Equality Act was being debated in Parliament, doctors’ organisations tried to get medical decision-making exempted, ‘but this was not allowed’.

His own study on the issue, which was commissioned by the Department of Health, warns: ‘Evidence of the under-investigation and under-treatment of older people in cancer care, cardiology and stroke is so widespread and strong that we must conclude that ageist attitudes are having an effect on overall investigation and treatment levels.’

Such concerns prompted Yasmin Qureshi, the Labour MP for Bolton, to campaign in Parliament on behalf of a constituent, Bill Clark, 67, who was taken off the waiting list for a double lung transplant last year because, he said, doctors told him he was too old.

Doctors at the Wythenshawe Hospital said he was no longer thought suitable for surgery after they had considered factors such as his age, weight and restricted mobility.

Qureshi twice wrote to the Health Secretary, Andrew Lansley, demanding he personally review the case, and asked questions in the Commons. She said: ‘It’s disgraceful. I don’t think life should be decided on the basis of age. It shouldn’t be a factor.’

Campaign: Yasmin Qureshi, Labour MP for Bolton, championed the need for treatment of a constituent after he was told he was too old for a double lung transplant
Campaign: Yasmin Qureshi, Labour MP for Bolton, championed the need for treatment of a constituent after he was told he was too old for a double lung transplant
Sadly, in January, Mr Clark, a great-grandfather, succumbed to lung fibrosis.

Vanessa Cole, 33, believes that she lost her father, Trevor, as a result of the elderly being written off. He died of liver cancer last November at the age of 67, and Vanessa, from Northampton, is devastated that he was denied treatment that might have saved his life.

For ten months he had visited his GP surgery every week to seek help with his symptoms. ‘Each time he was sent home with no answers,’ says Vanessa.

‘He knew he was seriously ill. He had pains in his chest, he was losing weight, and he was suffering bouts of confusion. But there was no impetus to distinguish aches and pains caused by old age from serious conditions such as cancer. There was no urgency.

‘I really do feel that age discrimination was a factor with my dad. I don’t think he was ever taken seriously. They saw him as an older person just wanting a chat. I do not think that he was ever given a full and proper physical examination.’ Finally, Vanessa persuaded her father to see a different doctor. ‘She looked at his physical condition — his arms and legs were very thin —and asked him how on earth he had been living like this.’

This doctor sent him to Northampton General Hospital straight away. There, he was given CT scans and found to be suffering from liver cancer. But instead of being treated, he was sent home. 

Vanessa asked for an urgent appointment with an oncologist, but had to wait nearly three weeks — by which time her father was so ill that could hardly stand.

She only found out how seriously ill he was when a community nurse accidentally left her notes behind after a home-care visit, which stated the purpose of treatment was ‘to provide a dignified death’. Three weeks later, Vanessa’s father died at her flat.

'My dad dressed old - and that was his undoing'

 
With the support of the Independent Complaints Advisory Service, she is drafting an official complaint about her father’s treatment.

‘My dad very much looked like an older gentleman  —  and I think that was his undoing in the eyes of the doctors. They thought he was just an old bloke having a moan about inevitable aches and pains.’ 

This injustice is compounded by the fact that, when our health services act to help older people with serious illness, the results can be life-changingly brilliant.

Last year, research by the National Cancer Intelligence Network found evidence of widespread age-based discrimination in the NHS on women with breast cancer.
Its study of 23,000 sufferers found that 90 per cent of those aged 30 to 50 are offered surgery to remove tumours, compared to 82 per cent of those aged 60 to 70, and 70 per cent of those in their 70s.

But Marjorie Holmes, 70, is living proof of the benefits that such surgery brings. 
Five years ago, the retired lecturer from Isleworth, Middlesex underwent a routine mammogram. Just before her 65th birthday, she received a letter calling her back for further examination.

‘My GP also wrote to me separately, inviting me to come in and have a chat about this, which was very kind,’ she says.

The mammography consultation revealed that there were two suspicious areas on Marjorie’s breast. These were investigated, found to be cancerous and removed.

‘I was scared but I just wanted the operation over with,’ she says.

‘Within a few weeks I was taken into Charing Cross Hospital for a lumpectomy.’
‘My age was never an issue at any point,’ says Marjorie.

‘After I was discharged from the unit, I learnt about the Mulberry Centre at the West Middlesex University Hospital in Isleworth, Middlesex.

‘They support people with cancer, as well as their carers and children. They offer advice, counselling and complementary therapies such as aromatherapy and massage. The atmosphere was so wonderful.’

