Dishonest journalism matters

I know I don’t blog much these days and I rarely read the Daily Mail, but I used to do both of these things. A lot. During this period I experienced a lot of eye-rolling if I attempted to talk to people about what the Mail (or other terrible newspapers) had written, and why it was a lie and what it was trying to do. Most people just didn’t care or they implied that they did care, but that in the great scheme of things it didn’t really matter because most people take what they read with a pinch of salt anyway.

This is the great paradox of a lot of people in Britain, and perhaps worldwide: we often profess to not trust journalists or newspapers, yet we seem to be entirely convinced by the media narratives that they create. We don’t trust newspapers, but we do blame all of our woes on the welfare state, benefit scroungers and immigrants. We don’t trust newspapers, but we do believe that obscene inequality is only right and natural and that the immensely wealthy are innately better people than us and they not only deserve to be that wealthy, but they have also earned the right to dodge as much tax as they can as well.

We don’t trust newspapers, but we’re pretty sure that climate change is a scam dreamed up by hippies and governments to tax us more. We don’t trust newspapers, but we do know that having human rights is definitely a bad thing. We don’t trust newspapers, but we do know that Christianity is under attack by the PC brigade and that they’re banning Christmas because it offends Muslims’.

For a people distrustful of the mainstream media, we sure do take on board a lot of their narratives. This brings me to this year’s Christmas card sent out by the BNP. Naturally, the card unsubtly wishes the receiver a ‘white Christmas’. Equally as expected, the BNP have edited the stock photo of the girl on the front – changing her eyes from hazel (brown) to blue (Aryan). Also par for the course is a short and cheery Enoch Powell quotation on the back (“It’s never too late to save your country!”), who is introduced as ‘The legendary Enoch Powell’.

I can live with all of those things, after all, what else would you expect to get from the BNP? What annoys me – in my position of being the world’s foremost expert on the Winterval myth – is that they only go and bloody repeat it! Under the banner ‘Protecting our Christmas’ they warn the reader:

Our Christian values underpin our British Identity. It’s why they’re under attack, not just from Islamification, but also from the Politically Correct authorities who put immigrants before us, the British people.

Christmas is being stealthily and ruthlessly dismantled and replaced. We’ve all heard of Winterval, it’s the Politically Correct replacement of our traditional Christmas – an engineered replacement complete with polar bears, penguins, and snowflakes to eradicate our traditional nativity scenes, with baby Jesus, Joseph, Mary, and the Three Wise Kings all to be airbrushed out.

Firstly, it does seem ironic that the xenophobic BNP miss the traditional ‘British’ Christmas – the celebration of a virgin birth in Jerusalem, which is a bit, well, foreign, is it not? Secondly, could it not be argued that we’re increasingly a less Christian country because people are finding it hard to believe that a white couple, with Western names, gave birth in the Middle East to a baby conceived as a result of angelic intervention? It might be less the result of ‘Politically Correct authorities’ and more a case of ‘it is quite clearly bollocks, and I object by child being subjected to it’.

Secondly, the idea that Neo-Nazi skinheads marching drunkenly through a city centre are motivated by the marginalisation of baby Jesus seems somewhat incongruous. After all, if they were good Christians they’d surely either turn the other cheek, forgive them or love thy new neighbours. I don’t think Jesus’ teachings would quite gel with the BNP worldview.

And finally, I love the idea that Christmas is being ‘stealthily’ replaced. Presumably, it’s stealthy in the sense that you cannot perceive it happening… because it is not happening. Those stealthy PC authorities, they might be putting up Christmas trees and sending out cards, but they’re ‘ruthlessly dismantling’ Christmas behind the scenes.

Which brings me, in a rambling, verbose way (I am out of practise), to my main point: when newspapers lie to pursue a media narrative it does matter, it does have consequences. Here we are, 16 years after the Winterval myth was initially spread by tabloid and broadsheet alike and it is still acting as an enabler for extremist right-wing views. As I demonstrated in my ebook, the longevity and popularity of the Winterval myth was largely because of its power as the seed from which other myths of Christian marginalisation could grow. Increasingly it formed the cornerstone of a rampant media narrative that authorities – out of fear – were actively pandering to the sensitivities of Muslims.

