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Found 1,491 results
  1. News Article
    A two-month-old baby died after doctors mistook symptoms of a suspected perforated bowel for a cow’s milk intolerance. Nailah Ally was diagnosed with a hole in the heart before she was born and necrotising enterocolitis (NEC) shortly after her birth in October 2019. Nailah died from multiple organ failure after she was sent home from hospital and went into septic shock A consultant believed Nailah might have an intolerance to cow’s milk and changed the formula she was being fed. A spokesman for the family said: “Nailah’s case not only vividly highlights the dangers of sepsis, but the potential consequences of poor communication between doctors as well as between doctors and families.” Read full story (paywalled) Source: The Telegraph, 7 March 2023
  2. News Article
    The government’s response to the East Kent maternity scandal inquiry has been condemned as ‘very disappointing’ by its chair. More than four months on from the inquiry report, ministers this morning issued what they called an “initial response” to it, as a brief written statement to Parliament. It contained few specific proposals, instead saying government was kicking off a series of other reviews, and “working” with various other agencies. Inquiry chair Bill Kirkup, the well-regarded former medic and expert in care failures, told HSJ the response was poor and should have been “wider and deeper”. Dr Kirkup said the response showed government had “not grasped how fundamental” some of the issues outlined in his report were, and “what sort of initiative” was needed to address them. Read full story (paywalled) Source: HSJ, 7 March 2023
  3. News Article
    An NHS whistleblower has sacrificed his career to capture on hidden camera the brutal reality of working in an ambulance service. After watching yet another patient die needlessly in the back of his ambulance, Daniel Waterhouse became a whistleblower. That decision would end his career with the NHS at the age of only 30. Waterhouse, from Finchley, north London, said his decision to go undercover for a Channel 4 Dispatches programme to be broadcast on Thursday was not easy. “I thought about it for quite a while,” said Waterhouse, an emergency medical technician who wore hidden cameras and microphones while on shift for the East of England Ambulance Service. “It was a moral choice, and there’s a caveat to that as well, because going undercover in those situations could be considered immoral and will draw criticism I’m sure. “But I think patient safety outweighs that, and those occasions were so strong in my head that I thought, ‘If only some change can happen, where some people don’t have to go through that and die or suffer permanent disability, then it would be worth it’.” Read full story (paywalled) Source: The Times, 3 March 2023
  4. News Article
    More than half of ambulance workers have seen a patient die because of a delay in reaching them after a 999 call or overcrowding in A&E, a new survey has found. The findings, from a survey of frontline paramedics and other ambulance staff, are another stark illustration of the patient safety risks created by the crisis in NHS urgent and emergency care. “These findings are utterly terrifying,” said Rachel Harrison, the national secretary of the GMB union, which sought the views of more than 1,200 members working in NHS ambulance services in England and Wales. It asked them if they had ever witnessed a death that had occurred because of a delay involving an ambulance or other part of the care system. Just over half (53%) said they had done so and another 30% were aware of it happening with a colleague. The findings are disclosed in a Channel 4 Dispatches documentary being shown this Thursday about how long delays in ambulance crews handing over patients to A&E staff, and thus being unable to respond quickly to 999 calls, are affecting both patients and staff. “The delay and dilation of care that we see is just unconscionable,” Dr Adrian Boyle, the president of the Royal College of Emergency Medicine, told the programme. Read full story Source: The Guardian, 6 March 2023
  5. News Article
    A misplaced medical tube contributed to the death of the first child in the UK to die after contracting Covid, a coroner has found. Ismail Mohamed Abdulwahab, 13, of Brixton, south London, died of acute respiratory distress syndrome, caused by Covid-19 pneumonia, on 30 March 2020, three days after testing positive for coronavirus. He had a cardiac arrest before he died. Ismail’s death prompted widespread alarm about the potentially lethal impact of Covid on children. Hours before Ismail died, an endotracheal tube (ET) used to help patients breathe was found to be in the wrong position. A consultant in paediatric intensive care decided to leave it and monitor him. Giving his judgment on Thursday, senior coroner Andrew Harris said: “I am satisfied that he [Ismail] would not have died when he did were it not for the tube misplacement.” On Wednesday, the inquest at London Inner South London coroner’s court heard evidence from Dr Tushar Vince, a consultant in paediatric intensive care at King’s College hospital who treated Ismail on 29 March after he had been intubated. Asked by Harris if it would be reasonable to put the positioning of the ET on the death certificate as one of the causes, Dr Vince said: “I think it would be reasonable to consider it, yes.” She said: “I was so focused on the lungs I just didn’t see how high this tube was and I’m so sorry that I didn’t see it.” Read full story Source: The Guardian, 2 March 2023
