Monday, 30 September 2013

Liverpool Care Pathway - The Dust Has Settled. All Change! Nothing's Changed.

If I am going to die, I would rather it be despite your best efforts to save me than because you have helped me on my way.

There are always consequences and the Review has had its own repercussions. Both overviews and self-congratulatory reaffirmations have been published...
They are as arrogant as ever they were and sure in themselves that they may 'diagnose' dying.

They are armed with the same tools and are confident in the efficacy of these tools to do the job.

They will continue to act in what they consider your best interests for this is what they have been groomed to do and groom others to do.

They know better than you what is best for you. They will act and, if necessary, will not keep you or your family fully informed if that is also what they deem to be in everyone's best interests.

They know what is best and they are trained to know what is best and not to waste finite NHS resources on what they, in their wisdom, deem to be futile interventions, and they will discontinue these interventions accordingly if necessary.

In this Halton Borough Council Report to the Health & Wellbeing Board, an "overview" of current End of Life services available in Halton is provided, including future priorities.

The recommended EoL tools are here reaffirmed -
- Halton Borough Council Report 
4.1 Identifying a Patient Approaching End of Life

Identifying when a patient is approaching the end stages of life is inherently difficult. As such, within primary care it is necessary to ensure that there is guidance in place to assist in identifying those patients and ensure they are recorded and monitored so that their care can be effectively coordinated.

The Gold Standard Framework (GSF) is a system designed to support this process supported by GSF Prognostic Indicator Guidance. This guidance is to assist GP’s in identifying symptoms that would indicate a patient is approaching the last 12 months of life. Once this identification has been made they should then be added to an End of Life register within their GP Practice.
Once added to the EoL register, the grooming may begin and a palliative response will take priority. Their best efforts will be directed to easing them on their way.

The weapon of choice is the GSF; the SPICT is given no mention.

The groomers are being groomed

In common with similar programmes reported in these pages, in Kent and on the Sussex coast in Brighton involving Macmillan Community Teams, 'bespoke' training initiatives are proceeding and an integrated EoL Register on which will be recorded EoL 'wishes'.
Oh, ye beware of what ye wish that it shall be your own undoing!
The Municipalisation of EoLC is established.
An Advanced Care Planning Team has been established within Halton, which includes an End of Life Care Facilitator and a Project Support Officer who are supported by the wider Palliative care network. The role of the Advanced Care Planning team is to provide staff within both health and social care settings with the skills and training to be able to initiate discussions and effectively communicate with patients and families.

To date, a number of initiatives have taken place to improve end of life skills across health and social care including:
• Bespoke training with GP Practices including all staff. 
• Half day training events on end of life tools 
• Commencement of the Six Steps training programme in 11 Care Homes
• A two day training Course across care management and assessment services with the aim of increasing knowledge of end of life care issues, which was attended by 74 staff including managers, Social workers, Occupational Therapists and Community Care Workers.
• A number of end of life champions identified across social care teams who will attend a Multi-Agency End of Life Champions Forum.
Warrington Clinical Commissioning Group (CCG) says:

It wasn't us...

Warrington NHS
is intended to help patients die a peaceful and dignified death but unfortunately in some parts of the UK, the Pathway has not been implemented correctly and this has led to the review and subsequent recommendations to replace it with personalised care plans. 
Dr. Andy Davies, Chair of the CCG -
“In Warrington, the Liverpool Care Pathway has been a successful guiding tool in improving the timeliness and quality of decisions about the care of dying patients.

“It is intended to help patients die a peaceful and dignified death but unfortunately in some parts of the UK, the Pathway has not been implemented correctly and this has led to the review and subsequent recommendations to replace it with personalised care plans.

“We are fully committed to ensuring that that only the highest standard of care is given to patients and we are currently working with our healthcare partners, providers and clinicians alongside patients and their carers to review the recommendations made and ensure that we continue to deliver the best care for our residents at the end of their lives.”
The St. Rocco's Hospice is grant funded by the CCG to provide palliative care to people with 'life-limiting' illnesses.
St. Rocco’s Hospice, which receives grant funding from Warrington CCG to provide specialist palliative care for people with all life limiting illnesses works to help hundreds of patients and their families in Warrington each year, providing clinical treatment, emotional and spiritual support, symptom control, nursing care and complementary therapies.

