Doctors in charge of the “Care Pathway” to “investigate” it
This is a bit like asking the fox to guard the henhouse. I predict only the usual mealy-mouthed conclusions that speak of an unreal ideal
A major review was announced last night into the Liverpool Care Pathway, the controversial ‘end of life’ treatment regime. The Association for Palliative Medicine, which represents 1,000 doctors who work in hospices and specialist hospital wards, will ‘identify and explore concerns’ over the system of caring for patients in their final days.
The Mail has highlighted the growing fears of patients’ relatives and many doctors that the care pathway is really a way of hastening the deaths of terminally ill patients.
Several families have been shocked to find that their loved ones have been put on the pathway – which involves the withdrawal of food and fluids as well as medical treatment – without their consent. The average lifespan of a patient on the pathway is 29 hours. Yet, some patients who were taken off the pathway at the insistence of their relatives have lived for several months.
The inquiry, which has the support of the Department of Health, comes after critics of the pathway said this week that they believed its effect is to ‘hasten death’.
The move by the Association for Palliative Medicine (APM) breaks ranks with the public stand of other medical bodies, who continue to give the pathway full support.
Last month a group of professional associations and charities, including the APM, issued a ‘consensus statement’ backing the method.
The change of heart follows weeks of controversy which have seen growing numbers of complaints from families about the way hospitals have cared for terminally ill relatives.
The pathway is a system by which doctors identify patients who are dying, and, instead of trying to save them, concentrate on trying to ease their suffering.
Doctors hostile to the pathway say it is impossible to predict accurately when patients may die, that death on the pathway becomes a ‘self-fulfilling prophecy’, and that the method is used to get rid of difficult patients and to free hospital beds.
Jeanette Burch, whose mother Janet Hayes, 88, died in July in King’s Mill Hospital, Nottingham, after being put on the pathway, said she welcomed the news of a review. Mrs Burch, 65, said: ‘Of course we are completely in support of this idea. ‘It’s too late for my mother. I am heartbroken and still wake up in the night thinking about her. It has devastated our family.
‘We would love to know the truth about what happened to my mother. ‘We never got to have closure but we hope that an inquiry will prevent the same thing happening to other families in the future.’
Last night, Professor Patrick Pullicino, the consultant neurologist who in June raised grave concerns that euthanasia had become a ‘standard way of dying’ on the NHS because of the pathway, said he would welcome an inquiry – but not at the hands of the APM. ‘We have to have outsiders looking into this,’ he said.
‘The depth of concern and the extent of suffering that have been brought to light through people who have been on the pathway warrants nothing less than a formal government inquiry.’
He added that the National Institute for Health and Clinical Excellence, the agency that had advised the Government to roll out the pathway across the country, urgently needed to ‘reassess its position’.
Care of patients on the pathway often involves sedation with morphine or other drugs, and in five out of six cases tubes carrying nutrition and fluids are removed or not provided to patients. Nearly one in three of all patients who die in hospitals are on the pathway.
An influential group of mainly Roman Catholic doctors issued a statement this week which said diagnoses of imminent death used to put patients on the pathway are often ‘in serious error’. They added: ‘It is self-evident that stopping fluids whilst giving narcotics and sedatives hastens death.’
Medical critics say patients who could have lived for many months are effectively condemned to death by being put on the pathway.
Explaining the APM’s move, its president, Dr Bee Wee, said it would be ‘more helpful’ to investigate public concern.
She said: ‘There are some very real anxieties among the public and some professionals about this whole concept. ‘Instead of simply defending the concept, or reiterating that if only it were used properly, it would be OK; it might be more helpful to stand back a bit, identify and explore the concerns properly, and find ways of addressing those concerns and improving practice.
‘The APM intends to undertake such a piece of work about integrated care pathways for the last days of life, in collaboration with a number of national organisations. Discussions are taking place about the details of the proposal, who else is involved etc.’
The Department of Health indicated last night that it will be involved in the inquiry. A spokesman said:‘Everyone wants to see appropriate care and support offered to dying people in their final days. ‘Expert groups like the Association for Palliative Medicine are well placed to look at whether improvements can be made and we will support them if we can.’
Doctors who couldn’t be bothered with very ill child
The parents of a little girl who suffered more than 100 fits a day were repeatedly told there was wrong with her, they have claimed.