It is easy to ignore the direct output of the Daily Mail – and all newspapers which pursue a similar worldview and agenda – but it is impossible to ignore the consequences. When the upcoming election is dominated by the ‘problem’ of immigration or the ‘reality’ of austerity and continued cuts to the welfare state, remember: this is because a lot of people buy into these media narratives. Politicians spend huge amounts of time and energy responding to the media agenda, irrespective of whether that agenda has any basis in reality or whether it best represents the interests of the majority.

We will never have be able to improve our society for as long as our media is owned by vested interests. They have sold us the lie that there is no alternative to inequality, injustice and unfairness – and, like Winterval, enough of us have fallen for it to make their lie, our truth.

You can buy my ebook from Amazon or Kobo.

Winterval: still continuing to fool lazy journalists

I had a message from a Twitter user a couple of days ago that Winterval had been trotted out again by yet another lazy journalist, this time Mary Kenny in a column for the Belfast Mercury. In her column she recounts how:

A few years ago, Birmingham city council sought to replace ‘Christmas’ with ‘Winterval’, alleging that it was “offensive” to Muslims and other non-Christians that a holiday based on ‘Christ’s Mass’ should be on the calendar.

Like so many later repetitions the Muslims are to blame, scaring Birmingham council with the very thought that such a holiday should even be on the calendar!

Of course, as I’ve repeated here and elsewhere many times: Birmingham council did no such thing, and the events they did hold (of which Christmas – called Christmas – was the focal point) were a marketing ploy to drive business into the city centre and had absolutely nothing to do with the religious sensitivities of anyone. Winterval took place in 1997 and 1998, as a media myth it has been debunked again and again, yet here we are, 17 years later still having it repeated by people paid to write for a living.

Now seems a good a time as any to plug my e-book on the subject, available via Amazon and Kobo for a very small price. In a year in which the press avoided regulation (again) it makes for pretty painful reading about how journalists are happy to repeatedly lie to push their media narratives – and how these media narratives become more extreme over time.

The reports of Angry Mob’s demise have been greatly exaggerated…

As you may or may not have noticed Angry Mob has been defunct for a little while now. This was due to me using a very old custom blog template that I made myself based on an old WordPress blank template which was being attacked and the site had to be shut down, wiped clean and now has to be made anew.

I have backed-up (hopefully successfully) the content of the old website, which will be restored when I get the new template finished.

I may even grace the restored blog with the occasional post. I don’t look at the Daily Mail much these days, but it still festers away in the background and hasn’t got any better in my absence.

Anyway, for the occasional visitor who might come across this website: rejoice, for it will return.

I am still available on Twitter.

Winterval: Still alive and kicking

Remember the dim and distant days of November 2011 when the Daily Mail published a correction to a Melanie Phillips article in which they finally acknowledged that Winterval had never renamed Christmas:

We stated in an article on 26 September that Christmas has been renamed in various places Winterval. Winterval was the collective name for a season of public events, both religious and secular, which took place in Birmingham in 1997 and 1998. We are happy to make clear that Winterval did not rename or replace Christmas.

As I wrote recently in my E-Book about Winterval (which this blog post will repeatedly plug) this correction from the Daily Mail did more to kill the myth than any debunking had managed before, and apart from the occasional mention the myth had pretty much died.

However, the Daily Mail has – 3 days ago – published another article on the myth: ‘She may as well have wished us Happy Winterval!’ MP who sent out Happy Holidays card faces backlash for ‘marginalising’ Christmas’. The article suggests – in one of the Mail Online’s various bullet-point sub-headings – that such a card ‘Draws comparisons to the 1990s Winterval furore in Birmingham’. The Mail also makes room for the following handy reminder to readers:

winterval

This little box is crammed full of lies. Winterval was never about ‘reflect[ing] the diverse nature of the city’s population’, nor did the council ever say anything about making the city a more welcoming place for ethnic groups. These are lies, I have read every single piece of news coverage, in both local and national newspapers, since 1997 on this subject and I have never, ever seen anything that could possibly justify these assertions. I know this will not come as a shock, but the Daily Mail is making this up, they are lying to their readers.

As for the then Bishop of Birmingham’s comments, they were made a year after the initial Winterval celebrations in 1997 (of which he seems to have been completely oblivious) and they were reported by a newspaper that up until that point had not criticised Winterval at all – indeed, newspaper reports after the 1997 event talked about what a success it had been and how Winterval 1998 was going to be bigger and better.

