Almost two patients die a month on average after failings by the ambulance service, including delays or a failure to recognise the severity of symptoms, a review of coroners’ reports has found.
Coroners in England and Wales have written to ambulance services or call handlers 86 times since July 2013 warning them that they need to make changes to prevent future deaths.
Forty-eight of the warnings related to ambulance delays or problems with call handling, according to the review by Minh Alexander, a former whistleblower who now campaigns on patient safety. She said the volume of reports suggested a “significant decline in ambulance safety in recent years”.
She added: “Action is needed to rectify underfunding, related workforce and skill mix issues, and pressures on the whole NHS that spill on to ambulance services.”
Coroners have a duty to write a report under regulation 28 of the Coroners (Investigations) Regulations 2013 if it appears there is a risk of other deaths occurring in similar circumstances. Dr Alexander, a psychiatrist who raised concerns about patient deaths, produced her report by analysing section 28 reports published by the chief coroner.
A number of the reports highlight delays caused by slow handovers at A&E departments, echoing warnings from the National Audit Office earlier this year. In many cases the delay was not found to have caused the deaths but coroners were sufficiently concerned by what they heard at inquest to warn ambulance service bosses that delays could be fatal in the future.
In April, Gilva Tisshaw, assistant coroner for Brighton and Hove, wrote to South East Coast ambulance service following the death of Ronald William Bennett, warning of “serious delays in ambulances arriving at the scene of an incident as a consequence of ambulance crews being delayed at the accident and emergency department”.
There were also a number of cases involving call handlers without medical training and their computer programmes failing to recognise the severity of a situation.
In June, Elizabeth Earland, senior coroner for the Exeter and Great Devon district, wrote to South Western ambulance service after the death of Colin James Sluman, 68, who had a burst varicose vein. He called an ambulance at 1.36am, but bled to death before an ambulance arrived at 3.03am.
Dr Earland said the protocol followed by call handlers, on which they were “completely reliant”, did not recognise reports of dizziness in a patient on their own “as important triggers for a rapid response”.
An ambulance service spokeswoman said the trust had taken action to address the concerns.
Martin Flaherty, managing director of the Association of Ambulance Chief Executives, said ambulance services took coroners’ reports “extremely seriously” and would make changes in response where possible.
In 2016 English ambulances handled 10.7 million emergency calls.
Grant Benson, 21, died in a fire following a car accident in August 2014 after making a 999 call. Andrew Tweddle, senior coroner for County Durham and Darlington, wrote to the Yorkshire ambulance service after the event. He said: “It is clear from listening to the recording how frantic the driver became as the fire began and took hold.”
The car came off the road near Barnard Castle, County Durham, but the call handler at the ambulance service was based in Wakefield. She and two colleagues failed to pinpoint the crash location so an ambulance could be dispatched. The inquest heard that it was not possible to transfer responsibility for calls between emergency services, and one ambulance service could not send a vehicle from another. Emergency services attended only after a further call had been made by a passer-by.
A Yorkshire ambulance service spokeswoman said it had “taken steps to review local practice.
Not to have enough staff to diagnose patients means nurses waste more resources, and refer more patients for more investigations. The efficient GP of yesteryear, “living with uncertainty” for a period of time, saving resources by allowing the natural course of disease to take place (in 80%) seems to be dying. The result has to be more and more rationing…. Most of us are irate at the rationing of medical school places over many years. Almost all rejected applicants could have done the job. Being a Dr is about determination and staying power as much as intellectual ability. Good Communication and Cultural awareness are also important, and the imported doctors will lack this. They will then block places for our own in the future, not to mention the immoral act of taking much needed doctors from poorer countries. In addition, after 40 years of building up an exam (MRCGP) to be proud of, the college of GPs is threatened with undermining by the pragmatic need for emergency recruitment.
