Scandal of patients thrown out of hospital in the night: Medic’s call for ‘chorus of disapproval’ to end policy of sending sick people home after dark
It is late at night. On the ward, most of the patients are asleep. A few doctors mill about, writing up notes. Then, the phone rings and something happens.
The nurses wake one of the patients and start to pack her bags in the gloom. She’s going home. The bleary-eyed patient is bundled into a taxi.
It seems an unbelievable scene but it happens in hospitals up and down the country. I have rightly been asked by many concerned relatives: What on earth is going on?
Sick, frail patients being turned out of their beds in the middle of the night? Surely this can’t be true?
Not only does it happen, but it is happening more and more. Figures obtained under the Freedom of Information Act show that last year, 239,233 patients were discharged from hospital between 11pm and 6am. That means that about 3.5 per cent of all discharges from NHS hospitals took place in the middle of the night, and the number has risen over the past five years.
Isn’t there a process to ensure that patients are well enough to go home?
The usual pattern for patients being discharged is that, after a morning ward round with a senior doctor when progress and investigations are reviewed, arrangements are made for them to be discharged later that day. Of course mistakes are sometimes made and things overlooked, but it’s a fairly well-oiled machine. Increasingly, however, this doesn’t seem to happen.
So who is doing this?
The decision to discharge at night usually falls to the bed manager. They identify unoccupied beds in a hospital and decide which ward a patient goes to and when. When they realise that the hospital is approaching capacity, they talk to the clinical staff to identify patients who can be discharged. Those who are due to be discharged in the morning find themselves most likely to be sent home that night.
Surely this can’t be safe?
It’s not just bad practice to discharge patients – many of whom are elderly, frail and recovering from an illness – back home at such an ungodly hour. It’s downright dangerous – and often completely pointless as they end up back in A&E in the morning, waiting for a bed.
At night, it’s impossible to ensure that adequate levels of support are in place as night staff have to hand over to the day team jobs such as ensuring social services are aware the patient is home. It’s also disruptive for the patient.
How can they be so cruel?
It’s easy to vilify the bed manager but their hands are tied – if there are acutely unwell patients in A&E waiting, they have to do something about it.
The four-hour rule in A&E was introduced by the Labour Government back in 2004 to limit the time people had to wait to be seen. The target means that every patient presenting to A&E must be either discharged or admitted to a ward within four hours.
Failure to deal with a patient in this time can land the hospital with a fine. In addition to this, the number of beds in many hospitals has been cut in recent years. PFI – private finance initiative – was a scheme introduced by the last Government whereby private companies rebuilt and took over the running of NHS hospitals. However, most new hospitals built under PFI have around 30 per cent fewer beds.
So what can be done?
Until there is a change in policy, there is little that can be done. While the hospital has a duty of care to the patient, there is no explicit rule stipulating the time of day when a patient should be discharged. If you or a loved one have been discharged late at night and this was inappropriate, you are entitled to raise the matter with the hospital.
If enough people do this, the chorus of disapproval may speed up change. I, along with doctors, nurses and countless patients and their relatives, hope that a way can be found to put a stop to this practice.
Schoolgirl diagnosed with eating disorder actually had two brain tumours that were making her sick every morning
Failed treatments should have triggered a scan much earlier
When Abigail Lightbown suffered dramatic weight loss and was continually being sick, her parents feared she may have developed an eating disorder. They took the nine-year-old to see a GP, who could only suggest she may have been suffering acid reflux and gave her medication to ease the condition.
It was not until seven months later, when the youngster fainted and underwent an MRI scan that the truth was discovered – she had one, possibly two, life-threatening brain tumours. By this stage she had lost 4kg.
She had to undergo an emergency operation was given just a 50/50 chance of pulling through.
Abigail, from Bolton, Greater Manchester, survived the operation in which 95 per cent of the tumour was removed and, now aged 11, recently completed a 48-week cycle of radiotherapy and chemotherapy treatment.
Her parents, Bernie and Gary Lightbown, heard Abigail throwing up every morning and feared she was deliberately making herself sick to look like ‘stick-thin celebrities’.
Mrs Lightbown, 34, said: ‘At first I thought it was down to travel sickness but at one stage she was throwing up every morning. She was given acid tablets by her GP but they weren’t working.
‘Her appetite started going – she was never a fussy eater and always had a fantastic appetite. ‘I took her to hospital to see a paediatric consultant and they were still thinking along the lines of acid reflux. We would try and tempt her with her favourite foods, but it just wasn’t happening. ‘That’s when I thought it was possibly an eating disorder.