Pam Massey, Chief Executive of St. Rocco’s Hospice, said: “At St. Rocco’s Hospice we strive to deliver the highest standards of individualised care and psychological support at end of life to ensure that our patients are regularly reviewed and assessed, are offered treatments to maintain comfort, are treated with the utmost dignity and respect and are continually communicated with by our skilled and trained doctors and nurses.

“Documentation that we are currently using to capture this quality care is the Liverpool Care Pathway document. It is not the means by which we provide the care but is how we record the care given to ensure the highest standards are consistent, appropriate and based on the needs of the person at that time."
If a person is diagnosed with a 'life-limiting' illness are they then deemed to be dying? Perception is everything.
“As new guidelines and information is developed over the next 12 month’s, St Rocco’s will review and agree any changes to our processes with our skilled clinicians, who will keep our patients and families fully informed.” 
The shape of things to come

The Amber document has been embraced by the NSW Government. Advance Planning for Quality Care at End of life is an EoLC Action Plan for 2013 - 2018. In this is discussed 'end of life conflict'.

End of life conflict is defined as disagreement which occurs about the goals of care or treatment decisions at the end of life and where such conflict is not resolved by the usual recourse to time and further discussion between the patient, the family and the treating clinicians, as appropriate.

The point of foreseen conflict is on the issue of what is considered the appropriate response.

Medical treatment is intended to intervene to promote recovery. That is the upsize perspective. The downsize perspective is that it prolongs the dying process and 'forestalls death'. Are these to be considered 'futile' interventions?

Perception is everything and alters outcomes fundamentally.

This is Croydon Health Services NHS Trust -
-  Croydon Health Services NHS Trust
Until national proposals are produced for a new framework, Croydon proposes to continue to use the latest version of the LCP (version 12), subject to stringent safeguards, notably that the decision to place a patient on the LCP will be taken by the patient’s Consultant, having discussed this with the patient (where possible) and the patient’s family and that the family are in agreement. CHS staff training will include priorities for the care of patients at the end of life across all clinical staff, and the Trust will work towards providing a seven day a week face to face specialist palliative care service with on-going provision for advice out-of-hours.

In accordance with the recommendations of the Neuberger Committee that a lay Board member should lead take responsibility for the care of dying patients across the Trust, Godfrey Allen will assume this responsibility in Croydon.
All change! Nothing's changed.
As an interim, we propose that CUH will continue to use Version 12 of the LCP as a framework to provide patient and family centric end of life care for those patients who meet the criteria for the pathway, whilst an alternative is developed. Use of the LCP will be phased out when a viable alternative is agreed. The new framework will be implemented by the Palliative Care Team. The Palliative Care Team strongly believe that abrupt withdrawal of Version 12 LCP will create a greater risk that poor quality end of life care may be delivered by CHS, than continuing to use Version 12 LCP with the caveats proposed in this report.

Wherein lies the risk and what is the risk?

The NHS is still running an office hours only service for people like Mr. Christopher Leggatt, an active 65-year-old, who was turned away from Bradford Royal because the medics had gone home.

It is disturbing that there is a focus on dying well and setting in place provision for dying well and not for living well; that, therein, lies the focus of concern.

Coordinate My Care (CMC) is being rolled out across London. The CMC record can be accessed 24/7 through a central password-protected secure internet connection used by the NHS.

The CMC may contain all your dying wishes.

The CMC permits access, according to 'need to know', to GPs, community nurses, community palliative care teams, hospitals, hospices, social workers, London Ambulance Service, 111, intermediate care and nursing/care homes.

The CMC and the NHS 111 services are now inter-operable.

Croydon University Hospital (CUH) is seeking increased uptake of Coordinate my Care record (CMCR) for patients discharged across the Trust with life-limiting conditions. Responsibility for this is with the Palliative care EOLC CQUIN lead. That speaks for itself.
It is established CUH practice that patients cared for at the end of life may continue, start or stop clinically assisted hydration and/or nutrition with all decisions made in an individual’s best interests, in line with the Version 12 LCP framework. 
Because of heightened awareness about the LCP at the moment, there may be increased anxiety. Professionals should go out of their way to check if patients and their families have any concern about their end of life care, whether or not the Liverpool Care Pathway is being used. There should be a very low threshold for referral to the specialist palliative care team for end of life care advice.
The patient may 'continue, start or stop' hydration according to 'best interests' and LCP mark XII.