Olivia Meredith, known as Livvy to her family, suffered from Rett Syndrome, a form of autism which leads to epileptic fits. But it took two years to get a diagnosis, with the toddler instead being diagnosed with a learning difficulty – and her fits being blamed on this.
Her mother Sara, 36, claims doctors said the seizures were quite common and accused her of ‘being neurotic’. She said: ‘Livvy went from being a happy healthy toddler, to one who couldn’t speak, walk or talk.’ It felt like it all happened overnight.
‘She was just 22-months-old at the time and before that she suffered no other symptoms. Eventually she started to have seizures and on one occasion she had 100 fits in 24 hours. It was terrifying.’
Mrs Meredith, a foster mother, and her husband Alan, 41, not only had to face caring for their sick daughter, they also had to battle with medics who refused to believe Livvy was seriously ill.
‘She would just scream instead of speaking,’ recalled Mrs Meredith. Doctors at the local Manor Hospital in Walsall diagnosed her with a learning disability. ‘But I knew this wasn’t the case,’ she said.
She claims the doctors continued to disregard the seizures of a sign of anything serious, saying they were common in children with a learning disability. ‘One doctor accused me of being neurotic.’
Finally, at the age of four, Livvy was referred to a neurologist, who immediately diagnosed Rett Syndrome.
She continued: ‘It was a big shock. To have a healthy child who you are then told has a life threatening illness is devastating.
‘We complained but we didn’t get an apology from The Manor Hospital for not diagnosing it. It was down to knowledge – they hadn’t come across it before. If we went there now – they would spot it.’
Livvy died in 2008 aged nine after contracting a virus.
‘I hope that no one will ever have to suffer the way we did with Livvy. It is soul destroying and the only reason Alan and I have managed to move forward is because we have three beautiful girls and our faith.’
Millions of Brits desert the Labour Party because of immigration — with 80% of supporters wanting drastic curbs on numbers
Millions of Labour voters have deserted the party in protest over mass immigration. A poll reveals that nearly eight in ten former Labour voters support drastic curbs on migrant numbers. It also shows huge support for sharp cuts in arrivals among those who have remained with the party.
In 1997, some 13.5million voted for Labour, but by the 2010 election that had fallen to 8.6million. Analysis of the views of some of the five million ‘lost’ Labour voters by YouGov shows 78 per cent want net migration cut to zero.
That policy would mean foreign migrants would be allowed in only to replace people who left – in effect, a one-in-one-out rule.
The YouGov poll, published in Prospect magazine, interviewed thousands of Labour ‘defectors’. Pollsters also found that two-thirds of Labour party loyalists backed zero net migration.
Sir Andrew Green, chairman of the MigrationWatch think tank, said: ‘This is stunning research which is bound to affect Labour’s immigration policies. ‘We will see whether they have the courage to declare a limit on immigration or whether they try to duck this essential issue. The track record so far is not encouraging.’
Ed Miliband signalled this month that he wanted more done to tackle immigration, saying low-skilled immigration into Britain was ‘too high’. But the Labour leader offered no policy proposals for how he would fix the problem.
Labour’s open-door migration policy led to the largest population explosion in Britain since the Saxon invasion. Between 1997 and 2010 the foreign-born population of the UK increased by three million, while nearly a million British citizens left the country.
Last year net migration stood at 216,000, down from 252,000 in 2010.
Home Secretary Theresa May has imposed a cap on migrant worker numbers and led a crackdown on family migration and bogus students.
Elected police bosses coming in Britain — despite much elite disquiet
With three weeks to go until the first elections for police and crime commissioners (PCCs), the public is at last beginning to hear about this major reform. TV adverts, cunningly placed during Downton Abbey, have alerted Middle England. Information is being despatched to every household. The media has stopped complaining about the lack of coverage and started to cover the story. The Prime Minister has urged people to get out and vote.
In a less-than-principled stand, the Labour Party, who opposed PCCs at every stage, are fielding candidates. Even the Liberal Democrats, despite their attempt to sabotage the reform by delaying the poll, are bravely contesting half the seats. More than 50 independents have thrown their hats into the ring.