  6. News Article
    April Valentine planned to have a complication-free delivery and to enjoy her life as a first-time parent to a healthy baby girl. Instead, California’s department of health and human services is investigating the circumstances of the April's death during childbirth. April, a 31-year-old Black woman, went to Centinela hospital in Inglewood on 9 January and died the next day. Her daughter Aniya was born via an emergency caesarean section. Her family and friends say that staff at the hospital ignored the pregnant woman’s complaints of pain, refused to let her doula be in the hospital room during the birth and neglected Valentine as her child’s father performed CPR on her. “It’s hard to even sleep, to even look at my child after seeing what I saw in that hospital that night,” said Nigha Robertson, Valentine’s boyfriend and Aniya’s father, to the Los Angeles county board of supervisors during its 31 January meeting. “I’m the only one who touched her, I’m the one who did CPR. Nobody touched her, we screamed and begged for help … they just let her lay there and die.” During the 31 January board of supervisors meeting, people who spoke in support of Valentine said that Centinela hospital is known around the community for being one of the “worst hospitals in the county” for Black and Latina mothers and their infants. Since 2000, the maternal mortality rate in the US has risen nearly 60%, with about 700 people dying during pregnancy or within a year of giving birth each year. More than 80% of the deaths are preventable, according to the US Centers for Disease Control and Prevention. The US has the highest maternal mortality rate among industrialized countries and Black women are three times more likely to die during childbirth than white women. Read full story Source: The Guardian, 3 March 2023
  7. News Article
    The government must end “age discrimination” against eating disorder patients that is causing avoidable deaths, experts have warned. A cross-party parliamentary group and the Royal College of Psychiatrists are calling for access targets to make sure adults with eating disorders get treated within a set time. The demands come after the healthcare watchdog said patients were dying while waiting to be seen. Wera Hobhouse, chair of the All Party Parliamentary Group, and Agnes Ayton, chair of the Royal College of Psychiatrists’ eating disorder committee, said the targets must be equal to those for children, which were set in 2016. According to the Health Service Journal, 19 patients under the care of inpatient and community eating disorder services have died since 2017. A senior coroner in Norfolk also highlighted failings in 2019 and sent a warning to both NHS England and the Department for Health and Social Care, over the deaths of five young women. Read full story Source: The Independent, 1 March 2023 To support Eating Disorders Awareness Week, we have pulled together eight useful resources to help healthcare professionals, friends and family support people with eating disorders: Top picks: Eight resources on eating disorders
  8. News Article
    A trust chief executive has suggested an inquiry team looking at 2,000 deaths is lacking in “expertise” and has created a “disproportionate impression” of the problems at his trust. Essex Partnership University Trust is at the centre of a high-profile inquiry into the deaths of patients over a 20-year period, which was sparked after serious concerns were raised over specific cases. The inquiry, led by Geraldine Strathdee, a former national clinical director for mental health, is reviewing the cases of 2,000 people who died while they were patients on a mental health ward in Essex or within three months of being discharged. In a letter to the inquiry, obtained by HSJ through a freedom of information request, trust chief executive officer Paul Scott wrote: “The headline number of c.1,500 or c.2,000 deaths used in publicity by the inquiry is, in my opinion, not a fair reflection of the deaths that would be of interest to the inquiry.” Read full story (paywalled) Source: HSJ, 1 March 2023
  9. News Article
    A consultant has said that doctors were put under pressure by hospital management not to make a fuss when they raised concerns about nurse Lucy Letby. Dr Ravi Jayaram said his team first raised concerns about unusual episodes involving babies in October 2015 but nothing was done Ms Letby, 33, is accused of murdering seven babies and attempting to murder 10 others at the Countess of Chester Hospital between 2015 and 2016. He told the court the matter was raised again in February 2016 and the hospital's medical director was told at this point. The consultants asked for a meeting but did not hear back for another three months, the court heard. Ms Letby was not removed from front-line nursing until summer 2016. Dr Jayaram told jurors that he wished he had bypassed hospital management and gone to the police. He said: "We were getting a reasonable amount of pressure from senior management at the hospital not to make a fuss." Read full story Source: BBC News, 28 February 2023
