Wednesday, March 25, 2009

Children's lives put at risk by poor care at specialist British hospital

Children's lives were put at risk by the poor standard of care at a specialist hospital, according to the second damning report into health provision to be published this week.

An investigation by the Healthcare Commission found that there was a shortage of beds at Birmingham Children's Hospital NHS Foundation Trust as managers "struggled" to meet rising demand for treatment. This meant that seriously ill young people were admitted late while others were sent to different hospitals miles away from their families. Surgeons warned that theatre staff were poorly trained, handed them the wrong instruments and even knocked their hands during critical operations.

In addition, managers failed to act when they were warned of the dangers by consultants, the report said. Paul O'Connor, the hospital's chief executive, resigned two weeks ago.

It comes just days after another report by the watchdog found that as many as 1,200 patients may have died needlessly at Mid-Staffordshire NHS Foundation Trust, as managers put targets and cost-cutting ahead of care.

Describing the situation in Birmingham, Anna Walker, the chief executive of the Healthcare Commission, said: "While we have no evidence of serious incidents causing harm to patients, the standard of care has not been as good as it should have been in some cases. "The response to safety concerns has been slower than ideal. It is deeply concerning that serious issues were raised but not properly or rapidly addressed over several months. While I would not say there were 'third-world' conditions, there were serious potential risks in the way care was provided."

Birmingham Children's Hospital is one of only four specialist hospitals for young people in England, caring for 140,000 patients in 2007-8. Last year it was rated "excellent" for use of resources by the Healthcare Commission although only "fair" in terms of quality of services.

Senior staff at nearby University Hospital Birmingham NHS Foundation Trust met managers from the children's hospital last June to discuss their concerns about standards of care. They then wrote a highly critical report that was obtained by a Sunday newspaper under the Freedom of Information Act before it had even been seen by the children's hospital, prompting the Government to order an official investigation in December.

The Healthcare Commission found that because of increasing demand for treatment at the hospital, average bed occupancy was running at more than 98 per cent. This led to 28 per cent of admissions being cancelled on the day and 70 children a month being sent to other hospitals for treatment because there was no room for them in Birmingham. The report said this is a "special concern" for patients with liver problems, who need to be seen urgently.

Many members of staff also warned it was "very challenging" to get access to operating theatres for urgent but not life-threatening cases. There are only two days on which neurosurgery sessions take place, meaning that children admitted after Wednesday have to wait until the following Monday for treatment unless they are put on the emergency list. This situation was said to have led to several "near misses" and was a risk to patients.

The watchdog found that "almost all" consultants were worried that they could not use interventional radiology to diagnose patients because demand was so high. Surgeons said theatre staff did not always know what instruments were required for operations, and sometimes consultants brought their own equipment because the hospital did not have it. Leadership of the neurosurgical ward was said to be inadequate, driving nurses to resign.

The watchdog concluded that it was "deeply concerning" that serious concerns had been raised but not dealt with properly, causing "alarm and anxiety" among patients and their families. It made 12 recommendations about how the children's hospital can improve, including monitoring demand better and working on its relationships with consultants.


More NHS authoritarianism

SOME NHS hospitals are banning mothers from collecting umbilical cord blood from their babies to use as a possible source for their future medical treatment. Parents seeking to reserve the blood for themselves so that they can derive stems cells from it in the future are being told they must instead donate it to public blood banks.

The alternative is to give birth in private hospitals, which are prepared to reserve it for the child's or family's own use. A family's chance of a successful treatment with the stem cells is much higher if there is a personal match. Doctors have already used such cells to treat children with leukaemia and believe they could cure many common conditions in the future.

The row highlights the growing tension between individuals' desire to pay for advanced treatment for their own families and the state's duty to provide free healthcare for all.

King's College hospital in south London and Watford General in Hertfordshire have banned parents from collecting stem cells from the umbilical cord blood even if they hire a private technician to carry out the procedure. Watford General asks women to give to the NHS cord blood bank and King's College encourages women to give the blood to the Anthony Nolan Trust. Other trusts, such as Wirral University teaching hospital and University College London hospital, ban personal collection of stem cells but do not donate to public banks. If the women donate to the public banks, the stem cells become available for whoever is a suitable match.

Shamshad Ahmed, managing director of Smart Cells, a commercial stem cell bank storing families' personal supplies, said: "It is an injustice that certain hospitals will participate in the collection of umbilical cord blood if parents agree to give it away to a public bank but not for their own use. "It is clear these hospitals believe in the technology but are denying individuals this important opportunity to store their own baby's stem cells."

The NHS cord blood bank website compares the advantages and disadvantages of private versus public cord blood storage but it suggests women have a choice. It says: "A public donation is made as a purely altruistic act, solely for the benefit of others. It has the potential to save the life of any person for whom the unit is a good match, including the person who donated it, if it is still available. Private cord banks store a unit solely for use by the donor or their family."

Sophie Isachen, 37, from southeast London, has a history of illness in her family and her younger sister, Rosalind, died aged 26 from a rare blood disorder. Her parents offered to pay 1,600 pounds to store the umbilical cord blood stem cells from her daughter, Freya, when she was born in December. King's College hospital refused to allow the collection. Isachen said: "We decided to go down the private route because of a family history of illness. My parents were going to pay for this because, tragically, my sister died at an early age. "We are in the fortunate position that we can afford it but the unfortunate position that we have a medical history that would make us think it is something that could help us."

A spokesman for King's College hospital said: "At King's, all donations of cord blood are made on an altruistic basis. We are committed to the scheme and the potential it has to help save the lives of thousands of people in need of stem-cell transplants."


No comments: