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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 + Brendan Chesterton whose daughter Emily died in November 2022 after suffering a pulmonary embolism
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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
Image:
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.”

Marion + Brendan Chesterton whose daughter Emily died in November 2022 after suffering a pulmonary embolism, missed by a physician associate

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 whose daughter Emily died in November 2022 after suffering a pulmonary embolism which was missed by a physician associate
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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).

British Medical Association (BMA) deputy chair Dr Emma Runswick
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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, general secretary of UMAPs trade union
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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.

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Angela Rayner: The working-class mum who went from union rep to Labour big-hitter

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Angela Rayner: The working-class mum who went from union rep to Labour big-hitter

Leaving school aged 16, pregnant and with no qualifications, Angela Rayner has had a meteoric rise to the second-highest office in the UK – and a spectacular fall from grace.

Sir Keir Starmer’s right-hand woman has now resigned after she admitted to Sky News political editor Beth Rigby she had not paid enough stamp duty on a second home she bought in Hove, East Sussex, earlier this year.

Politics latest: Angela Rayner resigns

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Rayner admits she didn’t pay enough tax

Growing up in poverty on a council estate in Stockport, Greater Manchester, Angela Bowen (her maiden name) and her two siblings were brought up by her grandmother, as her mother had bipolar disorder. She has said they had no books because her mother could not read or write.

She left school at the age of 16, without any qualifications, after becoming pregnant and has said her son, Ryan, “saved me from where I could have been, because I had a little person to look after”.

The teenage mother, now 45, studied part-time and gained a qualification in social care, working for Stockport Council as a care worker.

She entered politics when she was elected as a Unison trade union representative and then convenor of Unison North West – the region’s most senior official, becoming a Labour Party member during her time there.

Angela Rayner in 2016, a year after becoming an MP
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Angela Rayner in 2016, a year after becoming an MP

She married Unison official Mark Rayner in 2010 and they had two sons, Charlie and Jimmy. Charlie, now 17, was born at 23 weeks old and is disabled.

In 2017, her eldest son Ryan had a son, making Ms Rayner a grandmother at the age of 37. She gave herself the nickname “Grangela”.

She and her husband separated in 2020 and their divorce was completed in 2023. Since 2022, she has been in a relationship with former Labour MP Sam Tarry, with a break in 2023.

Pic: PA
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Pic: PA

NHS compensation and a trust

Days before her resignation, she revealed compensation was paid to Charlie by the NHS due to the circumstances around his birth, which left him with “life-long disabilities”.

A trust was set up to manage the compensation and to ensure her son was properly looked after, and so that he and his brother could remain living in their family home in Ashton-under-Lyne as part of a “nesting arrangement”, where children of divorced parents live in one house while parents take it in turn to stay there.

She said she sold her stake in that home to the trust in January this year and used that money as a deposit on the Hove flat.

The Labour MP said she was given legal advice that the coastal flat did not have to be considered as a second home for stamp duty but sought further legal counsel after media reports claimed she avoided £40,000 in stamp duty.

Her initial lawyers said they never gave her tax advice and said they were being made “scapegoats”.

Ms Rayner gave a tearful interview to Sky’s Beth Rigby before her resignation, telling the Electoral Dysfunction podcast she had spoken to her family about “packing it all in”.

MP to Labour deputy in five years

Ms Rayner rose up the Labour ranks quickly after becoming an MP for Ashton-under-Lyne in 2015.

She was made deputy Labour Party leader in 2020 and was made deputy prime minister and housing, communities and local government secretary after last summer’s general election.

A self-described socialist, “but not a Corbynite” (in her own words), she became well known for calling the Conservatives “scum”, for which she eventually apologised after initially refusing to.

Pic: Reuters
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Pic: Reuters

Council house and donor controversies

During last summer’s election campaign, Ms Rayner was investigated by Greater Manchester Police over allegations she misled tax officials in the sale of her council house in 2015 under the right to buy scheme.

She was cleared of any wrongdoing and HMRC concluded she did not owe any capital gains tax. She accused the Tories of using “desperate tactics” against her and went on to win her seat with a 19.1% majority.

Not long after becoming deputy PM and housing secretary, she was embroiled in another scandal in which she was accused of failing to properly register her use of Labour peer Lord Waheed Alli’s $2.5m New York apartment and being given clothes worth £3,550 by him.

She later announced she would no longer accept clothes from donors.