‘She has never been image conscious, but I couldn’t think of any other reason. I know how some girls are these days seeing all the celebrities in magazines and on TV, and I tried to catch her out. ‘We had rows about it and she would get really upset. I have since apologised.’
The truth of Abigail’s condition finally emerged in January 2011 – five months after she first felt unwell – when she fainted in front of her father during a visit to her grandmother’s house and claimed she had pins and needles in her legs.
She underwent an MRI scan at Bolton Royal Hospital and the family were told a tumour – and possibly a second one – had shown up on the scans.
In February 2011, Abigail underwent a seven-hour operation and then, starting in April that year, began chemo treatment to ensure the remainder of the tumour was not active.
Mrs Lightbown said: ‘It was when we met the oncology consultant I knew exactly what we were dealing with. I just kept thinking, things don’t happen to people like us.
‘But Abigail took it really well. She wasn’t bothered about the chemo and got really excited about the aspect of wearing all sorts of different hats and wigs.’ But despite losing her hair, Abigail has only worn a wig twice.
She returned home in April last year and started a 48-week cycle of chemotherapy treatment, with breaks in-between and continued physiotherapy.
She went for her final dose of treatment in June this year, and she will receive regular check-ups from now on to ensure the tumour does not become active again.
Her parents are now campaigning for greater awareness about brain cancer, one of Britain’s biggest killers.
Her father thinks Abigail could have been treated faster if there was more widespread knowledge about the disease’s symptoms.
Mr Lightbown said: ‘Through our experience we just can’t believe how little money and effort goes into raising awareness about brain cancer and the symptoms.
‘We honestly believed Abigail had an eating disorder. Yet brain tumours kill more women under the age of 35 than breast or any other cancer. It’s shocking, when you look at the campaigns that go on for breast cancer.
‘We are so proud of her daughter. People don’t understand how inspiring and motivating she has been. ‘We would have really struggled if she hadn’t been the way she is – she’s only worn her wig twice because she doesn’t let the chemo get to her.’
Major reform to British High school examinations
Michael Gove is to herald an end to a quarter of a century of ‘dumbed-down’ exams this week when he abolishes GCSEs and brings back a tough new O-level style system.
The Education Secretary will announce the new exams on Tuesday in a joint press conference with Liberal Democrat Deputy Prime Minister Nick Clegg after a furious behind-the-scenes row between the two men.
Mr Clegg has forced Mr Gove to delay the new system until September 2015, which means Labour could scrap it if they win the next Election, due in May 2015.
But Mr Gove won his battle to ensure the new exams are more rigorous and that the top grades only go to the brightest children. The joint appearance on Tuesday is designed to counter claims of another Coalition rift.
The reforms are designed to help schools in England catch up with other countries which have left us trailing in school standards.
The new exams, dubbed ‘Gove- levels’, follow claims that GCSEs, which replaced O-levels in 1986, are too easy. Under Mr Gove’s shake-up, the current system whereby nearly three in ten pupils get A or A* grades will go. Instead as few as one in ten will get the top mark, Grade 1.
Marks will depend on a traditional ‘all or nothing’ three-hour exam at the end of the two-year course, rather than the current system in which up to half the grading is based on modules and continual assessment, followed by a 90-minute exam at the end.
Pupils will no longer be able to bump up their grades with endless re-sits of each exam module. In future they will have to re-sit the entire exam, which is expected to deter most.
There will be more complex algebra questions in maths exams and a return to essays in English literature exams instead of trendy GCSE ‘bite sized’ answers.
And in a controversial move designed to counter claims that GCSEs are far too easy for bright pupils, questions in the new exam will be graded, starting with easy questions and building up to difficult questions which will stretch the cleverest pupils.
It means that less able pupils may be unable to complete the paper. But Mr Gove will argue it is vital to boost standards.
In addition, the new exams will be run by a single exam board following complaints that competition between rival boards is driving down standards.
Board officials have been accused of boasting how easy their exams are, and giving tips to teachers on the content of papers. Ministers said the current rules had created a ‘race to the bottom’ in standards.
According to a 2010 OECD study of 15-year-olds, the UK fell from 17th to 25th for reading, 24th to 28th for maths and 14th to 16th in science over a three-year period.
Mr Clegg was furious earlier this year when Mr Gove suggested replacing GCSEs with a two-tier exam, with a new version of O-levels for top pupils and a new version of CSEs, also abolished in 1986, for less able youngsters. Mr Clegg accused Mr Gove of acting in an ‘insulting and patronising’ manner by failing to consult him in advance.
