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Expert Witness : Medico Legal

NHS welcomes Neuberger report

Photo of Chief Nurse Jane Cummings for Your Expert Witness storyThe NHS in England has welcomed the report of the review by Baroness Julia Neuberger into the Liverpool Care Pathway (LCP).

Jane Cummings, Chief Nurse at NHS England and Chief Nursing Officer for England, said: “I would like to reassure everyone, particularly patients on the LCP and their families, that NHS England and the NHS are passionate about ensuring that every patient receives the best possible care at the end of their life. I have been a nurse for over 30 years and know how important care at the end of life is for our loved ones. I say this both on a professional and a personal level.

“The review and NHS England recognise the good principles of end of life care in the LCP, but there have been failings in the quality of care in some areas and this is never acceptable. Caring for someone when they are dying is difficult and emotional even for experienced healthcare professionals. But the NHS exists to provide personal and compassionate care to patients and their loved ones when they most need it.  Most of the time we do get it right but we have to get it right for everybody. Issues such as poor communication with relatives have nothing to do with any particular care plan. That is just poor care and we don’t want it in the NHS.

“Patients are at the heart of everything we do to ensure the NHS can deliver the right care to every patient at the end of their life to make sure it is the best it can possibly be. We will do this by listening to patients and their families and responding fully to the recommendations of this report to ensure that the principles of good end of life care are firmly embedded across the NHS.

“We will be carefully considering the findings of this report and working with our partners to respond fully in the autumn, to give the time and consideration such an important review deserves to meet the needs of patients and their families.”

The report, More Care, Less Pathway: a Review of the Liverpool Care Pathway, was published on 15 July and recommended that the LCP be phased out and replaced with an individual end of life care plan.

Baroness Neuberger said: “There is no doubt that, in the right hands, the Liverpool Care Pathway supports people to experience high-quality and compassionate care in the last hours and days of their life.

“But evidence given to the review has revealed too many serious cases of unacceptable care where the LCP has been incorrectly implemented. Examples include leaving patients without adequate nutrition, hydration and inappropriately sedated. This is not only awful for the patients, but it is deeply distressing to their relatives and carers.

“Caring for the dying must never again be practised as a tick-box exercise, and each patient must be cared for according to their individual needs and preferences, with those of their relatives or carers being considered too.

“Ultimately it is the way the LCP has been misused and misunderstood that has led to such great problems, along with it being simply too generic in its approach for the needs of some people. Sadly it is just too late to reverse this and turn the clock back to get it used properly by everybody.”

Other recommendations among the 44 made include:

•A general principle that a patient should only be placed on the LCP or a similar approach by a senior responsible clinician in consultation with the healthcare team

• Unless there is a very good reason, a decision to withdraw or not to start a life-prolonging treatment should not be taken during any ‘out of hours’ period

• An urgent call for the Nursing and Midwifery Council to issue guidance on end of life care

• An end to incentive payments for use of the LCP and similar approaches

• A new system-wide approach to improving the quality of care for the dying.

Last Updated on Tuesday, 16 July 2013 13:27

Claims against NHS up 18% and expected to soar

Stethoscope-2Government figures published in May show a dramatic increase in the number of medical negligence claims being made against the NHS and the health sector. According to statistics compiled by the Compensation Recovery Unit of the DWP the number of cases brought against the health sector in the year to March increased by 18% from 13,517 to 16,006.

Ian Pryer, senior partner at medical negligence solicitors Axiclaim, says NHS hospitals must now brace themselves for an “explosion” in medical negligence claims. In the wake of the Mid-Staffs hospital scandal, he believes publication of the Francis report has removed a mental barrier many victims may have had about claiming against the NHS.

Last Updated on Sunday, 09 June 2013 10:27

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College publishes its treatment plan for emergency medicine

Picture of an ambulance outside an emergency department for your Expert WitnessOn 15 May the College of Emergency Medicine published a comprehensive report into the state of emergency care systems in the UK and highlighted its view of the way forward.

In the report – The drive for quality – how to achieve safe, sustainable care in our emergency departments – experts in emergency medicine at the college have called for fundamental changes in the way we design, fund and run our emergency care systems. Ten recommendations are made across four domains that the college believes must be considered and adopted by national policy makers, commissioners, clinicians and trust boards in order to return systems to stability and deliver the quality of care patients expect when they seek help in an emergency.

The college states: “Emergency care systems…are facing their biggest challenge in well over a decade as they aim to cope with unsustainable workloads and a lack of sufficient numbers of middle-grade doctors and consultants in emergency medicine to deliver consistent quality care. Both the Care Quality Commission and NHS England have recognised the scale of the crisis and the need for urgent action.”

