Category Archives: Rheumatoid Arthritis

I’m a paramedic who has considered suicide and I’m not getting support

When I was 15, a teacher found me during lunch break and asked if she could have a word. Confused, as I was generally well behaved, I followed her to the office. I was told that a close friend of mine had been found by his parents that morning hanging in his bedroom. He was in intensive care at the local hospital but his family had been asked to prepare for the possibility that he would die shortly. Growing up, the ideas of major depressive illnesses, self-harm and suicide were almost entirely foreign to me.

People often ask whether this was what motivated me to enter healthcare at 17 and eventually land in my current position as a paramedic by 20. Frankly, I don’t know. What I do know, though, is that while suicide was a foreign concept to me at 15, it certainly isn’t now.

Almost a quarter of ­ambulance staff have post traumatic stress disorder, according to research published in the British Medical Journal, and about one in three suffer from mental health problems. Statistics are hard to come by, but reports of paramedics killing themselves suggest suicide in the profession is a problem. The Age in Australia reported that the rate of suicide among paramedics for the year to April 2010 was about 20 times higher than that of the general population.

I require antidepressants daily to numb thoughts of self-harm and suicide. I was diagnosed with major depressive disorder nine months after starting work with the ambulance service. When I attend call-outs to patients in a depressive crisis or who have self-harmed, it is like looking in the mirror. When resuscitating patients who have tried taking their own lives, it is akin to looking at what could have been.

It was after one such callout to a young man who had hanged himself in the living room to be found by his wife and young child, that I broke down.

I was in the middle of my fifth 12-hour shift, I had just had to pronounce a man not much older than myself deceased, counsel a grieving wife, assist the police with their investigations and ensure appropriate members of family and friends were coming to be with her. Having never called in sick in five years, I radioed the operations centre and asked them to stand me down as I would be going home for mental health issues. I was weeping, I was trembling, I was unsafe to continue working.

I will never forget the words that came back to me through the radio that night. “But there are calls waiting, can you not just wait until your days off?”

After explaining I was no longer safe to work, I was begrudgingly allowed to return home. I sat in silence for hours. The emotions of every patient I couldn’t save, every patient who had tried to hit me, every patient who had shouted at me while I worked to save them or their family came crashing over me like a wave.

Publicity around paramedic suicide generally focuses on the traumatic aspect of life on the road. What is either less known, or perhaps conveniently ignored, is the pervasive culture in ambulance services seemingly designed to incite suicide. Rostered 12-hour shifts which almost never finish in under 13 hours; missed meal breaks to attend more calls; threats to place poor performance markers on our record if we book ourselves unavailable to use the restroom more than once per shift; and, of course, frequent exposure to trauma most people will experience just once in their life are some of the stresses of the job.

Rather than immediate referral for six sessions with a psychotherapist, available to all employees, any request for help is almost universally met with the question: “Are you sure this is the right career for you?” This is followed by almost daily phone calls hounding for a return to work and questioning our commitment to the communities we serve.

This leads to any paramedic in a mental health crisis feeling unsupported and, worse, feeling they are weak. The worst part is, we all believe it subconsciously. We are afraid to take days off for mental health, fearing what our colleagues will think, fearing they will think we are weak, fearing what management will do. It is this dark undercurrent in ambulance services that continues to push paramedics to take their own lives rather than face their mental health problems.

  • In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

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First double hand transplant involving a child declared a success

After almost 11 hours of surgery involving four teams of doctors, Zion Harvey had earned his place in medical history. The eight-year-old had become the first child in the world to receive two new hands in a procedure that seemed to herald a revolution in transplant medicine.

Two years on, the sports-mad boy from Baltimore, Maryland, is enjoying the freedom and independence his new hands have given him. In the first medical journal report of Zion’s pioneering treatment, published on Wednesday, the experts involved declare the operation a success and say other children could benefit from the knowledge gained.

Zion had to rely on others after he had his hands and feet amputated aged two when he contracted sepsis. For six years he used a combination of his residual limbs and specialist equipment to dress, wash himself and eat – until the double transplant changed his life.

