Foreign doctors responsible for overdoses: NHS watchdog
Foreign doctors working as out-of-hours GPs risked the lives of patients by mistakenly giving them overdoses despite repeated warnings of the danger, a damning report has found.
An investigation into the Dr Daniel Ubani case, where the [Nigerian-born] German locum doctor killed pensioner David Gray by giving him ten times the normal dose of painkillers, has uncovered wider failings by foreign doctors.
The Care Quality Commission, which regulates health and social care, found that on at least two other occasions German doctors flying in to work for the same out of hours company as Dr Ubani administered overdoses of the same painkiller, diamorphine. Fortunately these overdoses were not fatal but neither were fully investigated.
The finding again raises questions about the skills and competence of foreign doctors covering out of hours shifts in Britain and the failure of managers to heed warnings.
The Care Quality Commission report said the competency of overseas doctors must be properly tested, serious incidents must be properly investigated and quality of care must be monitored closely.
Before the death of Mr Gray in 2008, managers at Take Care Now had failed to heed at least three warnings about the use of diamorphine.
The first came when a the National Patient Safety Agency alerted the NHS and the wider health community about the safe administration of diamorphine and potential for ovrdose.
Then senior clinician wrote to Take Care Now saying it “was only a matter of time before a patient is killed” due to an overdose of the drug.
Then in April 2007, a patient suffering severe back pain who received 30mg of diamorphine administered by German locom doctor but this was recognised as an overdose and a 999 call made.
Again, just four months later, a patient was again given 30mg of diamorphine by another German locum, when the correct dose should have been between 2.5 and 5mg.
The report said: “Take Care Now failed to recognise problems in its own systems that might have helped prevent the death of Mr Gray. It was reluctant to admit its shortcomings and provided information to the PCTs and to us that was often inaccurate or incomplete.”
Dame Jo Williams, CQC chairman, said: “Take Care Now failed on many fronts. Not only did it ignore explicit warnings about the use of diamorphine, it failed to address deep-rooted problems across its entire out-of-hours service. This had tragic consequences for Mr Gray. “Take Care Now is no longer in operation, but the lessons of its failure must resonate across the health service.”
Dr Ubani was found guilty of killing Mr Gray, 70, through negligence and has been struck off the register in Britain but is free to continue to work in Germany. He was working his first shift in Britain and was tired and unfamiliar with the drug – with is seldom used in Germany – when he administered 100mg of diamorphine to Mr Gray at his home in Cambridgeshire.
Other key failings identified in the report were:
– ‘Potentially unsafe staffing levels’ with the equivalent of eight per cent of shifts or 3,000 hours unfilled over just three months in the five primary care trust areas which employed the company.
– The company relied heavily on foreign doctors flying from Europe to work weekends, and sometimes long hours.
– Nurses and ambulance staff were brought in to cover for doctors for up to 40 per cent of shifts in some areas.
– On four occasions a nurse was the only clinician on duty for Wisbech an area covering 70 miles.
– Up to two thirds of local doctors thought Take Care Now provided a ‘poor service’.
– Take Care Now doubled the size of population it covered between 2005 and 2009 putting ‘significant strain on capacity’.
– Lack of clinical leadership at the organisation and poor staff inductions.
– Take Care Now doubled counted patients which ‘could have affected contract negotiations’.
– Take Care Now had an ‘inconsistent approach’ to investigating some deaths where system failure or clinician performance could have been an issue.
– None of the five NHS primary care trusts monitored the company correctly.
– NHS managers focused on national targets and finances because out-of-hours was not a priority.
Dame Jo added: “The Secretary of State has made it clear that there are changes around the corner. Regardless of what these changes may look like, the lessons are clear – the competency of overseas doctors must be properly tested; serious incidents must be properly investigated and quality of care must be monitored closely.”
Prof Steve Field, Chairman of the Royal College of GPs, who prepared a report into the Ubani case for government, said: “It is scandalous that doctors are allowed to work in the UK as GPs who aren’t at the same level of training as our own GP practitioners and are working in an unprofessional way when they are tired and are unsure of doses and medicines.
“There is a real danger and that danger will continue to be expressed in the deaths of patients until someone takes it seriously.”
Since the investigation Take Care Now has been taken over by another out-of-hours provider, Harmoni. However Harmoni does not provide out of hours cover for East Cambridge and Fenland, which was the primary care trust in question in the Ubani case.