If you care about the state of journalism, or you want others to realise just how happy newspapers are to make stuff up to incite hatred towards target groups, then please buy and read my E-book on the Winterval myth. It will – I think – open the eyes of any reader as to how one little myth can fuel a media narrative (atheists / Muslims / PC brigade are banning Christmas) for over 15 years, and how in each passing year the original myth becomes more and more embellished to suit the political needs of the newspaper at the time.

In other news, Ann Widdecombe recently crammed as many media myths into a few hundred words as I’ve ever seen, including Winterval and a Dr Chris Allen has completely ripped-off all of my research into Winterval in a blog post in which he basically rejigs my writing on the topic – adding nothing new.

The only way anyone can make me feel better is to buy my E-book:

winterval-book

Winterval E-Book published

I’ve spent the last few weeks fully updating, proofreading and finalising my first E-book and am pleased to announce that it has now been published via Amazon. I hope to publish the book with Kobo store in the next couple of days.

It should make a nice digital stocking filler for anyone interested in a good tale of bad journalism. Should it go well I hope to publish a few more books on the media next year.

Thanks, and Merry Christmas.

Due prominence

The Leveson inquiry examining the culture, practices and ethics of the press concluded with a printed report on the 29th November 2012. It recommended that the press – having failed to effectively regulate itself, despite being given more than one chance to do so – be regulated by a truly independent regulator with some form of statutory underpinning. What this meant in simple terms: because the press so clearly cannot be trusted to a, behave appropriately and b, punish any misdemeanors through the PCC, some formal system is needed to ensure that appropriate sanctions would actually be applied.

The press took this as the ‘end of press freedom’ and has been fighting against any form of regulation (again) ever since. What is interesting, though, is that whilst this fight has been ongoing the press has still been completely ignoring the PCC code of practice – which, as I have commented before, is actually not bad. What the PCC code of practice (both the shortened quick bullet points, and the longer, more detailed examination of how a modern press should behave) demonstrates is that newspaper editors understand the kind of behaviour that a decent, moral press would engage in, and what is unacceptable. It clearly isn’t ignorance of what a good press should be that is holding editors back, it is rather that they understand that they can completely ignore such a code as there are no sanctions for doing so.

Think of the PCC code of practice as being exactly the same as the New Year’s Resolutions you might set yourself: sure, you understand that eating healthy is a good thing to do and you could even right a perfectly logical rationale in support of it; this doesn’t mean you have any intention of sticking to the resolution and nor is there any external reason why you should. Most New Year’s Resolutions end in abject failure; just like the PCC and press self-regulation.

In terms of the Leveson report and the ongoing press struggle against any form of regulation you’d think it would be in the interests of the press to abide, strictly by the code to demonstrate to everyone that they are capable of self-regulation without statutory underpinning.

Yet they haven’t changed their practices at all.

One of the clearest examples is the PCC code of practice stating that:

A significant inaccuracy, misleading statement or distortion once recognised must be corrected, promptly and with due prominence, and – where appropriate – an apology published.

This, to my knowledge, has never happened – either before or after the Leveson report was published. The latest example is provided by the Sun:

I’m pretty sure that this story (having done the rounds on the Internet very effectively) wasn’t published in a tiny corner on page 2 (the page which is the least read in the newspaper format according to what I’ve read in the past).


The image was taken by Giles Goodall, you can follow him on Twitter if you’d like.


PS: Clicking on the Angry Mob TV videos earns me money, so feel free to have a click on them before you leave the site to help pay for web hosting.

Has the Daily Mail Jumped the Shark?

The TV show Happy Days in many people’s view went in to a terminal decline when The Fonze jumped over a shark whilst water-skiing. Watching the show always involved suspending disbelief to quite a large extent as the Fonze is clearly a ridiculous character but the point when he jumped over a shark was the point at which the writers went too far. Was it hubris or over-confidence or simply desperation that led the writers to take their audience for granted? Either way it was a watershed moment. I wonder whether the Mail has similarly over-reached itself – not with its attack on Ed Miliband via his father so much, but by their attempted defence.

fonzie_jumps_the_shark

In many ways the attack on Ralph Miliband was typical of the Daily Mail – it is typical of their Modus Operandi: prejudicial, ill-conceived and misrepresentive of the subject. This response by Miliband Senior’s biographer is very telling.

