Family of woman who died after misdiagnosis by ‘substitute doctor’ criticise govt review
The parents of a woman who died after her blood clot was misdiagnosed by someone who she thought was a doctor have called a government-ordered review “a missed opportunity”.
Marion and Brendan Chesterton have welcomed many of the recommendations in Professor Gillian Leng’s review of the role that physician associates (PAs) perform in the NHS, but say “they don’t go far enough”.
Emily, 30, died in November 2022 after suffering a pulmonary embolism. She went to see her GP at a north London surgery twice in the weeks before her death – and on both occasions was seen by a physician associate who missed the blood clot and instead prescribed propranolol for anxiety.
Marion and Brendan Chesterton
The actress from Salford had told her worried parents that she had been seen by a doctor, but she had not.
Her father Brendan told Sky News: “If she come out and said I’ve seen someone called the physician’s associate I’m sure we would have insisted that, you know, let’s go back and insist that you see a doctor. She never knew.”
Now, a government-ordered review led by Prof Leng, president of the Royal Society of Medicine, has recommended NHS physician associates should be banned from diagnosing patients who have not already had contact with a doctor for their illness.
The report suggests a major change to the role of PAs after it acknowledged they have been used as substitutes for doctors, despite having significantly less training.
Emily Chesterton. Pic: Family handout
More than 3,500 PAs and 100 anaesthesia associates (AAs) are working in the NHS and there have been previous calls for an expansion in their number.
But a general lack of support for the roles from the medical profession – plus high-profile deaths of patients who were misdiagnosed by PAs – led Health Secretary Wes Streeting to order a review.
Presenting her findings, Prof Leng said: “Crucially I’m recommending that PAs should not see undifferentiated or untriaged patients.
“If (patients) are triaged, they (PAs) should be able to see adult patients with minor ailments in line with relevant guidance from the Royal College of GPs.”
She said more detail was needed on which patients can be seen by PAs and national clinical protocols should be developed in this area.
She added: “Let’s be clear, (the role of PAs) is working well in some places, but there indeed has been some substitution and any substitution is clearly risky and confusing for patients.”
Prof Leng also recommended PAs should be renamed “physician assistants” to position them “as a supportive, complementary member of the medical team” – and have standardised uniforms to distinguish them from doctors – while AAs should be renamed “physician assistants in anaesthesia”.
Newly qualified PAs should also work in hospitals for two years before they are allowed to work in GP surgeries or mental health trusts.
The report said that while research suggests patients are satisfied after seeing a PA, some did not know they were not seeing a doctor.
Prof Leng concluded there were “no convincing reasons to abolish the roles of AA or PA”, but there is also no case “for continuing with the roles unchanged”.
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She recommended that both PAs and AAs should have the opportunity for ongoing training and development, with potential to prescribe medicines in the future, and they should also have the opportunity to become an “advanced” PA or AA.
Six patient deaths linked to contact with PAs have been recorded by coroners in England.
Emily’s mother Marion said some of the review’s findings were significant and her daughter would still be alive if the recommendations had been in place when she fell ill.
Marion Chesterton
She said: “I think so, yes, which is so important, which is why we’re so pleased that this review has been made.”
But Mrs Chesterton added that more could have done, including stopping all PAs from prescribing drugs.
“We feel it’s a missed opportunity. It could have gone all the way there and cleared things up totally. Our daughter died. She was prescribed a drug that she should not have been prescribed. And it had absolutely catastrophic circumstances. She died for goodness sake.”
The Chestertons’ concerns are shared by the British Medical Association (BMA).
Dr Emma Runswick, the BMA’s deputy chair
Dr Emma Runswick, BMA’s deputy chair, said: “It is definitely a problem that the roles of doctors and now physician assistants has been blurred and it’s positive that their name is going to change, that there will be a uniform.
“But whilst they continue to be deployed in a way that mimics doctors at the behest of any local employer decision, we have to have ongoing concerns about their safety.”
But UMAPs, the trade union which represents both PAs and AAs, has warned the changes will undermine their qualifications and their role, lengthen waiting lists and worsen the impact of any strike action.
Steve Nash, who represents PAs and AAs
“By trying to placate them, at a time when they’re striking – and they want their strikes to bite the hardest by taking us out of the workforce – we’re now putting patients at risk,” said Steve Nash, general secretary of UMAPs.
“I think the biggest patient safety risk, out there right now, is the BMA,” he added.
Health Secretary Wes Streeting, who ordered this review, is expected to implement all the recommendations of the report.
A council has won its bid to temporarily block asylum seekers from being housed at a hotel in Essex.
Epping Forest District Council sought an interim injunction to stop migrants from being accommodated at the Bell Hotel in Epping, which is owned by Somani Hotels Limited.
A government attempt to delay the application was rejected by the High Court judge earlier on Tuesday.
