Wednesday, January 07, 2009

Deaths from hospital blunders soar 60% in two years as NHS staff 'abandon quality of care to chase targets'

The number of patients killed by hospital blunders has soared by 60 per cent in just two years, the Daily Mail can reveal. Official records show that 3,645 died as a result of outbreaks of infections, botched operations and other mistakes in 2007/08. That was up from 2,275 two years before. Critics say quality of NHS care has suffered as doctors and nurses come under pressure to meet Government waiting time targets. The sharp rise is also down to the fact that more trusts have started to record medical errors - revealing a death toll which in previous years remained hidden under the carpet. But experts say the true toll is certain to be even higher, because many hospitals still do not record all of the 'patient safety incidents' - meaning that lessons which could have been learned are lost. In October last year, the Patients Association warned that one in every 300 NHS patients were killed because of medical blunder.

The latest figures, uncovered by the Liberal Democrats, show that 385 died last year due to botched operations and 156 because scans were read wrongly or patients incorrectly diagnosed. Some 309 died from infection control incidents related to hospital superbugs and 14 due to problems with documentation and records. Another 54 were killed by wrongly-administered drugs and 40 by faulty medical equipment. There were 171 cases of deaths following simple accidents, usually falls. On top of this, 22 died as the result of abuse by hospital staff or visitors, and 135 died because they were not transferred properly between wards or hospitals. Another 487 killed themselves on hospital premises when their depression should have been spotted by doctors. A range of other blunders brought to total toll to 3,645. The figures are certain to rise as hospitals get round to reporting mistakes which took place between April 2007 and March 2008 to the National Patient Safety Agency.

'These statistics are stark and the trend is shocking,' said LibDem health spokesman Norman Lamb. 'There needs to be a change of culture at the heart of the NHS. We have got far too many targets and there is a real risk that, although they are very effective at addressing a specific issue, they mean trusts do not see safety as a priority.'

Roger Goss of pressure group Patient Concern said: 'This news is shocking. Patients are already extremely nervous when they have to go to hospital, so they need this news like a hole in the head.'

Peter Walsh of pressure group Action Against Medical Accidents, said many incidents are not reported in official 'patient safety' figures. He added: 'We need to make patient safety a much higher priority. Staff need training and there needs to be an overhaul of surgical practice, where many avoidable errors happen. 'Double- checking that you've got the right patient, that you're operating on the right side might seem obvious, but we know that it isn't routinely done at many hospitals. 'Resources and staffing are also an issue. It's no surprise to find that more things go wrong at weekends and at night.'

Concerns around the safety of many surgical operations carried out on the NHS are so serious that the all-party Commons health select committee is looking into the issue, and will report in April.

Clare Bowen, whose five-year-old daughter Bethany died as a result of mistakes made during routine surgery in 2006, said: 'I have no doubt these figures will continue to rise unless hospital trusts, and surgeons in particular, are prepared to learn from their mistakes.' Miss Bowen, whose story is told in today's Good Health section, added: 'Nobody should be afraid to go into hospital. 'But equally, no one should be afraid of asking questions that will make the doctors in charge of their care think carefully about how they behave.'

The rise in avoidable deaths mirrors recent rises in NHS pay-outs for blunders. Around 6,000 cases go to court each year, and compensation to injured patients rose by 18 per cent last year, to 382million. A spokesman for the Department of Health said: 'The NHS sees a million people every 36 hours. Unfortunately, as in any health service, mistakes and unforeseen incidents will occasionally happen. 'Only a tiny number of errors put patients at serious risk and the quality and safety of healthcare is improving all the time.'


How 'gung-ho' surgery by a trainee set off a chain of tragedy that destroyed this little girl's family

When a trainee surgeon was let loose on this little girl, he set off a chain of tragedy that destroyed her family - and reveals the true, brutal cost of hospital blunders.

For Clare Bowen, the single parent of two boys, this Christmas has been particularly bleak. For in the space of about two years, she lost first her eldest child, Bethany, at the age of five, and then, 11 months ago, her husband, Richard. What makes her story particularly harrowing is that this double tragedy was apparently the result of `gung-ho' risk-taking behaviour by surgeons at the John Radcliffe Hospital, Oxford, one of the top hospitals in the UK. `If it hadn't been for the arrogance of the surgeons involved, Bethany would still be alive,' claims Clare, 32. `And if the hospital authorities had faced up to their responsibilities, instead of protecting the doctors at every step, my husband would not have suffered the terrible stress that eventually killed him, too.'