The National Health Service is planning to pay recruitment agencies up to £100m to find 5,000 doctors — about half of them from overseas — to plug mounting staffing gaps.The recruitment drive over the next three and a half years is intended to tackle a growing shortage of general practitioners in England, as well as fulfil a pledge by Jeremy Hunt, the health secretary, to make GPs available to the public seven days a week by 2020.The hiring is expected to start in the autumn and will enable recruitment agencies to secure about £20,000 in fees per GP, according to a contract notice published by NHS England this month.Up to eight agencies, which could include Hays, Reed, and Healthcare Locums, are due to be awarded the contracts to hire recruits collectively, with 2,000 to 3,000 of the 5,000 expected to come from overseas. The shortage of GPs in England has been caused by multiple factors, including doctors leaving the profession early because of an increasing workload linked to a rising population.The shortage predates Britain’s vote last year to leave the EU, but the Royal College of GPs said before the June general election that Brexit might exacerbate the shortfall.Gus Tugendhat, head of Tussell, a company that compiles data on public procurement, said the new recruitment contracts were the biggest tender for international hiring by the NHS since October 2014 and an example of the challenge facing the government’s post-Brexit policies.
“There is an inherent conflict between the need to hire international staff in order to maintain public services and the Brexit-related agenda of reducing immigration,” he added.“In future, if the government really is to improve its public services without relying on international recruitment, the NHS will have to invest more either in training UK nationals or in productivity-enhancing automation.”Arvind Madan, NHS England director of primary care, said most new GPs would continue to be trained in the UK but argued overseas doctors were essential to maintaining services. “The NHS has a proud history of ethically employing international medical professionals, with one in five GPs currently coming from overseas,” Dr Madan said. “This scheme will deliver new recruits to help improve services for patients and reduce some of the pressure on hard-working GPs across the country.”The hiring initiative follows a move by the government last year to increase GP funding in England by £2.4bn, to enable the recruitment of 5,000 doctors.The Royal College has warned some of the GPs working in England but born elsewhere in the EU could have to leave if their immigration status were not protected during the Brexit negotiations between the UK and Brussels.
It estimated about 2,000 of the 34,000 GPs in England are from other EU countries, and its chair, Helen Stokes-Lampard, said in May: “EU workers in general practice — and the NHS as a whole — play a vital role . . . Losing this skill and experience would be disastrous for the sustainability of our health service, and our ability to deliver the care our patients need.”A report by the National Audit Office, parliament’s spending watchdog, this year found that Health Education England, which is responsible for NHS staff training, filled 3,019 GP places out of a target of 3,250 in 2016-17. That was an increase from 2,769 in 2015-16.The NAO also warned that poor access to GPs during the working day could be fuelling pressure on hospitals’ accident and emergency units.Michelle Tempest, a partner at Candesic, a heathcare consultancy, said hiring GPs from overseas was an “expensive way of building a workforce”. “Training and retraining your own doctors is much cheaper and more efficient,” she added. The decision to pay up to £100m to recruitment agencies is likely to fuel concerns over the planned sale of NHS Professionals, a state-owned agency that oversees recruitment for a significant part of the NHS.The agency is estimated to save the NHS up to £70m a year by supplying staff more cheaply than private sector recruitment agencies.
Sir, Paul Johnson is correct to point out that we need to ask how the NHS can change for the better and to improve the way in which money is spent (“The NHS doesn’t deserve our hero worship”, Comment, Aug 25).
Nine out ten hospital trusts are in financial deficit because of increased staffing costs. There is a shortage of nurses and so they have to employ more staff (often from agencies) to comply with safety standards.
There is also a shortage of junior doctors, resulting in consultants having to act down to fill the gaps. Many doctors in training are leaving to work abroad to seek better conditions. GPs are retiring early to escape the relentless pressure and bureaucracy.
We need to retain our workforce by improving working conditions. We need to end the constant tide of blame which is heaped on those trying to provide a service.
The NHS is being asked to find £22 billion in efficiency savings while huge sums are being wasted through the present complex system of commissioning healthcare. By getting rid of this wasteful market approach, as in Scotland, and by ridding the NHS of the armies of management consultants, millions could be redirected to improve standards in primary and social care, disease prevention and hospital building.
The market sets different parts of the NHS against one another and leads to a fragmented approach rather than ensuring that all work together for the welfare of patients.
A return to a system in which healthcare is planned for a given population would ensure an integrated approach, improve care, restore professionalism, pride and satisfaction in working in the NHS.
Professor Robert Elkeles Northwood, Middx
Sir, Paul Johnson’s realistic appraisal of the NHS needs to be understood in Westminster. The NHS has become a political football, with the government claiming how wonderful it is and the opposition putting all its failings down to the government.
The truth is that NHS England is too big to manage even if it did not have the politicians, nearly 2,000 civil servants, 29 quangos and assorted lobby groups. Given all that, it is amazing the NHS is as good as it is.
