The "Liverpool Care Pathway" (Continued)

Today's Telegraph continues the saga of the so-called "Liverpool Care Pathway".
This time it was in Birmingham where they call it the "Supportive Care Pathway (SCP)", another example of Doublespeak which means the exact opposite of what it says.
The doctors at Birmingham City Hospital decided that an elderly lady who had been admitted suffering heart and kidney failure would not be expected to live for more than 48 hours, and put her on the SCP.  Following intervention by her daughter, the lady was given treatment and discharged from hospital only six days later.

The Telegraph reports that
A spokeswoman for the trust said: “Mrs Edwards was very ill when she was admitted to our Medical Assessment Unit"
and
“We are sorry to hear that Mrs Edwards’ family were unhappy with aspects of her care. "

That last sentence is the most ridiculous of the lot!
"We are sorry to hear that the family were unhappy" How would they expect the family to feel? Perhaps the family should ask whether Birmingham City Hospital being paid on the basis of the number of patients that die they kill, in a similar manner to that being paid the Victoria Hospital in Blackpool? (See my previous blog)

Surely questions should be raised as to the competence of those who prescribed this course of action, and the family should be demanding a full enquiry.

Knowing my daughters, if that had happened to Mrs EP or myself, they would not be "unhappy", they would be bloody furious. Both have good connections through their work and other interests so I am quite sure that they would be  busy contacting everybody they know who might be able to help them to get an independent enquiry and demanding disciplinary action against the doctors involved.

The "Liverpool Care Pathway"

I know that it's late in the day, but I've just got round to reading the daily newspapers!

As I'm getting on in years, I have some interest in the so-called "Liverpool Care Pathway", which seems to be a method that doctors have agreed to use for patients whom they decide are not going to live, and is said to give them a peaceful death.
As it involves the withdrawal of food and fluids as well as medical treatment, it does not seem to me to be particularly caring, and amounts to starvation and dehydration. Far from being a "Care Pathway" it seems to me more like "A Road to Death".
Now doctors admit that they can never be certain that a patient is dying, and this example from today's Mail shows that they can most certainly be wrong.

But what appalled me most was the statement in the article that

"The hospital concerned has been paid more than £600,000 in the last two years to hit targets for the number of patients who die on the Pathway, according to documents uncovered by the Mail".

So we now have a situation whereby a hospital is required to hit targets for the number of people who "die on the Pathway" that is meet a target for the number of patients who are deliberately killed by the hospital staff.

Surely this is incitement to murder and should be investigated by the police. 

We ought to know who authorised the payment of taxpayers' money to a hospital to kill people. Was it within the NHS or did the incentive come from elsewhere such as the Local Authority who didn't want to fund places in care homes, was it from the DHSS in an attempt to reduce the state pensions bill, or did it even come from the Treasury as part of cost cutting measures.

It's certainly time for some answers.

My Sphygmomanometer

 

 This is it !

I've been "under the weather" for quite a few weeks and Mrs EP decided that I should go and visit the doctor. I have a new GP, the previous one having decided to retire at 60 because under the new NHS he felt that he was doing more paperwork than doctoring. The new lady doctor is very young, and doesn't look old enough to have gone through university, let alone qualified as a GP.  Mrs EP's comment was "She's very sweet, but does she know what she's doing!".

Anyway, she went through all the usual tests, decided that I wasn't yet senile, and all that seemed wrong was that my blood pressure was a bit on the high side. Hence the machine above, which I have on loan with instructions to take my blood pressure two or three times a day for the next couple of weeks.

Now being a (retired) engineer, things like this device are interesting in the technical sense. When my old GP took my blood pressure he used the old fashioned method which balanced the pressure against a mercury column and listened my pulse with a stethoscope to determine the reading. All that has gone now in favour of this machine. What puzzles me is that there is no apparent way that it listens to my pulse, so how does it know when to record the values? Then the next questions, which any researcher asks about instrumentation is "How accurate is it?" and "Does it give reproducible results?"