“At 18 months [after the transplant], the child had exceeded his previous adaptive abilities. As of 18 months after transplantation surgery he is able to write and feed, toilet and dress himself more independently and efficiently than he could do before transplantation,” writes the team from the Children’s hospital of Philadelphia in the Lancet Child and Adolescent Health.

Organ transplantation is risky in that a recipient’s body may reject the new body part, while the drug regime involved carries a series of health risks. Two years on from the surgery he had in July 2015, Zion, now 10, is coping well with both.

Zion playing baseball


Zion playing baseball. Photograph: The Lancet/PA

“Cases like this demonstrate how new developments and innovation in science and transplantation have the potential to make enormous differences to the quality of life of patients,” said Lorna Marson, the president of the British Transplantation Society, which represents specialists working in the field across the NHS.

“Transplantation is a constantly evolving sector and it is heartening to hear the positive outcomes of groundbreaking transplants such as this one.”

More than 100 people worldwide have had a hand or arm transplant since the first adult received a new hand in 1998, closely followed by the first replacement of both hands in 2000. Many countries now conduct such transplants on small numbers of carefully selected patients.

In May 2000, a baby girl in Malaysia who was born with a severe congenital deformity became the first child to receive a new hand and arm, transplanted from her identical twin sister who died at birth.

Hand transplant graphic

In an update last year on his progress in the year since his surgery, Zion said: “The only thing that’s different is instead of no hands, I have two hands. I’m still the same kid everybody knew without hands.”

Referring to his new hands, he added: “Here’s the piece of my life that was missing. Now it’s here, my life is complete.”

Within eight months of the operation Zion was using scissors and crayons and after a year he was able to swing a baseball bat with both hands – once throwing the opening pitch at a Baltimore Orioles game.

Dr Scott Levin, team leader for Zion’s 10-hour surgery, has praised his young patient’s bravery. “I’ve never seen Zion cry. I’ve never seen him not want to do his therapy. He’s just such a remarkable human being, let alone child or adult. He has such courage and determination and gives us all inspiration,” he said.

But the last two years have been mentally and physically hard for Zion. He has had huge amounts of physiotherapy and occupational therapy to help him adjust, as well as counselling to aid his psychological recovery.

Zion after the transplant surgery in 2015


Zion after the transplant surgery in 2015. Photograph: Clem Murray/Rex Shutterstock

The doctors write: “Since his surgery he has undergone eight rejections of the hands, including serious episodes during the fourth and seventh months of his transplant. All of these were reversed with immunosuppression drugs without impacting the function of the child’s hands.”

He is still taking four different immunosuppressant drugs to maximise the chances of his body continuing to tolerate the pair of new hands, though doctors hope to reduce the dose.

“While functional outcomes are positive and the boy is benefitting from his transplant, this surgery has been very demanding for this child and his family,” said Dr Sandra Amaral, a member of the team at the Philadelphia hospital.

However, in an accompanying comment article, Dr Marco Lanzetta, an Italian expert in hand transplant surgery, doubts that many children could tolerate a similar procedure and highlights the risks from lifelong use of immunosuppressants. Zion’s case was exceptional as he was already on the drugs, after receiving a kidney from his mother, Pattie Ray.

Prosthetic hands and limbs, adds Lanzetta, have now developed so much that they, rather than transplant surgery, are more likely to prove the future for patients like Zion.

Rise in life expectancy has stalled since 2010, research shows

A century-long rise in life expectancy has stalled since 2010 when austerity brought about deep cuts in NHS and social care spending, according to research by a former government adviser on the links between poverty and ill-health.

Life expectancy at birth had been going up so fast that women were gaining an extra year of life every five years and men an additional 12 months every three-and-a-half years.

But those trends have almost halved since ministers made a “political decision” in 2010 to reduce the amount of money it put into the public sector, said Sir Michael Marmot. The upward trend in longer life that began in Britain just after the first world war has slowed so dramatically that women now only gain an extra year after a decade while for men the same gain now takes six years to arrive.

The rate of increase was “pretty close to having ground to a halt”, Marmot said.

“I am deeply concerned with the levelling off; I expected it to just keep getting better. Since 2009-2015 it’s pretty flat, whereas we are used to it getting better and better all the time,” added Marmot, who published a major review of health inequalities for Gordon Brown’s Labour government in early 2010.

