Wed

03

Jul

2013

Mid Staffs, Morecambe Bay and Cumbria patient care tragedies may be legacy of New Labour’s NHS targets

New Labour’s NHS targets for patient care may be an underlying factor in a series of scandals surrounding NHS hospital trusts.

 

The Francis report into excessive death rates and failures in patient care at Mid Staffs trust found that the Department of Health had been too remote in its management of the NHS – and had introduced organisational changes which were counterproductive to patient care.

 

An excessive death rate among Mid Staffs patients admitted as emergencies had been investigated by the Healthcare Commission in 2008 – and after the report was published in 2009, New Labour Health Secretary Andy Burnham ordered a public inquiry into the trust.

 

This fell to the Coalition to launch in 2010 and earlier this year the Francis report made a series of damning conclusions about a lack of compassion and care, which had led to the excessive death rate and appalling instances of patient neglect at Mid Staffs.

 

Some patients had been forced to drink water from flower vases after being left thirsty – while others went hungry after meals were left out of their reach. Inexperienced junior doctors were left to make life or death decisions in critical care – and nurses were allowed to use life changing medical equipment without proper training. Patients had been found crying for help on the wards – and others were left without vital pain relief, causing them agonising discomfort.

 

Some families received an average compensation payout of £11,000 for the loss of their loved ones – many still question how such an uncaring and compassionless culture could have arisen in the NHS, with data on failings and abnormal death rates being suppressed rather than flagged up as a cause for concern.

 

The Francis report has called for such cover ups to face criminal charges – and for doctors to be more transparent when mistakes in patient care occur.

 

The Royal College of Nursing was also criticised for failing to support nursing staff who tried to flag up failings in patient care at their own trusts.

 

Recently an inquiry into mother and baby deaths at Furness General Hospital in Cumbria has reawakened concerns over the standard of patient care in the health service – and the Met Police have been asked to investigate an alleged cover up relating to baby deaths at Morecambe Bay NHS trust.

 

Under New Labour, NHS trusts were set targets for the amount of time doctors could spent with emergency admission patients, with a four-hour limit being set from admission to A&E to discharge after treatment or admission to a ward as an inpatient.

 

Many trusts struggled to achieve the targets, with the result that failings were not reported and were even “covered up” so hospitals would not lose their “star rating” – another NHS performance incentive introduced by New Labour.

 

The Francis report has now called for compassion to be placed first in the recruitment, training and education of nursing staff.

 

The main witness at the Mid Staffs inquiry was the trust’s then chief executive Sir David Nicholson – now CEO of the NHS.

 

During the public inquiry led by Robert Francis QC, Sir David claimed that the failings in patient care at Mid Staffs did not constitute a systemic failure in the NHS as it was only hospital involved in such a scandal.

 

Counsel for the inquiry called his statement “naïve” and “dangerous” – and Sir David is set to step down from his NHS post by March 2014.

 

However, Sir David is credited with hauling the NHS out of a £1bn debt in 2006 and with tackling the hospital-acquired infections outbreak in 2007 – and has remained at the NHS helm under the Coalition government as a result.

 

Many families continue to ask themselves how their loved ones could have died at Mid Staffs in the care of staff supposed to help them – and whether the inquiries into Cumbria and Morecambe Bay NHS trusts will open the floodgates to yet more cover ups over patient care in the health service.

 

Presenting his report into Mid Staffs NHS trust, Robert Francis QC said:

 

“People must always come before numbers. Individual patients and their treatment are what really matters. Statistics, benchmarks and action plans are tools not ends in themselves. They should not come before patients and their experiences. This is what must be remembered by all those who design and implement policy for the NHS.”

 

Despite his findings, he also concluded that Mid Staffs NHS hospital not be closed.

 

More information on the Mid Staffs Hospital Scandal here.

 

131 Comments

Mon

24

Jun

2013

Coping with cerebral palsy

For adults with cerebral palsy there are many organisations which can offer support and help with leading as normal a life as possible.

 

Because the range of symptoms and severity of cerebral palsy vary so much, young adults and older adults can have a wide range of needs – and even in residential care there need to be options available which help cerebral palsy patients develop interests and skills and make the most of their lives as much as possible.


For parents with children at school, making sure they receive any help available is paramount. Special Educational Needs (SEN) statementing can ensure that extra help at school or in the home – or help with transport to and from school – is put in place. Check out the government’s own website GOV.UK for more information about statementing.


Contacting an education solicitor can help take some of the stress from parents who have to apply for statementing and may have to make an appeal.