Having found the specification on the web, the accuracy is quoted as + or - 3 mm Hg but I'm unable to confirm that without a "Standard arm" to check it against. I did some tests on reproducibility. My method was to put the cuff on my arm, sit in a comfortable chair and continue with a book I'm reading (not the newspaper, that would certainly raise my blood pressure). I took a reading every few minutes for twenty minutes or so and no two were the same varying from a high of 177/87 to a low of 143/73 which is considerably more variance than might be expected from the quoted accuracy figure. So did my blood pressure vary by + or - 10% from the centre value of 160/80 or is the meter faulty?

I will repeat my experiment sometime, taking care not to move between readings, but somehow I suspect that discussing instrumentation accuracy and reproducibility will not be within my lady doctor's abilities.

As most of the figures were on the high side, I suspect that I will be issued with some pills to get it down. Just as long as she doesn't expect me to give up my nightly tot, I'm not too concerned !

Mortgages

The Telegraph reported yesterday that "Tough new mortgage lending rules to be announced tomorrow are expected to hit millions of prospective first-time buyers as well as those in their 50s" 
Looking at the new rules, they hardly seem tough compared with those that were in place when I took out my first mortgage in the early sixties. However, more recently, until the crunch came, most lenders were throwing money at borrowers, based on the assumption that in an era of rising house prices, they couldn't possibly loose out!

First in line to be hit are interest only mortgages, where lenders will require proof that the prospective borrower is making appropriate arrangements to repay the sum borrowed when the mortgage period expires. What's tough about that?  Surely that's quite reasonable for the borrower to explain how he expects to repay the money. The Mail today suggests that these represent a £100bn 'time bomb' where the home owners have no idea how they will pay off their mortgage when the time comes.

Next come the oldies,  where lenders will be told to make sure that a mortgage cannot be given out unless a homeowner will repay it before their 70th or 75th birthday.Well that lets me out!

As I said, rules like these were commonplace when I took out my first mortgage back in the sixties, so what is all the fuss about?
Common sense says that you don't lend anyone money unless you think they will be able to repay it. Not only did I have to find about 25% deposit for my first house, the maximum amount that they would lend me was limited to 2.5 times my annual salary with no consideration being given to my wife's earnings. As well as that, I also had to demonstrate that I would be able to repay it by having a savings account with my chosen Building Society and making regular savings similar to my potential mortgage payments for at least a year before they would even consider putting my name on the list for a mortgage. All this whilst I was paying rent at the same time.
I would add that in the sixties, interest rates were far higher than they are now, with the base rate varying between 6 and 8%. At one point, in 1976, the base rate reached a high of 15%  before falling back to 9-10% for a long period up to 1992. The all time high, in November 1979 was 17% ! Now the base rate is 05.% and it will probably be less by Christmas if the media is to be believed.

But it did teach us to save and set our priorities. No going out to buy the latest "must have" gadget! No expensive (or even cheap) package holidays.  My wife brought up two children without disposable nappies or a washing machine. Nappies had to be washed by hand and dried each day, if necessary in front of the fire. Anyone who has to do that now would consider themselves seriously deprived, but at least by the time I retired, we owned our house outright and had a bit of money in the bank.

If these new rules start to make people think about the real priorities in their lives, then they must be a good thing.

Afterthought:
I've just received a letter from the Halifax telling me that the interest rates on my "Reward Savings Account" will fall from 2.5% to 0.5% on 8th November. Time to do some research into savings accounts elsewhere!

The BBC and Jimmy Savile

The questions about the Jimmy Savile affair seems to have changed from "How was he able to do it"  to "Why was a Newsnight Programme dropped". The Media Select committee yesterday seemed to concentrate all its efforts into finding out from George Entwistle who cancelled the Newsnight programme about Savile. The recent Panorama programme did exactly the same. Why? Whilst the cancellation of the programme is of interest, it seems to be diverting attention from the main issue, which is to find out how Savile was allowed to get away with his perverted behaviour for so long.

The main thing that has come to light in this new investigation is that the BBC seems to have a huge unwieldy, dysfunctional management structure with nobody having an overall picture of what was going on. The attitude that one mustn't ask questions because they could be construed as interfering with editorial independence is total rubbish. It is the job of the man at the top to have a very good idea of what is going on, even if he has no wish to interfere.
What has been revealed is the large number of layers in the BBC's management structure, seemingly with no clear-cut reporting arrangements. This, as anyone with even the most basic management experience will know, is a recipe for total disaster. Any business must be able to hold people to account and know who made what decisions and when they made them..