Norman Lamb, the Liberal Democrat shadow health minister, has called for a cross-party NHS strategic review. Lord Saatchi has, similarly, called for a royal commission. Mr Lamb’s petition rapidly gained 83,000 supporters before the last election closed it down. The NHS has always been a vote loser for the Conservatives. Surely they should recognise the benefits to them, as well as the UK, of taking it out of politics?
Tim Ambler Cley next the Sea, Norfolk
Sir, On healthcare Paul Johnson says that “we spend a perfectly respectable amount: somewhat less than the French, Germans and Dutch, rather more than the Spanish and Italians”.
In fact the French, Germans and Dutch spend about 11 per cent of their GDP on healthcare against our 9 per cent.
However, the GDP per capita of Germany and the Netherlands is significantly higher than ours — about $42,000 and $45,000 respectively against our $40,000 — so their spending on healthcare turns out to be more like 25 per cent more than ours.
Drivers are insured by law. So should cyclists be insured by law. If it became obligatory people who drove cars could bolt on a policy addition for their bikes. If they only ride bikes, and otherwise use public transport, they would have to have a separate policy. Long term injuries due to any form of road accident (cars and bicycles) should be redressed by insurance claims. The cost should not be a burden on the state. There could be a reduction in premium for organ donors, especially those who ride motorbikes. There could be “family policies” attached to car drivers or independently. Why should the health service cover the costs of either road or cycle accidents?
Following the recent conviction of a cyclist for driving furiously and dangerously with no front brake, the letters in the Times 28th August are interesting. I have put the one I think addresses the issue in the long term, and in reality, first.
LAWS FOR CYCLISTS
Sir, Cyclists should take a riding test to demonstrate their acquaintance with the Road Traffic Act and their fitness to be on the road. They should also be required to be insured, to subject their bicycle to an annual MoT test and to display a registered licence plate.
It would also be good if cyclists made a financial contribution to the upkeep of the roads and the construction of cycle-specific features through the road fund licence tax.
Sir, The law already requires bicycles to be equipped with a bell, a reflector and front and rear lights at night (letter, Aug 25, and “Killer cyclist facing two years in jail”, News, Aug 24). However, it is the effective abandonment of road policing, relying instead on cameras — which some argue are sited to increase revenue rather than improve safety — that puts cyclists at risk, as well as those of us seeking to use the pavement safely.
Clive Fletcher-Wood Bristol
Sir, Clearly cyclists should not be using bikes that do not comply with legal brake requirements, but pedestrians also have a duty to respect road users. The increasing problem of cyclists using pavements and pedestrians more intent on their phones than watching traffic will inevitably result in tragic cases.
Sir, I too was knocked down by a reckless cyclist at the age of 44, and although I suffered severe brain damage which left me unable to work, I appreciate I’m lucky to have survived. I think the public need to be made aware of how much combined energy and weight a speeding cyclist is carrying, and the impact can be as traumatic as being hit by a car travelling at 30 mph.
The paradox of the pharmaceutical industry is that they are not getting very far nowadays, and the cost of new product development, especially in countries with a time limited patent, is such that investment is reluctant. Some companies have indicated that UK Plc should invest (and take a share in the company?) and some have retrenched. Has pharmacy research reached its end? Will any new developments be affordable in a universal system? Unfair post code and ageist selection of exclusions is already happening, and new gene therapies may only be justified to a select few.. Treating populations does not involve investment in pharmaceutical companies. The risk must be taken by investors. For most of us the quality of care, and of death is more important than more new therapies. We cannot afford these new drugs, and yet we cannot afford to ignore them. Unless we ration low cost services overtly, new pharmacy will increase the social divide.
It may not be glamorous, but Stevenage is set to become a world-leading centre for gene therapies, the new wave of pioneering treatments that hold great promise for tackling illnesses such as cancer and rare diseases.
On the outskirts of the somewhat drab Hertfordshire town, a Government-backed drug development factory is springing up that covers an area the size of the pitch at Wembley Stadium. It will house start-ups dedicated to the fast-growing branch of gene medicine, which fights illnesses by modifying genetic code.
