A&E waits: Hundreds of patients a week in England may have died unnecessarily

Published

2 months ago

April 2, 2024

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More than 250 patients a week in England may have died unnecessarily last year due to very long waits for a bed in A&E, new estimates suggest.

A study by the Royal College of Emergency Medicine (RCEM) suggests patients are put at risk by spending hours in A&E, particularly after a decision has been made to admit them.

The NHS recovery plan set a target in March for 76% of patients attending A&E to be admitted, transferred or discharged within four hours.

But data for the month shows just 70.9% of patients were seen within that time.

In February, the number of people waiting more than 12 hours in A&E departments – from a decision to admit to actually being admitted – was 44,417.

For its new excess death estimates, the RCEM used a study of more than five million NHS patients published in the Emergency Medicine Journal (EMJ) in 2021.

This found there was an excess death for every 72 patients that spent eight to 12 hours in A&E.

The risk of death increased after five hours and got worse with longer waiting times.

In 2022, the RCEM said it believed 300 to 500 excess deaths were likely to have occurred in England each week using this calculation.

But after a Freedom of Information audit of NHS trusts to refine this figure, it found that 65% of people waiting 12 hours or more in A&E are patients waiting for a hospital bed.

NHS data for England shows more than 1.5 million patients waited 12 hours or more in major emergency departments in 2023, meaning more than a million of those were waiting for a bed.

The RCEM has calculated that, when looking solely at patients awaiting admission, an average of 268 excess deaths are likely to have occurred each week in 2023, which is “only 17 fewer than 2022 when applying the same method”.

The college added that patients delayed in the back of ambulances, “of which there are thousands”, are not included in the figures but are also at risk.

Professor Pat Cullen, general secretary and chief executive of the Royal College of Nurses, said her members reported hospital corridors “packed with patients” and were living with the reality of the new study’s findings.

She added: “This crisis is taking lives and nursing staff in England’s hospitals are forced to witness it every shift.

“Care is not only undignified but fatally unsafe.

“One nurse told me a lady had died on a trolley in a corridor and it went unnoticed far too long – that is the current state of our health service.”

Dr Adrian Boyle, president of the RCEM, said: “The direct correlation between delays and mortality rates is clear. Patients are being subjected to avoidable harm.

“Urgent intervention is needed to put people first. Patients and staff should not bear the consequences of insufficient funding and under-resourcing.

“We cannot continue to face inequalities in care, avoidable delays and death.”

Asked about the figures by Sky News, business minister Kevin Hollinrake pointed to “huge demand-side pressures” – like admissions and attendances at A & E being up 8% year-on-year.

The minister said the “extra demand” was partially down to “demographics”, which makes “life difficult in providing health care and social care in our system”.

He also blamed strikes in the NHS for the situation in the health service.

Mr Hollinrake said 110,000 more doctors and nurses work in the NHS now when compared to 2010, and said the government has brought in a 13% real-terms increase in funding after inflation over the past five years.

NHS England said hospitals were responding to “significant increases in demand for A&E”, with attendance up by 8.6% in February, and emergency admissions up by 7.7%.

It added: “The latest published data shows our urgent and emergency care recovery plan – backed by extra funding with more beds, capacity and greater use of measures like same day emergency care – is delivering improvements, alongside continued work with our colleagues in community and social care to discharge patients when they are medically fit to go home, freeing up beds for other patients.

“The cause of excess deaths is down to several different factors and so it is right that the experts at the ONS – as the executive branch of the stats authority – continue to analyse these causes.”

The Department of Health and Social Care added: “We are committed to ensuring people get the emergency care they need, when they need it, and all patients attending A&E are assessed by a doctor or nurse before any treatment takes place, to ensure the most seriously unwell people are treated first.

“We are determined to continue improving experiences for patients and making access to care faster, simpler and fairer.

“We are making progress in reducing A&E waiting times, including adding an extra 5,000 permanent staffed beds this winter to increase capacity and help patients be seen as quickly as possible.”

UK

About 100 sub-postmaster convictions separate to Post Office cases may be ‘tainted’

Published

2 hours ago

May 17, 2024

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About 100 sub-postmaster convictions separate to Post Office cases may be 'tainted'

Prosecutions of sub postmasters by the Department for Work and Pensions could be “tainted” as Sky News reveals officials worked with now discredited Post Office investigators to secure convictions.

Around 100 prosecutions of Post Office staff were led by the Department for Work and Pensions (DWP) between 2001 and 2006.

It is understood that these usually involved the cashing in of stolen order books.

The Post Office itself wrongly prosecuted hundreds of sub-postmasters between 1999 and 2015 – based on evidence from the faulty Horizon accounting system.