Mr. Les Mitton's step-daughter, Shirley Bolger, has a thing or two to say about that. And Mr. Mitton would if he could but his life has been taken!


Wherein lies the risk and what is the risk?

The Royal Wolverhampton has it all in hand. This is the Trust Board Report -
The Royal Wolverhampton NHS Trust
The lead Clinician for Palliative Care, Dr Clare Marlow undertook a review of all inpatients on the LCP at the time. Only one patient was found to be on the LCP and a review of that patient care showed it was being used appropriately.

The Medical Director sent out an email to all consultants to remind all teams of the importance of following the guidance on use of the LCP (copy of this e-mail is attached for reference).

Every patient already has a named consultant, whether in the therapeutic or dying phase of care. More work needs to be undertaken to ensure clarity of management when more than one specialty are involved in an individual patients care.

The email from the Medical director, Jonathan Odum, contains the following nota bene -
NB: Because of heightened awareness about the LCP at the moment, there may be increased anxiety. Professionals should go out of their way to check if patients and their families have any concern about their end of life care, whether or not the Liverpool Care Pathway is being used.
This statement, word for word, is contained in the CHS document...

The Bee Wee memorandum is also reproduced at the end of the document.

The grandiose and delusional Dr. Bee Wee, of the newly established and rather grandiose 'Leadership Alliance for the Care of Dying People' signs herself in a grand fashion...

Friday, 27 September 2013

Liverpool Care Pathway - After The Review, After Everything, They're STILL Killing People

It was all really a bit of a muchness, but now it's done and dusted. And once the dust has settled, its back to business as usual…

And a withering silence descends: the silence of the Lamb.

This is an AMDA Live Webinar on Palliative Care in LTC (Long Term Care) scheduled for Thursday, October 24, 2013 -

Upon completion of this activity, participants should be able to:
  • Describe the suffering of the frail elderly
  • Delineate the physician's mandate to provide compassionate care
  • Compare and contrast palliative care and hospice care
  • Develop mechanisms to ensure compassionate care for the frail elderly by implementing a palliative care

The suffering of the frail elderly...

The physician's mandate...

In the Session Description, attitudinal and behavioral changes are sought in the physician.

This is dangerous. The physician is to be groomed/ brainwashed into believing that the final decision lies with them to determine the course of treatment/non-treatment and implementation of palliative care.

The mandate is theirs to determine what is best for those in their charge for they know the suffering of the frail elderly.

The story reported here in the Hereford Times is an objective example of this malpractice put into practice.

Hereford Times reports -

Mr Mitton’s step-daughter Shirley Bolger said: “He had a most horrendous death, and none of us had a clue that he was on the Pathway.

He seemed really hungry and really thirsty, but we didn’t make the connections.

“He was absolutely desperate and kept grabbing my hand, asking for a drink.

When I touched his lips with a sponge moistened with tea, he tried to eat it. He suffered terribly.

“All he wanted was to go was to go up to Birmingham and have his operation and get back to planting his daisies and geraniums. For a man of his age he was so fit.

This was an absolute waste of life.”

She said that Mr Mitton, aged 84, of Mabels Furlong, had a benign brain melanoma, adding he went into Hereford County Hospital believing he was waiting for a move to Birmingham’s Queen Elizabeth Hospital for a life-changing operation.

Instead, his family claim, he was put on the Liverpool Care Pathway.

“They (hospital staff) said they don’t really operate on people over 80-years-old,” said Alison Turner, Les’ stepdaughter-in-law.

“They said ‘do you want to put him through that’. We said he has no chance of life without it.”
The Ledbury Reporter -

A SENSE of bewildering loss, for family members and community alike, prevailed at the funeral of former Ledbury postman Les Mitton.

More than 150 people attended the funeral of a man who was described, in a funeral eulogy, as “a cornerstone of society”.