Last Updated on Wednesday, 15 May 2013 17:29

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Misdiagnosis leads to most medical claims, US study finds

Logo for John Hopkins Medical School for your Expert Witness storyResearchers studying 25 years of medical malpractice claims in the US found that diagnostic errors accounted for the largest number of claims. Diagnostic errors also caused the most severe patient harm and attracted the highest compensation payments –amounted to $38.8bn between 1986 and 2010. The research was carried out by a team from the Johns Hopkins University School of Medicine in Baltimore, Maryland, and was published online by the journal BMJ Quality and Safety.

The leader of the research, Prof David E Newman-Toker MD PhD, said: "This is more evidence that diagnostic errors could easily be the biggest patient safety and medical malpractice problem in the United States. There's a lot more harm associated with diagnostic errors than we imagined."

While the new study looked only at a subset of claims – those that resulted in a compensation payout for malpractice – the researchers estimated the number of patients suffering significant, permanent injury or death as a result of misdiagnosis ranges from 80,000 to 160,000 in the US annually.

Last Updated on Friday, 26 April 2013 14:37

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GPs call for delay of NHS 111 roll-out

GP leaders have urged health minister Earl Howe and NHS Commissioning Board chief executive Sir David Nicholson to delay the launch of NHS 111, according to a report by the British Medical Association.

In a letter sent following reports of problems with the service aired at the March meeting of the BMA GPs Committee, its chair Laurence Buckman wrote: "We have repeatedly asked for the implementation of NHS 111 services not to be rushed and stressed that a smooth transition is essential for patient safety. As yet, many areas seem not to be ready for that transition and, from some of the examples reported, I am worried that patients may be put at risk."

In a statement issued on 28 March, Dr Buckman added: "We cannot sacrifice patient safety in order to meet a political deadline for the launch of a service that doesn't work properly. There have been widespread reports of patients being unable to get through to an operator or waiting hours before getting a call back with the health information they have requested. In some areas, such as Greater Manchester, NHS 111 effectively crashed because it was unable to cope with the number of calls it was receiving."

NHS 111 is the new telephone triage service designed to direct people with urgent but non-life threatening conditions to the right part of the NHS within the appropriate timeframe. It is supposed to replace the former NHS Direct.

John Hughes is honorary secretary of Manchester Local Medical Committee, where a 'soft launch' for NHS 111 had been planned for 21 March. He said signs of trouble emerged when a carer reported that she had been waiting with a 90-year-old woman for 90 minutes for a call back from NHS 111.

"Shortly afterwards, it became apparent that the same thing was happening right across Manchester," Dr Hughes continued. "There were significant delays. People were waiting hours for calls back. There was also information from the North West Ambulance service that they were being completely overwhelmed by 999 calls because people were fed up waiting or couldn't get through."

It later emerged that in parts of inner London NHS 111 was put on hold until at least April 9 after problems emerged in other boroughs.

Dr Stewart Kay represents south-east London region on the GP Committee and worked for the GP OOH (out-of-hours) co-op SelDoc for 12 years.
He said: "We are back to a sort of daft hybrid, where some of the calls are going to NHS Direct and are being forwarded I think via fax to the traditional OOH provider...The majority are going through in the traditional way by GPs putting the co-op telephone number on their answer machines."

In Shropshire, the ShropDoc out-of-hours GP co-op has taken back call handling for four weeks after the Shropshire clinical commissioning group assessed that NHS Direct, which won the bid to run NHS 111 across the wider West Midlands region, was not ready, according to Shropshire Local Medical Committee chair Mary McCarthy.

She said GPs at ShropDoc had to step in and visit patients in their homes after reports of waits of up to 45 minutes for call backs or longer. She said patients have left feedback about their NHS 111 experiences on the ShropDoc website.

Dr Buckman commented: "The chaotic mess now afflicting NHS 111 is not only placing strain on other already overstretched parts of the NHS, such as the ambulance service, but is potentially placing patients at risk. If someone calls NHS 111 they need to be able to get immediate, sound advice and not be faced with any form of delay."

A spokesperson for the NHS Commissioning Board is reported as saying: "NHS England [the board's new name from 1 April] is aware of some difficulties in the introduction of the NHS 111 service in some areas, but we are confident that measures now in place will ensure resolution of these early problems.

"Many sites are already up and running, but in areas where NHS 111 is not yet available we will make a thorough assessment of readiness before new sites are introduced."

Last Updated on Tuesday, 02 April 2013 13:42