Sir Keir Starmer and Angela Rayner during a visit to a construction site in Cambridge. Pic: PA
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Sir Keir Starmer and Angela Rayner during a visit to a construction site in Cambridge. Pic: PA

Building pledge

One of the Labour government’s biggest pledges was to build 1.5m new homes in this parliament and, as housing secretary, this came under Ms Rayner’s remit.

Sir Keir admitted in December the pledge might be “a little too ambitious”.

Ms Rayner was warned by some of the UK’s biggest developers there was not enough skilled labour to get anywhere near that target, but she has insisted it will happen.

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‘House building target is achievable’

She also led the charge to overhaul planning rules, announcing planning officers would be able to rubberstamp development proposals without permission from council committees if they complied with locally agreed plans.

The changes will be made through the planning and infrastructure bill, which was introduced to parliament in March and is making its way through the Commons.

It also promises to unblock 150 infrastructure projects, such as gigafactories, windfarms and railways, while protecting the environment and nature by setting up a fund to help builders meet their environmental obligations faster by pooling contributions to fund larger nature protections

Right to buy

In February, somewhat controversially given she bought the council house she grew up in, Ms Rayner announced it would be harder for tenants to buy their own council homes to help reverse the housing stock shortage.

She also announced “Awaab’s Law” – introduced by the Conservatives in 2023 and named after two-year-old Awaab Ishak, who died from damp and mould – would come into force in October 2025, forcing social housing landlords to fix dangerous damp and mould in a set amount of time and emergency hazards within 24 hours.

In her role as deputy PM, Ms Rayner occasionally stood in for Sir Keir at Prime Minister’s Questions, one time facing Tory Oliver Dowden and saying it was the “battle of the gingers”.

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Katharine, Duchess of Kent, dies aged 92

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Katharine, Duchess of Kent, dies aged 92

The Duchess of Kent has died at the age of 92, Buckingham Palace has said.

Katharine – who became the oldest living member of the Royal Family when Queen Elizabeth II died in 2022 – was known for consoling Wimbledon finalists, notably a tearful Jana Novotna in 1993.

A skilled pianist, organist and singer, she dropped her HRH style, preferring to be known as Mrs Kent, and retreated from royal life to spend 13 years teaching music at a primary school in Hull.

The duchess famously comforted emotional Wimbledon runner-up Novotna after the 1993 final. Pic: AP
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The duchess famously comforted emotional Wimbledon runner-up Novotna after the 1993 final. Pic: AP

The palace said in a statement on Friday: “It is with deep sorrow that Buckingham Palace announces the death of Her Royal Highness The Duchess of Kent.

“Her Royal Highness passed away peacefully last night at Kensington Palace, surrounded by her family.

“The King and Queen and all Members of The Royal Family join The Duke of Kent, his children and grandchildren in mourning their loss and remembering fondly The Duchess’s life-long devotion to all the organisations with which she was associated, her passion for music and her empathy for young people.”

The Union Flag at Buckingham Palace was lowered to half-mast as a mark of respect shortly after the duchess’s death was announced. A formal framed announcement is displayed on the palace railings.

Katharine meeting Nelson Mandela in 1998. Pic: PA
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Katharine meeting Nelson Mandela in 1998. Pic: PA

The duchess, who volunteered for Unicef, is greeted in northern India in 1996. Pic: PA
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The duchess, who volunteered for Unicef, is greeted in northern India in 1996. Pic: PA

An online condolence book will be available in the coming days and funeral details will be announced in due course.

Katharine married Prince Edward, the Duke of Kent – who is the cousin of the late Queen Elizabeth II – in a grand ceremony at York Minster in 1961.

The couple have three surviving children, George, Earl of St Andrews, Lady Helen Windsor, and Lord Nicholas Windsor.

Read more:
Angela Rayner resigns
Three Britons among Lisbon crash fatalities

The Duke and Duchess of Kent at their York Minster wedding. Pic: PA
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The Duke and Duchess of Kent at their York Minster wedding. Pic: PA

The duchess suffered heartbreak when she was forced to have a termination after catching German measles while pregnant in 1975. Two years later, she endured the devastation of giving birth to a stillborn son, Patrick.

She led a separate life from the Duke of Kent for many years but the couple did not divorce – and were said to be closer than ever after Edward suffered a stroke in 2013, which prompted his wife to move back into their Kensington Palace home.

Katharine’s famous Wimbledon moments

Her appearances at Wimbledon, where she presented the winners’ trophies, became a familiar feature of the summer sporting calendar.