It’s an approach that is in its earliest stages, boasting only a handful of approved treatments globally, but in clinical trials has made breakthroughs in tackling conditions as varied as leukaemia and inherited blindness. The £55m facility, first announced in George Osborne’s 2014 Budget, is a Government play for a slice of this developing market. Building work will complete within weeks and two biotech companies – Autolus and Cell Medica – have signed up for space, with several other firms in discussions.
It is exactly the kind of high-skill manufacturing the Government is desperate to promote and export, particularly ahead of Brexit. It is also likely to feature prominently when the Government’s industrial strategy is rebooted on Wednesday, with Sir John Bell, the immunologist and geneticist, set to launch the first report on how to boost the £60bn life sciences sector.
Ministers will have their work cut out as the UK has too often failed to translate medical breakthroughs into blockbusters made in Britain. An example is monoclonal antibodies, a common component of biological drugs discovered at Cambridge University in the Seventies.
It led to a Nobel Prize for the scientists involved and has since exploded into a field worth around £70bn globally today. Yet just 3,000 of the 100,000 people working in this area are in Britain. Over the past eight years the UK’s historic status as a major net exporter of medicines has been gradually dwindling.
Since 2009, every year bar one has seen a lowering of net exports of pharmaceutical products and medical devices, with the UK even becoming a net importer for the first time on record in 2014, according to UN trade data. So what barriers will industry and the Government have to overcome to make the UK a medicines manufacturing powerhouse once again?
Britain’s drug makers outlined a blueprint this week for doing just that, in a report entitled Manufacturing Vision for UK Pharma. In it they called on government to invest up to £140m to build a further three drug manufacturing “centres of excellence”, like the one in Stevenage. They also urged pharmaceutical firms to learn from their counterparts in the automotive and aerospace industries on how to partner with government and pool research and development efforts.
“It’s about trying to grow the medicine footprint in the UK,” says Andy Evans, chairman of the organisation behind the report, the Medicine Manufacturing Industry Partnership, and head of FTSE 100 giant AstraZeneca’s 3,500-strong Macclesfield drugs manufacturing site.
“These facilities will act as a bridge between the science and getting products to market,” Evans adds. He says public sector contribution is essential to “share risk” and to enable SMEs to access facilities.
Both the Government and industry will be hoping to replicate the UK’s early wins in gene therapy, a field now boasting 60 firms with £1bn investment behind them. Among them is Oxford BioMedica, a company that has developed a novel lentiviral delivery mechanism for modifying genes.
The AIM-listed firm’s market value has jumped by almost three quarters since June thanks to its partnership with Swiss conglomerate Novartis, which got provisional approval for a landmark gene therapy for leukaemia. All of Oxford BioMedica’s operations remain in Oxford.
“We have looked extensively at other countries,” John Dawson, its chief executive, says. “But we are happy with what we’ve got. We’ve had a very good run of being supported by government.” That support has included millions of pounds of research grants.
Keith Thompson, chief executive of the Cell & Gene Therapy Catapult, the Government body behind the Stevenage facility, says: “We’re hoping that when companies grow out of using the facility and need a bigger place, they’ll simply build it down the road.”
Sceptics point out that a broader package of policies will be needed to compete with rival countries.
Dr Tobias Silberzahn, a partner at consultancy McKinsey & Company, said: “What’s the skill level, salary level, unrest potential, how do salaries develop, how is the tech scene, and what special incentives are offered from government?”
He adds: “If the UK wants to attract more drug manufacturing they need to look at their tax breaks and other financial incentives.”
Industry experts note policy has been moving in the right direction, with corporation tax falling and initiatives like the patent box scheme – offering a reduced tax rate on UK and European patented products – providing incentives. But all these considerations ignore the Brexit elephant in the room.
Last month, Pascal Soriot, AstraZeneca’s chief executive, said all its new capital investment was on hold due to the current uncertainty, although it is expected to commit to a “mid-size” project in Macclesfield. John Rountree, a consultant at Novasecta, which advises both UK and European firms, says his clients are generally putting capital spending on hold.
“With supply chains across different countries, if there are extra barriers and paperwork clearly that will be a deterrent.”
One company that remains a firm believer in UK drugmaking is GW Pharma. The company – which develops treatments derived from the cannabis plant to alleviate the symptoms of MS and epilepsy – grows, processes and purifies all its cannabis in the UK.
While the firm moved its listing from London to New York last year for funding reasons, Adam George, managing director, says: “We are proud to be a UK company, and we’re scaling up. We plan to create 70 jobs next year and to invest £50m in capital over the next three years.”