The role of government

A Sky News investigation, however, has discovered that information was shared between Post Office investigation teams and the DWP.

Chair of the Justice Select Committee, Sir Robert Neill KC, said as a result DWP convictions “need to be looked at”.

“I hadn’t been aware of that, for example, there may have been material in the DWP case as a result of joint investigations – which suggests a disclosure failure,” he added.

“I think that’s the area they need to look at if we are saying their approach was tainted from the beginning – in the way the investigators adopted things – then joint operations I suspect would be just as tainted arguably as something where it has been the Post Office on its own.”

What was known?

A 2003 DWP report into fraud describes “joint working” and the “sharing of information” with the Post Office.

It also outlines a “Fraud Prevention Board” established by the DWP and Royal Mail Group plc which includes “the exchange of information that directly assists fraud prevention and investigations”.

In addition, separately, a 2003 letter seen by Sky News also indicates a connection between DWP and Post Office investigations.

The letter, from the then post affairs minister Stephen Timms, references the case of Roger Allen, a sub-postmaster from Norwich.

It states: “Subsequent investigations by the police, the Post Office Investigation Department and the Department for Work and Pensions (DWP) led to a prosecution by DWP…”

Roger Allen was convicted in 2004 of stealing pension payments and was sentenced to six months in prison. He died in March of this year.

Mr Allen had pleaded guilty to spare his wife – after his lawyer told him in a letter that there had been “an indication from the Crown that they may discontinue the proceedings against Mrs Allen were you minded to plead guilty”.

Despite the Criminal Cases Review Commission deciding Mr Allen had grounds to appeal against his conviction – it was upheld by the Court of Appeal in 2021.

DWP prosecutions are not covered in upcoming government legislation that will overturn Post Office convictions.

Fighting to clear names

Keren Simpson, Roger’s daughter, has vowed to fight to clear his name posthumously.

She describes her father as a “proud” and “honest” man who “couldn’t face or deal” with the fact his conviction would not be overturned.

She says “in the end he obviously gave up” and there is “very little surviving evidence” because of the passage of time.

“He’s the innocent one,” Keren states. “I don’t see why he’s got to try and prove it. They have got to try and prove it, and show what evidence they actually had on my dad.

“Because the Department of Work and Pensions have put a statement out saying there was surveillance and witness testimonies and physical evidence to show it.

“Show me it.”

Investigation failures?

Sky News has also seen documents that suggest failures by DWP investigators in a different case in the 2000s.

It involved a sub-postmaster who decided to plead not guilty and was acquitted of stealing by a jury.

In one extract it says a “senior investigating officer” was “willing to admit in open court that (they) had been neglectful in (their) duty in securing evidence”.

Another document appears to show a failure to review transaction logs used as evidence against the sub-postmaster.

Some logs appear to show that the accused did not cash the “dockets”, used to collect pension payments.

Other transaction logs indicate the sub-postmaster was not present at a particular branch when the theft was alleged to have occurred.

Chris Head, former sub-postmaster and a campaigner for others, has also seen the documents and says they point to a “deeply flawed” DWP investigation.

“…they failed to obtain all transaction logs for the entirety of this case, but the ones that they have, they have they clearly haven’t looked at.”

He believes there are “more cases out there” which could be “part of a miscarriage of justice”.

A Department for Work and Pensions spokesperson said: “We do not recognise these claims.

“DWP investigates offences against the welfare system to protect taxpayers’ money, and between 2001 and 2006 a small number of Post Office staff were convicted for welfare-related fraud.

“These cases involved complex investigations and were backed by evidence including filmed surveillance, stolen benefit books and witness statements – they did not rely on Horizon evidence, and this has been accepted by the Court of Appeal.”

The Post Office says it “continues to help other prosecuting authorities to ensure that they have every assistance in taking their work forward”.

“This includes sharing all the information we have in relation to prosecutions which have been brought by other prosecutors.”

Meanwhile, Lord Sikka has tabled an amendment in the House of Lords to the Post Office (Horizon System) Offences Bill to include all DWP convictions.

UK

What is cryptosporidium? The diarrhoea-causing parasite found in Devon drinking water

Published

9 hours ago

May 16, 2024

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What is cryptosporidium? The diarrhoea-causing parasite found in Devon drinking water

An outbreak of a waterborne disease in Devon has prompted urgent warnings for residents to boil their tap water.

At least 22 cases of cryptosporidiosis disease have been confirmed in and around the town of Brixham in South West England.

But what is the parasite that is making people sick, what are the symptoms of being infected with it and how serious can it be?

What is cryptosporidiosis disease?

Cryptosporidiosis is the disease caused by the parasite cryptosporidium.

Often shortened to crypto, infections can be caused by drinking contaminated water or swallowing contaminated water in swimming pools or streams.