For young adults with cerebral palsy who wish to attend college, there may be organisations which can offer support while they are studying. The Bristol-based charity Cerebral Palsy Plus works with families with children who have cerebral palsy, as well as adults to make sure they can enjoy a life which is as independent as possible. The Full Circle Foundation in Glasgow also supports young adults and runs classes in music and technology, plus speech and communication to help young adults socialise when they embark on a course of study. The charity Scope can help you find an organisation in your area to support families caring for a child with cerebral palsy, or help young adults with cerebral palsy gain their independence. Headway also offers support to people with cerebral palsy and other types of brain injury.


Cerebral palsy can leave you with a range of challenging physical conditions, but it is important to make the most of your life and enjoy as many different activities as you can. Outreach groups can help bring you into contact with others who have cerebral palsy so that you can establish and maintain a social life.


The website Disability Direct has a list of organisations and groups which can offer services to people with disabilities, including cerebral palsy. Some of the listings offer discussion forums where you can meet up online with others who have cerebral palsy and a range of physical disabilities. There are also sections on benefits, publications, carers and disability services.

The website Ableize.com also a large compendium of local and regional disability groups and clubs in the UK, which is updated regularly and also contains details of sports clubs and other activities for disabled adults and children.


People with cerebral palsy can also get help with driving a car and adapting it to suit their particular needs. Ricability offers research and information for older and disabled people and has an online consumer guide for motorists with cerebral palsy with advice on buying and adapting a car. The guide shows you how to buy a car and also has useful advice on topics like how to get your wheelchair into the back, as well as the best way to get yourself out of the front seat safely. There is also a section on the legalities of driving for people with cerebral palsy.


If you are disabled and would like to go on holiday, the Disabled Holiday Directory has a wide range of accessible holiday accommodation in the UK and abroad – and also offers information on cruises for those with disabilities. The company guarantees holidaymakers will be allocated hotel rooms with specially adapted facilities.


Disability Travel UK also offers holidays for disabled people and those who use wheelchairs – and these include city breaks and trips for disabled holidaymakers to Africa and Europe, as well as Florida.


Finally, if you have cerebral palsy or another disability and are looking to meet someone special, there are now lots of dating sites online for people with cerebral palsy and other disabilities. Flirtbox UK has a section of posts from people of all ages and backgrounds with cerebral palsy looking to find new friends and maybe more – and there is also Cerebral Palsy.com.

 

If you or a member of your family requires brain injury support or rehabilitation, or is seeking advice in any of the areas discussed, contact us today.

206 Comments

Wed

29

May

2013

Will your child need a special educational needs statement?

Children with brain injury conditions often need extra support in education –and how your child can be helped will be set out by the Local Educational Authority (LEA) in a Special Educational Needs (SEN) statement. This is also sometimes called a statement of special needs and is updated every school year to take into account a child’s changing needs as they grow.

 

SEN could offer extra help with certain subjects or aspects of school life, as well as making provision for help with travelling to or from school – or even being educated at home or receiving extra help with education at home from a specialist tutor.


The sort of children who might need the extra support of an SEN statement include:

  •         Children with brain injury
  •         Children with physical disability
  •         Children with a specific difficulty (eg speech, hearing, sight impairment)
  •         Children who are exceptionally gifted
  •         Children who have suffered long-term illness
  •         Children who suffer social isolation or who find social interaction difficult (eg children with autism)
  •         Children with learning difficulties (for example, dyslexia)
  •         Children with social difficulties (eg attention deficit hyperactivity disorder or ADHD)
  •         Children with an interrupted education (eg as a result of travelling).

 

It is important to discuss with your child’s health team and therapists as well as teachers exactly what their needs are – and might be in the future – before deciding whether an SEN statement would be appropriate.


Every school has a member of staff who is responsible for children with SEN at the school and they referred to as the SENCO (SEN co-ordinator). Discussing your child’s needs with this staff member can help you find out what support would be available – and whether there are other educational support issues you may have overlooked regarding your child (eg they may have difficulties with written work or numeracy which you may not be aware of). The SENCO member of staff at a school will use the SENCO Code of Practice to assess your child’s needs and decide whether they do need an SEN statement.


Sometimes it can be hard for parents to learn about their child’s needs from a teacher and so it is also important to remember that making an objective appraisal of the help your child needs is the best way of helping them achieve their full potential and happiness in the future – try and remain calm about the process, as addressing any issues is not a criticism of your child.


The SEN statement sets out the ways in which your child will be helped and supported, either at school or at home – eg specially adapted computer equipment or equipment to enable deaf/blind or physically disabled children to use a computer.