This bullishness is something the Government is hoping to foster more of.
Campaigners say freedom of information requests to NHS trusts and government have been turned down
Yes, we have to ration services. Don’t deny it, but accept and discuss how. Unfortunately short term time horizons mean politicians work out that they will lose more votes in honesty than they win.
The NHS has been accused of keeping the public in the dark about controversial plans to plug a £250m funding gap by rationing services.
The crowdfunded campaign group 38 Degrees submitted freedom of information (FOI) requests to the government, NHS leaders as well as trusts and clinical commissioning groups in the 13 areas affected but all except two refused to release details of planned changes.
Leaked proposals from three areas have already revealed plans including downgrading or closing A&Es and extending waiting times for operations, and 38 Degrees says the public is entitled to know what else is in store…..
…The Guardian revealed in June the threat of closures and increased waiting times under proposals to save £183m across five London boroughs under the CEP programme. There is also concern that cancer treatment may be delayed if the NHS in Cheshire reduces the number of diagnostic endoscopies it undertakes by 25%, and that patients in east Surrey and Sussex may be denied angiograms and angioplasty surgery as part of the CEP savings drive.
An NHS England spokesman accused 38 Degrees of “a rehash of months-old claims”. He added: “The NHS has always had to live within the budget that parliament allocates, and the usual requirements for public consultation on any suggested major service reconfigurations of course continue to apply. However, it’s grossly unfair if a small number of areas in effect take more than their fair share at the expense of other people’s hospital services, GP care and mental health clinics elsewhere in the country.”
…The evidence just does not support the contention that we have the best health service. Suggesting we run healthcare better than anyone else because we do it better than the Americans is rather like saying we have the best parliamentary democracy in the world because we do things better than the North Koreans. Other models are available.
Here is the first headline finding from the OECD’s most recent set of international comparisons: “While access to care is good, the quality of care in the United Kingdom is uneven and continues to lag behind that in many other OECD countries”. That is borne out across a wide range of measures. Overall life expectancy is no more than middling. We are in the bottom third of comparable countries for cancer survival rates and in the middle third for strokes and heart attacks. In an understatement of which we British might be proud, this Paris-based organisation concludes “the UK does not excel at providing high-quality acute care”.
This is not because we have healthcare professionals who are any less dedicated than those in other countries. We do not lack will, effort, compassion. And of course we do some things well. Survival rates from cancers, strokes and heart attacks are improving, albeit from a low base. Our performance on breast and cervical screening as well as vaccination is better than most. And on many measures of efficiency, such as spending on drugs and length of hospital stays, we perform well. Yet for all that dedication and compassion, for a wealthy nation we have no more than a fair to middling health system. Some bits are good, many much less so…..
As recent work from the Nuffield Trust has shown, this is not because we spend much less than others on health. Across developed nations as a whole, and against wealthy EU nations, we spend a perfectly respectable amount: somewhat less than the French, Germans and Dutch, rather more than the Spanish and Italians….
In the first six months of this year, almost 100,000 permanent residence cards were issued to EU citizens who have been in the UK for five years.
The ONS bulletin showed that the number of EU citizens leaving the UK increased by 33,000 year-on-year to 122,000, the highest outflow for nearly a decade. There was a rise of 17,000 in departures of migrants from the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia and Slovenia, the countries that joined the EU in 2004. There was also a 19,000 fall in the numbers arriving from the EU, although the ONS said that this was not “statistically significant”.
Total EU net migration was estimated at 127,000, a dip of 51,000 on the previous 12 months. The figure for migration from the rest of the world was also down, by 14,000 to 179,000, and included 87,000 students, according to the ONS.
Sir Vince Cable, the Liberal Democrat leader, said that the figures showed a “deeply worrying Brexodus of EU citizens who have made the UK their home”.
Some business leaders expressed alarm at the drop in numbers. A spokesman for the Institute of Directors said: “Given unemployment is currently at its lowest level ever, without the three million EU citizens living here the UK would have an acute labour shortage.”
Brandon Lewis, the immigration minister, called the figures “encouraging” but added: “There is still more work to do to bring net migration down further to sustainable levels.”
Migrants from the EEA pay about six times more in tax and national insurance contributions than they take out in benefits and tax credits, HMRC figures released yesterday showed.