Mr Clegg’s main objection was that this system would be ‘elitist’ and would ‘stigmatise’ children considered not bright enough.
The two men thrashed out their differences in a series of meetings over the summer. Mr Gove won his battle to ensure the exams can test so-called ‘elite’ pupils.
However, Coalition insiders say there could be further Tory-Lib Dem friction as details of the new single tier exam emerge.
‘Gove is determined to ensure it is much more demanding than the existing exam,’ said one source.
‘Schools will be given time to raise their game and adjust to that. If they can’t, or decide their pupils simply aren’t up to taking the new exam they may be forced to find a different option. That could reopen the debate about having another, less difficult exam.’
Mr Clegg persuaded Mr Gove to delay starting the new exams until September 2015, arguing that a 2014 deadline would cause chaos in schools. It was a blow to Mr Gove who had hoped to show the system was up and running before the next Election. Furthermore, the 2015 start date – with the first new exams in 2017 – means that, in theory, if Ed Miliband wins the next Election, the new exams could be scrapped weeks before they are due to begin.
It is certain to put education at the heart of the next Election campaign.When Mr Gove first floated his ideas of a two-tier exam system, Labour education spokesman Stephen Twigg called it ‘a cap on aspiration’ and accused Mr Gove of ‘harking back to a nostalgic view of the past’.
The new proposals are also expected to run into fierce opposition from teaching unions who claim they could ‘lower aspirations and exacerbate inequalities in society’.
Tuesday’s announcement is a key moment in the fast-rising political career of former journalist Mr Gove, brought up by adoptive parents and partly state-educated. A growing number of Tories believe he is a contender to succeed David Cameron as Tory leader, though Mr Gove has laughed off such reports, offering to ‘sign a parchment in my own blood to prove I do not want to be Prime Minister’.
Deplorable ignorance from a British climate skeptic
In a completely unreferenced guest post by a Lloyd Robertson on Bishop Hill we read:
“Of course I am a skeptic, and I am giving the impression that the egregious faults are all on the other side. I suppose the skydragons, whoever they are, are plain ignorant, not trying to learn, but probably honest. I don’t read them, I had never even heard of them until Judy Curry sharpened her lance against them.”
The idea of judging someone whom you know nothing about is very adolescent and as ignorant and unscientific as any of those he criticizes. If he has any self-respect and intellectual integrity the ecclesiastical one should take this bit of foolishness down.
The article claims to be a taxonomy but the first step for a taxonomy is to be very familiar with the subject matter.
For reference I am not myself one of the “skydragons”. Background on the “skydragons” here
Families facing £2,000 bills for green heating ‘that does not work in Britain’
Millions of pounds of public money have been spent installing a ‘green’ central heating system that residents claim doesn’t work properly – and that has made their heating bills four times higher than expected.
Annual running costs had been estimated at £500, but instead some housing association tenants have been saddled with bills of up to £2,000 a year – nearly twice the UK average.
Some families in ‘affordable homes’ said their electricity bills last winter were so high that they had to choose between heating and eating.
The so-called exhaust air system works by sucking heat from waste air leaving the house and pumping it back in to provide heating and hot water. But if it does not raise the boiler water temperature enough, an electric immersion heater kicks in, sending bills rocketing.
Government grants were spent on the all-electric Swedish NIBE systems but experts say they are wrong for most British homes, which are not as well insulated as those in Sweden.
Heating expert Geoff Morgan, of Rodney Environmental Consultants, has inspected homes in the UK with NIBE heating and said: ‘In Sweden, very little heat escapes through walls, doors and windows, so more is available to be pumped back in. ‘These systems are just not very suitable for your average British home when mains gas is available – it’s just not going to be economical.’
One housing association in St Neots, Cambridgeshire, is considering legal action after claiming that it was ‘mis-sold’ the systems, which cost about £6,000 each. Another in Runcorn, Cheshire, recently spent £145,000 ripping out 69 NIBE sets and replacing them with gas boilers.
To be eligible for public money for new housing from the Government’s Homes and Community Agency, housebuilders have to follow its Code for Sustainable Homes, which urges low-carbon solutions. But residents have reported problems on at least 15 estates from East Anglia to Orkney, and various Facebook sites have been set up by disgruntled householders.
Mother-of-four Sam Claussen said she and her partner Jeff were excited in May 2010 when they moved into a three-bedroom house in St Neots, on an estate owned by the Bedfordshire Pilgrims Housing Association (BPHA).
