Friday, April 17, 2009

The NHS killed my mother: MP Nigel Evans reveals how a routine operation ended in horror

Total indifference to patient welfare

The last, harrowing moments of my mother's life will live for ever in the collective memory of my family. An 86-year-old lady of infinite grace and dignity, she had the most agonising of deaths. Lying bewildered and distressed in an NHS hospital bed, her body racked with pain, she kept desperately grabbing at the air with her hands as if she was drowning, while all the time being violently ill.

'It was torture, worse than a horror film. We felt so helpless,' says my sister, Louise, who witnessed the tragic scene. But it should never have been like this. My dear mother should have been able to depart this earth in serenity and peace, not forced to go through such a traumatic experience. The reasons for her ordeal can, I believe, be found in a mixture of neglect, incompetence and indifference shown by the NHS.

For my mother died of the notorious superbug Clostridium difficile, known as C.diff, which she must have contracted while undergoing hospital treatment in Swansea. If she had been cared for properly, if the ward had been cleaner or greater urgency had been shown in handling her case, then this tragedy might never have happened.

The NHS is often a saviour, but it can also be a killer. What happened to my mother is all too common in the health service. There were 8,324 deaths from C.diff in 2007, with most of the victims elderly people. That statistic is too high for a 21st century healthcare system in an advanced industrialised country. Moreover, an estimated 59,000 people in this country are disabled or die because of poor hygiene or care in our hospitals.

Even the essentials, such as providing patients with sufficient fluids or cleaning bathrooms properly, are neglected. That is why I am campaigning for drastic improvements in the basics of healthcare in the NHS, so deaths from C.diff and other superbugs can be eliminated. I have demanded an investigation into the circumstances surrounding my mother's death at the Singleton Hospital in Swansea, but I also want the lessons of this episode to be learned much more widely, so that Britain has a health service that meets the needs of its users, not one that carries the risk of killing them.

My mother's case encapsulates the best and worst of the NHS. On one hand, she had the highest quality treatment from a leading surgeon after she was diagnosed with cancer of the oesophagus. On the other, when she returned to hospital for a routine operation - unconnected with the cancer - she received nothing like the same expert, attentive care. That is almost certainly why she contracted C.diff and why medical staff were too slow in responding to symptoms. It seems as if there is a deep contradiction within the NHS, pulling the service in two directions. We have phenomenal advances in drugs, medical technology and surgery, which can conquer-disease and prolong life in a way that would have been revolutionary only two decades ago. Yet, at the same time, we have abandoned the most basic standards of hygiene and care.

My mother deserved better from the NHS. Determined, kind and diligent, she was a pillar of strength, not just to my family but to the community in her area of Swansea, where she and my late father ran a newsagent's shop. After my father died, she carried on working until she was 85. She was a wonderful mother, instilling her strong sense of morality in me and my siblings and giving us the best possible education. With her ethic of service, she was the reason I became involved in politics. Her unwavering maternal devotion was a tremendous source of support. Whenever I became disillusioned, she urged me to keep going, and I became Conservative MP for the Ribble Valley in Lancashire. Now she is gone - and in the grimmest way imaginable.

The heart-breaking saga began at Christmas, when we noticed she was not her usual cheerful self, had lost her appetite and complained about not being able to swallow properly. We arranged for her to undergo tests. Cancer of the oesophagus was diagnosed quickly. She was in the care of James Manson, an excellent specialist at the Singleton Hospital. I was aware of Mr Manson's brilliant work because 11 years earlier he'd operated on my brother to combat oesophageal cancer. The prognosis for my brother had been bleak, yet more than a decade later, he is still with us - a tribute to Mr Manson's skill.

The same wonders were performed on my mother. After an initial failed attempt to fit a stent in her throat to push back the tumour, he refused to give up and tried again. The second procedure was a success, and Mr Manson told my sister Louise that the tumour was 'not as bad as I thought'. Radiating confidence, he said there was no reason why my mother could not live another two years or more. So when she returned home, the family was in a positive frame of mind. But then the real problems started - and they were nothing to do with cancer.

In March, my mother had to go into the Singleton Hospital again for the removal of a gallstone. It was the most routine of operations and initially appeared to have been a success. But during her overnight stay in hospital, she developed a high temperature, so bedclothes were removed and a window opened to try to cool her. The next day, Wednesday, March 18, she was discharged.

What surprised me was that she was sent home without having seen a doctor. A nurse gave her approval for the discharge. Just as disturbing were my sisters' reports of the lack of hygiene in the hospital. There was litter under my mother's bed, and the toilets did not seem to have been cleaned properly.

Though we were told the gallstone removal had been a success, my mother was not well, complaining of severe stomach pains. Her distress was all the more difficult to watch because she was not a woman to complain. But her condition was so bad by Friday that my sister Louise decided she had to be brought back to hospital. There, she was rehydrated intravenously and given painkillers, anti-sickness tablets and some laxatives, the last a rather odd choice given that she had not complained of bowel problems.