In this fervour of democracy, one voice dissents: Lord Blair, former commissioner of the Metropolitan Police, has told people to stay at home. He claims that a single individual cannot represent one police force area. Yet this is apparently not too big a task for one chief constable. Lord Blair himself headed a force of 55,000 people, serving a population of 7.4 million, with a budget of £4 billion. But perish the thought that the people should be given a say.
There’s something particularly distasteful about an unelected peer unsuccessfully seeking to halt a democratic reform, then urging the public to boycott the ballot box despite the parliamentary vote. Lord Blair is a member of the once-governing class who felt no need for public consent and who regard popular views as dangerous. His like ran the quangos of the land, presiding over a public that could not possibly be trusted to take decisions for themselves.
Well, good riddance to them. There’s an obvious reason why we need the police to be accountable: you can’t choose your force. Increasingly there’s choice over your local school or GP. But the police are a natural monopoly. If you live in London you get the Met. If you lived there between 2005 and 2008, you got Ian Blair. And there wasn’t a thing you could do about it.
But then along came Boris. With the democratic mandate of a newly elected mayor, he swiftly despatched his police chief. No wonder the victim opposes this policy. And that’s the power of the reform: it puts the people in charge. It makes the police accountable for their actions and, in turn, the elected representatives who supervise the force have their feet held to the fire.
Interminable objections were mounted to this change. It would politicise the police, critics said, though my experience was that chief constables were as skilful political practitioners as my colleagues in the Commons. They usually ran rings round the chairmen of local police authorities, who the public had rarely heard of. The chiefs will find it harder after next month.
There are plenty of checks and balances. Chief constables will remain operationally independent. No politician should have the power to demand an arrest or investigation. PCCs will swear an oath of impartiality, undertaking to serve all without fear or favour. Her Majesty’s Inspectorate of Constabulary will continue to watch over forces.
But the most powerful safeguard of all is that the public will be connected with their force. Decisions about whether to increase the amount we all pay through council tax for policing will no longer be taken behind closed doors. Big questions about whether to engage the private sector to deliver behind-the-scenes policing services will have to be settled in public. I think that letting companies do back-room tasks more efficiently is the way to protect the front line. But it will be Commissioners who decide.
The subtext of opposition to these changes is that the police don’t need reform. But it’s very hard to look at the tragic story of Hillsborough, or failings to investigate child abuse, or the murky business of phone hacking, without concluding that a powerful searchlight needs shining in some dark corners of policing. Any public service that routinely leaked confidential information to the press would give cause for concern. When that organisation is entrusted to uphold the law, yet some of its officers see nothing wrong, we have a problem.
This is why the new College of Policing, which will set standards and guard integrity, will be so important. Police officers should be trusted as professionals, able to exercise discretion without the bureaucratic interference that has kept them off the streets, but then held properly to account.
It’s true that crime is down – inconveniently undermining Labour’s sole policy on policing, which is to oppose cuts. Yvette Cooper, the shadow home secretary, would rather you didn’t know that her party is quietly committed to cutting police budgets, too. That would mean fewer police officers. But it’s not something she whispers while she’s locked in the embrace of the Police Federation.
In fact, across the 41 police force areas, good people are standing and they deserve attention. These are candidates with local roots who care about their communities. Their decisions over the next four years will matter. That’s why people should ignore the ill-intentioned advice of Lord Blair and exercise the precious right of democracy on Thursday, November 15. Those who hold power over the people should be accountable to the people.
The Twittermob is watching you, too
The twitch-hunt of far-right nutjob Nick Griffin over one daft tweet has frightening implications for us all
Nick Griffin, leader of the far-right British National Party (BNP), currently has 19,356 followers on Twitter. Given the events of the past week, it seems many of these are not following Griffin because they enjoy his rants on anything from fracking to Islamists. Rather, the majority are following him in order to monitor his newsfeed, seemingly just waiting for an opportunity to report him to the police for offensive tweets.
Griffin’s latest misdemeanour was to tweet part of the address of two gay men who had won a court case against a couple of Christian B&B owners who had refused the men a room. Griffin then suggested to his followers that they might like to cause ‘a bit of drama’ outside the gay couple’s home in Huntingdon. So did any Twitter followers turn up? No – they were too busy shopping Griffin to the police.