Venus Williams receives the women's singles trophy from the duchess in 2001. Pic: Reuters
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Venus Williams receives the women’s singles trophy from the duchess in 2001. Pic: Reuters

In 1993, she put royal formalities and protocol aside to hug tearful runner-up Jana Novotna after she lost the ladies’ singles final to Steffi Graff.

Her relationship with Wimbledon authorities later soured, when she was refused permission to take the young son of murdered headmaster Philip Lawrence into the royal box at the tournament.

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Three British nationals among those who died in Lisbon funicular crash

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Three British nationals among those who died in Lisbon funicular crash

Three British nationals are among the 16 who died after the iconic Gloria funicular in Lisbon derailed and crashed, authorities have said.

The crash, which also left 22 people injured, happened at around 6pm on Wednesday.

Footage showed one of the railway’s two carriages practically destroyed and emergency workers pulling people out of the wreckage.

Read more
Everything we know about the Lisbon crash so far

So far, the nationalities of 11 of the people who died have been released by the authorities. They are: five people from Portugal, including four workers at a charity based near the funicular, three from Great Britain, two from Korea, and one person from Switzerland.

Brakeman Andrew Marques is the only person killed to have been identified so far.

All but one of the victims was declared dead at the scene, with the other dying of their injuries in hospital.

Sky News has contacted the UK Foreign, Commonwealth and Development Office for further information on the three British victims.

A spokesperson for Prime Minister Sir Keir Starmer said he is “deeply saddened” to hear of the British nationals who have died.

“His thoughts are with families and those affected,” they said. “We stand united with Portugal during this time.”

Emergency workers scramble to rescue people at the scene. Pic: Enex
Image:
Emergency workers scramble to rescue people at the scene. Pic: Enex

Majority of dead and injured foreign nationals

Among the injured are 12 women, seven men, and a three-year-old child, according to Portugal’s Civil Protection Authority.

Three who suffered injuries are from Portugal, two from Germany, one from Spain, one from Korea, one from Cape Verde, one from Canada, one from Italy, one from France, one from Switzerland, and one from Morocco.

According to CNN Portugal, the two from Germany were the three-year-old child and his mother, who were both pulled from the wreckage.

The lower carriage in the foreground with the remains of the one that crashed further up the hill in Lisbon. Pic: AP
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The lower carriage in the foreground with the remains of the one that crashed further up the hill in Lisbon. Pic: AP

The Gloria funicular connects Lisbon's Restauradores Square to the Bairro Alto viewpoint
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The Gloria funicular connects Lisbon’s Restauradores Square to the Bairro Alto viewpoint

The Gloria funicular is hugely popular with tourists and classified as a national monument.

Its journey between Restauradores Square in downtown Lisbon and the Bairro Alto neighbourhood is just 265m (870ft) and three minutes long, but climbs up a steep hill, with two carriages travelling in opposite directions.

It was believed to be operating at full capacity as rush hour began in the Portuguese capital on Wednesday evening when the top car hurtled down the hill, left the tracks, and crashed into a building 30m (98ft) from the bottom.

According to the people who were in the lower carriage, a few metres into their ascent, it started going backwards. When they saw the other car speeding towards them, they jumped through the windows to escape.

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Lisbon funicular crash: ‘We felt no brakes anymore’

Preliminary crash report due on Friday

It is not clear what caused the crash.

The Portuguese government office for air and rail accident investigations said it has completed its analysis of the crash site and will release a preliminary report on Friday.

One eyewitness who was in the lower carriage told Sky’s Europe correspondent Alistair Bunkall that the brakes appeared to fail.

Engineer Dave Cooper told Sky News on Thursday that the two carriages may have become detached from one another because of a fault with the cables.

The second carriage is lifted from the crash site to be removed overnight on Thursday. Pic: Reuters
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The second carriage is lifted from the crash site to be removed overnight on Thursday. Pic: Reuters

The funicular tracks empty after both carriages were removed overnight on Thursday. Pic: AP
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The funicular tracks empty after both carriages were removed overnight on Thursday. Pic: AP

Flowers for the victims at the foot of the hill where the funicular is in downtown Lisbon on Friday. Pic: AP
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Flowers for the victims at the foot of the hill where the funicular is in downtown Lisbon on Friday. Pic: AP

Emergency services and engineers worked throughout the night on Thursday to remove both carriages from the site, while the other two funiculars in the city remained closed until the crash investigation concludes.

A mass was held, attended by Portuguese Prime Minister Luis Montenegro and Lisbon mayor Carlos Moedas, in memory of the victims at a nearby church on Thursday evening.

Lisbon declared three days of municipal mourning, while Portugal observed a national day of grief on Thursday.

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