  10. News Article
    A mother-of-one died after a breathing tube was put into her food pipe, despite staff raising concerns it was inserted incorrectly, an inquest heard. Emma Currell, 32, had just received dialysis and was heading home to Hatfield, Hertfordshire, in an ambulance when she had a seizure. An anaesthetic team was called to sedate her as her tongue had swelled and she was bleeding from the mouth. Dr Sabu Syed, who was a trainee anaesthetist, told the hearing: "I used suction to remove blood and I was able to push the tongue to the side and got a partial view." She said she believed she inserted the tube into the trachea - the windpipe - and had asked her senior colleague Dr Prasun Mukherjee to check the position of the tube. "Dr Mukherjee was busy doing other tasks," she added. Technician Nicholas Healey said he flagged his concerns when there was no carbon dioxide reading on the ventilator, which was not faulty. He said that both he and Dr Syed had raised concerns about the tube being in the wrong place. The court heard the hospital had drawn up a guideline checklist for trachea procedures since Ms Currell's death and staff were due to have "no trace = wrong place" training on the warning signs of incorrect insertion. Read full story Source: BBC News, 27 February 2023
  11. News Article
    One patient is dying every 23 minutes in England after they endured a long delay in an A&E unit, according to analysis of NHS figures by emergency care doctors. In all, 23,003 people died during 2022 after spending at least 12 hours in an A&E waiting for care or to be admitted to a bed, according to the Royal College of Emergency Medicine (RCEM). That equates to roughly 1 every 23 minutes, 63 every day, 442 a week or 1,917 each month. The college said its findings, while “shocking”, were also “unsurprising” and reflected the fact that emergency departments are often overwhelmed and unable to find patients a bed in the hospital. Rosie Cooper, the Liberal Democrats’ health spokesperson, said “patients are now dying in their droves” due to successive Conservative governments neglecting the NHS, and added that the lives lost due to A&E snarl-ups constituted a “national disaster”. “Long waiting times are associated with serious patient harm and patient deaths,” said Dr Adrian Boyle, RCEM’s president. “The scale shown here is deeply distressing.” Read full story Source: The Guardian, 28 February 2023
  12. News Article
    Urgent action is needed to prevent people dying from eating disorders, the parliamentary and health service ombudsman for England has warned, as he said those affected are being “repeatedly failed”. The NHS needs a “complete culture change” in how it approaches the condition, while ministers must make it a “key priority”, according to Rob Behrens. Little progress has been made since the publication of a devastating report by his office in 2017, which highlighted “serious failings” in eating disorder services, he said. Lives continue to be lost because of “the lack of parity between child and adult services”, and “poor coordination” between NHS staff involved in treating patients. There remain issues with the training of medical professionals, Behrens added. “We raised concerns six years ago in our ignoring the alarms report, so it’s extremely disappointing to see the same issues still occurring,” he said. “Small steps in improvements have been taken, but progress has been slow, and we need to see a much bigger shift in the way eating disorder services are delivered." Read full story Source: The Guardian, 27 February 2023
  13. News Article
    NHS waiting times, staff shortages and service backlogs have been flagged as concerns in relation to dozens of patient deaths across England and Wales since the start of last year, the Observer can reveal, with coroners facing a succession of inquests concerning ambulance delays. Coroners issue prevention of future deaths reports (PFDs) when they believe preventive action should be taken, and send them to relevant individuals or organisations, which are expected to respond. Among 55 cases identified by the Observer are 24 patient deaths where coroners raised concerns about ambulance delays – all of them occurring before this winter’s ambulance crisis, when response times rocketed to their worst-ever levels. Wes Streeting, shadow health and social care secretary, said: “The NHS is in the biggest crisis in its history – and the crisis has a cost in lives. Patients are waiting for far longer than is safe, with terrible consequences.” But the issues highlighted by coroners in relation to patient deaths are wider than ambulance delays. They include: lengthy elective surgery backlogs; high referral thresholds and long waiting times for children’s mental health services; a national shortage of neurologists; long waiting times for psychological therapies; a lack of mental health beds and unfilled mental health staff vacancies; and a shortage of cardiologists compounded by a shortage of theatre capacity and beds. Read full story Source: The Guardian, 26 February 2023 Further reading on the hub - see a selection of Prevention of Future Deaths reports in our dedicated coroner's report section of the hub.