In 1919 men lived for an average of 52.5 years and women for 56.1 years. That rose to 64.1 years and 68.7 years respectively by 1946. Life expectancy then rose in an almost unbroken gradual upward curve to 77.1 years for men and 81.4 years for women in 2005 and again to 78.7 and 82.6 in 2010, the year David Cameron’s Conservative-Liberal Democrat coalition took office.

Since then life expectancy has continued to creep upwards, but at a slower rate, according to Marmot’s latest analysis. In 2015 average life expectancy in Britain was 79.6 years for men and 83.1 years for women, according to the latest Office for National Statistics data.

Marmot, who is the director of the Institute of Health Equity at University College London, denied the rise had stalled because there was a natural limit to how much life expectancy can increase. “It is not inevitable that it should have levelled off,” he said.

There is no reason why the UK could not emulate Hong Kong, where life expectancy for men is 81.1 years for men and 87.3 for women – the highest in the world – Marmot added. Hong Kong has overtaken Japan in terms of how long citizens can expect to live.

Marmot, who has also advised the World Health Organisation, did not claim that the introduction of austerity had led directly to life expectancy stagnating. But he highlighted that “miserly” levels of spending on health and social care in recent years – at a time of rising health need linked to the ageing population – had affected the amount and quality of care older people receive.

The long-term trend for NHS budget increases is 3.8% a year, with rises of 1.1% a year since 2010. “If we don’t spend appropriately on social care, if we don’t spend appropriately on health care, the quality of life will get worse for older people and maybe the length of life, too,” he added.

Marmot cited the growing numbers of deaths among the over-75s and over-85s and continuing high death rates from heart disease as other key potential factors in the stalling rise in life expectancy.

“Life expectancy has been increasing year on year for a generation, to the extent that we had begun to take it for granted as inevitable. But this authoritative analysis suggests this long period of improvement may now be coming to an end, with big implications for us all,” said a spokesman for the charity Age UK.

Cases of dementia and Alzheimer’s have been rising so rapidly that they are now the leading cause of death for both sexes, among women 80 and over and men 85+.

The increase in dementia and needs of the ageing population will place the NHS and social care services “under considerable strain” in the near future, Marmot added.

Dr Matthew Norton, director of policy at Alzheimer’s Research UK, said: “This report shines a spotlight on a hard truth: that unless we can find ways to prevent and treat dementia, deaths from the condition will continue to rise as our population ages. The reality today is that with no treatments to stop or slow the underlying diseases, the condition is placing an ever-growing strain on our health services.”

The Department of Health played down Marmot’s findings. A spokesman pointed out that the NHS had just last week been judged to be the best, safest and most affordable healthcare system out of 11 rich countries analysed in a major review published by the Commonwealth Fund, a respected US thinktank.

“Life expectancy continues to increase, with cancer survival rates at a record high whilst smoking rates are at an all-time low. We continue to invest to ensure our ageing population is well cared-for, with £6bn extra going into the NHS [in England] over the last two years and an additional £2bn for the social care system,” he added.

Rise in life expectancy has stalled since 2010, research shows

A century-long rise in life expectancy has stalled since 2010 when austerity brought about deep cuts in NHS and social care spending, according to research by a former government adviser on the links between poverty and ill-health.

Life expectancy at birth had been going up so fast that women were gaining an extra year of life every five years and men an additional 12 months every three-and-a-half years.

But those trends have almost halved since ministers made a “political decision” in 2010 to reduce the amount of money it put into the public sector, said Sir Michael Marmot. The upward trend in longer life that began in Britain just after the first world war has slowed so dramatically that women now only gain an extra year after a decade while for men the same gain now takes six years to arrive.

The rate of increase was “pretty close to having ground to a halt”, Marmot said.

“I am deeply concerned with the levelling off; I expected it to just keep getting better. Since 2009-2015 it’s pretty flat, whereas we are used to it getting better and better all the time,” added Marmot, who published a major review of health inequalities for Gordon Brown’s Labour government in early 2010.