Bethany's death was just one of the thousands that occur each year as a result of medical blunders. In the past two years, the numbers have risen dramatically, by 60 per cent, as the Mail reveals today. In Bethany's case, the surgery should have been straightforward. She was born with a hereditary blood condition called spherocytosis. Though not fatal, it causes anaemia and excessive tiredness. Surgery to remove the spleen to get rid of these symptoms has been a tried-and-tested treatment for decades.

Three generations of Clare's family had already had the operation: most recently Clare's second child William, aged six. Bethany's grandfather had his spleen removed as a child nearly 50 years ago; Clare herself had undergone the same operation when she was Bethany's age. The difference was that when Bethany was due for the operation in July 2006, it was to be performed with keyhole surgery to avoid an unsightly scar on her stomach. Because of this, Clare and Richard, an electrical engineer, had discussed every detail of the operation with the surgeons before signing the consent form - and were confident they had done everything they could to ensure a successful outcome. But their confidence in the surgical team was misplaced.

Even as Richard accompanied Bethany into the anaesthetic room and gave her a last kiss, telling her that Mummy and Daddy would be waiting for her when she woke up, the surgeons were making a controversial decision to test a new piece of equipment on the child. Known as a morcellator, this is a drill with a 20cm-long barrel and a 1cm-wide blade that rotates at up to 1,000 rpm. It was designed for use in hysterectomies, enabling surgeons to cut the uterus into tiny pieces to allow it be removed laparoscopically, through small incisions. Until Bethany's operation, the morcellator had not been used in paediatric surgery in the UK - and it has not been used since. And further, neither the trainee surgeon performing the operation nor the supervising surgeon had been given the training recommended by the manufacturer in using the drill.

During the operation, Richard and Clare were waiting in a tiny room. Suddenly, the door opened and five or six doctors filed in one after the other - Clare remembers noticing that the junior surgeon had blood on his gown. `Something dreadful has happened. I am so sorry,' said the senior surgeon. `Is Beth dead?' Clare asked at last - and the surgeon nodded. `We accidentally cut a blood vessel, resulting in major blood loss,' the surgeon explained. Bethany had bled to death. For nearly an hour, two of the surgeons stayed with her parents while the rest of the team prepared their daughter so they could spend a few precious minutes with her body.

It was agonising,' recalls Clare. `The surgeons seemed in shock themselves. `For months afterwards, I'd get flashbacks of being stuck in that tiny hospital room, suffering once again those intensely desperate feelings as I came to terms with what had happened: that we could never again be the family that we had taken for granted that morning.' A full investigation was promised by the hospital - but within days of their daughter's death, the grieving parents began to suspect a decision had been made to cover up what had happened. Clare says: `I remember meeting the surgeons on the Monday after Beth's death - they were completely obstructive. These were the same doctors that had sat with us for that terrible hour and they were now refusing to discuss what had happened.'

The parents' request to speak to the nurses present during the operation was denied and the Bowens had to instruct a solicitor before a full inquest was held. The couple even discovered that the evidence which should have been retained following an unexpected death had gone missing, including the bag containing the extracted spleen, the swabs, all the blood Bethany had lost and all the disposable parts of the morcellator. `That was the point at which we realised Beth's death could have been avoided. It made us both feel sick.'

Then at a meeting with hospital managers seven months after Bethany's death, a `totally different story' emerged - that the blood loss from the severed blood vessel had been `insignificant' and `the cause of death was unclear'. The managers' apparent indifference to the truth was shocking - though by that time, the Bowens were beyond surprise. It was only through a chance remark by their GP, who'd assumed they'd been told the full facts, that they learned that Bethany's aorta, the main blood vessel that feeds the heart, had been cut in two places. Then, a few weeks after the death, the family found out that a trainee surgeon had operated on their daughter - and that he had used a tool never used on children before. `That was the point at which we realised Beth's death could have been avoided. It made us both feel sick.'

Both parents accepted that new technology has to be used for the first time on a patient. `But it should be done as safely as possible in the interests of the patient,' says Clare. `That was not the case here. `If the operation had gone well, the surgeons would have been celebrated for successfully introducing a new technique into the country. `Their fatal mistake was never to consider the possibility that anything could go wrong. I imagine them walking into the operating theatre thinking in a gung-ho manner: "This is fantastic; it is going to be the next best thing." 'None of the surgical team saw Beth as a little girl, only as a patient to practise on. If just one of them had said: "Hold on a minute, shouldn't we step back here? What if something goes wrong; are we ready for this?" `If there had been a system to prevent spur-of-the-moment decisions that radically alter the risk to patients, then Beth - and Richard - would be alive today.'