The sole basis for this assertion was a diary entry at the age of 16 in autumn 1940, where Ralph Miliband wrote that “the Englishman is a rabid nationalist” and, “when you hear the English talk of this war you sometimes almost want them to lose it to show how things are.” Such sentiments might sound shocking, but they need to be put into their real context.

A few months earlier Miliband had arrived in Britain with his father, having walked from Brussels to Ostend, where they took the last boat leaving for Britain. While working hard to improve his English, he was also spending much of his time wandering through the streets of London trying to make sense of his new environment. He was in a constant state of anxiety about the fate of his sister and mother, who had remained in Nazi occupied Belgium as stateless Jews.

Because he believed that the earlier appeasement of Hitler was largely responsible for the situation, he was occasionally exasperated by the atmosphere of complacency and superiority amongst the British upper classes, and this no doubt provoked his intemperate diary outburst.

There is nothing new in any of this: The Mail has done this to many others. What is unusual is that Daily Mail could not deny Ed Miliband a response.

 

The petulance that accompanied the printing of Ed Miliband very measured article was impressive to behold.

Ed Miliband:

Britain has always benefited from a free Press. Those freedoms should be treasured. They are vital for our democracy. Journalists need to hold politicians like me to account — none of us should be given an easy ride — and I look forward to a robust 19 months between now and the General Election.

<snip>

The Daily Mail sometimes claims it stands for the best of British values of decency. But something has really gone wrong when it attacks the family of a politician — any politician — in this way. It would be true of an attack on the father of David Cameron, Nick Clegg, or mine.

There was a time when politicians stayed silent if this kind of thing happened, in the hope that it wouldn’t happen again. And fear that if they spoke out, it would make things worse.

I will not do that. The stakes are too high for our country for politics to be conducted in this way. We owe it to Britain to have a debate which reflects the values of how we want the country run.

The Daily Mail Comment

Red Ed’s in a strop with the Mail. Doubtless, he’s miffed that his conference was overshadowed by the revelations of his former friend, the spin doctor Damian McBride, serialised in this paper, which exposed the poisonous heart of the Labour Party.

Nor did he see the funny side when we ridiculed the yucky, lovey-dovey photographs of him and his wife, behaving like a pair of hormonal teenagers in need of a private room.

But what has made him vent his spleen — indeed, he has stamped his feet and demanded a right of reply — is a Mail article by Geoffrey Levy on Saturday about the Labour leader’s late father, Ralph, under the arresting headline ‘The Man Who Hated Britain’.

They seem to want us to believe it was an act of great magnanimity for them to publish the response rather the act of cowardice and calculation it really was. They know how much worse it would be if it was published elsewhere under the headline What the Mail refused to print. The choice of the grave photo shows the standard dehumanising attitude of the DM to those they oppose – although to be fair to them they have at-least acknowledged that this was in poor taste. Note the choice of language – responding to a deeply personal attack on his father, Ed is characterised as behaving childishly, whilst the Mail repeat the words ‘evil’ in reference to Ralph Miliband’s views.

If the professional ethos of journalism is to speak the truth to power then the Mail is undoubtably the very antithesis of a journalistic organisation. The reaction to this particular example though is interesting. The hardcore Mailites remain loyal but their wider credibility as a newspaper has been compromised. I – and many others – have long seen through them but the Mail has always maintained this pretence of seriousness. It is interesting, and not a little ironic, to see this pretence stripped away by their own bloody-mindedness. While Stephen Glover whines about the leftist conspiracy and alleged hypocrisy, the country at-large seems to take a different view. I find myself wondering if they have perhaps over-reached themselves this time?

I for one, truly hope so.

 

AFZ

Stop buying the Daily Mail: it is not out to help you

It’s been a while since I last posted anything on this blog, or indeed have written anything about anything. Yet every now and again the Daily Mail does something that stirs up Twitter and occasionally it makes me want to make some sort of comment, but I don’t get round to it or I feel as if everything has already been said. But as it has been such a long time since I blogged about just what a terrible newspaper the Daily Mail is, I thought it worth going over again.

