Concerns raised over Liverpool Care Pathway
Intervention from a leading UK neurologist has added fresh fuel to the debate surrounding the Liverpool Care Pathway.
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Concerns have been mounting over the approach, which was created to ensure the proper care of dying patients in NHS hospitals. It can involve the withdrawal of drugs, fluids and food, and the administration of powerful pain relief medication. The Government has ordered a review of the pathway amid these concerns and cases in which families claim they were not consulted when food and fluids were withheld from patients.
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Professor Patrick Pullicino, consultant neurologist at East Kent Hospitals, revealed his fears about the use of the Liverpool Care Pathway to The Sunday Telegraph, describing how one of his patients survived for 14 months after being discharged from it.
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Crucially, his case raises concerns over the ability of doctors to objectively forecast death, and whether halting treatment and sustenance speeds up dying.
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Prof Pullicino?s patient, pensioner Sammy di Francisci, had his feeding, medication and fluids withdrawn by weekend staff at Kent and Canterbury Hospital. Neither his family nor Prof Pullicino, the consultant in charge of his care, had been informed.
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Following urgent reinstatement of his treatment on Prof Pullicino?s request, Mr di Francisci quickly recovered and was soon discharged to go home, where he enjoyed 14 months of family life before his death in March 2011.
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The neurologist believes this case highlights that the approach may be open to ?terrific abuse?, and that putting patients on the pathway can become a ?self-fulfilling prophecy?.
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Doctor allowed to carry on working despite catastrophic negligence
A surgeon is facing legal action after being allowed to carry on working for twenty years despite hospital authorities knowing he was responsible for several catastrophic blunders.
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Rob Jones, who went on to deliver to deliver Samantha and David Cameron?s baby by caesarean section in 2010, had been identified by the Royal Cornwall Hospital as having ?significant surgical incompetence?. There had been seven official reviews into Mr Jones? professional competence, while the hospital?s reports reveal that concerns had been raised about his performance on 23 separate occasions. He was finally suspended in May 2012, but only after an anonymous letter sent to David Cameron sparked a final investigation.
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The obstetrician and gynaecologist has been held accountable for a series of tragic failings, including the death of a baby in January 2010, just two days after birth.
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In 1993, the hospital paid out ?9million to the family of a baby born with brain damage after Jones failed to spot warning signs in the mother?s condition.
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Now, lawyers acting for 60 women who suffered botched surgery are preparing a multi-million-pound action against the hospital trust that employed Mr Jones from 1992 until last year.
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Midwives at the hospital, who referred to Jones as ?The Butcher?, had tried to prevent him working alone because of their fears, while colleagues had warned for years that his patients were at considerable risk. However, an internal review concluded that it would be a ?mammoth task? to compare his record with that of other surgeons.
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The case raises serious concerns about why Mr Jones was allowed to carry on working despite a catalogue of failings and claims, as well as the ways in which performance is examined within hospitals.
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Is NHS care to blame for Britain?s lagging breast cancer survival rates?
Women with breast cancer in Britain are less likely to survive three years following diagnosis than elsewhere, new research finds, casting doubt on the theory that later diagnosis is to blame for lagging survival rates.
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The proportion of women in the UK surviving at least three years after being diagnosed with breast cancer during 2000 and 2007 was 87%-89%, a similar amount as in Denmark. However, in Australia, Canada, Norway and Sweden, three-year survival increases to 91%-94%.
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It has been said that the gap in survival rates was largely down to British women being diagnosed later, either due to women failing to recognise the early symptoms or delaying in seeing their GP.
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These findings suggest that poor NHS treatment may be the differentiating factor. Furthermore, the research shows significant variation in three-year survival rates for women whose cancer was only detected when it had already spread extensively. In Britain, only 28% lived another three years, compared to 42% in Sweden.
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The research was carried out by the London School of Hygiene and Tropical Medicine, and findings have been published in the British journal of Cancer.
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Changing NHS pay and conditions could affect quality of care
The NHS will not be sustainable unless staff work longer hours, take cuts in their pay and lose holiday time, say NHS managers struggling with the pressures of rising drug costs, squeezed budgets and an ageing population.
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However, Unison argues that changing terms and conditions and moving away from national pay would ?seriously damage? industrial relations and could have a detrimental effect on quality of patient care.
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Chris Dowd, chief executive of Poole Hospital NHS Foundation and leader of the ?South West Consortium? which raised the topic of regional pay has said that NHS trusts can no longer ?bury their heads in the sand? when it comes to the thorny issue of pay, terms and conditions.
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Deeply controversial, the regional pay plan was dropped when ministers expressed their concerns; doctors and nurses are currently paid the same rates across England.
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Now, the consortium is attempting to change conditions for instance by cutting annual leave by two days, making staff work another hour each week and reducing redundancy and maternity pay.
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Changing arrangements to get more from staff while incentivising them to provide better care is essential, according to Dowd.
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Fear of reprisal discourages nurses from raising care concerns
In the wake of the Francis Report, which highlighted a lack of support for nurses who try to raise care concerns, a poll reveals that many nurses feel discouraged from speaking out.
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Almost one third (30%) of 800 nurses surveyed by Nursing Times magazine cited ?being seen as a troublemaker? as the key barrier to them raising concerns. Inaction by managers was the reason given by 23%.
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Despite these barriers, some 84% of survey respondents have raised concerns about a colleague?s ?practice or attitude?, with 23% having done so ?several times? or ?regularly?.
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The poll also raises issues about the efficacy of nurses voicing their concerns, since 52% said there had been ?no appropriate outcome? since doing so.
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Roughly half of the nurses polled said that they had faced negative consequences as a result of speaking out.
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Speaking to the BBC, Dr Peter Carter, chief executive of the Royal College of Nursing, said: ?It is extremely worrying that a large number of nurses still feel their concerns are going unheard, even worse that some have to live with the threat of reprisal.?
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A number of measures have already been implemented in the effort to protect and support whistleblowers in the NHS. These include funding for a national helpline, embedding rights in employment contracts and issuing new guidance in partnership with trade unions and employers. Ministers are now considering whether they need to ?go further? in the interests of patient safety, according to health minister Dan Poulter.
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??Communication error? leads to death of nil-by-mouth patient
Luton and Dunstable Hospital has said it ?deeply regrets? the death of a patient who died after being fed when he should have remained ?nil-by-mouth?.
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While at the hospital, John Burr,68, had been suffering a bad chest infection which required intensive care treatment. He had needed a procedure to keep his airway open and was not eating as he had problems with swallowing.
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Mr Burr had been scheduled to have an operation for a fractured hip following a fall at the hospital, with instructions given for him to have a gastric feeding tube inserted. On the day, the operation was postponed as Mr Burr was found to be anaemic. A communication error between a locum consultant and a nurse led to Mr Burr being given food.
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Lawyers acting for the Burr family said that Mr Burr choked and struggled for breath for three hours before his death. They added that he was not given any help due to a Do Not Resuscitate order in his medical notes, of which his family were unaware. No justifications were given to explain why the DNR order was deemed appropriate at a time when Mr Burr?s health seemed to be improving.
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A medical negligence claim was settled last October, with compensation secured for Mr Burr?s family.
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Luton and Dunstable Hospital NHS foundation issued a statement detailing a ?comprehensive programme of quality transformation? undergone since the incident occurred.
Photo: Hirotomo
Source: http://www.axiclaim.co.uk/medical-negligence-monday-round-up-4/
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