A fit man of 31 with no history of heart disease, Richard died suddenly last February, 19 months after his daughter. While going for a run to clear his head, Richard had a heart attack, brought on, the family believe, by stress. `Deep down, Richard felt he should have been able to keep Beth alive,' says Clare. `She was his "little princess". When she died, he couldn't think of anything but her. `He worked late every night, coming to bed in the early hours and then still unable to sleep. His head was full of questions for the hospital, pulling together bits of a story that never made sense. 'He was an intelligent man, able to cope mentally. But all the time the physical stress was slowly killing him. I can't express what a terrible blow it was to lose him.'

Theirs is not an isolated tragedy. Indeed, such reckless lapses by surgeons are now recognised to be a universal problem. Later this month, a study by the World Health Organisation, confirming evidence of `dismayingly variable standards of quality and safety in surgery in even the most prestigious hospitals', is due to be published in The Lancet. `With 250 million operations taking place every year globally, there are also a million deaths and seven million complications, a high proportion of which are unnecessary and occur because of human factors,' says the WHO's lead researcher, Boston surgeon Professor Atul Gawande.

One of the key human factors known to put patients at risk is this tendency to recklessness, a `lack of situational awareness' as it is known in other high-risk, fast-moving activities. In aviation, for instance, pilots have to undergo regular training in situational awareness where they learn to `imagine the unimaginable' before every flight, so that preparing for the worst scenario becomes routine.

Now a checklist for the operating theatre, similar to one that has been mandatory in aviation for 20 years to prevent the consequences of human factors and thereby make surgery safer, is due to be launched on a voluntary basis in the UK later this month. The Safer Surgery checklist, developed by a team headed by Professor Gawande and backed by the Government, takes less than three minutes to perform. It helps surgical teams to prepare for every eventuality - with all members of staff entrusted to speak out to ensure patient safety is the top priority. If such a checklist had been in use at the John Radcliffe, Clare is convinced her daughter would be alive.

Last November, she found the strength to take the family's concerns to the Health Select Committee, which is investigating safety in surgery. The MPs, who are due to publish their report in April, listened with close attention to Clare, her measured voice never once breaking or showing the emotion beneath, as she gave evidence about Bethany's death, based on tape recordings of hospital meetings and the inquest.

Because in Bethany's case most of the physical evidence had gone missing, Clare believes the surgeons' evidence at the inquest, which was held in November 2007, was subjective - yet it was accepted as proper evidence by the coroner. `The surgeons said they applied the tip of the morcellator no more than 3cm into the abdomen. But there is no marking on the barrel of a morcellator to give an indication of how far the device has been pushed in. `Yet the final verdict of the coroner's court, based on testimony given by the doctors, is that the blood vessel was not cut by the morcellator - even though the surgeons admitted that it was the only instrument in use at the time of her sudden blood loss.'

She called for cameras to be attached to the walls of every operating theatre, with the data protected with tamper-proof seals. `When an operation goes wrong, an independent investigation team needs to be given access to all the evidence. The coroner accepted the theory that Bethany's aorta mysteriously and simultaneously burst open in two places,' she says.

However, the trust was forced to admit negligence for failing to obtain consent for use of the morcellator and breaching its duty of care. But the promised report into the `thorough investigation' was repeatedly postponed - and was finally given to the Bowen family only last month. The family was paid 10,000 pounds [It should have been millions] following the admission of negligence, a sum donated to Bethany's school for a new playground.

Clare says: `It was never about money. Nor do we want revenge, which is why I've chosen not to name the doctors concerned - all of whom are still practising. `From the beginning, we have wanted the hospital to acknowledge the mistakes that were made so that lessons could be learned.'

As an unwilling expert in the way hospitals operate, Clare says the public needs to realise what can happen under the current system. `Before Beth died, I would never have believed an NHS surgeon could use equipment they had never been trained to use. Nor did I understand that when doctors make mistakes, it's not in their interests to tell the truth and thereby damage their career, and implicate colleagues with whom they work closely.'

Clare has a particularly pressing reason to make surgery safe. Three-year-old James, her younger son, is already showing the symptoms of spherocytosis, and will need surgery within the year. `I'm taking James to Birmingham Children's Hospital, where I feel that my concerns are being taken seriously.'

The John Radcliffe Hospital says it has investigated what went wrong during Bethany's operation `in great detail' and learnt from the tragedy. `An operation of this nature will never be without risk, particularly when carried out on such a young child,' said Elaine Strachan-Hall, director of nursing and clinical leadership at Oxford Radcliffe Hospitals. She said she would welcome further conversations with Clare about incorporating her views into the trust's ongoing patient safety programme. `Although this will be no consolation to the family, we have learnt from the tragedy and put those lessons into practice,' she said.