In 1919 men lived for an average of 52.5 years and women for 56.1 years. That rose to 64.1 years and 68.7 years respectively by 1946. Life expectancy then rose in an almost unbroken gradual upward curve to 77.1 years for men and 81.4 years for women in 2005 and again to 78.7 and 82.6 in 2010, the year David Cameron’s Conservative-Liberal Democrat coalition took office.

Since then life expectancy has continued to creep upwards, but at a slower rate, according to Marmot’s latest analysis. In 2015 average life expectancy in Britain was 79.6 years for men and 83.1 years for women, according to the latest Office for National Statistics data.

Marmot, who is the director of the Institute of Health Equity at University College London, denied the rise had stalled because there was a natural limit to how much life expectancy can increase. “It is not inevitable that it should have levelled off,” he said.

There is no reason why the UK could not emulate Hong Kong, where life expectancy for men is 81.1 years for men and 87.3 for women – the highest in the world – Marmot added. Hong Kong has overtaken Japan in terms of how long citizens can expect to live.

Marmot, who has also advised the World Health Organisation, did not claim that the introduction of austerity had led directly to life expectancy stagnating. But he highlighted that “miserly” levels of spending on health and social care in recent years – at a time of rising health need linked to the ageing population – had affected the amount and quality of care older people receive.

The long-term trend for NHS budget increases is 3.8% a year, with rises of 1.1% a year since 2010. “If we don’t spend appropriately on social care, if we don’t spend appropriately on health care, the quality of life will get worse for older people and maybe the length of life, too,” he added.

Marmot cited the growing numbers of deaths among the over-75s and over-85s and continuing high death rates from heart disease as other key potential factors in the stalling rise in life expectancy.

“Life expectancy has been increasing year on year for a generation, to the extent that we had begun to take it for granted as inevitable. But this authoritative analysis suggests this long period of improvement may now be coming to an end, with big implications for us all,” said a spokesman for the charity Age UK.

Cases of dementia and Alzheimer’s have been rising so rapidly that they are now the leading cause of death for both sexes, among women 80 and over and men 85+.

The increase in dementia and needs of the ageing population will place the NHS and social care services “under considerable strain” in the near future, Marmot added.

Dr Matthew Norton, director of policy at Alzheimer’s Research UK, said: “This report shines a spotlight on a hard truth: that unless we can find ways to prevent and treat dementia, deaths from the condition will continue to rise as our population ages. The reality today is that with no treatments to stop or slow the underlying diseases, the condition is placing an ever-growing strain on our health services.”

The Department of Health played down Marmot’s findings. A spokesman pointed out that the NHS had just last week been judged to be the best, safest and most affordable healthcare system out of 11 rich countries analysed in a major review published by the Commonwealth Fund, a respected US thinktank.

“Life expectancy continues to increase, with cancer survival rates at a record high whilst smoking rates are at an all-time low. We continue to invest to ensure our ageing population is well cared-for, with £6bn extra going into the NHS [in England] over the last two years and an additional £2bn for the social care system,” he added.

The scandal of big tobacco’s behaviour in the developing world | Letters

I welcome your editorial and related coverage (Stop the spread of the tobacco companies’ poison, 13 July). Tobacco smoking is still the largest single preventable cause of ill-health and death. In the UK the reduction in smoking is one of the great public health success stories. However, it is important that this achievement is not reversed. E-cigarettes should be monitored closely.

Tobacco companies have tremendous financial and political power and, despite the overwhelming medical evidence against cigarettes, they are still able to sell their products. Moreover, certain markets are expanding. Two of the world’s largest tobacco companies are based in the UK. Both continue to perform strongly and are confident about their future performances, especially as markets are growing in lower income countries where there is tremendous potential for profit.

Many of the current strategies used by tobacco companies are not new. More than 30 years ago, Peter Taylor published a seminal book which provided a comprehensive insight into the world of public health politics. The Smoke Ring discusses the ring of political and economic interests surrounding the tobacco industry.
Dr Michael Craig Watson
University of Nottingham

We are concerned, if not surprised, to read the Guardian’s exposé of big tobacco’s use of trade measures to threaten African countries into watering down their efforts to promote public health (Report, 12 July).