The Daily Mail is a cowardly newspaper. Attacking Ed Miliband through his dead father is just the latest in the long line of comment published solely in an attempt to discredit someone (without ever wanting to actually debate the points made). The argument of the press that it exists as a check and balance to the rich and powerful has long been a sick joke (too often repeated by spineless politicians of all bland and samey flavours who are too scared to court the vitriol of the industry) and the state of our society today is evidence enough that they have not provided any kind of check to the power of big business or giddy politicians.

The Daily Mail is part of a press that is largely part of the system of control, the noisy attack dog of big business and politicians bent on giving the last remnants of the state over to private firms to run into the ground for the benefit of a few shareholders – who increasingly hoover up the wealth of the planet into the hands of a few thousands of people (money does not ‘trickle down’ in the form of capitalism the world has been forced to adopt, it steadily – and increasingly rapidly – flows up; evidenced by the fact that the rich keep getting richer and the rest of us squabble around for ever smaller bites of the capitalist apple).

The Daily Mail is not a newspaper, it never has been. It is a wonderfully successful vehicle to ensure that enough people largely fear and despise one another whilst not really noticing that the people around them are, in fact, just like them; only different in some inconsequential way. The Daily Mail is brilliantly evil because it doesn’t do this by carpet bombing the nation with free newspaper drops, it actually sells this hatred to a willing public. One of the things that society enjoys repeating is the sorry cycle of electing politicians who wear different colour ties, but enact policies that are largely the same. We boot out the Tories, only to then boot out Labour for being just as bad… just to return the Tories; who are terrible, so we vote in Labour and so on.

We exist in a permanent state of limbo in which politicians only focus on short-term populism which ultimately results in bad choices and long-term decline. Politicians only attempt to make changes that they can push through in their short time in office, each competing vainly to make the biggest impact during their time on stage – a stage which they are normally ill-equipped on which to stand (Michael Gove possibly being the worst of the current very sorry bunch). Thus politicians dabble in education, bringing in sweeping changes on nothing more than a whim and a misty-eyed view of their own schooling, reorganize the NHS, safe in the knowledge that the next incumbent will only serve to twist it into a different shape anyway.

Meanwhile the country drifts towards blackout because a long-term energy strategy is expensive, unpopular and doesn’t give the politician the chance to make a noticeable mark in the same way that blaming teachers for the state of education does (hint: teachers are not the reason why education is increasingly becoming the antithesis of the word). Part of our inability to take action, to understand the problems that we face, is the constant disinformation spread by the Daily Mail and it’s sorry cohort of newspapers determined to maintain the status quo and indeed tighten the grip of the rich around the throats of just about everyone (they allow us just enough breath to watch TV and buy more shit we don’t need to distract ourselves from the misery of existing in a world in which millions die of starvation, whilst millions shovel money into the hands of false saviours to try and halt their descent into morbid obesity).

We can’t get out of this cycle unless we organise ourselves and change politics to actually work for the majority. We need a long-term energy goal, we need worthwhile jobs and decent housing for all. I sometimes feel that we look back through history at the rigid class system and extremes in wealth and poverty as if those days are gone, when clearly little has changed. It’s not enough to point to Alan Sugar and argue that the class system is dead, its just that most people born on housing estates clearly aren’t working hard enough (although the media seems intent on trying to make this case).

I guess what I’m trying to say is this: we will not move forward as a society or planet if we keep buying newspapers, or indeed willingly believe most forms of media with which we are bombarded. These organisations are not looking out for us, they are there to silence us, to bully us into submission with the their power, or cower us into inaction because we fear the fellow citizens without which we are incapable of enacting change.

Buying most newspapers is an antisocial act, reading the Daily Mail and disseminating the hate within is akin to smoking and blowing smoke into the faces of the people around you. You can’t avoid the health hazards of smoking if people smoke around you, anymore than you can avoid the poison breathed by the readership of the Daily Mail. Turning your back is not an option, the Daily Mail will not be defeated with a blind eye, it needs to be stared down.

Buying the Daily Mail should be as socially unacceptable as drink driving – we don’t care if you die from your own stupidity, but it’s the danger you cause to others that we will not tolerate.