Primary care trusts in Worcestershire, Suffolk, Great Yarmouth and Waveney and South West Essex also used Take Care Now and were investigated by the Care Quality Commission.
The General Medical Council which registers doctors to work in Britain is frustrated at European legislation on the free movement of labour which prevents extra language and skills testing of EU doctors.
Niall Dickson, Chief Executive of the GMC, said: “This report highlights disturbing failures in the provision of out of hours care. The CQC rightly emphasises the important role employers have to play in ensuring that the doctors they contract with are competent, proficient in English and fit to do the job they are being given.
“We are working with the Department of Health to close the current gaps in our regulatory system and protect patients. We are pleased that the government has made this issue a priority.”
Under the health White Paper released earlier this week local GPs will take over responsibility from primary care trusts for commissioning services for patients in their area, including out-of-hours services.
Health Secretary, Andrew Lansley said: “Out of hours care needs urgent reform. GPs are best placed to ensure patients get the care they need, when they need it. That is why we intend to give GPs the responsibility for commissioning health services, including out of hours care, for their local communities.
“This report by CQC compellingly demonstrates a serious lack of attention by PCTs to their commissioning responsibilities; it shows that SHAs lacked leadership. It demonstrates clearly why we are right, as the White Paper proposes, to place commissioning responsibility for urgent and out of hours care in the hands of General Practice-led consortia.”
Dr Nizar Merali, Chair and a founding GP of Harmoni, which took over Take Care, said: “We will obviously examine the CQC report in detail and look to implement any service improvements that are recommended. We believe that we have already addressed many of the issues that came out from both the coroner’s report and the subsequent Department of Health report.”
How migration and high birth rates ‘will increase UK population to 78 MILLION by 2051′
The population of the UK could reach nearly 80million by the middle of this century, according to new research. Higher levels of immigration, higher birth rates and people living longer would push the total to 78.8 million by 2051, academics found. The increase – of nearly 20 million since 2001 – would be likely to make the UK the largest country in Europe.
The research, by academics at the University of Leeds, also predicts major changes to the ethnic mix of the UK population. They found ethnic minorities would make up one in five of the population by mid century, up from fewer than one in ten a decade ago.
Official statisticians have long projected the population would hit 70million by 2029. But the new estimate, from independent researchers, shows increases potentially continuing into later decades.
Population projections carry a greater degree of uncertainty over longer time periods because different factors influencing its size can change in importance. The academics produced a range of estimates according to different birth, death and migration rates. According to the highest projection, the population will reach 78,848,000 in 2051.
The highest figure assumes immigration increasing from current levels – although the coalition government has already put a temporary cap on some forms of migration and plans further reductions.
Of the 78.8million Britons in 2051, some 55million would regard themselves as White Britons – an increase from the current figure of 52.5million. But measured as a slice of the population, that would represent a fall from more than one in eight to fewer than one in seven.
Numbers of ‘other whites’ – a category which includes Eastern European migrants – are projected to increase dramatically, to nearly seven million, or one in ten of the population. In 2001 – before the mass wave of Eastern European migration caused by the accession of former Soviet states to the EU – they made up just 2.5 per cent.
The study predicts an increase in the number of Indians – nearly doubling from 1,432,000 to 2,672,000. There will also be sharp rises in numbers from Pakistan and Bangladesh.
The three- year study found minority groups would be better integrated in society and more likely to live in affluent areas.
Project leader Professor Philip Rees said: ‘The ethnic make-up of the UK’s population is evolving significantly. ‘Groups outside the white British majority are increasing in size and share, not just in the areas of initial migration, but throughout the country, and our projections suggest that this trend is set to continue through to 2051. ‘At a regional level, ethnic minorities will shift out of deprived inner city areas to more affluent areas, which echoes the way white groups have migrated in the past.’
Commentators said a population of 80million would be a ‘nightmare’. Sir Andrew Green, chairman of the MigrationWatch UK think tank said the research demonstrated the need for cuts in migrant numbers. ‘The prospect of better integration is welcome but will be a huge challenge if the ethnic minority population is to more than double,’ he said. ‘That apart, a population of nearly 80 million in mid century on this tiny island is a nightmare. These projections underline the case for getting immigration right down as the Government have promised.’