Delivering the eulogy, his friend, Martin Burton MBE said: “A few months ago, he was walking about in Ledbury in the same way he did for so many years. He was one of the best-known people in Ledbury.

“Les was a great and lovely man who lived respected and died regretted.”Mr Mitton, who was 84, died on August 1; but his funeral at St Michael and All Angels Church only took place on Tuesday because his family questioned the circumstances of his death at Hereford County Hospital.

 He would not let anything overcome him.
“With a patience, and a compassion and an understanding which was brilliant – no matter what he faced, he would not let anything overcome him. He deserves not to be forgotten.” - Reverend Howard Mayell.
Les Mitton went into hospital for an op. He expected treatment.

Les Mitton was a man typical of a generation which believed in facing up to life's hardships and meeting them head on. He went for treatment. He expected treatment. Les Mitton was not 'lost'; Les Mitten was TAKEN!

Les Mitton was taken by a decision not to come to his aid.

Les Mitton's wishes should have been respected. Wishes, however, are only respected, only count, when treatment is being declined.

They wouldn't give Les Mitton treatment because they know all about the suffering of the frail elderly.
“They said, ‘Do you want to put him through that?’ We said, 'He has no chance of life without it.'”
Les Mitton was over 80. They don't operate on people over 80. People over 80 are the frail elderly.

Les Mitton was 'past it'. Not content with denying him the treatment he sought and had expected, they put him on the LCP.

This is The Mandate -
This mandate – the first of its kind in the world – underlines my responsibility as Health Secretary to preserve and defend those principles to which we all remain indebted.

Never in its history has the NHS had to face such a profound shift in our needs and expectations.

An ageing population, rising costs of treatments, and a huge increase in the number of us with long-term, often multiple conditions are rewriting our relationship with health and care, all at a time of acute pressure on public finances.
JEREMY HUNT Secretary of State for Health
1. Preventing people from dying prematurely
1.1 We want people to live longer, and with a better quality of life. Too many people die too soon from illnesses that can be prevented or treated. From cancer, liver and lung disease – and for babies and young children, England’s rates of premature mortality are worse than those in many other European countries. There are also persistent inequalities in life expectancy and healthy life expectancy between communities and groups, which need to be urgently addressed by the NHS Commissioning Board.
Les Mitton went into hospital for an op. He expected treatment. He got treatment, but not quite the treatment he expected!

This is not just a case of whether or not the family were informed; this is a case of the patient, Les Mitton, not being informed.

This was a man who would not let anything overcome him. Against the 'God Squad', however - the doctors and nurses who, possessing the 'god complex', would play god with other people's lives - Les Mitton stood little or no chance.
"Too many people die too soon from illnesses that can be prevented or treated." [The Mandate]
Les Mitton went into hospital for an op. He expected treatment.

Les Mitton should have been treated. He died prematurely because the treatment he sought was denied him.

The DoH has committed itself against ageism. The Mandate, to which Mr. Hunt is committed, has a stated purpose to prevent people from 'dying prematurely'.

Les Mitton died prematurely in a most cruel  and desperate manner. It was a 'most horrendous' death.

Mr. Hunt, it is time, particularly following the review, to reign in these megalomanic medics!

This is The Mandate:
"An ageing population, rising costs of treatments, and a huge increase in the number of us with long-term, often multiple conditions are rewriting our relationship with health and care, all at a time of acute pressure on public finances."
An aging population...

Rising costs of treatments...

A time of acute pressure on public finances...

Is that what it's all about, Mr. Hunt? All about the money, money, money?
"34. No such difficulty arises, however, in the situation that has caused Mr Burke concern, that of the competent patient who, regardless of the pain, suffering or indignity of his condition, makes it plain that he wishes to be kept alive. No authority lends the slightest countenance to the suggestion that the duty on the doctors to take reasonable steps to keep the patient alive in such circumstances may not persist. Indeed, it seems to us that for a doctor deliberately to interrupt life-prolonging treatment in the face of a competent patient's expressed wish to be kept alive, with the intention of thereby terminating the patient's life, would leave the doctor with no answer to a charge of murder." (Family Law Week)
Mr. Hunt, these megalomanic medics did not 'interrupt' life-prolonging treatment; they refused to even commence it! They have no answer to a charge of murder.