One of the quickest off the mark was the Labour LGBT campaign group, which claimed to take ‘genuine offence’ at Griffin’s tweets. Labour LGBT tweeted: ‘If you agree Nick Griffin has just breached Sec 127 (1) of the Communications Act 2003 (see link), report him!’ This was retweeted by over 400 individuals, with the group sending interested individuals to the Metropolitan Police website where Griffin could be reported for a hate crime. A full-blown twitch-hunt had begun, with the hashtag #bangriffin heavily used. And almost 40,000 people signied a petition to ‘Get Griffin off Twitter’ for ‘publicly tweeting the address of a gay couple and inciting protest outside their home’.
The National Union of Students (NUS) joined in, posting a statement that the reporting of hate crime should be ‘encouraged’ and ‘the NUS LGBT campaign welcomes the police investigation into these tweets and will be monitoring the situation on behalf of our members’. The LGBT office of campaign group Hope Not Hate wrote an open letter to Cambridgeshire police stating: ‘In Nick Griffin’s tweets he seeks to incite violence against the gay couple.’ Griffin’s Twitter account was suspended and Cambridgeshire police declared that it was investigating Griffin.
Without doubt, tweeting the address of a gay couple, and threatening to give them ‘a bit of drama’ in the form of a demonstration, is an idiotic thing to do. But did anyone really think that a militant wing of the BNP was going to swoop down to Huntingdon and pay the sixtysomething gay couple a visit? Certainly not the couple themselves, whose chilled-out approach – as Brendan O’Neill has pointed out in his Telegraph blog – contrasts sharply with the hysteria of the Twittermob. Any demo, the couple said, would be a ‘damp squib’. Furthermore, ‘it would be difficult for people to gather as we live in a small village and there’s nowhere to park’.
Such cool reasoning was not shared by members of the Twittersphere, or by some gay-rights campaigners. In the words of a spokesperson for gay-rights group Stonewall, Griffin’s behaviour was ‘beyond words, unbelievably shocking. It is a real example of the hatred still out there towards gay people.’
‘Out there’ – it is a revealing phrase. It seems that this Twitter-stoked furore is not just about the loon Griffin, who has for many years developed notoriety for spouting offensive rubbish. It speaks also to the fear of some sort of silent, bigoted majority that Griffin supposedly represents. All it takes, it seems, is a tweet from Fuhrer Griffin and the gay-bashing hordes will arise. They won’t, of course, because they don’t exist. Yet, that someone widely known as a bit of a nutjob is seen as a ‘real example’ of hatred towards gays says more about a culture of offence-seeking than actual attitudes towards homosexuals in twenty-first century Britain.
It appears, however, that Cambridgeshire police has decided not to press charges against Griffin. And his Twitter account has been reinstated, albeit with the offending tweet deleted. To Griffin’s delight, he’s even attracted 3,500 extra followers on the back of the publicity. This time, it appears Griffin lives to tweet another day.
But the furore provoked by a few words online, coupled with the Twittermob’s censorious desire neither to debate nor countenance protest, speaks volumes about the increasingly intolerant nature of the Twittersphere. In its hounding of Griffin, the Twittermob is sending a frightening message: we are watching you, too. Conform or else.
Drug firms are ‘risking lives by hiding bad trials and side effects of their medicines’
This is a routine claim but where is the evidence for it? Some studies are legitimately not reported if defects are found in their methodology. As a peer reviewer I have myself caused studies not to be reported by pointing out methodological defects in them
Drug companies are deliberately withholding the results of adverse clinical trials – putting patients at risk, an MP warned yesterday.
Dr Sarah Wollaston, a Tory backbencher, said pharmaceutical companies were burying bad news about the effectiveness and side effects of their medicines.
She is backing a campaign for a change in the law to force drugs firms to publish the details of all trials – good or bad.
The family doctor said such a move would save the NHS millions, because at the moment taxpayers fund medicines which may not be as effective as they claim.
Yesterday Dr Wollaston told MPs: ‘Missing data from clinical trials distorts the evidence and prevents patients and their doctors from making informed decisions about treatment.’
Norman Lamb, the care minister, agreed to meet campaigners to see what more could be done to promote transparency.
Earlier, Dr Wollaston told BBC Radio 4’s Today programme that the previous government had spent £500million stockpiling Tamiflu despite companies ‘holding back’ full clinical study reports about the drug’s effectiveness.
‘You have to ask yourself why is that being held back,’ she said. ‘This is hugely important. And it’s not just about wasting money. This very much matters.’