Parents can state on the application form which school they would like their child to attend. Sometimes schools offering certain therapies or specialist teaching methods which may suit a child’s needs better than a mainstream school. Attending this school could mean additional travelling costs or find a means of transportation to the school.


If you child has a special need which local schools in your school catchment area might not be able to address as well as a school outside the normal school catchment area, the SEN application offers parents the chance to opt for the school they prefer for their child – although there is no guarantee that the LEA will accept this and again, an appeal might be necessary.


Obviously there is enormous competition for the extra support which an SEN statement offers – and parents may find they may have to appeal if their application for SEN is not accepted in full, or is even rejected.


Your local Parent Partnership Service will be able to advise on SEN statements and the best course for your child.  You can also search online for the Parent Partnership Service nearest to you.


With young or pre-school children, the first step to making an application for SEN is to speak to your GP about their needs and any concerns you have about their development or learning skills. You may have noticed your child is not as advanced in some ways as their peers – this does not necessarily mean they are having difficulties or will need an SEN statement; but the earlier you address any issues, the better the outcome for your child.


Children do progress at their own rate, however, and your GP will be able to help you with any concerns you may have.

Specialist children’s lawyers can also offer advice to parents who need help in making an SEN application or whose application has been turned down or amended.


More information about SEN statements is available from the government’s website GOV.UK.


If you child has a disability, the website Parents of Children With Disabilities offers useful advice about SEN statements in its user forum and details of how statementing can help children with physical disability and brain injury.

 

50 Comments

Fri

10

May

2013

Definition of birth injuries to babies

Birth injuries to new-borns are fortunately extremely rare, but even a forceps delivery may cause some trauma such as bruising or a head/brain injury if care is not taken by medical staff. More serious birth injuries involving brain injury can occur if the baby is starved of oxygen during delivery. This can happen if a delivery is delayed, an emergency Caesarean does not take place when needed urgently – or the umbilical cord is wrapped round the baby’s neck at birth and starves the baby of oxygen for a period of time.

 

The Apgar score test is used to test a baby’s appearance, breathing and reflexes one minute after birth and again five minutes after birth. It is also performed 10 minutes after birth if the initial scores cause concern. A score of around five might indicate your baby needs a little support such as help with breathing and this would be usual if a baby were premature or of low birth weight.


There are recognised birth injuries, however, among new-borns and sometimes these result in personal injury claims if the injury could have been avoided or occurred as the result of medical negligence.


Some widely accepted birth injuries include:

  • ·         Asphyxia (lack of oxygen)
  • ·         Bell’s palsy (injury to facial nerve causing drop in features on one side of the face – usually heals itself)
  • ·         Cerebral palsy (brain injury causing movement dysfunction, epilepsy and hearing or visual problems)
  • ·         Head or facial injuries (eg after forceps delivery)
  • ·         Nerve damage
  • Bone fractures
  • Brachial plexus injury (damage to nerves operating shoulders, hands and arms)
  • Caput succedaneum (swollen head tissues)
  • Cephalhaematoma (bleeding between the skull and periosteum which usually heals itself )
  • Cranial nerve injury (damage to one of the12 cranial nerves – usually the facial nerve causing asymmetrical facial reactions and movements)
  • Intracranial haemorrhage (bleeding round the brain caused by traumatic birth eg if baby is too large or delivery to a first-time mother)
  • Neck injury
  • Peripheral nerve damage (nerve damage which extends to surrounding tissues)
  • Spinal cord injury (from minor to severe cases leading to paralysis or partial paralysis or movement problems)
  • Sternocleidomastoid haematoma (also known as congenital torticollis, baby’s head is twisted round to one side during delivery)
  • Subaponeurotic haemorrhage (serious brain haemorrhage requiring urgent blood transfusion)
  • Subgaleal haematoma (swollen head tissues and blood clots after vacuum suction delivery).

 

Birth injuries can occur in a wide range of circumstances – and not all of them may be the result of medical negligence.

Breech births – when the baby is in the wrong position – can be rectified before delivery, but sometimes babies may just turn themselves round again. Breech babies are sometimes the result of a twin conception when only one twin survives the pregnancy and the other may fail to develop at an early stage of gestation – as many as one in 8-10 single births are thought to have started as twins. Turning baby in breech position can also mean that care needs to be taken to ensure that the umbilical cord does not become wrapped round the baby’s neck and impair breathing.


Births involving first-time mothers or mothers giving birth to large babies – or who need an emergency Caesarean – may also result in some degree of birth injury. Many birth injuries rectify themselves and are a case of bruising or minor grazes or cuts during assisted births, when forceps or vacuum extraction (VE) is required to help the delivery along, especially if the baby is in distress.