Clare wants anyone undergoing surgery to learn from Bethany's death. She says: `Ask the surgeon of their experience, their training in safety procedures, if trainees will be used in the operation, and if new equipment is being used. `The more open your surgeon is, the more likely it is that they are not arrogant enough to believe they cannot make mistakes. I just wish I'd asked these questions when I trusted those surgeons with my little girl.'


Britain 'must set population limit to safeguard national security' say Greenies

As if the Greenies cared about national security! The OPT is Britain's chief group of people-haters -- descended from the old Zero Population Growth freaks. Now that we have sub-zero population growth in most of the world, they aim at halving the population, at least. That will happen this century in many countries too. What will they do then? They will then aim at having only themselves around. And if that happens they will find that they don't like one-another very much either! LOL

Britain must set a maximum population level if it is to avoid destroying the environment and putting national security at risk, say experts. The Optimum Population Trust has written to ministers calling for a policy of 'zero net migration' - matching numbers allowed into Britain each year to numbers leaving. The UK's population is projected to increase from 60 to 70million over the next 20 years, and to 85million by 2081.

The trust, a panel of academics and environmentalists, says achieving zero net migration would cut Britain's population in 2081 to 57million. Mass immigration 'feeds through into rising greenhouse gas emissions' and more congestion, the experts say.

The trust warns that because Britain can produce only 30 per cent of the food, energy and other goods that it needs, it will become increasingly vulnerable to 'resource nationalism' as foreign powers hoard their own scarce resources. 'This imperils future national security as well as destroying the environment,' it says. The trust is demanding a Royal Commission to establish 'an environmentally sustainable level of population'.

The Home Office said its new points-based immigration system would help manage immigration, 'which will contribute to future population projections and control'.


Keeping a diary can help the body recover from injuries

This sounds like a fairly reasonable study but whether the effect generalized beyond Scottish students is a questioin

Writing a diary may help athletes and people with muscle injuries recover quicker because expressing emotion reduces stress. Writing a diary could help athletes and others with muscle injuries recover more quickly, scientists say. A new study has discovered that sportsmen and women who write about their injuries and associated emotions recover muscle strength three times more quickly than usual. Researchers believe facing up to distress rather than bottling it up reduces stress and inflammation, boosting the body's ability to repair damage.

Study leader Dr Elaine Duncan of Glasgow Caledonian University recruited 46 students aged 19 to 34 who competed in sports including athletics, basketball and football. All had muscle injuries serious enough to prevent them training. Half were asked to write about how they had hurt themselves and how they felt about it. They saw muscle strength improve by nine per cent over the five weeks of the study, compared with three per cent for the others.


A day in the life of an ordinary British school: drugs, violence and intimidation

Documents released to the Sunday Telegraph paint a disturbing picture of the challenges facing Britain's teachers. It is 9am, the start of the school day, and already an English teacher has been on the receiving end of a torrent of abuse from a 15-year-old boy. Outside on the playing field, the PE teacher has stopped a lesson to deal with teenage pupils who are swearing and not doing as they are told. Later that afternoon, three more members of staff will report being verbally abused by their charges, and the day will end with a pupil vandalising the library.

This is just another typical day at Northfields Technology College in Dunstable, Bedfordshire. It is not a particularly extreme example of the unruliness that many state schools have to deal with on a regular basis, but it is a snapshot that will horrify parents as they prepare their children for the new term.

Records of classroom and playground incidents, known as behaviour logs, from five schools on the National Challenge list (those in which fewer than 30 per cent of pupils leave with five "good" GCSEs, with grades A* to C), reveal for the first time the struggle to maintain order in our secondary schools. The logs, obtained by the Sunday Telegraph under freedom of information legislation, and taken from April and October 2008, show some secondaries recording up to 30 incidents a day. Children storming out of class and refusing to work is now commonplace. More worrying, however, are the serious offences contained in the logs. During one week, which was chosen at random, a pupil at Tong School, Bradford, was stabbed in the thigh by a student and had to be taken to hospital.

"The age of deference is dead," says Mary Bousted, general secretary of the Association of Teachers and Lecturers. "As these documents show, in some schools, keeping behaviour under control is a massive challenge. Schools may well be coping, but it shows the level of indiscipline that teachers have to deal with every working day."

The picture painted by the logs comes as no surprise to Colin Adams, 50, a former IT teacher who was awarded 250,000 pounds compensation in an out-of-court settlement last month after an assault by a pupil ended his career. Adams joined the teaching profession after working as an engineer. He loved his job and was head of department at Kingsford Community School in east London. In 2004, a 12-year-old pupil strangled him to the point of unconsciousness. Colleagues who witnessed the attack were at first too afraid to pull off the boy in case they were accused of assaulting him.