The interim injunction now means the hotel has to be cleared of its occupants within 14 days.
Somani Hotels said it intended to appeal the decision.
Several protests have been held outside the hotel in recent weeks after an asylum seeker housed there was charged with sexually assaulting a 14-year-old girl.
Hadush Gerberslasie Kebatu, 38, was charged with trying to kiss a teenage girl and denies the allegations. He is due to stand trial later this month.
Police officers ahead of a demonstration outside The Bell Hotel in July. Pic: PA
At a hearing last week, barristers for the council claimed Somani Hotels breached planning rules because the site is not being used for its intended purpose as a hotel.
Philip Coppel KC, for the council, said the problem was “getting out of hand” and “causing great anxiety” to local people.
He said the hotel “is no more a hotel [to asylum seekers] than a borstal to a young offender”.
File pic: PA
Piers Riley-Smith, for Somani Hotels Limited, said a “draconian” injunction would cause “hardship” for those in the hotel, arguing “political views” were not grounds for an injunction to be granted.
He also said contracts to house asylum seekers were a “financial lifeline” for the hotel, which was only 1% full in August 2022, when it was open to paying customers.
Protesters and counter-demonstrators outside The Bell Hotel in July. Pic: PA
The hotel housed migrants from May 2020 to March 2021, then from October 2022 to April 2024, with the council never instigating any formal enforcement proceedings against this use, Mr Riley-Smith said.
They were being placed there again in April 2025 and Mr Riley-Smith said a planning application was not made “having taken advice from the Home Office”.
At the end of the hearing last week, Mr Justice Eyre ordered that Somani Hotels could not “accept any new applications” from asylum seekers to stay at the site until he had made his ruling on the temporary injunction.
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TikTok and Instagram have been accused of targeting teenagers with suicide and self-harm content – at a higher rate than two years ago.
The Molly Rose Foundation – set up by Ian Russell after his 14-year-old daughter took her own life after viewing harmful content on social media – commissioned analysis of hundreds of posts on the platforms, using accounts of a 15-year-old girl based in the UK.
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The charity claimed videos recommended by algorithms on the For You pages continued to feature a “tsunami” of clips containing “suicide, self-harm and intense depression” to under-16s who have previously engaged with similar material.
One in 10 of the harmful posts had been liked at least a million times. The average number of likes was 226,000, the researchers said.
Mr Russell told Sky News the results were “horrifying” and showed online safety laws are not fit for purpose.
Molly Russell died in 2017. Pic: Molly Rose Foundation
‘This is happening on PM’s watch’
He said: “It is staggering that eight years after Molly’s death, incredibly harmful suicide, self-harm, and depression content like she saw is still pervasive across social media.
“Ofcom’s recent child safety codes do not match the sheer scale of harm being suggested to vulnerable users and ultimately do little to prevent more deaths like Molly’s.
“The situation has got worse rather than better, despite the actions of governments and regulators and people like me. The report shows that if you strayed into the rabbit hole of harmful suicide self-injury content, it’s almost inescapable.
“For over a year, this entirely preventable harm has been happening on the prime minister’s watch and where Ofcom have been timid it is time for him to be strong and bring forward strengthened, life-saving legislation without delay.”
Ian Russell says children are viewing ‘industrial levels’ of self-harm content
After Molly’s death in 2017, a coroner ruled she had been suffering from depression, and the material she had viewed online contributed to her death “in a more than minimal way”.
Researchers at Bright Data looked at 300 Instagram Reels and 242 TikToks to determine if they “promoted and glorified suicide and self-harm”, referenced ideation or methods, or “themes of intense hopelessness, misery, and despair”.
They were gathered between November 2024 and March 2025, before new children’s codes for tech companies under the Online Safety Act came into force in July.
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What are the new online rules?
The Molly Rose Foundation claimed Instagram “continues to algorithmically recommend appallingly high volumes of harmful material”.
The researchers said 97% of the videos recommended on Instagram Reels for the account of a teenage girl, who had previously looked at this content, were judged to be harmful.
Some 44% actively referenced suicide and self-harm, they said. They also claimed harmful content was sent in emails containing recommended content for users.
A spokesperson for Meta, which owns Instagram, said: “We disagree with the assertions of this report and the limited methodology behind it.
“Tens of millions of teens are now in Instagram Teen Accounts, which offer built-in protections that limit who can contact them, the content they see, and the time they spend on Instagram.
“We continue to use automated technology to remove content encouraging suicide and self-injury, with 99% proactively actioned before being reported to us. We developed Teen Accounts to help protect teens online and continue to work tirelessly to do just that.”
TikTok
TikTok was accused of recommending “an almost uninterrupted supply of harmful material”, with 96% of the videos judged to be harmful, the report said.