She called for all historic data to be published, adding it was ‘vitally important’ for patient safety. ‘This really is a current issue,’ she said. ‘It affects patient safety and it’s wasting millions. If we could see a release of all the historic data…I think we would have a completely different evidence base for medicine. I think it’s vitally important for patient safety.’
Her campaign is supported by senior figures at the Royal College of GPs, the British Medical Journal, the Lancet and the Cochrane Library, which holds the largest collection of reports on clinical trials.
Other drugs for which campaigners say full information has not been made available include weight loss drugs orlistat and rimonabant.
Critics of the system estimate that around half of all clinical trials are never published in academic journals – and that trials with positive results are twice as likely to be published.
Yesterday in the Commons, Lib Dem care minister Norman Lamb told Dr Wollaston: ‘The Government support transparency in publishing results of clinical trials, and they recognise that more can, and should, be done.
‘Greater transparency can only serve to further public confidence in the safety of medicines. I am happy for my noble Friend Lord Howe or me to meet her and experts to discuss this important issue further.’
Stephen Whitehead, chief executive of the Association of the British Pharmaceutical Industry, denied drugs firms were not being transparent.
‘As the representative body for pharmaceutical companies in the UK, we take the issue that we are not transparent in our undertaking of clinical trials and causing patient harm very seriously,’ he said.
‘There has been much discussion of clinical trial data transparency over recent weeks, but we stand firm in our position that, as one of the most heavily regulated enterprises in the world, we do not seek to mislead or misinform.
‘Regulation of the industry is rigorous. In the UK, if a medicine is to gain a licence, then the complete clinical trial dataset relating to quality, efficacy and safety must be submitted to the regulatory authorities for approval.
‘We realise that there is still work to be done as we continually move toward greater transparency.’
Get orf our land! (or how my village blew away a 140ft turbine)
By James Delingpole
Two months ago my family and I finally moved out of the Big City and into paradise – a pretty rented cottage on a 2,500-acre estate in Northamptonshire with lakes, Capability Brown parkland, a 12th Century church, a ruined Elizabethan haunted house, an 18th Century walled garden and an ancient bluebell wood teeming with badgers, bats, deer and rare birds.
But what we didn’t know was that there was a snake in the garden: a planning application for an ugly 140ft wind turbine on the hill overlooking our new idyll.
The first I heard of it was when a woman called Sue accosted me at the Fawsley village fayre. ‘We’re so glad you’re here,’ she said. ‘Now you can help lead our fight against the wind turbine!’
Flattering though this was, I had to explain that I’m a troublemaker not an organiser. Sure, I could help out with an angry article, but if she wanted a leader she’d have to look elsewhere. Run a campaign? I can scarcely run a bath.
But from that moment on our paradise felt lost. Every time I went for a walk I couldn’t help glancing up at that hill, wondering how it would look when the wind turbine came. I thought of the sunrises it would blight, the low-frequency noise, the birds and bats it would slice and dice, and the hundreds of thousands of pounds going into the landowner’s pocket while the neighbours had their landscape ruined.
A fortnight ago, our worst fears came true. Sue emailed me to say the turbine had been recommended for approval by the planning officer. With only a week before the meeting when a decision would be made, we had left it too late. Only 12 people had written to object and planning approval was surely now a formality. ‘If only we’d put up more resistance earlier,’ said Sue.
At this point something in me snapped. There are things worth fighting for, and for me this was one of them. Come what may, the dragon must be slain.
What you don’t realise until you’ve fought one of these wind applications is just how grotesquely rigged the system is in favour of the developer.
Apply to your council’s planning department for a slightly bigger than normal conservatory and they’ll likely turn you down flat. On the other hand, propose to erect a noisy, gleaming white industrial wind turbine twice the height of the tallest oak tree…..
Incredibly, it’s the developer (not the council) who gets to commission all the expert environmental, architectural, acoustic and ecological surveys assessing the proposed turbine’s impact. Is it any surprise that these surveys generally tend to find in favour of the person who has paid for them – of course there won’t be any noise, the bats will do fine, and the turbine will meld perfectly into the landscape.
Worse still, under current planning law, the presumption is in favour of renewable energy schemes. In other words, unless you can prove that the adverse effects of a turbine will ‘significantly and demonstrably’ outweigh its supposed carbon-reduction benefits, then the application is likely to be approved regardless of how strongly the local community objects.
