Twice as many patients are dying because of poor care after operations than previously thought
Sloppy NHS care after operations is costing the lives of thousands of patients, research shows. Nearly four in 100 people having common forms of surgery die as a result – twice as many as once thought.
The study also found the death rate is higher in Britain than in many European countries, including Finland, Estonia and Hungary.
The researchers said patients were dying from blood poisoning, kidney failure, heart attacks and strokes that medics had not picked up in time.
A shortage of intensive care beds was also cited as a factor; there are fewer in NHS hospitals than in many other countries.
Andreas Hoeft, one of the Anglo-German study’s authors, who is based at the University Hospital in Bonn, said: ‘Nurses are coming into the room in the morning and finding somebody dead in their bed.
‘Many of the patients get sepsis, or blood poisoning, overnight and often it is not detected. The bad news is that mortality is higher than we thought but hopefully there is room for improvement.’
Rupert Pearse from Queen Mary, University of London, who led the research, said: ‘It’s certainly very worrying and I believe some of these deaths are preventable. ‘We need to get the overall mortality down to one in 100 deaths per patients.’
The researchers, whose study is in the Lancet, looked at data on more than 46,500 patients in 28 European countries. All had undergone surgery that required them to stay in hospital at least one night.
These included a vast range of procedures from hip replacements to hernia removal to operations to take out bowel cancer tumours.
The researchers did not include those who had undergone heart or brain surgery or women needing emergency operations during pregnancy.
They found that 3.6 per cent of British patients had died within 60 days of having the operation.
This figure is higher than in Finland, Norway, Estonia, Cyprus, Sweden and Switzerland – but the researchers said they needed to investigate further before they can conclude that National Health Service care is worse.
The research, which was partly funded by the European Society of Anaesthesiology, found that just 6 per cent of patients were admitted to intensive care. This was lower than many other countries and a lack of available beds may partly explain the high death rates, according to the academics.
In 2010, Cambridge University researchers found there are 3.5 beds per 100,000 of the UK population compared with 24.6 in Germany, 20 in the US and 9.6 in France. Professor Heoft said that in order to bring down the death rates, the most at-risk patients needed to be monitored properly. These include the elderly, those with diabetes, heart problems or kidney disease for example who are more likely to suffer complications.
He added: ‘Simply calling for more intensive care unit beds will not solve the problem. ‘It’s certainly very worrying and I believe some of these deaths are preventable. We need to get the overall mortality down to one in 100 deaths per patients’
‘New, cost-effective ways of identifying and monitoring patients at risk must be developed.’
The researchers said that it wasn’t the surgery that was poor, but rather the after care. Medical staff were not doing enough to monitor patients so any sudden deterioration in their health was often going undetected.
They should carry out regular checks of their blood pressure, heart rate, breathing and temperature up to five times a day.
But many hospitals do not have enough adequately trained doctors or nurses to carry out the checks and who also know what to do when patients suddenly deteriorate.
Professor Bruce Keogh, the NHS medical director, said: ‘The NHS is already among the best in Europe for some surgery specialties but these reports are vital as they show surgeons where they need to improve.’
One in three elderly cancer patients diagnosed only after an A&E visit with many tumours so advanced they are untreatable
One in three cancer sufferers over 70 is diagnosed only after they turn up in casualty, a major study has found. In many cases, the patient’s tumours were so advanced by the time they sought help at an A&E department that they were untreatable. Had the symptoms been picked up earlier – either by their GP or another specialist – their lives could have been spared, the researchers claimed.
Cancer survival rates in Britain are notoriously low compared with those in other European countries and experts believe late diagnosis is to blame. The Government has previously claimed that as many as 5,000 lives could be saved every year if the NHS improved its detection and treatment of cancer to the level of other nations.
Experts say the elderly are particularly vulnerable to late diagnosis, because they are more reluctant to see their GP when they are unwell.
And even when an appointment is made, doctors often find it harder to diagnose cancer in older patients as they may have a number of other health problems with confusing symptoms.
In the first study of its kind, researchers from the National Cancer Intelligence Network looked at data on 740,000 patients of all ages diagnosed with cancer between 2006 and 2008.
They specifically looked at where the illness had been diagnosed –whether via screening, in an appointment with a specialist or in A&E.
When the researchers included patients of all ages they found that one in four cancers were diagnosed in A&E units, but the rate increased to 31 per cent among the elderly.
Some patients went to A&E because they were suffering very severe symptoms caused by the cancer such as pain, breathing difficulties or fitting. But others just happened to have the cancers picked up after going to casualty with a broken hip or another entirely unrelated health problem.
Some had turned up in A&E of their own accord, while others had been referred by their GP.
Professor Mike Richards, the Government’s national cancer director who led the research, said: ‘This has come as a surprise to many people working in the field of cancer. It’s very important that we give equal access to care for people for all ages.