‘I loved the idea of having this modern and green heating system which we were told was going to give us really low bills,’ said Ms Claussen, 40. Indeed, Energy Performance Certificates issued on the new properties estimated annual electricity costs for heating and water at between £400 and £500.
But after living in the property for two months, Ms Claussen was shocked to receive an electricity bill for £252. Costs continued to mount for Ms Claussen and her neighbours on the Loves Farm Estate, and eventually the BPHA stepped in to help meet tenants’ bills – to the tune of £45,000.
By last Christmas, the Claussen family had unpaid bills of £1,500 and were on a key meter.
They found that during a cold snap they were having to spend £10 a day. ‘With such a high electricity bill, we had to choose between eating or keeping the house warm,’ Ms Claussen said. ‘The children were fed, but I hardly ate at all. It was an awful Christmas.’
A spokesman for the BPHA said the NIBE system was recommended by the contractor, Kier Homes, to comply with the Government’s green code. ‘We had representations from NIBE and as a result we were convinced that it was a very good solution. Unfortunately that has not been our experience. Some residents have reported excessive bills, and also there wasn’t enough hot water for their needs.
‘We are currently replacing 43 of the systems with gas boilers. We are also taking legal advice on the next step forward.’
Kier admitted that some NIBE systems were found to be undersized and that some houses had two wall vents rather than one, which meant more heat was escaping.
The company has agreed to underwrite the cost of replacing undersized units with gas boilers, replacing all vents and contributing towards a hardship fund for residents.
A statement added: ‘Since the issues with the NIBE system came to light, we have stopped specifying the boilers.’
NIBE managing director Phil Hurley said: ‘These systems are working brilliantly in thousands of homes across the UK without increased energy costs and, according to independent research, have dramatically reduced costs in many cases. ‘Where costs are high, the issue isn’t with the system, it’s with the way it has been installed or is being used.’
British Leftist leader talks conservative talk
Tony Blair did the same, with no obvious effect
Ed Miliband today declares that Labour will be on the side of capitalists who want to get rich, provided they work hard for their money.
In an interview with The Daily Telegraph, the Labour leader pays tribute to Baroness Thatcher for creating an era of aspiration in the 1980s.
Mr Miliband says he will not “pass moral judgment” on those who accrue significant personal wealth but insists they have a responsibility to play by the rules.
His comments represent a moderation of Lord Mandelson’s now infamous boast that New Labour was “intensely relaxed” about people becoming “filthy rich”. Both Mr Milband, and Lord Mandelson, have accepted that this sentiment no longer applies in the aftermath of the financial crisis.
Mr Miliband says that the last Labour government was too ready to accept that businesses and financial services needed “light touch” regulation.
However, he says the “creativity” of capitalism should be harnessed and made “more decent” and “humane”. “I believe capitalism is the least worst system we’ve got.”
Asked whether it is good to be rich, he replies: “Yes, if you make it the hard way. It’s not for me to pass moral judgment.”
Mr Miliband has sought to shed the “Red Ed” caricature which his opponents invented after he beat his brother David to the Labour leadership in 2010 with votes of the trade unions.
His father, Ralph, was a leading thinker of the Marxist Left who made capitalism his enemy, but Mr Miliband insists he does not subscribe to the same doctrine.
“My Dad was sceptical of all the Thatcher aspirational stuff,” he says. “But I felt you sort of had to recognise that what she was talking about struck a chord. I want to save capitalism from itself.”
Must not tell blacks they need to work harder
Judging by their generally low levels of economic and educational achievement they do need to but you must not tell them that, apparently
Pupil, 11, told to work harder by school worker ‘because as a black person he would struggle in life for not being white’
The mother of an 11-year-old boy has received an apology after a school official told her son he would have to ‘work harder in life’ – because he is black.
Rosamaria Failla, 34, discovered that a truancy officer had told her child Sonny that he would struggle in life because he is not a ‘white British boy’.
Sonny, who suffers from ADHD, had been struggling with teachers at Bowmansgreen School, Hertfordhire, when his attendance started slipping.
In a bid to make her British-born son feel better about education his mother arranged for council truancy officers to visit him at home in July.
But Mrs Failla was upset when the officer gave Sonny a brutal evaluation of his life prospects, warning him he would ‘have to work harder in life to gain people’s respect’ because of his colour.
She complained to police and the council about the comment, which she says was: ‘Because you are not a white British boy, you are going to have to work harder in life to gain people’s respect and achieve high things,’ which she claims is racist.
Hertfordshire County Council has now launched a full investigation into the claims while the officer has written a letter of apology to the family.
This is probably advice that the kid needed but there is not much chance of him heeding it now.