  14. News Article
    A mental health trust is to be prosecuted after three patients died in its care. The Care Quality Commission (CQC) is bringing charges against the Tees, Esk and Wear Valleys (TEWV) NHS Trust. It is thought they relate to the deaths of Christie Harnett, 17, Emily Moore, 18, and a third person. The trust is said to have failed "to provide safe care and treatment" which exposed patients to "significant risk of avoidable harm". Both Christie Harnett and Emily Moore had complex mental health issues and took their own lives. The CQC said the trust "breached" the Health and Social Care Act, which relates to healthcare providers' responsibility to "ensure people receive safe care and treatment". In response, a spokesperson for the trust said: "We have fully cooperated with the Care Quality Commission's investigation and continue to work closely with them. "We remain focused on delivering safe and kind care to our patients and have made significant progress in the last couple of years." Read full story Source: BBC News, 25 February 2023
  15. News Article
    Progress to cut the number of women dying in pregnancy or childbirth has stalled or even reversed in recent years, with a death recorded every two minutes, the United Nations has said. Years of gains had begun to plateau even before the pandemic and there had been “alarming setbacks for women’s health,” according to a new report from several UN agencies, including the World Health Organization (WHO). Maternal mortality rates had fallen widely in the first 15 years of the century, but since 2016, they had only dropped in two UN regions: Australia and New Zealand, and in Central and Southern Asia. The rate went up in Europe and North America by 17% and in Latin America and the Caribbean by 15%. Elsewhere it stagnated. Read full story (paywalled) Source: The Telegraph, 23 February 2023
  16. News Article
    Only half the recommended number of medical staff were on duty at the O2 Brixton Academy on the night of a crush at the south-west London venue. Industry guidelines suggest there should have been medical cover of at least 10 people, including a paramedic and a nurse, but no paramedics or nurses were present. Rebecca Ikumelo, 33, and security guard Gaby Hutchinson, 23, died in hospital following the crowd surge on 15 December 2022 at the concert. The medical provider, Collingwood Services Ltd, said it was "fully confident" its team had "responded speedily, efficiently and with best practice". Two whistleblowers who regularly work for Collingwood Services Ltd at Brixton told BBC Radio 4's File on 4 programme that medical cover at the south London gig had been "inadequate". Neither of them was there when the crush happened, but one said he had spoken to colleagues who were. "[They] had two student paramedics, so they're basically unqualified," said one whistleblower. "They have to be supervised by a paramedic, not by anybody of a lower grade. They didn't have appropriate supervision." Read full story Source: BBC News, 23 February 2023
  17. News Article
    People from ethnic minority backgrounds are no longer significantly more likely to die of Covid-19, new Office for National Statistics (ONS) data shows. Early in the pandemic, deaths involving coronavirus were higher among black and Asian people than white people, with the highest risk among Bangladeshi, Black Caribbean and Pakistani groups. Covid mortality rates for all ethnic minorities decreased last year. The latest data shows there is no significant statistical difference between the number of Covid deaths among ethnic minorities and the white population. The ONS also said that "all cause" mortality rates - measuring how likely people are to die of any cause, including Covid-19 - have returned to pre-pandemic patterns. The reasons for this change are complex, and experts say there are "various factors" to consider. Read full story Source: BBC News, 22 February 2023
  18. News Article
    Three women who died under the care of a hospital's maternity unit may have survived if earlier recommendations had been implemented, a report has said. The cases occurred at University Hospitals of Derby and Burton (UHDB) NHS Foundation Trust over 16 months. A review by the Healthcare Safety Investigation Branch (HSIB) also found a culture of intimidation and bullying. The report found that although there was no common theme to the deaths - and four other life-threatening cases that occurred in the same period - processes and leadership had been inconsistent and fragmented. HSIB said "robust action planning and prompt addressing of the learning" from previous recommendations from other investigations "may have had an impact on the outcome for the women who received care during the seven events included in this thematic review". Read full story Source: BBC News, 22 February 2023