An MP, Sir Roger Gale, is reported in the Telegraph, to have said that Lord Patten, the chairman of the BBC Trust, and George Entwistle, the BBC director-general, may have to “fall on their swords.”
I would agree with this; In my view Entwistle may have been an effective "Head of Vision", but as DG, he has been promoted to his level of incompetence with no idea how to run a multi-faceted organisation. But then as Head of Vision, one might reasonably ask, why didn't he know what was going on with Savile over the years.

Yes, it is time for a huge shake up at the BBC so as to remove several tiers from the management structure and provide clear lines of responsibility.

EU Budget

According to the Daily Telegraph,
"The Prime Minister renewed a threat to veto any real increase in the EU budget, despite warnings that his approach is alienating Germany’s Angela Merkel."
It goes on to say that
"Reports from Berlin suggest Mrs Merkel, the Chancellor, is prepared to call off a planned EU summit to discuss the budget unless Mr Cameron changes his tone."

The picture that one gets from these exchanges (if they are correct) is that Germany, in the form of Angela Merkel, is running the EU. If we aren't prepared to do what she wants, she will call off the summit.  In fact the EU comprises 27 countries and I'd like to know what the other 25 think about the prospect of Germany calling off the summit. Surely, if anyone is to call it off, it should be the EU president.

I'm sure that we are not the only country who opposes an above inflation increase. Are the others too scared of Germany to object, or is it just that they want us to do the dirty work?

It will be interesting to watch what happens. However, the way things are at the moment, my money is on Cameron giving in, claiming, for example, the extra money is for some new purpose and that it is therefore justified. Personally, if I was in his position, I would call Germany's bluff, it would after all save the cost of the meeting which is probably totally unnecessary in these days of electronic communication.

The End of the Tories

Judging by the way that David Cameron is running this government, one begins to wonder if he is doing his best to ensure that the Tories are out of power for a long, long while after the next General Rlection. Almost everything that he or members of the cabinet do seems deliberately designed to reduce the party's standing in the opinion polls.  Why on earth should this be so? He has more Public Relations experts in the cabinet than any previous government yet all they are getting is bad publicity. There was no real reason for any of the recent fiascos, yet they just keep coming. Yesterday, Alex Salmond labelled UK politicians ‘incompetent Lord Snooties’ and it is hard not to agree with him in so far as the top Tories in government are concerned. 

In the Observer today, Lord Tebbit says broadly the same thing:
"This dog of a coalition government has let itself be given a bad name and now anybody can beat it. It has let itself be called a government of unfeeling toffs".
As he points out previous  Tory governments have had far more toffs, but they were real toffs not wannabe ones like the present lot.  He adds: "The abiding sin of the government is not that some ministers are rich, but that it seems unable to manage its affairs competently."
For what it is worth, my view is exactly the same, Whilst they may not actually call people outside their own circle "plebs", as Mitchell is alleged to have called the police, there seems no doubt in my mind that this is what they think.

If the Tories are to regain any standing in the polls, they need to come up with some carefully considered solid policies and put them into effect. Changing planning laws won't affect most of us, won't achieve much for the economy, but will attract a lot of flak from all directions, which is hardly good news. Nor will claims of more severe punishments for criminals, they are available already but rarely implemented. A new law to deal with the illegal supply of guns, it sounds good, but I'm quite certain the existing laws are more than adequate, Proposals to cut benefits for those who are not actively trying to get work again sound good, but will probably be squashed by human rights issues and of course concern about "the children". And as for "gay marriage", well this is hardly a vote winner with traditional Tories!

On Europe we are getting contradictory statements and all that does seem clear is that it is unlikely that we will be offered an IN/OUT referendum. With new terms of membership being discussed, it is more likely that we will be asked whether we accept the new terms or prefer the existing ones. At the same time we have UKIP steadily gaining ground, picking up, as they go, a number of traditional Tory policies which have been abandoned in the scramble for the centre ground. The European elections should give a good indication of things to come and I wouldn't be surprised if the Tories hit an all time low.

I am now convinced that this is the last Tory Government that I will see in my lifetime unless firm competent action is taken within the next few months. And I don't believe that this will happen whilst Cameron is at the helm.