Wednesday, 25 September 2013

Liverpool Care Pathway - Nothing Changes But It Stays The Same

They have ploughed £Billions into EoLC. Loadsamoney. Loadsa, loadsa, loadsamoney.
But they still can't find the dosh for weekend cover.

This is the End of Life Baseline Report -
End of life care is a key priority of the North West regional QIPP workstream for 
Demand and Threshold Management and the North West SHA in recognition that improving QIPP across the end of life care pathway will significantly support overall delivery against the £20 billion QIPP challenge by 2014/15. 
The North West vision is for people to be supported to die well in the place of their choice; with a broad aim to reduce avoidable hospital admissions for patients at the end of life and to expedite discharge for end of life care patients who are admitted to hospital for emergency care.

Our population is getting older and sicker. Currently there are around 1.5 million people with long term conditions living in the North West; it is estimated this figure will be 3 million by 2030. In tandem with this, population statistics estimate that the people over the age of 65 will increase by 252% by 2050; described by Sir John Oldham as “a Tsunami of need”.

There is a 'vision' to support people to die. There is no vision to support people to live. And you can say there is no programme to limit life...?
The Baseline Report was published in 2011. The projections are not marrying up. There are 'excess deaths'. There are 'missing' 90 year-olds...
This is Mail Online in September 2013 -
A grieving daughter has accused the NHS of running a Monday to Friday service, blaming the death of her sport-loving father on Britain’s ‘healthcare lottery’.
Christopher Leggatt, 65, died as he was being transferred between hospitals as there were no surgeons available at the first because it was a weekend.
The father-of-four collapsed with a ruptured abdominal aortic aneurysm as he refereed a football match - and had a 70 per cent chance of surviving a routine operation on it.
But he suffered a heart attack in the ambulance taking him from Bradford Royal Infirmary to Huddersfield Royal Infirmary. 
Paramedics managed to revive him but his heart stopped again before he could be operated on. 
His death was recorded at 6.15pm - two hours after he first arrived at Bradford Royal Infirmary.
An inquest was triggered when his daughter Andrea, 43, lodged a formal complaint. 
After the case she said: ‘I don’t want my father to be another statistic. 
‘I hope what has happened highlights the fact that the NHS as it stands is a Monday to Friday service.
‘If my father had collapsed on a weekday then the outcome would have been very different.
‘If he had been operated on straight away he would have most likely survived the operation but there were no surgeons working at the hospital in Bradford that weekend.
‘He was taken to Bradford because it was the nearest hospital but they didn’t have the means to treat him.
Andrea, a company director, said despite sending a letter of complaint to the hospital, she has never received a response.
She said: ‘At the inquest I learnt that if there had been someone there to operate, there was a 70 per cent chance he would have lived.
‘The operation is really simple and only takes around 40 minutes but it was the delay which killed him.
‘To treat a ruptured abdominal aortic aneurysm it is like mending a pipe and the vast majority  of people make a full recovery from it.’
The inquest in Bradford last week heard that Mr Leggatt, a ‘well and active man’ from Pool-in-Wharfedale, West Yorkshire, had been diagnosed within 20 minutes of arriving at Bradford Royal Infirmary.
Paul Needham, a surgical registrar with the Bradford Teaching Hospitals Trust at the time, said the transfer represented his best chance.
He said: ‘Our vascular surgical cover that day was provided by Huddersfield. ‘Our view was that a blue-light ambulance transfer would be more rapid than having a surgeon driving across [to Bradford].”
Consultant vascular surgeon at Calderdale and Huddersfield NHS Trust, Anver Mahomed, told the inquest that the two hospitals took turns to provide acute care cover as part of a formal network arrangement.