‘What we are trying to understand is whether they were patients who had been to their GP, but hadn’t been referred to hospital. Equally they may have been patients who never saw their GP. My hunch is that it’s partly one and partly the other.’
Professor Jane Maher, chief medical officer of Macmillan Cancer Support, said: ‘It is appalling that so many cancer patients are still diagnosed through emergency admissions. This route to diagnosis can have a disastrous impact on survival chances.
‘It can be more difficult to spot cancer symptoms in older people who have other health conditions but this does not excuse such a high number of people being diagnosed in this way.’
The research, published in the British Journal of Cancer, also found that certain types of cancer, such as pancreatic, lung or brain, were far more likely to be picked up in A&E.
There is widespread concern that an age bias exists across the NHS, with the elderly frequently denied the same standard of care as younger patients. Professor Richards said that in this instance, he did not believe that the late diagnosis in the elderly was due to age discrimination. He said it was more likely due a ‘reluctance’ among this generation of patients to see their GP.
From the start of next month it will be illegal for healthcare professionals to deny patients treatment on the basis of their age.
A new law will enable patients to sue their doctors, nurses or entire hospitals if they think they have fallen victim to age discrimination by the NHS.
Gypsy wins human rights case against campsite that threw her out for causing ‘very substantial nuisance’
A gipsy thrown off a campsite after her son threatened other travellers with a gun suffered a breach of her human rights, European judges ruled yesterday.
Maria Buckland and her family were evicted after being accused of causing a ‘very substantial nuisance’ and presenting ‘a risk of disturbance and violence’.
Despite a series of appeals being rejected by Britain’s highest courts, judges in Strasbourg yesterday ruled the eviction was an ‘extreme’ interference with the 53-year-old’s human rights. They also ruled she should receive £3,400 to compensate her for ‘feelings of frustration and injustice’.
The judgment by the European Court of Human Rights could now pave the way for other traveller families to use human rights grounds to fight eviction orders.
The Buckland family first moved to the Cae Garw caravan park in Port Talbot, South Wales, in 1999.
Six years later the Gipsy Council – the traveller-run organisation which operated the local authority-owned site – obtained a possession order claiming Mrs Buckland and five others were causing trouble.
The family were, the Council said, ‘guilty of causing very substantial nuisance’.
In November 2007, three Appeal Court judges headed by Lord Justice Dyson upheld a possession order against Mrs Buckland, saying that she had a ‘generally disruptive family’ with a ‘culture of disrespect’ who ‘presented a risk of disturbance and violence’.
The European judges admitted that, during another appeal, a Swansea county court judge ‘was satisfied that her son, who resided part of the time with her, had been involved in an incident in which he threatened someone with a gun, although it was not clear whether the gun had been real or an imitation; and had dumped garden refuse’.
However they claimed that the only wrong committed by Mrs Buckland herself was the failure to pay a £95 water bill.
They ruled that British judges had been wrong to claim the eviction order was beyond challenge, ruling it should have been considered in the light of Article Eight of the European Convention on Human Rights, which guarantees respect for a person’s home, private and family life.
They said: ‘The loss of one’s home is the most extreme form of interference with the right to respect for the home.
Any person at risk of an interference of this magnitude should in principle be able to have the proportionality of the measure determined by an independent tribunal.’
In total Mrs Buckland – who left the site in May 2008 to live on land owned by her brother, which had no planning permission for residential use – was awarded nearly £7,000 in damages and legal costs.
In past cases British courts have ruled against traveller families who have protested that evictions break their human rights, especially when there has been evidence of their disruptive behaviour.
Mrs Buckland’s case is thought to have cost taxpayers around £80,000 in legal aid and local authority fees on its way through the British court. Legal aid is not paid by the taxpayer to support cases in Strasbourg.
Prudish fundamentalist clergyman objects to saucy British postcards
Cheeky postcards from the seaside are a British tradition
Police were called to a gift shop on a seaside pier after a complaint that the postcards on sale were ‘obscene’ and ‘damaging the image of the town’.
Shop owner Ian Donald was stunned when an officer turned up at his store in Eastbourne, East Sussex, and accused him of selling pornography next to buckets and spades.
The cheeky postcards, featuring women on the beach displaying their bottoms or breasts, had outraged Ashley Steinschauer, an assistant minister at the local church, but the complaint has left some bemused.
Mr Donald has owned his shop on Eastbourne Pier for 25 years and said the light-hearted postcards are popular with all ages and were just part of the ‘seaside tradition’.
He said: ‘People would see worse than these postcards if they just walked along the beach. ‘The police officer saw the funny side of it though when I showed him the postcards.’
But Mr Steinschauer from Elim Family Church was not laughing when he made his complaint to the local council, arguing that the postcards were obscene and ‘damaging’ the town’s image.
The complaint made to the council was passed on to Trading Standards who told police that obscene images were on sale on the pier.