This cruel injustice is spreading heartbreak, misery and fear across our land. The length of Britain – from the Stopit Meddon campaign in North Devon to once-wild and unspoilt Orrin in Ross-shire, Scotland – small groups are engaged in desperate battles to spare their cherished patch of the countryside from ruin.
All they want is peace. Instead, they’re having their nerves shredded, their spare time eaten up, and their savings exhausted in a frantic guerrilla war against ruthless, powerful developers with bottomless pockets and an insatiable appetite for the vast subsidies wind farms attract.
How to win against so mighty a foe? Simple. You have to call on the same reserves of courage, ingenuity, determination and raw cunning that in the past helped us see off the Spanish Armada, Napoleon’s navy and Hitler’s Luftwaffe. I’m not exaggerating. Truly, the Blitz spirit is alive and well in your nearest anti-wind-farm campaign group.
A few urgent phone calls later and our entire community was mobilised. From the lord of the manor to the lowliest tenant, from the village’s two resident hot-shot barristers to the former bass guitarist from Echo And The Bunnymen, from the children at the village school to the woodsman on the estate, everyone was determined to do their bit.
By the weekend before the hearing our position had changed from totally hopeless to not-entirely futile. Our crack team had spotted any number of serious flaws in the planning application. Nearly every conservation body going had raised objections, including English Heritage.
Quite why the planning officer had decided to override these objections – and in a protected landscape area too – was a mystery.
A mystery, it turned out, that the council’s planning committee found as baffling as we did. At a packed meeting – preceded by a demonstration by the village’s placard-wielding children – we were first astonished, then almost tearful with gratitude, as one by one the members of the planning committee at Daventry District Council stood up to say how appalled they were that such a blight was even being considered in an area so beautiful and unspoilt. They rejected the idea by nine votes to one.
I’d love to end the story at the glorious pub celebration where jubilant villagers – many of whom had never met until we were united through struggle – toasted the wisdom of those councillors and the power of local democracy. But sadly I can’t.
Since then I’ve heard the landowner is going to appeal against the decision and try to force through a wind turbine that no one (except him) wants and which will disfigure our neighbourhood.
Our community’s plight is by no means an unusual one. Something has gone badly awry with both our energy policy and our planning laws. Is anyone at Westminster listening?
Take a walk if you want to beat dementia
This is just the usual correlational rubbish — and based on self-report questionnaires at that. To state the obvious, it is maybe people who were healthier to begin with who did more exercise
Forget the crossword – going for a walk may be better insurance against developing dementia, say researchers. A study has found physical exercise, rather than mind-stretching activities, offers the best protection against excessive shrinking of the brain in later life.
Previous studies have found regular exercise can cut the risk of developing dementia by a third, while others suggest keeping mentally active with crosswords, playing cards and computer work.
Study author Alan Gow, from the University of Edinburgh, said the research provided objective evidence that exercise is critical for brain health.
He added: ‘People in their seventies who participated in more physical exercise, including walking several times a week, had less brain shrinkage and other signs of ageing in the brain than those who were less physically active. ‘On the other hand, our study showed no real benefit to participating in mentally and socially stimulating activities on brain size, as seen on MRI scans, over the three-year time frame.’
Altogether, 638 Scottish people born in 1936 who had been involved in a long-term study of ageing took part in the research.
They were asked to fill in questionnaires aged 70 and were given MRI scans at 73. They gave details about their exercise habits, ranging from moving only in connection with household chores to keeping fit with heavy exercise or playing competitive sports several times per week. They also recorded any socially and mentally stimulating activities they did.
The study, published in the journal Neurology, found that after three years those doing more exercise had less brain shrinkage than those who exercised minimally. They also had larger volumes of grey matter in the brain, showing that fewer brain cells had died.
Professor James Goodwin, head of research at Age UK, which supported the study, said: ‘This research reemphasises that it really is never too late to benefit from exercise, so whether it’s a brisk walk to the shops, gardening or competing in a fun run it is crucial that, those of us who can, get active as we grow older.’
Dr Simon Ridley, head of research at Alzheimer’s Research UK, said: ‘While we can’t say that exercise is the causal factor in this study, we do know that exercise in middle age can lower the risk of dementia later in life.’