  19. News Article
    A coroner has urged the health secretary to take action to prevent needless deaths after a woman died of heart failure following a four-hour wait in the back of an ambulance. Lyn Brind, 61, was taken to the Queen Elizabeth Hospital (QEH) in King’s Lynn, Norfolk, with chest pains and low blood oxygen levels but could not be admitted because the hospital had “no space”. Instead she remained in a queue of ambulances outside A&E without a timely diagnosis or treatment and where warning signs about her condition were missed. It was only after four hours and 25 minutes of waiting that she was transferred to a ward, by which time she was “agitated and short of breath”. She was placed on life support but died 22 minutes later. Brind’s family believe the grandmother of four, a former dinner lady from the town, “might still be alive today” had she been admitted more swiftly. “She wasn’t given a chance,” her partner of 38 years, Richard Bunton, said. After an inquest earlier this month into Brind’s death in May 2022, the senior coroner for Norfolk, Jacqueline Lake, took the unusual step of writing to England’s health secretary, Steve Barclay, to raise concerns about the NHS and social care. She warned that others could die in similar circumstances unless action was taken. “I believe you have the power to take such action,” Lake wrote in a prevention of future deaths report. Read full story Source: The Guardian, 29 January 2023
  20. News Article
    Two health watchdogs have issued safety warnings after junior staff were left to work unsupervised on maternity wards previously criticised after a baby’s death. Training regulator, Health Education England (HEE), criticised the “unacceptable” behaviour of consultants who left junior doctors to work without any superiors at South Devon and Torbay Hospital Foundation Trust’s wards. The maternity safety watchdog Healthcare Safety Investigation Branch (HSIB) also raised “urgent concerns” over student midwives and “unregistered midwives” providing care without supervision. The latest criticism comes after the trust was condemned over the death of Arabella Sparkes, who lived just 17 days in May 2020 after she was starved of oxygen. According to a report from December 2022, seen by The Independent, the HEE was forced to review how trainees were working at the trust’s maternity department after concerns were raised to the regulator. It was the second visit carried out following concerns about the department, and reviewers found there had been “slow progress” against concerns raised a year earlier. Read full story Source: The Independent, 16 February 2023
  21. News Article
    A health board has been fined £180,000 for failing to protect a vulnerable pensioner who died after repeatedly falling in hospital. Colin Lloyd, 78, was assessed as posing a high risk of falling and required one-to-one care after being admitted to Raigmore Hospital in Inverness. Despite repeated requests for more nursing staff none were made available and the pensioner suffered falls on the ward, which caused fatal injuries. Fiona Hogg, NHS Highland’s director of people and culture, said: “We are deeply sorry for the failures identified in our care. Our internal review following the incident identified several areas of improvement and we have made a number of changes to our practice.” Read full story (paywalled) Source: The Times, 15 February 2023
  22. News Article
    A record number of eating disorder patients are not getting the life-saving treatment they need due to lengthy waits, leaked NHS data shows. More than 8,000 adults are waiting to be seen for therapy, according to internal figures from NHS England – the highest figure recorded since data collection began in 2019. In March 2021, there were around 6,000 adults waiting, while it was less than 2,000 in March 2019. One leading doctor warned that delays were leading to avoidable deaths, while multiple coroners investigating the deaths of nine patients since 2021 have repeatedly called on the NHS and ministers to improve services to prevent more. An investigation by The Independent can also reveal that long waits have led to a woman, 24, taking her own life while waiting two years for appropriate care, and patients being admitted to hospital because their conditions became so severe they developed life-threatening physical conditions. Dr Agnes Ayton, the Royal College of Psychiatrists’ lead for adult eating disorders, said long waits meant patients were “dying avoidably” because under-resourced services were forced to turn them away or leave them waiting for years. Anorexia has the highest morality rate of any psychiatric disorder. “One important thing is eating disorders are treatable, people can get better with time and treatment. We shouldn’t accept anorexia has the highest mortality rate because a lot of these deaths are avoidable and treatable. We should be aiming to provide high-quality care,” she said. Read full story Source: The Independent, 6 February 2023 Further reading on the hub: People with eating disorders should not face stigma in the health system and barriers to accessing support in 2022 Eating disorders: challenges of the pandemic