Home Secretary Theresa May unveiled the country’s first cap on migrant numbers last month – reducing the number of permits for skilled workers by five per cent. The temporary limit on the number of non-EU workers will be followed by a final cap to be unveiled next April. David Cameron has pledged to reduce net migration – currently 176,000 to the low tens of thousands.
Around 70 per cent of the current population increases are due to immigration – through direct arrivals or children born to them. The current UK population of 61,398,000 is an increase of three million since 1997. But even that count may be too low because no one can estimate how many migrants have come into the country illegally.
Labour’s supposedly ‘tough’ points-based system actually led to increases in the number of foreign workers and students cleared to live here. The number of non-EU migrants given work permits, or permission to carry on working in Britain, rose by 20 per cent, from 159,535 in 2007 – the year before points were introduced – to 190,640 last year, including dependents. The number of student approvals increased by a third, from 208,800 to 273,445 a year later.
The Brits have always been good at propaganda (even Hitler admired it) but this is rich indeed
The so-called “Liverpool pathway” used on the very ill elderly in Britain is nothing short of State-sanctioned murder in many instances. Britain is the last place I would want to be if I were very ill and elderly
BRITAIN leads the world in the quality of care it provides for the dying, leaving many developed nations lagging a long way behind, according to a study released overnight.
State support for end-of-life care and an effective network of hospices put Britain top of the list of 40 countries, despite not having the best healthcare system overall, said a report by the Economist Intelligence Unit (EIU).
Researchers looked at factors including public awareness, availability of training and access to pain killers and doctor-patient transparency to compile the “quality of death” index.
Australia ranked second on the global list followed by New Zealand and Ireland, with Germany, the US and Canada also featuring in the top 10.
Many rich nations were in the bottom half of the list, including Denmark (22nd) and Finland (28th). India scored worst at number 40, with Portugal, South Korea and Russia also in the bottom 10.
In the worst cases, the study found the quality and availability of care was often poor and policy co-ordination was lacking.
It said “few nations, including rich ones with cutting-edge healthcare systems” incorporate end-of-life care strategies into their overall healthcare policy.
In many of these countries, increasing longevity and ageing populations mean demand for end-of-life care “is likely to rise sharply”, said the study.
Falling birth rates, especially in developed countries, are likely to complicate the situation and, for the first time in history, the number of people over 65 will outnumber children under five years old, it said.
“For the end-of-life care community, this presents a new and complex set of problems,” the report said.
It also found the availability of pain-killing drugs, rated in the report as the most important practical issue in the standard of palliative care, was “woefully inadequate across much of the world”.
This is mainly due to concerns about the drugs’ illicit use and trafficking, and a lack of training among medical personnel on how to administer them.
“The result of this state of affairs is an incalculable surfeit of suffering, not just for those about to die but also for their loved ones,” the study said….
Researchers interviewed doctors, specialists and other experts across the 40 countries listed, including 30 nations within the Organisation for Economic Cooperation and Development (OECD) and 10 others for which data was available.
Jerusalem’s NOT dark and Satanic says Church of England
I am delighted to hear this. Its theology is absurd but I just LOVE that hymn. Blake’s words are pure magic and the Parry setting is uplifting too.
The hymn’s rousing tone has inspired millions, from rugby supporters to the Women’s Institute – but their enthusiasm has not always been shared by the Church of England clergy.
The CofE leadership has now urged ministers to stop banning Jerusalem from weddings for being un-Christian and ‘too nationalistic’.
The Rev Peter Moger, the CofE’s national worship development officer, said William Blake’s much-criticised lyrics can be used a springboard to explore deeper theological themes.
But he may have a hard time persuading many of the clergy. Their objections include that the hymn’s opening lines ‘And did those feet in ancient time/Walk upon England’s mountains green’ are inspired by the apocryphal story that a young Jesus visited Glastonbury in Somerset.
Donald Allister, now the Bishop of Peterborough, has complained: ‘What it is actually saying is, “Wouldn’t it be nice if Jesus lived in England?” Yet we all know he did not, so it is just nonsense.’ Other ministers have complained that references to bows, arrows and spears are ‘too militaristic’ and not suitable for worship.
The parish church of Parliament, St Margaret’s in Westminster, once refused to allow the hymn because the contrasting of ‘dark satanic mills’ with ‘green and pleasant land’ could alienate city-dwellers. The final verse, which describes striving to build Jerusalem in England, has also been branded ‘too nationalistic’.