A major problem with trade and investment agreements is their chilling effect on public interest legislation: countries that lack the time or resources to defend themselves against a trade dispute hold back from introducing new measures that are good for the public but threaten corporate profits and could provoke a trade challenge. This is particularly problematic where corporations are able to use the investor-state dispute settlement mechanism to sue governments in private tribunals where corporate lawyers act as judges.

For example, after Philip Morris challenged Uruguay and Australia for introducing graphic warnings on cigarette packaging and plain packaging respectively, Costa Rica, Paraguay and New Zealand delayed introducing similar measures. Philip Morris lost that case, but big tobacco is still attempting to bully (particularly low and middle income) countries that attempt to put the health of their citizens before shareholder profit. This has to be stopped.

Countries must be free to pursue independent development and public health strategies. That means having the space to regulate and tax in the public interest without the threat of litigation. We would like to see trade agreements that encourage governments to promote public health objectives, rather than acting as a brake on progress. This requires a fundamental shift in the way that we approach trade deals in the future.
Matthew Bramall Health Poverty Action
Paul Keenlyside Trade Justice Movement
David McCoy Professor of Global Public Health, Queen Mary University London
Dr Penelope Milsom Medact
Deowan Mohee African Tobacco Control Alliance
Alvin Mosioma Tax Justice Network – Africa
Mary Assunta South East Asia Tobacco Control Alliance
Deborah Arnott ASH (UK)
Laurent Huber Action on Smoking and Health (US)
Chiara Bodini and David Sanders People’s Health Movement 
Andreas Wulf Medico International
Jean Blaylock Global Justice Now
Mark Dearn War on Want
Tabitha Ha STOPAIDS
Thanguy Nzue Obame People’s Health Movement Gabon

That big tobacco hinders the adoption of anti-smoking legislation is no surprise. Your leader correctly identifies the best route to behavioural change – shareholder pressure – but does not highlight the key channel to achieve this. Big tobacco needs to diversify. This is where shareholder pressure should be applied: to encourage manufacturers and associated leaf merchants to invest in non-harmful products and speed up the process of product diversification. In addition, governments in the south and their development partners should work with manufacturers and merchants to reduce big tobacco’s own addiction to the evil weed.
Dr Martin Prowse
Lund University, Sweden

It is a proud claim we make in this country that 0.7% of our GDP is committed to international development. But efforts to reduce poverty and ill health in developing countries are seriously undermined by the activities of companies such as British American Tobacco.

The tobacco industry has an unrivalled record for dishonesty in trying to prevent its customers becoming aware that there is a 50% chance that they will die from smoking-related causes. It has been a long battle in this country to establish strong measures of tobacco control which have significantly reduced the prevalence of smoking.

In response, the tobacco companies are seeking to get many more people in the developing world addicted to their products. They use the same bogus arguments that have been defeated in the UK to prevent attempts by governments in those countries to prevent this happening. They behave in this way because they make great profits.

The world would be a much better place if such dangerous products were banned. But if this cannot be done by international agreement, then we must at least ensure that we tax them in such a way as to deter such behaviour. The funds raised could also help poorer countries in their fight to establish similar measures of tobacco control to those that are working in the UK.
Chris Rennard
Liberal Democrat, House of Lords

It is deeply unethical that BAT has taken African countries to court to dilute their efforts to protect their populations’ health from tobacco. These countries are still fighting infectious diseases and face a double burden of poor health as a result of non-communicable diseases, with very limited budgets to deal with these.

According to the international covenant on economic, social and cultural rights in the context of business activities (June 2017), these countries are obliged to protect their public’s health, and this includes regulating to restrict marketing and advertising of harmful products such as tobacco.

BAT is headquartered in the UK, so the UK is required to take the necessary steps to prevent human rights violations abroad and it is “contradictory to remain passive where the conduct of an entity may lead to foreseeable harm”.

Moreover, “extraterritorial obligation to protect requires the UK to take steps to prevent and redress infringements of rights that occur outside their territories due to the activities of business entities over which they can exercise control.”

