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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.

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.

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.

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.

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.

Revealed: NHS cuts could target heart attack patients in Surrey and Sussex

Patients at risk of a heart attack could be denied vital tests and potentially life-saving operations under NHS plans to make £55m of budget cuts in Surrey and Sussex, the Guardian can reveal.

NHS organisations in Surrey and Sussex are considering restricting the number of patients who have an angiogram or an angioplasty – the insertion of stents to tackle blocked arteries – despite the evidence that both procedures reduce the risk of patients dying.

The disclosure came as senior Tory MP Sarah Wollaston, the chair of the Commons health select committee, urged ministers to scrap the “capped expenditure process” – the secretive cost-cutting regime which the NHS is imposing on 14 areas of England in a bid to save £500m – because it involves “draconian” cuts to services that will hit patient care.

“I don’t think that these extra cuts are reasonable. You can’t justify £500m to the DUP while taking another £500m out of the English NHS,” she told the Guardian.

“The kind of issues that are being discussed [in the 14 areas subject to the CEP] would involve draconian measures that would have an impact on public health and services. [And] I do have concerns about ultimately patient safety.”

Hospitals routinely use an angiogram to assess the health of a patient’s heart. The number of people in the UK undergoing angioplasty has risen eightfold since the early 1990s to almost 100,000 a year, reflecting its growing popularity as a non-invasive alternative to a heart bypass.

Cutting the number of people who have either is one of a range of options which NHS bosses in Surrey and Sussex are considering in order to save £55m more under the CEP by March 2018 than the £106m of “efficiency savings” already agreed.

NHS bodies in Surrey and Sussex privately admit that fewer people will have those procedures as part of their plan to save the £55m by reducing “huge variation” in patients’ chances of having one, depending on which hospital they are treated at and which cardiologist they see. “We have to rationalise cardiac investigations and treatments. There’s variation of 60% to 70% between hospitals. We’re looking into why that is. Who in future won’t get an angiogram? That’ll be up to cardiologists,” said one senior doctor.

In future an unknown number of patients at risk of a heart attack will be monitored by “watchful waiting” rather than given an angiogram or angioplasty, the doctor explained.

Senior NHS sources in the area have disclosed that they are also being forced to consider proposals to:

  • Ration knee arthroscopy operations, cataract removals and tonsillectomies
  • Introduce “lifestyle rationing” so that patients who are obese and smoke will have to lose weight and stop smoking before they can have, for example, a knee replacement to treat their arthritis
  • Shut beds or even whole wards in community hospitals
  • Restrict patients’ access to hearing aids and IVF treatment

“We have been told to leave no stone unturned and think the unthinkable [in the quest to save the £55m],” one local senior NHS figure said, speaking anonymously.

“It’s quite delusional to think we can take out the £106m already planned and now this extra £55m so quickly. But NHS England have told us to do this. The trouble is that, after making lots of efficiency savings in recent years, there is very little fat to take out,” the official added.

NHS organisations in Surrey and Sussex tasked with pursuing the savings drive confirmed that access could be reduced to many different types of care. “We have been looking at all treatments and procedures provided across our area,” they said in a joint statement.

“There is considerable variation in the thresholds and criteria applied before patients are referred for treatment. We want to ensure that referral decisions are based on the latest clinical evidence of what works and are applied consistently, delivering the best value for money for the public and fairness for patients.”

The bodies made clear that they have to contemplate such controversial measures because NHSE and NHSI have told them to save the £55m. Despite already having “ambitious financial plans for 2017-18 … collectively, the plans would overspend by £55m against the financial ‘control total’ that has been set by NHS England and NHS Improvement,” they added.

Heart specialists warned that patients’ health could suffer if decisions about who had either procedure was made on anything other than purely medical grounds. “Any restriction on angiography or angioplasties should be based on clinical criteria and guidelines to ensure no adverse effect on patient care and health,” said Prof Sir Nilesh Samani, the medical director of the British Heart Foundation.

The British Cardiology Society, which represents heart specialists, underlined the importance of both procedures as measures to help save lives. A spokeswoman said: “Cardiovascular disease remains a significant burden to the UK and requires appropriate investigation and management to reduce mortality and morbidity. Despite significant reductions in mortality through medical and invasive treatments both primary and secondary preventive strategies remain important.”

The Royal College of Surgeons said introducing “lifestyle rationing” was “wrong”. A spokesman said: “There is no clinical guidance from NICE, the Royal College of Surgeons and other surgical associations to support restrictions for routine surgery on the basis of whether patients smoke or are overweight.

Saving the £55m this year will prove to be a false economy that costs the NHS more money in the long term, warned Nigel Edwards, chief executive of the Nuffield Trust health thinktank.

“Many of these cutbacks in procedures will only save money in the short term. If they go ahead, this will mean putting off treating patients whose hip and eye conditions will worsen and must be treated eventually. Getting savings out will also require cutting staff,” he said.

This story was amended to correct the statement that a number of cabinet ministers’ seats are in the affected area.