In response to the incident some took to micro-blogging site Twitter. One posted: ‘Charge the complainant with wasting police time.’
On the website of local paper The Argus, readers also commented on the police visit. One wrote: ‘Some people do really need to get a life and a sense of humour.’
Another posted: ‘So the country is going down the toilet, Police are being murdered and there is a sense of general dissatisfaction but some person has taken the time to call the Police about a postcard at a seaside stall? Grief.’
Mr Donald, who sells other postcards including scenic shots, said: ‘I sell 600 of these every year and I’m not going to stop now.
‘We get loads of elderly people buying them, although they do tend to turn them face down when they come to the counter because they are a bit embarrassed.’
Neil Stanley, the council’s lead member for tourism, said: ‘Visitors to Eastbourne expect wholesome good fun and the saucy postcard is a vital part of our seaside heritage.’
A Sussex Police spokesman said they could not find any record of a complaint being made to them about ‘saucy postcards’.
Britain’s mixed-ability classes ‘are holding back bright pupils’ says head of education watchdog
Bright pupils are losing out due to the ‘curse’ of mixed-ability classes, the head of Ofsted warned yesterday. Sir Michael Wilshaw said thousands were failing to reach their full potential due to poor teaching methods.
Inspectors will now be critical of schools that do not differentiate between high and low achievers.
This could lead to schools falling into the new category of ‘requires improvement’ (which replaces the old ‘satisfactory’ description), or even being labelled ‘inadequate’.
Statistics published following a Parliamentary question show that 55 per cent of lessons in English state secondary schools last year involved children with different academic needs.
Ofsted cannot force schools to adopt setting – grouping pupils according to their academic ability in single subjects – or streaming, where ability groups cover most or all subjects.
However, Sir Michael’s intervention is likely to make headteachers rethink their practice of mixed ability classes for fear of being marked down in future inspections.
The chief inspector of schools said that of the brightest pupils at primary schools, about one in five did not go on to achieve top grades at GCSE. ‘It’s a combination of low expectations of what these youngsters can achieve, that their progress is not sufficiently tracked, and what I would call and have done ever since I have been a teacher the curse of mixed-ability classes without mixed-ability teaching,’ he said.
The former head said mixed-ability classes did not work ‘unless there is differentiated teaching to groups of schoolchildren in the class’ and ‘individual programmes of work’.
He added it was ‘critical’ that if schools had a youngster with low basic skills next to a youngster with Oxbridge potential, this was ‘taken into account and they are taught by people who are experienced and good at teaching mixed-ability classes’.
He admitted it will be ‘hugely difficult’ for schools to tailor the same lesson to both the brightest and less able pupils. Many schools had recognised this and ‘moved towards setting arrangements’, he said.
Early entry for GCSEs was also ‘limiting the potential of our brightest pupils’, Sir Michael warned.
Many achieve poorer grades and some stop studying core subjects altogether.
Ofsted figures show that about a third of pupils are now entered early for English and maths – more than 200,000 in each subject.
Sir Michael said: ‘We will be critical of schools using early entry, except where they are absolutely confident that youngsters are reaching their full potential. By full potential, we means A* and As if they are bright.’
Are statins really such a wonder pill? New study finds they DON’T prevent blood clots
A reduced effect on replication is common but this was a complete wipeout.
Cholesterol-lowering statin drugs do not appear to help prevent blood clots, according to an extensive new study.
Researchers from Oxford University led a team that looked at 29 published and unpublished trials involving over 100,000 people.
They found venous thrombosis (a blood clot formed in a vein) occurred in 0.9 per cent of people taking statins compared to one per cent of people who were not taking the drugs. There was no difference between those who took higher or lower doses of statins.
The study, published in the open-access journal PLoS Medicine, said: ‘We were unable to confirm the large proportional reduction in (clot) risk.’ However, it added that ‘a more modest but perhaps clinically worthwhile’ effect could not be ruled out.
In 2009, a trial called JUPITER found that so-called rosuvastatin — marketed as Crestor — halved the risk of blood clots among apparently healthy adults, a finding that boosted suggestions the drug should be taken preventively. But the figures to support this finding were relatively small.
The 2009 study randomly assigned 17,800 people to take Crestor or dummy pills. After two years of followup, 34 in the statin group and 60 in the placebo group developed a venous thrombo-embolism, a clot which can form in the legs and travel to the lungs. The latest study, led by Kasem Rahimi, found no such effect.
Commenting on the findings, British Heart Foundation medical director, Professor Peter Weissberg, said: ‘It has long been thought that statins may have additional health benefits on top of their proven ability to reduce heart attacks and strokes.
‘An earlier study suggested that one statin, rosuvastatin, might reduce the risk of blood clots in deep veins and lungs, known as venous thromboembolism. ‘However, findings in single studies can sometimes happen by chance. By pooling a large amount of data on several different types of statin, this analysis shows that any significant protection against blood clots is highly unlikely.’