According to Adams, deteriorating behaviour in schools is a reflection of society. "I have seen children coming in high because they have smoked their fourth joint on their way to school," he says. "I have also had students who have brought knives in to school because they are worried about what will happen to them on their way home. Society, if it is not broken, has a lot of problems and these are mimicked by children."

The boy who attacked him fits an all too familiar profile - he came from a broken home, with a father who lived 100 miles away. Within a few months of joining the school, the pupil had chalked up 27 serious incidents, nine for violence. Adams was on the receiving end of the tenth. "The day he assaulted me, he had already punched two other pupils, but was still in school. I had not been made aware of what had been going on," says Mr Adams. "He came from behind and ran at me, knocked me down and when I was on the floor, he strangled me. The teacher who eventually intervened had to prise his thumbs off my neck." Months earlier, the boy was involved in a fight which led to staff requesting his permanent exclusion from the school. Their concerns were not acted upon.

However, the former teacher's experience, and the incidents revealed by the Sunday Telegraph's investigation of school behaviour logs, are not recognised by the Government as significant. Ministers insist that behaviour in schools is improving, and that head teachers have more powers than ever to deal with unruly behaviour. Last week, they dismissed figures which revealed that thousands of pupils were escaping expulsion, despite violent and sexual offences which the Government's own guidelines class as serious enough to deserve permanent exclusion.

Teachers' unions complain that head teachers - under pressure from local authorities, which have a duty to provide alternative education for expelled pupils - are avoiding the ultimate sanction. Heads are also finding their decisions increasingly overturned by appeal tribunals or even their own governors, who are afraid of legal challenges.

Even the National Union of Teachers, which argues that schools are still one of the safest places for many children, has concerns. "While teachers have the powers to deal with bad behaviour, it has become a serious matter for wider society that the behaviour of a minority of pupils and, in some cases, their parents, has seriously worsened in recent years," says Christine Blower, the NUT's acting general secretary.

Even if schools are dealing swiftly and efficiently with the challenging behaviour they encounter, at the very least other children are having their education ruined on a daily, even hourly, basis. At Cheshire Oaks School in Ellesmere Port, the behaviour log for one week shows 73 cases of pupils talking, shouting and disturbing lessons, 61 refusing to obey the teacher, including more than 20 incidents of children simply walking out of the lesson, 65 incidents of poor behaviour, 32 refusing to work when asked, 39 cases of rudeness, 20 cases of verbal aggression towards staff, 10 incidents of children wandering around the classroom or using mobile phones, 14 incidents of lateness, 15 cases of pupils throwing things in lessons and four physical assaults.

And during one week at John Bunyan School in Bedford, pupils were reprimanded for smoking, verbal abuse, aggressive behaviour, drugs, dangerous behaviour and physical assault. Hayling Manor High, in Croydon, averaged between 20 and 30 incidents of bad behaviour a day.

None of the schools which provided records for the Sunday Telegraph study are thought to be failing in the eyes of officialdom. Indeed, inspectors say many are improving, and have "clear and consistent" policies for dealing with threatening behaviour from pupils. However, all of the schools studied are operating in difficult circumstances. Each has a high proportion of pupils eligible for free school meals. Ofsted inspections have found that many children entered these secondary schools, at the age of 11, still unable to read and write properly.

According to Adams, despite the big increases in spending in the last 10 years, staff do not have the training and resources to deal with the increasing number of pupils who display problems. "It is true that some head teachers and local authorities do not take behaviour seriously enough and support teachers," he says. "But there is also not enough money to deal with these children. I had one class where eight of the 19 pupils had behavioural and emotional difficulties. When you're spending your time trying to separate them and keeping them in their seats, the level of teaching plummets."

The Conservatives have promised greater powers to exclude pupils who otherwise "fester" in the mainstream, as well as better provision for those who are kicked out. Labour's answer is the 5 billion academy programme, which is supposed to transform education in deprived areas. However, recent problems at academies in Southampton and Carlisle have revealed that these "independent" secondaries are not immune from the behaviour issues that plague other schools. As revealed last month in the Sunday Telegraph, an emergency Ofsted inspection was triggered at the Richard Rose Central Academy in Carlisle, when complaints were made about gang fights and bullying. The head of the Oasis Academy in Southampton resigned in November after a riot at the school led to five pupils being expelled and 25 suspended.

"The public has no idea about what goes on in schools," says Adams. "At the three I worked in, there were examples of children involved in prostitution, the selling of drugs, gangs, intimidation. Teachers do their best to police it and keep these things external, but they are still getting in to our schools."


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