Nowadays, Marjorie regularly goes walking and enjoys yoga, pilates and line dancing. ‘In many ways my life has become better now than it was before the cancer,’ she says.

‘I always used to be anxious about the future and the past. Now I focus on enjoying today.’

Modern treatment such as this has given Marjorie a completely new lease of life. The tragedy is that many doctors are simply too eager to throw such older people onto the scrap heap.

Liverpool Care Pathway - The Reaper At the Town Hall Door

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 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 Program.

What does this tell you..?

What does this say..?

That's a lot of money. How is that going to be found out of the Public purse?

"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)

Meanwhile, since 2010, that's during this same period, councils have reduced their spending on older people’s social care by £500million. The number of elderly people receiving daycare has been reduced by almost a quarter since 2009. (See the Mail Online article which follows below)

The cuts have hit 20,000 pensioners, leaving the elderly potentially isolated and lonely as councils reduce spending on social care.

To be fair to the hard-pressed councils, central funding channelled to councils has been cut. This is BBC NEWS Politics -

Core funding being cut by 12.1%, say councils

The Local Government Association has said the settlement for 2011-12 is the toughest "in living memory" and will "inevitably" mean cuts in services. Local government leaders say English councils face a 12.1% cut in their core central government funding next year.
  • Meanwhile, Commissioners will be commending CQUIN payments for 'best practice' measures such as this -



With at least one fifth of NHS spending relating to end of life care and large amounts of data to support the claim that end of life patients often access GP and acute services when greater support at home would meet the needs they present to doctors with, the potential for a significant improvement in the quality of care alongside savings is self-evident.

Cash-strapped hospital managers have been going overboard to meet the 'best practice' targets Commissioners have set them. Likely, the same will now happen in the arena of local government. 

The Dementia CQUIN for 2013 is well-advanced –


The National Institute for Health Research -

Summary of funded Dementia Research Projects

DTC-RP-PG-0611-20005 Supporting Excellence in End of life care in Dementia 

via an integrated care pathway (SEED programme) Northumbria Healthcare 
NHS Foundation Trust. 
This research aims to support professionals, both commissioners and providers, to 
deliver good quality, community-based end of life care in dementia.  Key outputs 
include: 
i) A prototype integrated care pathway (ICP) for end of life care in dementia 
ii) Educational resources to support the use of i) and 
iii) Commissioning guidance for clinical commissioners. 
Our ageing population will mean more people with long term, and age-related, 
illnesses like dementia. This will lead to an increased need for end of life care for 
those with complex needs living in the community.  People with dementia already 
receive poorer end of life care compared to those with cancer, with more hospital 
admissions and worse pain control. Still in contracting stage.  


How will the cuts impact on the elderly? They will impact  psychologically, limiting opportunities for social interaction. Isolation will be a major concern and this will impact on physical well-being.

And the final psychological blow..?

The elderly are a group who are going to be targeted for the GP death lists simply because they are elderly. This is the same demoralised group already targeted by spending cuts.

The final blow is this: to be put on the death list, told your days are numbered, advised to start making provision to wind up your affairs - not because you have been diagnosed with a life limiting or life threatening illness such as cancer, but because you tick off all or most of the categories in the Commissioners' list of things the GP is instructed to watch out for.  This includes the advice that GPs ask the 'surprise question' and use their intuition! (See the Dying Matters guide to GPs here and here)


According to the Local Government Information Unit -

Councils, with their new convening powers through the Health and Wellbeing Boards, are ideally placed to bring together health, social care and housing. Our report therefore calls for councils to take ownership of the end of life care agenda in order to enable people to spend their final days in dignity.

So, what does this tell you..?

And what does this say..?

This is Mail Online -

Daycare cuts hit 20,000 pensioners: Warning that elderly could be left isolated and lonely as councils reduce spending on social care

  • Councils reduced spending on social care by £500million since 2010
  • Number of elderly receiving daycare reduced by almost a quarter since 2009
  • Age UK says 'crisis' in social care is making people lead 'isolated existence'


Tens of thousands of frail older people risk being left lonely and isolated as a result of cuts to daycare facilities, a charity has discovered.

Recently-released official figures show that the number of older people receiving such care from their council has plummetted by almost a quarter in the past two years alone.

Day care includes support for vulnerable pensioners including lunch clubs, foot care, gentle exercise and social activities such as bingo.

Without these activities, many older people receive no social interaction. In many cases, a visit to a day centre provides the only cooked meal a pensioner has a day.