P.S. it would also help if millions of people slapped themselves firmly around the face and realised that the lives of celebrities are a pointless distraction and stopped making the Daily Mail website one of the busiest on earth.

Just imagine a world in which people spent time informing themselves about the things that matter instead of reading celebrity drivel. The things we might achieve.

A sad day for palliative care

Three weeks ago I wrote about my dismay at the Daily Mail’s attack on the Liverpool Care Pathway. This week Baroness Neuberger’s team has published its report: “More Care, Less Pathway.” Amongst its recommendations is this:

The name ‘Liverpool Care Pathway’ should be abandoned, and within the area of end of life care, the term
‘pathway’ should be avoided. An ‘end of life care plan’ should be sufficient for both professionals and lay
people.
Unsurprisingly the Mail is gloating over its victory:
  • Ministers order Liverpool Care Pathway to be ditched within a year,
  • Review by Baroness Neuberger reveals how end-of-life treatment was used as an excuse for appalling levels of care
  • Families were not told their loved ones were on the ‘pathway’ to death

The Mail has been leading a campaign against it…

I stand by every word I wrote three weeks ago. I am quite disappointed by how much the report has pandered to the Mail. If you read the comments sections of my last post, you will see many of the commentators are strongly opposed to the LCP. Whilst I think many of the comments are misguided, and just plain wrong I have not moderated any of them. (Unlike the Mail website which always blocks all of my comments posted as ‘alienfromzog’). I want to take this opportunity to respond to the comments, to the report and to the Mail. My main frustration is that when you read what people think caring for the dying should involve, it’s often words like “Caring,” “TLC” or “Individual” are used. Similarly many relatives say they want good communication. What is so frustrating is that this is precisely what the LCP is. What it’s for. If you don’t believe me , read this: Marie Curie Example LCP documentation.
It took years to recover from the damage done to the vaccine program by the Mail’s irresponsible reporting – and we’re still not there yet. This is why the Mail is so malevolent. And yes, I do blame the Mail in part for the children who have died of measles. Years of hardwork, research, evidence and education – all undone by Melanie Phillips and her malicious publication. And who suffers? The most vulnerable in society. There have been various articles and blogs written to defend the LCP. In all of them that I’ve read, they begin with an acknowledgement that the LCP used inappropriately has led to many of the problems reported in the press. I have not done that and this is deliberate. I am not pretending that bad practice does not occur. It does – in all areas of healthcare and all healthcare systems. I will always condemn bad practice but the idea that not using the LCP pathway properly means there’s a problem with the LCP is ridiculous. Moreover, by beginning with such acknowledgements I believe that all these articles and also the Neurberger report has conceded too much ground – allowing the LCP critics to claim victory.
Perfectly preventable problems of communication between clinicians, relatives and carers
appear to account for a substantial part of the recent controversy and unhappiness
surrounding the LCP.
I care about quality of care. Abolishing the LCP will make the Daily Mail happy. It will make the government look like they’re doing something and will almost certainly lead to less-good care. Almost without exception, the critics have said “Care of the dying should be….” and what follows that, as I said above, is in the LCP. So, in order to improve care we plan to abolish a tool that works when used properly rather than addressing the issues that lead to it not being used properly. This is insane. But then, that’s what government by tabloid press always is. My great fear is that scrapping the LCP will mean a return to ad-hoc, ‘hit and miss’ palliative care. This is a major backward step.
I do want to address a couple of specific points as well; firstly the LCP is not euthanasia by the back door. Secondly the payments for use of the LCP to hospitals have been presented as money for killing off patients and this is a gross misrepresentation.
I am against euthanasia. I think giving doctors the power the kill is a grave error – even when people are suffering horribly. Good palliative care is the very opposite of euthanasia. My professional experience – and this is especially true in children – is that we over-treat to the nth degree. We are not good in the profession in acknowledging that we cannot cure and fix everything. Most of us in medicine are ‘fixers’ by nature. A lot of what we do in medicine is nasty and invasive. I have no problem with doing nasty and invasive things to people who will benefit from them. I have major issues with doing nasty and invasive things to people when it will not help. This is about not having another round of chemotherapy when we know it won’t help. This is about not force-feeding people with artificial nutrition as their body shuts down. This is about not doing endless – and increasingly difficult  – blood tests just so we can chart the dying process. Integrating care pathways for dying patients mean we provide comfort and care for people in their last hours and days. This is vital.
The way the NHS funding works is quite complicated. Since the early 1990’s there has been a so-called purchaser-provider split and hospitals then get paid for providing specific treatments. One of the parts of this is so-called ‘quality-care indicators’  (or whatever they’re called this week). Essentially a portion of the money paid by primary care trusts / GP consortia is dependent on meeting the quality indicators. One such indicator was the use of the LCP in dying patients – x% was the threshold for payment. This actually makes a lot of sense; Let us assume that the LCP provides an excellent framework for caring for dying patients. Secondly, all patients who die in hospital are categorised as ‘expected’ or ‘unexpected.’ Death is often not a surprise – i.e. medical staff know that a patient is in the last phase of illness. The internal audit process simply reviewed what percentage of the ‘expected’ deaths were on the LCP when they died – i.e. had the medical team stopped doing invasive procedures on someone or were they still trying to cure? Nothing is absolute and some patients will die unexpectedly. Some people will have a theoretically reversible condition and it is right to keep on treating and yet we still fail – but the evidence is clear, in the majority of cases, we know someone is dying and the focus of care should change. A simple audit of whether the LCP is used of not is a good marker of this. The use of money to drive things is an inevitable consequence of how the modern NHS is structured – a perhaps cynical view that NHS trusts will only do things for financial incentives. On a more practical level, the trusts used this money to pay for specialist palliative care teams to support the use of the LCP and help the other clinical teams use it effectively. The abolition of such payments is a sensible political move but will probably also result in trusts not focusing on palliative care.
Speaking as the son of someone who died in an excellent hospice; speaking as a doctor who has worked on the wards where integrated care plans for dying patients have been used – and as someone familiar with LCP specifically I say this:

This is a very sad day for the healthcare in the UK. There is not a problem with the LCP – there is only a problem with poor practice – rarely. The number of patients who have received excellent care far outweighs the few who haven’t. Not that those don’t matter, they really do but I am sure that the bad practice was worse before we had integrated care for dying patients and will probably be worse again. What’s most annoying is when you read the comments sections or listen to radio phone-ins people talk about what they want end-of-life care to look like and it is precisely what is in the LCP. It is worrying to me that the Daily Mail wrote a couple of sensational and misleading articles and forced this change of policy. Deeply worrying. I know that a small group of people in the late 90s worked very hard to put together the research and develop the LCP. I suspect they are very demoralised. I know a lot of people work in palliative medicine and I expect they are depressed and despondent. All because a lying, evil rag – not even fit to be fish ‘n’ chip wrapping – calls itself a newspaper and constant prints streams of lies and sensation. A sad day.

Dr alienfromzog BSc(Hons) MBChB MRCS(Ed) DCH

Liverpool Care Pathway – The Daily Mail vs Care for the Dying

An inevitable philosophical question:

I’ve been occasionally contributing to Angrymob for a few years now. Kevin (aka Uponnothing) very kindly gave me a login. I write because I care about the truth. I write because I believe that the lies and agenda of the Mail are pervasive and damaging. I write because I hope to share my thoughts with enough people to help change the story – to help people realise what the media in general and the Mail in particular are doing. To provide the facts – as best I can – so that people who know the Mail is lying have the ammunition to respond.

I have no idea really if I’m achieving anything.

But the question that I’ve pondered for sometime now – especially when I read stories like this one – is what is going on within the Mail? I wonder if they believe what they write? I wonder if they just want an agenda to push? And I wonder what level of research they do before holding a particular position?

Either way, what they publish is demonstrably false and often deeply poisonous. This is why I have written about vaccines so much. The recent events in Wales with measles have shown the real-world effects of the Mail’s agenda. And this is moreover true is so many areas – immigration, race relations, the Welfare State, the NHS, our attitudes to poverty…etc. etc.

So, whilst I continue to ponder that question, which I admit does intrigue me greatly, I will try to continue to respond when I have the time. For the most part I write about healthcare issues as this is what I know about.

On the subject of poverty I invite you to read this from my personal blog. (I make no apology for the theology).

