Saturday, 3 October 2015

Liverpool Care pathway - Killing On Demand

Deficient and wanting, or just different?

They wanted them to kill their child; they chose to let him live.

“Terminate.” That's the word they used. It sounds like Dr. Who and the Daleks.

It’s actually killing. Say it how it is. Killing is become both a therapy and a treatment.

Sky News

This is Jaxon Emmett Buell. He was diagnosed with anencephaly and was born with most of his skull missing. He was given days to live.

Jaxon has confounded the predictions and lived to see his first birthday. In that year, he has both given and experienced the joys of living, something he might never have known.

Jaxon has been dubbed 'Jaxon Strong' and has his very own Facebook page.

Life has its highs and lows but that is life. There are peaks and there are troughs.

Without the hard climb, how else may we go freewheeling down the other side?

That is life's lesson.

Killing is become both a therapy and a treatment. It’s still killing, whatever else you call it. Say it how it is.

Another kind of killing is here discussed. It is called Euthanasia.

This is News.Com Australia –

FIVE minutes after Simona de Moor heard her daughter had died from a heart attack, she decided she wanted to end her life, too.

The 85-year-old mother, who was considered healthy by doctors and was not taking any medication, made arrangements to be quietly put to death.

More than 8000 people, probably more, have been euthanised in Belgium, where assisted suicide has been legal for 13 years. Patients don’t have to be terminally ill, just deemed to be suffering “incurable, unbearable pain” by a doctor.

The country has faced controversy over the soaring numbers of cases in which people with psychological problems, from depression to dementia, are asking to die. With the rest of the world moving towards bringing in euthanasia laws, some people are asking where and how you draw the line.
Journalist Brett Mason went to Belgium to film Simona being killed for a ‘Dateline’ special that aired September 15 on Australia's SBS (Special Broadcasting Service) network.
We could be looking at Australia’s future. In July, the Victorian parliamentary inquiry into end of life choices began hearing from medical professionals and palliative care providers about possible changes to Australia’s legislative framework. The inquiry will report back on 31 May 2016.

An Assisted Dying Bill was debated in the UK parliament this month, but did not pass its second reading debate on 11 September and will make no further progress.

It’s clear that giving people the right to die is not a simple decision.

“Most of us have reached a low in our lives where we’ve lost a loved one or suffered a trauma,” said Brett.

“The challenge for doctors — many with no psychological training — is being able to make that call and know when someone’s pain isn’t going to heal. I’m not sure I could. For me, there will always be a ‘what if” with Simona’s euthanasia.”

Killing is both a therapy and a treatment.

Killing as policy

HSJ has published an investigation which purports to show an ‘unwarranted and unfair’ disparity in elective surgery.

Knee Replacements
Hip Replacements
In the regard of both knee and hip replacements, that is something which is commanded by demographics.

As an example, Tower Hamlets has a more youthful and diverse population than does Guildford.

Professor Stephen Page, from Bournemouth University, has said there will be a growing polarisation by age of local populations. This will distort the uptake figures.

The borough of Tower Hamlets, for instance, has the lowest median age in the country at 29 along with Newham, compared to the London average median age of 33.

Guildford and Waverley by contrast has the largest 5 year cohort aged 45-49 reflecting the baby boom of the early 1960s. The fastest growing cohort since 2001 is the 60-64 age group which has increased by 35%.

As older people become more dominant in the local economy, young people often go away to university and get jobs in bigger cities and don't come back, further distorting the local age profile.

What the researcher wishes to demonstrate will depend on how the statistics are presented as readers of these pages will know.

This 'disparity in elective surgery' is not even new news.

Read the 'olds' in this paper dated 26 November 2010 from Public Health Wales Observatory -

The Daily Mail has picked up an investigation published by Pulse -

Perhaps, we are all selective in what we present and the manner in which it is presented but, again, as readers of these pages will know, GP incentives are not new.

The report says:
GP practices are being offered thousands of pounds to refer fewer patients for specialist care, including those with suspected cancer, finds a Pulse investigation.

Pulse has learnt that in at least nine CCGs, practices are being offered payment for keeping within targets for outpatient referrals and follow-ups. And some of these schemes even count two-week cancer wait referrals towards the target.

Payments of between £6K and in excess of £11K are being offerred. The payments come following on from recommendations just a year ago to double cancer referrals.

This is BBC News –

GPs got beavering away and, before anyone knew it, Pulse had a banner headline in January of this year proclaiming: "Urgent GP cancer referrals increased by 50%"

Pulse reported –
There has been a 51% increase in the number of GP urgent referrals for suspected cancer cases in the last five years, a major audit of cancer outcomes has found. The National Audit Office’s ‘Progress in improving cancer services and outcomes in England report’, released today, lists improvements ‘across a range of indicators’, including GP urgent referrals, five-year survival rates and a drop in overall mortality rates. The report states: ‘Urgent GP referrals for suspected cancer increased by 51% between 2009-10 and 2013-14 from 0.90 million referrals a year to 1.36 million referrals a year.’


Reports, reports and more reviews, the fact is that command control distorts and does not address issues.

The fact is that killing as policy has been proceeding for a long, long time via EoLC policies imposed by a grand alliance of State, Third and Private Sector interventions and strategies, in downsizing care expectations and designing programmes, death lists and pathways.

There is  crisis.

The news is dire: Addenbrooke’s recovery ‘could take years’; Shelford Group Trust and West Herts are in special measures; more than one in ten Trust chief posts are unfilled; a third of CCGs may ration services; bailouts have ‘rocketed' to £1.2bn; GP practices may get a £1m emergency assistance fund after one in six practices have closed their lists…

GPs have been asked by commissioners to not refer to a local acute trust for at least three months to allow the hospital to clear up its backlog of operations.

The chair of NHS Redditch and Bromsgrove CCG, Dr Jonathan Wells, shared the letter online which asked GPs ‘to refer patients to another NHS or independent sector provider other than Worcestershire Acute Trust for an initial period of three months’.
Just a year ago The telegraph reported on a 'debt timebomb' –

A Westminster think tank, the Institute of Economic Affairs called for ‘radical measures, including a smaller NHS’, to deal with the ‘debt mountain’.

Time bombs, silver-haired tsunami...

We have heard all this before -
Liverpool Care Pathway - Of CQuINs, Tipping Points And QUELCAs
Further reading - 
Liverpool Care pathway - A Life Less Perfect, Or Just Different...?

Liverpool Care Pathway - 'Informed Consent'

Liverpool Care Pathway - A Perverse Symmetry

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