Victoria Williams and Stuart Turton were prevented from having Jerusalem played at their wedding at Cheadle Church in Stockport in August 2001 because the vicar objected to it.
Mr Moger said: ‘It is possible to respond to a couple wishing to include Jerusalem in their marriage service in one of two ways: negatively, ‘banning’ the hymn, as some have done, or positively, including it, and using it as a helpful springboard from which to explore themes during the address.’ He gave a discussion of how Jesus would react to modern Britain as one possible theme.
The words to Jerusalem were written as a poem by Blake in 1804 and transformed into a hymn by Sir Hubert Parry in 1916.
How British taxpayers’ money is STILL being wasted on pointless PC jobs
From trampoline experts to walking advisers – hundreds of public sector non-jobs are advertised by councils every day, despite warnings that budgets may have to be slashed by as much as 40 per cent to tackle our huge deficit.
The out-of-control hiring spree that continues shows the enormity of the challenge the coalition Government faces in its attempts to rein in Britain’s growing debt.
When Labour came to power in 1997, state spending accounted for 40 per cent of Britain’s economy. Thirteen years later, they left a country in which that figure had risen to 52 per cent and the bloated public sector increased by almost another one million employees.
That army of new workers has fuelled the rise of the notorious non-job: hugely generous public sector wage packets for an often incomprehensible work description.
Alarmingly for David Cameron, the hiring spree is not only a feature of Labour-run councils, but exists in Conservative-controlled local authorities as well.
Nationwide, non-jobs being advertised include an artist-in-residence in an area that is already one of Britain’s cultural hotspots; a ‘weekend explainer’, whose job description specifically stipulates that the chosen candidate must be available for birthday parties; and a dance co-ordinator responsible for expanding the local authority’s ‘dance infrastructure’.
‘Organising recreational walks’ is something most people do without assistance, but Islington Council has turned it into a permanent position. The successful applicant will ‘be key in ensuring this scheme continues to thrive by developing new walks, working with partners and supporting and recruiting a team of volunteer walk leaders’.
Happily for the unenergetic, the prospective walking co-ordinator can fulfil their responsibilities from their desk. Islington is Labour-controlled and council tax most recently averaged £1,184 annually.
carbon partnership officer
A green non-job, the new worker will ‘enthuse partners to develop their own action plans which collectively will drive down our carbon footprint’. Prospective candidates ‘are likely to be educated to degree level but equally important is your ability to work collaboratively and confidently with partners, other stakeholders
Not content with creating non-jobs within Britain, the public service is doing so abroad as well.
Our man in Bangkok will soon be provided with his own climate change officer, whose chief responsibility will be ‘developing a strategy to support a low-carbon, high-growth economy in Thailand’.
community engagement apprentice
Adding yet another layer of bureaucracy, the new community engagement staffer will ensure that ‘local people come together to discuss how to improve their area’. To do this, the advertisement says the new apprentice should, among other things, ‘find out what is happening in the area and meet new people’. Lewisham Council is controlled by Labour and council tax averages £1,054 a year.
Sought for their skill at trampoline instruction, this new youth officer nonetheless faces demanding requirements. The council specifies ‘global and environmental issues’ among its preferred skills.
Much more HERE
More than half of British students fear unemployment
More than half of university students fear they will face unemployment when they graduate after racking up record levels of debt, a new survey has warned. According to research, 55 per cent of students are worried they will be unable to find work after leaving university due to the effects of the recession.
A shortage of money could lead to graduates abandoning their career goals, the survey suggested, with one in three students saying they would look for a higher paid job rather than their career vocation in order to pay off their debt.
Graduates are poised to leave university burdened by record levels of debt, with those leaving university in 2011 forecast to owe an average of £21,198, according to university guide push.co.uk.
In 2009 the average debt of graduates was £15,812, while for those starting university courses in September – most of whom will graduate in 2013 – the figure is likely to rise to £23,500.
This projection could increase further if the government lifts the current cap on tuition fees following an ongoing review into university funding being led by Lord Browne, the former BP chief executive.
The new survey, carried out by the Association of Investment Companies (AIC), an investment trade organisation, showed that half of students expect to take more than 10 years to pay off their debts incurred at university.
Results also indicated the recession has been a burden on parents, with 82 per cent saying it has increased the financial strain of supporting their children through university.
The AIC said: “Many young people go to university to enjoy some of the best years of their life but the reality on graduation is a huge financial burden which will take years to pay off.”