If the UK does not fulfil its extraterritorial responsibility to protect future smokers in Africa, it is possible that it could be liable for damages when many develop cancer, heart disease and strokes. It is incoherent to give British aid for healthcare to these countries while at the same time a UK company is promoting harmful products that diminish people’s right to health.

On a related subject, British MP pension fund, the Parliamentary Contributory Pension Fund (PCPF), invests in BAT and some UK local authority pensions invest large sums in the tobacco industry which many already consider unethical even before the article in the Guardian.
Dr Bernadette O’Hare
University of Malawi and University of St Andrews

Smoking remains a major public health concern, a major contributor to overall mortality and morbidity, to air and water pollution and to physical, economic, social and psychological trauma. However, I must take issue with your allusion to the size of the distance from the developed to the developing world.

The Grenfell tragedy has shone a light on the ills of western societies where people are denied their fundamental rights to safe, clean and adequate housing; where hundreds of thousands are languishing in cramped and dangerous buildings; where homelessness, labour exploitation, knife crimes, racial and religious intolerance and joblessness are increasingly becoming hallmarks of society – and where cover up and deceit are becoming the norm rather than the exception.

To be fair, many developing countries have already recovered from the ills that still plague the developed world. Take a look in the mirror.
Dr Munjed Farid Al Qutob
London

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Terminally ill man challenges UK’s ban on assisted dying at high court

The case of a terminally ill former lecturer will come before the high court this week in the first substantial legal challenge to the UK’s ban on assisted dying.

Noel Conway, 67, from Shrewsbury, was diagnosed with motor neurone disease in November 2014. His condition is incurable and he is not expected to live beyond the next 12 months.

The high court hearing, involving three senior judges, is scheduled to last five days. Conway is supported by Dignity in Dying and other organisations campaigning to change the 1961 Suicide Act. Those who seek help to end their lives are currently forced to travel to a clinic in Switzerland.

Last week several hundred supporters staged a protest on a Thames river boat outside the Houses of Parliament. Afterwards Conway said: “In the past months I have been struck by the number of people who, like me, want the right to choose how we die. Today has shown the huge strength of feeling of people who want the right to a dignified death.”

Ahead of the hearing, Sarah Wootton, chief executive of Dignity in Dying, said: “The British public overwhelmingly support a change in the law to give terminally ill, mentally competent adults like Noel the choice of an assisted death. [The high court hearing] will consider detailed evidence and legal arguments about whether the current law breaches Noel’s human rights.”

Conway’s lawyers will ask the courts to declare that the blanket ban on assisted dying under the Suicide Act is contrary to the Human Rights Act. They will argue that as a terminally ill, mentally competent adult, his right to a private life – which includes the right to make decisions on the end of his life – is unnecessarily restricted by current laws.

The case has been brought against the Ministry of Justice. Conway is represented by the law firm Irwin Mitchell. The organisation Humanists UK, whose Conway is a member, has been given permission to intervene in the case. His aim is to bring about a change in the law that would legalise assisted dying for those who are terminally ill and are assessed as having six months or less to live.

Andrew Copson, chief executive of Humanists UK, said: “It is completely wrong that people who are of sound mind but terminally ill or incurably suffering are denied the choice to die with dignity. The deliberate extension of suffering as a matter of public policy is a stain on our humanity.

“The majority of the public want change but as long as parliament is unwilling to act, it is up to brave individuals such as Noel to fight for all our rights. We will always stand with such courageous and public-spirited champions.”

The last time a right to die case was considered in detail by the courts was in 2014 when the supreme court asked parliament to reconsider the issue. Parliament debated the subject but rejected making any changes to the law.

Rabbi Dr Jonathan Romain, chair of the interfaith clergy group in favour of assisted dying, said: “Noel Conway’s case is important not just for him, but for all those – including many people of faith – who believe that parliament needs to be given a clear signal by the courts to introduce legislation that permits terminally ill people of sound mind to opt for an assisted death if they so wish, rather than endure further suffering as they decline. It is not only their human right, but in keeping with religious ethics too. There is nothing sacred about suffering, nothing holy about agony.”