This is The Portsmouth News in November 2009 -

Grieving widower Rex Patterson launched a protest campaign after spending almost a year trying to find out why his wife died in hospital. 
Thelma Patterson, 59, died two days after being admitted to Queen Alexandra Hospital in Cosham with a blood clot on the lung. 
Mr Patterson says she was refused a scan that could have located the clot because the hospital did not operate the machines at the weekends. And he says medical staff left her even though they could not find a pulse or reading for her blood pressure. 
The 61-year-old has written to the hospital 16 times since his wife's death on January 11. NHS guidelines say most complaints should be resolved within 25 days. 
Mr Patterson says that on nine occasions his letters were ignored. 
He has sent the order of service from his wife's funeral to the hospital on the 11th of every month to remind it of his case 
And in a desperate bid for attention, this week he parked his wife's car, covered in the words 'Killed by medical neglect at QA Hospital', in the hospital car park. 
'I have tried so hard to get answers', said Mr Patterson, a former police officer of Swanage Road, Lee-on-the-Solent. 'But I have just been ignored or told they're investigating and will be in contact, and then I've heard nothing. What else could I do to make them listen?' 
Recalling the hours leading up to his wife's death, Mr Patterson said: 'She was told she'd need a scan to locate the clot. But then we were told she would have to wait until Monday as the machine wasn't operated over the weekend. All they did was put her on blood-thinning drugs. 
'She was getting weaker and weaker. At one point she actually said to me "I'm going to die in here. They are not doing anything."' 
Mr Patterson said a nurse checked his wife's blood pressure and pulse at 3pm on the day of her death. 'There was no reading for either. But the nurse just said "I will do it again later." 
'Several more nurses tried over the next few hours and still got no reading. One even said "Maybe the machine's broken." I was pleading with them to call a doctor. I even said to them, "You are killing my wife.'" 
A senior health official arrived about 6.45pm. 
Mr Patterson said: 'They said they were treating her with a drug that would kill the clot but their concern was that she had been left too long and her body was too weak to recover.' 
A cardiac team then arrived and at about 7.30pm Mrs Patterson died. A post-mortem examination revealed she died of a build- up of fluid on the lungs. 
Mr Patterson said: 'I feel she was killed by negligence. She was left too long.' 
Portsmouth Hospitals NHS Trust, which runs QA, said it had reviewed Mrs Patterson's case and her husband would now be invited to the hospital to discuss the findings. 
Peter Mellor, the trust secretary, said: 'A thorough investigation has been carried out. Because the investigation needs to be thorough, it takes time. 
'We recognise that the death of Mrs Patterson is a tragedy for which we are sorry. If we have not kept Mr Patterson as well informed about our progress I can only apologise for that. That is a shame on our behalf.' 
In a desperate attempt to get hospital officials to give him answers about his wife's death, Rex Patterson parked his wife's Mini Cooper S outside Queen Alexandra Hospital, Cosham, on Monday. 
He had put pictures of his wife, Thelma, on the car and slogans such as 'Killed by neglect at QA'. 
The car was parked at the hospital from 7.30am and caused chaos at the front entrance. 
Security guards could be seen covering the car in a white sheet, and a group of security men, later joined by police, were stationed around the vehicle throughout the morning. 
A security car was also parked behind the vehicle, blocking one lane of the road and slowing traffic.
The car was being treated as a suspicious vehicle and so police were called. 
Mr Patterson returned to his car at 11.30am. Health officials said the car was covered up to protect other patients. Peter Mellor, the secretary of Portsmouth Hospitals NHS Trust, which runs QA, said: 'I fully recognise that Mr Patterson is upset and distressed and I fully recognise his right to ask difficult questions, criticise, and we enjoy the freedom of speech in this country. 
'However, putting up statements like that in view of other patients arriving at the hospital were likely to cause harassment, alarm and distress. This was not about covering anything up. It was about shielding patients.' 
Thelma Patterson had the ability to put a smile on the face of all those who knew her, husband Rex said.
She was a happy, popular and witty woman and a much-loved wife, mother and grandmother.
Her untimely death at just 59 has left an enormous void in her family's lives, especially Rex's, her life-long sweetheart.
The pair met when they were just children – Thelma aged three and Rex five. Both lived in Cherry Close, Lee-on-the-Solent.
As they grew up they went to the same school and started dating as teenagers, eventually marrying in 1969.