In the case of cerebral palsy, the symptoms of birth injury may not become evident for a few months after the event – and if the Apgar score was reasonable or no incidence of medical negligence can be pinpointed, then it can be very difficult to assess how the birth injury occurred.


The most commonly heard of cases involving birth injury usually relate to oxygen deprivation during birth, or at some stage during pregnancy if the mother has undergone surgery during pregnancy and was herself deprived of oxygen. This is a common cause of cerebral palsy being diagnosed shortly after birth – and the difficulties a child with severe disability as a result of brain injury or cerebral palsy may face means that compensation cases can become extremely involved.


Birth injuries may simply be caused by circumstances, however – the size and shape of a woman’s pelvic area, combined with the size of her baby and intervention by the supervising medical team can all combine to result in minor injury to a bay during delivery. Emergency Caesareans can cause injury both to mother and baby if an incision is not carefully placed or the baby is lying awkwardly in the womb. However, small nicks and grazes usually heal well and good infection control can prevent postnatal complications in mothers and babies.

 

 

45 Comments

Mon

22

Apr

2013

Definition of birth injuries to mothers

The process of giving birth should be a safe and happy experience – but sometimes things go wrong, or the delivery could have been managed better by clinical staff overseeing a birth. Thankfully serious incidents during birth are rare – but mothers who suffer emotional and physical trauma may be left unable to bond with their babies immediately and fearful of any future pregnancy or birth.

Birth injuries to mothers can involve physical trauma such as tears to the vagina, unnecessary bruising and lack of pain relief. In extreme cases, mothers may suffer adverse incidents such as stroke or even heart attack. Oxygen deprivation during birth can happen but is rare.

However, any physical trauma to a mother giving birth – and especially if urgent medical intervention or surgery is needed – can undermine what should be the happiest and most fulfilling time for a family.

This may cause long-term emotional issues, as well as further need for medical care to rectify problems. Birth injuries to mothers which could have been avoided or which result from a failure in care during pregnancy or delivery are often the subject of medical negligence claims, which can cover both the physical and emotional trauma this can cause.

The sort of physical birth injuries which women may suffer include:

• Perineal tears can occur to the area of skin between the vagina and the anus (the perineum) and are categorised according to four different levels of severity:

• 1st degree perineal tears will not usually cause long-term issues and require suturing to repair the tear and help healing

• 2nd degree perineal tears can spread further and affect muscle tissue

• 3rd/4th degree perineal tears are more severe and usually require immediate treatment, as the tear may extend as far as the anal sphincter.

Sometimes during birth an episiotomy has to be performed to enable the baby’s head or bottom to pass through the vagina. This involves making an incision in the perineum which will then be sutured after delivery.

Perineal tears are more likely to occur with larger babies and forceps deliveries, when invasive treatment takes place to help a mother deliver her baby. 

Some perineal tears occur naturally during childbirth, however, and it is important that mothers receive treatment and support in dealing with any long-term issues resulting from this.

If not treated adequately or fully, complications such as pain, infection, problems passing stools and future problems with resuming sexual relations can occur, causing enormous distress to a new mother and placing pressure on the family unit.

• Nervous shock is an umbrella term for a range of emotional and psychological conditions which can arise if a birth is physically or emotionally traumatic for a mother. Fear, anxiety, postnatal depression, post traumatic stress disorder and being unable to bond with a new baby are just some of the symptoms new mothers can suffer if a birth is not handled properly by health services and medical staff in attendance. Some traumatic situations are unavoidable, however, and may be circumstantial rather than the fault of anyone else. Nervous shock can have long-term implications for the mother and the family unit and should be addressed by GP services.

• Retained products of conception involve situations in which tissues such as the placenta are not expelled during miscarriage or delivery, causing infections, pain, discomfort and sometimes heavy bleeding. Mothers who miscarry at home need to be examined by a doctor to make sure all the tissues related to conception have been expelled by the uterus. Retained products of conception can not only cause physical problems for a woman, but add to the trauma of miscarriage or cause emotional trauma and physical discomfort after giving birth.

• Surgical instruments left inside a new mother after a Caesarean, for example, can lead to pain, infection and bleeding and mean further surgery is necessary to remove them once the problem has been diagnosed. Medical negligence such as leaving a surgical instrument inside a patient can be the subject of personal injury claims for both the physical and emotional issues which arise as a result. Diagnosis can also be difficult to obtain, as this is still a rare occurrence, meaning the patient continues to suffer discomfort unnecessarily and may not be able to work or look after their newborn and family.

 

Resource

52 Comments