Earlier this year, Conway explained why he was fighting the case: “I am going to die, and I have come to terms with this fact. But what I do not accept is being denied the ability to decide the timing and manner of my death. I am not prepared to suffer right to the end, nor do I want to endure a long, drawn-out death in a haze of morphine.

“The only alternative is to spend thousands of pounds, travel hundreds of miles and risk incriminating my loved ones in asking them to accompany me to Dignitas [in Switzerland]. This would also force me to die earlier than I want.

“The option of an assisted death should be available to me, here in this country, in my final six months of life – this is what I am fighting for. It would bring immense peace of mind and allow me to live my life to the fullest, enjoying my final months with my loved ones until I decide the time is right for me to go.”

A separate legal challenge is being brought by a man identified only as “Omid T”, who is also a member of Humanists UK. He is suffering from an incurable condition which causes multiple systems atrophy. His case will be heard in the autumn.

In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

Sick patients dying ‘unnecessarily’ in NHS because of poor care

Some of the sickest patients that hospitals treat are dying unnecessarily because they receive poor care, blighted by shortages of staff and equipment, a new NHS inquiry has revealed.

A death rate of one in three among inpatients who need emergency help with breathing is already high by international standards, and is getting worse.

The analysis by the National Confidential Enquiry into Patient Outcome and Death of NHS services for the 50,000 patients a year who receive emergency oxygen treatment uncovered a series of major flaws in the care they received. It described its findings as “shocking”.

The growing numbers of patients who receive non-invasive intervention (NIV) – oxygen through a face mask – usually have chronic obstructive pulmonary disease, pneumonia or other conditions which mean they cannot breathe unaided. Despite their lives being at risk, the vast majority receive sub-standard care, according to an in-depth examination of 353 patients during February and March.

“The care of these patients was rated as less than good in four out of five cases. The mortality rate was high: more than one in three patients died,” the inquiry found. “Supervision of care and patient monitoring were commonly inadequate. Case selection for NIV was often inappropriate and treatment was frequently delayed due to a combination of service organisation and a failure to recognise that NIV was needed.” In addition, investigators found from examining case notes that “the quality of medical care provided was often poor. This poor care included both non-ventilator treatment and ventilation management, which were frequently inappropriate”.

Dr Mark Juniper, a co-author of the report and NCEPOD’s lead clinical coordinator for medicine, said the sheer extent of problems he and his colleagues uncovered meant their hard-hitting conclusions were justified.

“This is a major problem which is resulting in unnecessary loss of life. Four out of five patients didn’t receive care that we as doctors would be happy to receive. That’s quite an indictment. That’s shocking because all these patients are at risk of dying.”

NIV in emergency situations is meant to reduce the risk of dying from 20% to 10%. However, NCEPOD found that the death rate among UK patients is 34% – “really troubling”, said Juniper. By contrast, it is only 18% in Spain while France has cut its death rate in recent years from more than 20% to 10%. The UK death rate has been rising steadily since the 30% recorded in 2011.

Two out of five hospitals at some point had been unable to cope with the number of patients who needed NIV because they lacked equipment. “Lack of ventilators is a common problem, even though a basic machine costs about £1,000 to £2,000. When there are too many patients, some end up receiving other medical treatment that’s not as good as ventilation. That will give them a higher risk of dying.”

Other failings researchers found included a lack of nurses, meaning that less than half of hospitals are able to provide the staffing ratio – one nurse to two NIV patients – which guidelines since 2010 have said should be in place. One in five patients who received NIV either did not need it, or needed to be on life support in an intensive care unit instead. In 47% of cases doctors did not convert the patient’s vital signs, such as their temperature, blood pressure and oxygen levels, into an “early warning score” to help dictate the treatment they received. Doctors were often “really poor” at documenting the condition of patients on NIV, probably because of understaffing.

“With these very sick patients the NHS needs to improve a lot – and fast, because lives are at stake,” said Juniper.

Dr Mike Davies, a consultant in respiratory medicine and spokesman for the British Thoracic Society, which represents lung specialists, said the findings had to “act as a stimulus to improve care for NIV patients. We need a concerted effort across the NHS to help reduce avoidable deaths.”