Cuts: The number of elderly people receiving daycare from their councils has fallen by nearly a quarter since 2009
Cuts: The number of elderly people receiving daycare from their councils has fallen by
 nearly a quarter since 2009

The figures show that more than 20,000 fewer pensioners are now receiving care provided by or arranged by their local authority than before the last election, according to the Department of Health statistics.

Age UK, which uncovered the figures, said it was a ‘worrying’ sign of how town hall cuts are affecting the most vulnerable in our society.

Day care services are also important because they can allow family carers to enjoy a much needed break.

The charity said the cuts will leave elderly people at risk of loneliness and isolation. And, with little support to spot problems early, they could be left with growing health needs as they get older.

The statistics show that over the past two years, the number of older people in England who receive council day care services has fallen by 23 per cent - from 88,498 in 2009/10 to 68,160 in 2011/12.

The cuts will either leave people without day care at all, or could leave them having to pay for them out of their own savings or their pensions.

Michelle Mitchell, Age UK’s charity director general, said: ‘This reduction in the number of older people who can depend on day care services arranged by the local authority is extremely worrying for a range of reasons.

‘We know that these services are really important to many older people but the brutal reality for older people with high care needs is that all too often there is not enough funding to allow for anything more than meeting the basics of their personal care.

Falling:Since 2010, councils have reduced spending on social care for the elderly by £500 million in real terms
Falling:Since 2010, councils have reduced spending on social care for the elderly by 
£500 million in real terms

‘The crisis in social care is leading to vulnerable older people having no choice other than to lead an isolated existence. Social care funding pressures and tightening eligibility criteria mean that thousands of older people are facing an end to their social life, and the prospect of living out their last years in loneliness.’ 

She added: ‘Any decent society needs to protect its most vulnerable and we are deeply worried that these figures indicate that many more older people and their carers are being forced into coping alone.

‘We urge the Government to recognise and act on the current underfunding of social care and commit to a sustainable and affordable new system of paying for care and support in old age.’ 

Age UK said the downturn in the use of day care centres is part of a general trend which has seen across-the-board reductions in social care and support provision by local authorities.
There has also been a tightening in the amount of support provided to those older people who need services.

Analysis by the charity has shown that funding for frontline services has not been adequately protected from cuts.

Between 2010/11 and 2011/12, councils reduced their spending on older people’s social care by £500million in real terms.

Suffering: 20,000 fewer pensioners are benefiting from lunch clubs serving hot meals, gentle exercise classes and social activities such as bingo, Age UK claims
Suffering: 20,000 fewer pensioners are benefiting from lunch clubs serving hot meals, 
gentle exercise classes and social activities such as bingo, Age UK claims

In an attempt to save money, town halls have made it harder to qualify for social care support. In the vast majority of councils, only the most disabled and frail older people now receive any help with social care.

Approximately 80 per cent of local authorities only provide social care support to those judged to have ‘substantial’ or ‘critical’ care needs.

This means that older people with lesser but still serious needs do not get any state funded support.

Age UK said that the evidence shows that demand for day centre places by older people continues to be high, but that many people feel unable to afford to pay the additional cost of a day centre place after they have met their essential care needs.

Local branches said they are seeing day care facilities whittled down as funding reduces and those who are able to access them restricted to only the most disabled and frail.

Julia Hines, chairwoman of Age UK Barnet said that while her local authority has not cut back day care services as fast as others, funding has been reduced and many more people have been asked to pay for using the services.

In Barnet, in north London, the cost to attend a local authority day care centre is around £34 and users would also have to pay for their own transport meaning that the cost could easily rise to around £50 a day – just under half a week’s basic state pension and beyond the reach of many older people.

Ms Hines said: ‘It is vitally important that people are able to escape the four walls of their own home, and that they have a place to go, not just to meet other people, but to meet their particular friends. 

Our clients have described our day centres as having a club-like feel, or being like a family.
'It is hard for anyone to admit that they are lonely. It is humiliating. Older people tend to avoid that word and have talked to us about the importance of “keeping busy” or that they are “lucky” because they have a daughter, or supportive neighbours.

‘Being busy is not the same thing, in my mind, as having friends, and if you can count your friends on the fingers of one hand, I am not sure that most of us would count ourselves lucky. Our clients have the opportunity to make and sustain real friendships.’ 

She added: ‘Day centres also often provide the only cooked meal of the day for clients as well as opportunities to join exercise classes or activities like art classes, bingo, or bridge.

‘I am very proud of the work our day centres have done, and incredibly grateful to the staff and volunteers who make this possible.’