  23. News Article
    A health board has apologised to the family of a patient after medical staff failed to consult with them over a decision not to resuscitate her. While the decision was clinically justified, the public services ombudsman for Wales said Betsi Cadwaladr health board did not discuss it with the patient and her family. The ombudsman, Michelle Morris, also upheld a complaint by the patient's daughter, identified only as Miss A, that her mother's discharge from Ysbyty Gwynedd in Bangor was "inappropriate" and that insufficient steps were taken to ensure her needs could be safely met at home. The final complaint, which was also upheld, was that medics failed to communicate with the family about the deteriorating condition of the patient, identified as Mrs B, which meant a family visit was not arranged before she died. In her report she said the Covid pandemic had contributed to the failings, but added "this was a serious injustice to the family". As well as apologising to the family, she asked that all medical staff at Ysbyty Gwynedd and Ysbyty Penrhos Stanley be reminded of the importance of following the proper procedure when deciding when a patient should not be resuscitated. Read full story Source: BBC News, 6 February 2023
  24. News Article
    Rana Abdelkarim died at Gloucestershire Royal Hospital in March 2021 after suffering a bleed post-birth. The Healthcare Safety Investigation Branch (HSIB) found there were delays in calling for specialist help. Her husband, Modar Mohammednour, said that in March 2021 his wife attended the maternity unit at 39 weeks into her pregnancy for what she thought was a routine check-up. Mr Mohammednour said due to language barriers his wife thought she was going "for a scan and to check on her health" and then "come back home", but in fact she was being sent to be induced. "Immediately" after the labour, Ms Abdelkarim suffered heavy bleeding and her condition deteriorated - something Mr Mohammednour said he was "unaware of", until he was eventually called into the hospital to speak to a doctor. According to the investigation by the HSIB, the obstetric team of senior doctors were not told about the drastic change in her condition for almost 30 minutes. An investigation into her death by the HSIB found that once Ms Abdelkarim had been given a drip to speed up labour, regular support from midwives and assessments could not be given to her because the maternity ward was so busy. It also found there was a 53-minute delay from the point of bleeding to administering the first blood transfusion. HSIB also found Ms Abdelkarim was "uninformed" about the reason for her admission, "consent to induce labour was not given" and because she was thin and small, staff underestimated how much relative blood volume she was losing. Read full story Source: BBC News, 7 February 2023
  25. News Article
    More than 500,000 people in the UK will be diagnosed with cancer every year by 2040, according to analysis by Cancer Research UK. In a new report, researchers project that if current trends continue, cancer cases will rise by one-third from 384,000 a year diagnosed now to 506,000 in 2040, taking the number of new cases every year to more than half a million for the first time. While mortality rates are projected to fall for many cancer types, the absolute numbers of deaths are predicted to increase by almost a quarter to 208,000. In total, it estimates that between 2023 and 2040, there could be 8.4m new cases and 3.5 million people could have died from cancer. Cancer Research UK’s chief clinician, Charles Swanton, said: “By the end of the next decade, if left unaided, the NHS risks being overwhelmed by the sheer volume of new cancer diagnoses. It takes 15 years to train an oncologist, pathologist, radiologist or surgeon. The government must start planning now to give patients the support they will so desperately need.” Read full story Source: The Guardian, 3 February 2023
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