Over half (55%) of the For You posts were found to be suicide and self-harm related; a single search yielding posts promoting suicide behaviours, dangerous stunts and challenges, it was claimed.
The number of problematic hashtags had increased since 2023; with many shared on highly-followed accounts which compiled ‘playlists’ of harmful content, the report alleged.
A TikTok spokesperson said: “Teen accounts on TikTok have 50+ features and settings designed to help them safely express themselves, discover and learn, and parents can further customise 20+ content and privacy settings through Family Pairing.
“With over 99% of violative content proactively removed by TikTok, the findings don’t reflect the real experience of people on our platform which the report admits.”
According to TikTok, they not do not allow content showing or promoting suicide and self-harm, and say that banned hashtags lead users to support helplines.
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‘A brutal reality’
Both platforms allow young users to provide negative feedback on harmful content recommended to them. But the researchers found they can also provide positive feedback on this content and be sent it for the next 30 days.
Technology Secretary Peter Kyle said: “These figures show a brutal reality – for far too long, tech companies have stood by as the internet fed vile content to children, devastating young lives and even tearing some families to pieces.
“But companies can no longer pretend not to see. The Online Safety Act, which came into effect earlier this year, requires platforms to protect all users from illegal content and children from the most harmful content, like promoting or encouraging suicide and self-harm. 45 sites are already under investigation.”
An Ofcom spokesperson said: “Since this research was carried out, our new measures to protect children online have come into force.
“These will make a meaningful difference to children – helping to prevent exposure to the most harmful content, including suicide and self-harm material. And for the first time, services will be required by law to tame toxic algorithms.
“Tech firms that don’t comply with the protection measures set out in our codes can expect enforcement action.”
Peter Kyle has said opponents of the Online Safety Act are on the side of predators. Pic: PA
‘A snapshot of rock bottom’
A separate report out today from the Children’s Commissioner found the proportion of children who have seen pornography online has risen in the past two years – also driven by algorithms.
Rachel de Souza described the content young people are seeing as “violent, extreme and degrading”, and often illegal, and said her office’s findings must be seen as a “snapshot of what rock bottom looks like”.
More than half (58%) of respondents to the survey said that, as children, they had seen pornography involving strangulation, while 44% reported seeing a depiction of rape – specifically someone who was asleep.
The survey of 1,020 people aged between 16 and 21 found that they were on average aged 13 when they first saw pornography. More than a quarter (27%) said they were 11, and some reported being six or younger.
Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK.
There is one thing scarier than markets lurching around. And that’s markets lurching around without a very compelling explanation.
Just yesterday, the yield on the government’s 30-year bonds – the best measure out there of the UK government’s long-term cost of borrowing – closed at the highest level since 1998, not long after Oasis released the album Be Here Now. Indeed, the yields on pretty much all UK government debt has been creeping up in recent weeks, though not all are back to Britpop era levels.
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In some senses, this looks very odd indeed. After all, the Bank of England just cut interest rates. In normal circumstances, you would expect measures of borrowing costs to be falling across the board. But clearly these are not normal times.
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‘Is the Bank worried about recession risk?’
All of which raises the question: is this a UK-specific phenomenon? Are markets singling out Britain for particular concern, much as they did after Liz Truss’s notorious mini-budget? Actually, there are more questions on top of that one. For instance, is this all about Rachel Reeves’s recent woes, and her need to find another £20bn, give or take, to make her sums add up? Are investors fretting about the Bank of England’s inflation-fighting credibility, given its cutting rates even as prices rise?
The short answer, I’m afraid, is that no one really knows. But a glance at a few metrics can at least provide a bit of context.
The first thing to note is that while government borrowing costs in the UK are up, they have also been rising in other leading economies. The UK, it’s worth saying, is a bit of an outlier with higher yields than in fellow G7 nations. But that’s not exactly a new thing: it’s been the case since the mini-budget. But the UK is a particularly ugly duckling in a lake full of them.
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Are taxes going to rise?
Indeed, look at other nations, and you see that Britain’s budgetary challenges are hardly unique. The US and France have ballooning budget deficits which are rising rapidly. Most European nations have pledged enormous increases in military spending to satisfy Donald Trump’s demands of NATO.
And over the Atlantic, the US administration has just committed to a sweeping set of generous fiscal measures, under its One Big Beautiful Bill Act. Even Elon Musk has voiced concerns about what this means for the deficit (which is set to continue rising ad infinitum, at least on paper).
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All of which brings us to the broader, possibly scarier, lesson. There are signs afoot that while G7 nations could depend for decades on other surplus countries – most notably China and other Asian countries – buying vast amounts of their debt in recent years, that might no longer be the case. In short, even as rich countries borrow like crazy, it’s becoming less clear who will lend them the money.
That’s an enormous conundrum, and not good news for anyone.
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