Professor Lesley Regan, who chairs NCEPOD, said the NHS had to learn lessons from the inquiry, given how many patients receive inadequate care. “Many hospitals fail to grasp the size of the problem, as acute NIV usage is all too easily hidden due to poor coding.”

NCEPOD has also found inaccurate coding causes problems among patients who have had a tracheostomy or have sepsis or acute pancreatitis.

She wants hospitals to appoint “local champions” to assess the state of NIV services and ensure that they have the staff and equipment needed.

Sick patients dying ‘unnecessarily’ in NHS because of poor care

Some of the sickest patients that hospitals treat are dying unnecessarily because they receive poor care, blighted by shortages of staff and equipment, a new NHS inquiry has revealed.

A death rate of one in three among inpatients who need emergency help with breathing is already high by international standards, and is getting worse.

The analysis by the National Confidential Enquiry into Patient Outcome and Death of NHS services for the 50,000 patients a year who receive emergency oxygen treatment uncovered a series of major flaws in the care they received. It described its findings as “shocking”.

The growing numbers of patients who receive non-invasive intervention (NIV) – oxygen through a face mask – usually have chronic obstructive pulmonary disease, pneumonia or other conditions which mean they cannot breathe unaided. Despite their lives being at risk, the vast majority receive sub-standard care, according to an in-depth examination of 353 patients during February and March.

“The care of these patients was rated as less than good in four out of five cases. The mortality rate was high: more than one in three patients died,” the inquiry found. “Supervision of care and patient monitoring were commonly inadequate. Case selection for NIV was often inappropriate and treatment was frequently delayed due to a combination of service organisation and a failure to recognise that NIV was needed.” In addition, investigators found from examining case notes that “the quality of medical care provided was often poor. This poor care included both non-ventilator treatment and ventilation management, which were frequently inappropriate”.

Dr Mark Juniper, a co-author of the report and NCEPOD’s lead clinical coordinator for medicine, said the sheer extent of problems he and his colleagues uncovered meant their hard-hitting conclusions were justified.

“This is a major problem which is resulting in unnecessary loss of life. Four out of five patients didn’t receive care that we as doctors would be happy to receive. That’s quite an indictment. That’s shocking because all these patients are at risk of dying.”

NIV in emergency situations is meant to reduce the risk of dying from 20% to 10%. However, NCEPOD found that the death rate among UK patients is 34% – “really troubling”, said Juniper. By contrast, it is only 18% in Spain while France has cut its death rate in recent years from more than 20% to 10%. The UK death rate has been rising steadily since the 30% recorded in 2011.

Two out of five hospitals at some point had been unable to cope with the number of patients who needed NIV because they lacked equipment. “Lack of ventilators is a common problem, even though a basic machine costs about £1,000 to £2,000. When there are too many patients, some end up receiving other medical treatment that’s not as good as ventilation. That will give them a higher risk of dying.”

Other failings researchers found included a lack of nurses, meaning that less than half of hospitals are able to provide the staffing ratio – one nurse to two NIV patients – which guidelines since 2010 have said should be in place. One in five patients who received NIV either did not need it, or needed to be on life support in an intensive care unit instead. In 47% of cases doctors did not convert the patient’s vital signs, such as their temperature, blood pressure and oxygen levels, into an “early warning score” to help dictate the treatment they received. Doctors were often “really poor” at documenting the condition of patients on NIV, probably because of understaffing.

“With these very sick patients the NHS needs to improve a lot – and fast, because lives are at stake,” said Juniper.

Dr Mike Davies, a consultant in respiratory medicine and spokesman for the British Thoracic Society, which represents lung specialists, said the findings had to “act as a stimulus to improve care for NIV patients. We need a concerted effort across the NHS to help reduce avoidable deaths.”

Professor Lesley Regan, who chairs NCEPOD, said the NHS had to learn lessons from the inquiry, given how many patients receive inadequate care. “Many hospitals fail to grasp the size of the problem, as acute NIV usage is all too easily hidden due to poor coding.”

NCEPOD has also found inaccurate coding causes problems among patients who have had a tracheostomy or have sepsis or acute pancreatitis.

She wants hospitals to appoint “local champions” to assess the state of NIV services and ensure that they have the staff and equipment needed.