'She's the only woman who's ever been in my life,' said Mr Patterson, 61. 'I miss her. Everyone does.'
Mrs Patterson began working life as a bank worker. She then stopped working to have their children, Gary, now 38, and Clair, 36.
Before she died, she had been working as a doctors' receptionist at Lee Health Centre for six years. 
'She was extremely popular,' said Mr Patterson. 'Even at work she had friends both sides of the counter. 
'She had such a wit and would always make people smile. She was just so funny and had an infectious laugh. She loved her family and was such a kind person.' 
Between 2006 and 2007, Mrs Patterson had a battle with breast cancer. Otherwise, she was a healthy and active woman. 
She loved seeing her family and her granddaughter Jess, eight. 
She also loved gardening and enjoyed nothing more than the passion she shared with her husband for Mini racing. 
The pair would travel all over the country for race meetings and Mrs Patterson cherished her beloved Mini Cooper S. 
January 13 - Rex Patterson writes to Ursula Ward, the chief executive of Portsmouth Hospitals NHS Trust, which runs QA, requesting the complaints procedure. 
January 16 - Receives a letter from a secretary at the hospital saying his letter had been forwarded to the head of legal services. 
January 19 - Mr Patterson phones head of legal services Sue Skye and is told to write in, outlining his complaint. 
January 20 - Mr Patterson sends a letter of complaint and a request for admission records. 
January 23 - Receives a letter from hospital saying he cannot have the admission notes until after an investigation has been carried out. 
January 27 - Receives a letter from Amanda Alder saying she has been appointed complaints officer for his case. 
January 27 - Mr Patterson makes another request for admission records. Receives no reply. 
February 9 - Mr Patterson writes to Ms Ward and Ms Skye pointing out his unanswered letter of January 27 and the records issue. 
February 11 - Mr Patterson receives record notes but some are missing. 
February 27 - A letter received from the complaints officer states the NHS guidelines of 25 working days to reply to a complaint could not be met. No extended timescale discussed. 
March 12 - Mr Patterson writes to Ms Ward pointing out time limit for responding to a complaint had passed and there was no agreed 'extended timescale'. 
March 17 - Mr Patterson writes to Ms Ward again as he had had no reply. Still no reply. 
April 9 - Mr Patterson writes to Ms Ward saying that with the three months since his wife's death approaching he expects a reply by April 17 at the latest. 
April 18 - Mr Patterson receives a letter from Ms Ward. It says they could not identify the nurse who found Mrs Patterson had no measurable blood pressure or pulse and an investigation was on-going. 
April 25 - Mr Patterson tries calling Ms Ward but cannot get hold of her. Mr Patterson then responds in writing. He says he would be happy to meet any time and asks for a fixed date for the final report. No reply. 
May 19 - Mr Patterson again writes to Ms Ward for an estimated date for the final report and updates. No reply. 
May 26 - Mr Patterson again writes to Ms Ward pointing out he had no replies and asks if the complaints department had a manager. Again, no reply. 
May 29 - Receives a letter from Sheena King, head of risk management and legal services, saying his complaint was being reinvestigated by an independent healthcare professional under the trust's risk management processes. 
June 3 - Mr Patterson replies to Ms King pointing out the lack of updates and incomplete admission notes. No reply. 
June 9 - Mr Patterson writes again asking for admission notes. 
June 24 - Notes received but no information on updates or final report. 
July 10 - Mr Patterson e-mails Ms King, stating that six months have passed and there is still no report or regular update. 
July 17 - A letter is received from the hospital saying a second draft of the report would be complete by the end of the week and Mr Patterson will be contacted. 
August 11 - Mr Patterson e-mails Ms King to point out there has been no update or agreed date for the report. He also says he will display posters about his case at the hospital. 
August 11 - E-mail asks Mr Patterson not to put up posters. He is told the report will be going to the serious incident review group in September for final sign-off and he will then be invited to a meeting. No news follows about the report or meeting. 
September 11 - Mr Patterson sends a letter to Ms Ward pointing out it has been eight months and still no update. He receives no reply. 
November 16 – Mr Patterson parks his dead wife's car at QA in protest and The News gets involved. The hospital then says it has completed its report and offers to meet Mr Patterson
Readers of these pages will well know that the CQUINs are still being awarded for EoLC Pathways...
Nothing changes but it stays the same.
Further reading -