Discharged once more, she seemed much better on Saturday. But then she deteriorated rapidly. That Sunday, Mother's Day, she was quiet and had lost her appetite. Then on Monday, she had the first bouts of chronic sickness and diarrhoea that were to plague her last days. At first, my sister thought her quietness and disturbed stomach were related to nerves at having to embark on the first radiotherapy session for her cancer that day. But her condition was too serious for this to be the explanation. On Tuesday, she was so weak she could hardly walk down the stairs.

After further consultation with the GP, more anti-sickness tablets were prescribed, but they did not alleviate the problems. Yet even in the midst of her suffering, she retained her stoical outlook, apologising to my sister for the inconvenience she'd caused. But something urgent had to be done as her decline accelerated.

On Thursday, my sister called an ambulance. The paramedics who took her to hospital treated her with great tenderness. It is an indicator of the respect and affection in which she was held by the local community that they knew her well, having often visited her newsagent's shop. On the ambulance's arrival at the Singleton, there was at first no bed available, so my mother was asked to wait in the ambulance while one was found. Again, the paramedics could not have been more sympathetic. But the same cannot be said of all the staff at the Singleton. Though she was admitted to the hospital in the morning and soon underwent tests, my sisters were not properly consulted until late afternoon.

First, they saw one oncologist, who asked a series of questions about her recent medical history. Then they saw another and had to run through the same routine again. This second oncologist seemed off-hand and evasive. At one stage, she had an extraordinary exchange with Louise, telling her it would be 'inappropriate' to admit my mother to intensive care 'because of her condition'. 'What condition is that?' asked Louise. 'Her inoperable cancer.' 'But Mr Manson has fitted a stent. He says she may live for two years or more.' 'Perhaps he's being optimistic.' 'Mr Manson is a realist, not an optimist,' she replied.

This conversation was all too indicative of the cold, impatient, fatalistic way my mother's case was handled that last night. It is bizarre that it was not until the early evening that the hospital finally revealed she had C.diff and therefore began treatment. Here she was, a sick 86-year-old on her third hospital visit in nine days, yet nothing had been done to check the most likely cause of her condition. It would have been easy, after her first difficult night following the gallstone operation, to carry out a check for C.diff. Even on that last day, the hospital could have moved more quickly, instead of leaving her for almost nine hours without acting.

The indifference carried on through the night. My sisters were not made aware of how lethally serious the situation was. That is why I was not urged to come down from Westminster. It was in the early hours of Friday that the last anguish descended, as the full effect of the virus tightened its grip and my dear mother began to choke. Shaken, my sisters did all they could to help, receiving little support from staff.

Suddenly, they were ushered to a side-room by a doctor. There he asked if they had 'ever discussed resuscitation' with my mother. It was a bewildering question. If my mother was at death's door, surely the doctor should have been trying to save her, rather than indulging in a debate? While they were with the doctor, my mother passed away. Yet even then, they were not told she had died. They were merely informed that they could go and 'sit with her'. If they had known that my mother was in her death throes, they would never have left her.

This is not the way such cases should be handled. Families must be kept informed. Early, routine tests for C.diff must be carried out. And, above all, hospitals need to be cleaned up. Progress in medicine is useless if the basics are going wrong. If we can achieve improvements here, then my mother will have left a legacy to be treasured.

A spokesman for Singleton Hospital said they met Nigel Evans and his family and are more than happy to look into the questions raised and provide a full response to them.

With regard to Mrs Evans's care, they confirmed that she was taken in as an emergency patient 'when she was promptly assessed, treated and monitored by a number of medical staff, including surgeons. Sadly, she died a few hours later'.


Australia: Royal North Shore Hospital in trouble still

Firetrap fears for children at NSW government hospital

SICK children are being treated in the maternity unit of a major hospital because its children's ward is still a firetrap. More than a year after the children's ward at Royal North Shore Hospital was deemed a deathtrap, The Daily Telegraph can reveal that the hospital has been forced to set up a makeshift children's ward. It is also still treating children in its children's ward, which was deemed a deathtrap by fire investigators. Sources told The Daily Telegraph that about half the beds in the children's ward had been moved to the maternity unit because airconditioning vents still had not been coated with fire retardant.

It is the latest bungle to hit the trouble-plagued hospital and its $1 billion upgrade. A fire brigade's inspection exposed the safety risk in April last year, yet yesterday the safety upgrade still had not been completed.

Children had also been allowed to remain in the ward despite work going on there. Others were moved to a part of the maternity unit, fenced off by a makeshift plywood gate with a piece of A4 paper stuck to it reading "Children's Ward".

The mother of a child recently discharged from the hospital told The Daily Telegraph she was shocked to learn of the arrangements and would have taken her sick baby elsewhere had she known. Brianna Casey took her six-month-old baby Oliver Herngren to Royal North Shore with bronchialitis, a viral disease particularly dangerous to children under a year old. Ms Casey was shocked to discover Oliver was put into the maternity ward. "They couldn't find a bed for us upstairs in the children's ward," she said.

Ms Casey said that while staff had done the best they could, the area seemed completely inappropriate. They even had to bring down a cot for her son. "There's no equipment. This place is a joke," she said.

It is understood that when the ward was handed over by builders in 2003 it complied with fire safety regulations. However, the rules have been tightened since then and the building has not been upgraded accordingly. At least 15,000 children pass through the hospital's emergency department every year.


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