It can also be acquired through contact with the faeces of infected animals or humans.

What are the symptoms?

The symptoms of cryptosporidiosis include:

• profuse watery diarrhoea
• stomach pains
• nausea or vomiting
• low-grade fever
• loss of appetite

How long does it last?

Most people develop symptoms within one to 12 days of picking up the parasite.

Symptoms usually last for about two weeks, but can last up to six weeks or longer when the immune system is not working properly.

During the illness, you might think you are getting better but the illness returns a couple of days later before you fully recover.

How serious is it?

Most people recover, but in people with severely weakened immune systems it can cause severe disease and can be fatal.

Serious cases and death used to be more common, according to Paul Hunter, professor in medicine at the University of East Anglia (UEA).

This is because before effective antiretroviral treatments were introduced for HIV/AIDS, people living with these illnesses would not recover if they picked up cryptosporidiosis.

Who is most at risk of serious illness?

People with weak immune systems are at greater risk of serious illness. This includes:

• people on some immunosuppressive drugs, for example cancer or transplant patients
• people with untreated HIV/AIDS
• malnourished children

Does it need treatment?

There is no specific treatment for cryptosporidiosis.

It important to drink plenty of fluids as diarrhoea or vomiting can lead to dehydration, according to advice from the UK Health Security Agency (UKHSA).

You might also want to talk to a pharmacist about oral rehydration sachets to help replace the sugar, salts and minerals the body has lost.

Dr Lincoln Sargeant, Torbay’s Director of Public Health, said anyone with “severe symptoms like bloody diarrhoea” should contact NHS 111 or their GP.

Severe cases may require hospital treatment.

How do you know if you have crypto?

The symptoms of crypto are similar to other stomach bugs, so the only way to know for sure if you have it is for your doctor to send a sample of your faeces to be tested in a laboratory.

How can you stop the illness spreading?

If you are ill, stay away from nursery, school or work while you have symptoms, and for at least 48 hours after they stop.

You should also avoid swimming for two weeks after being unwell.

You should not prepare food for anyone else until 48 hours after diarrhoea has stopped.

Make sure you’re using good handwashing practices too, washing your hands thoroughly when handling food and after using the toilet.

The UKHSA also advises washing bedding and towels on the hottest possible cycle.

UK

Lucy Letby: Families of victims want inquiry live streamed to stop ‘grossly offensive’ conspiracy theories

Published

9 hours ago

May 16, 2024

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Lucy Letby: Families of victims want inquiry live streamed to stop 'grossly offensive' conspiracy theories

The inquiry into how nurse Lucy Letby was able to murder babies at a hospital in Chester will begin to hear evidence in September.

Lawyers for the families of Letby’s victims told a preliminary hearing that the inquiry should be live streamed to the public to prevent the spread of “grossly offensive” conspiracy theories.

Letby was sentenced to 14 whole-life orders after she was convicted of murdering seven babies and attempting to murder six others while working on the neo-natal unit at the Countess of Chester Hospital in 2015 and 2016.

At the preliminary hearing, inquiry chair Lady Justice Thirlwall heard submissions on whether the hearings should be publicly broadcast.

Peter Skelton KC, on behalf of the families of six babies, said Letby’s crimes continued to be the subject of conspiracy theories online.

“One of the most effective antidotes to those theories and the damage they cause will be to see and to hear the people involved in the hospital give a true and comprehensive account of the facts,” he said.

But Andrew Kennedy KC, representing the Countess of Chester, said there was a “high level of anxiety” from staff at the prospect of giving evidence which was live streamed.

He said: “If a witness is concerned about live-streaming then if we can remove that concern we can, we would suggest, encourage candour, frankness and openness.”

Richard Baker KC, representing some of the other families, said: “Their desire in this case is for change and so that others do not experience what they have experienced.”

They were “saddened” and “concerned” at the suggestion the lack of transparency might continue, he said.

Lady Justice Thirlwall will give her decision on whether the hearings will be broadcast at a later date.

She had begun the proceedings with a pause for reflection on the “lives lost”, “injuries sustained” and “suffering” of the families.

The hearing was told 188 requests for information had been made to individuals including midwives, nurses, doctors, managers and members of the hospital board.

The inquiry hearings are scheduled to begin on 10 September at Liverpool Town Hall.

The parents of the babies will be among the first to give evidence.

Counsel to the inquiry Rachel Langdale KC told the hearing: “There are no sides. It is a search for the truth.”

Last month Letby asked the Court of Appeal for permission to mount a full legal challenge to her conviction. Judges are due to rule on this at a later date.

The former nurse is due to face a re-trial next month on one charge of the attempted murder of a baby in February 2016.