 

The Liverpool Care Pathway

I think I should begin with a confession; I am not a big fan of the LCP. I will explain that comment in a moment but first I need to alter it slightly. My feelings have changed and I have become very keen to defend it because the attack by the Mail seeks to (well maybe not, see above, will- ) damage the way we care for the dying in this country. If you want to read about the pathway itself and to understand what it is and how it works, here is a good place to start.

Simply put, the LCP was designed to consolidate best practise in the care of dying patients. In the UK we have a hospice movement to be proud of. Most people, however don’t die in hospices – most people die in hospitals. Historically (by which I mean the last 30 years) and culturally, hospitals are not conditioned to best care in the process of dying. Hospitals are places for curing. Modern medicine particularly is built on the notion of curing everything. Trust me, doctors know this to be a lie. Most of us have had enough humbling experiences with meeting death to know that we can’t cure everything and that the old saw about medicine being the art of delaying the inevitable is not without its truth. However, and this is a vital and massive ‘however’ – we are in the business of healthcare. Providing curative treatment when possible and appropriate and dignity, compassion and comfort when not.

Recognising that a patient is dying is notoriously difficult but experienced nursing and medical staff will tell you that we often know that it’s time to stop. I graduated in a time when these kind of approaches were widely accepted and beginning to be more formalised. It is about the fact that most people die relatively slowly – by which I mean hours to days  and not the seconds to minutes we see in TV and movies. Given that putting everyone in a hospice is not practicable, I think most of us will agree that providing the best kind of end-of-life care in hospital is a priority.

The principals are this: When a patient is near to death; stop unnecessary and invasive interventions (like blood tests) and treat symptoms effectively. This usually means three things; analgesia, treating anxiety and treating secretions.

The Liverpool Care Pathway codifies these in a way designed to ensure that best possible care is provided. Feeding may be stopped as in the last few days as artificial feeding does more harm than good.

So why do I not like the LCP? Well, this is not really my area of medicine and as I’ve moved into my specialty of paediatric surgery, I haven’t done any adult work for over three years now. But I was a junior doctor on the wards – and anyone who has done that job will have dozens of stories of how the LCP is a really effective way of CARING for dying patients. My objection is the same as that of a professor of palliative care I know, the LCP is a little cumbersome and involves too much paperwork and it got a lot of national attention and funding  – potentially at the expense of other areas. But is does work. Really well.

The LCP is very very good at what it does. The LCP – or something like it – is exactly what I would want for me, for anyone I love – or for any human being near to death.

 

The Daily Mail’s latest Witchhunt.

Back in November, I picked up on Melanie Phillips evil comment piece on the LCP and its effects. I do not use the word ‘evil’ lightly but something so completely dishonest that increases distress and anxiety for people who are watching loved-ones die I think is evil. If someone wants to provide me a better word, please do. Again I don’t know if Phillips is being dishonest of just not bothering to research properly – but I suspect dishonesty as she has never effectively engaged with the debate or criticism – where it has been repeatedly demonstrated where she is wrong.

And so we come to this week’s piece. The British Medical Association has been discussing the LCP and the public’s perceptions leading to this Daily Mail headline:

‘Don’t call it the Liverpool Care Pathway': Doctors admit it sounds like a one-way ticket to the grave

  • Leading doctors have admitted that there are problems with the controversial end of life care regime
  • Involves withholding food and water from the dying patient and is meant to help them die with dignity
  • Doctors admitted some patients have been left on it for weeks without having their case reviewed
As always, the culpability lies with the medical profession and not with the Daily Mail for printing misleading articles… The implications that doctors are killing patients or that they don’t care or that somehow this is a NHS initiative to save money are ———– well, I don’t know, I’ve run out of adjectives… (insulting, misleading, offensive, damaging, dangerous, horrific, indefensible, typical for the Mail, wrong, cynical, plain dishonest) – take your pick!
Well, actually I think all of those and then some more:  The implications that doctors are killing patients or that they don’t care or that somehow this is a NHS initiative to save money are insultmisleadinglyoffensivelydamaginglydangeroushorrificlyindefensiblelytypical-for-the-Mail-wronglycynicallyplain-dishonestetc!
As always the comments section provides a worrying perspective, but this is my favourite:
comment
No my dear-UKIP Supporter the reason they don’t have this ‘uncomfortable controversy’ in the States, is I suspect, because they are blessed enough not to have the Daily Mail.
AFZ