Tag Archives: patients’

Surgeon who burned initials into livers of two patients fined £10,000

A surgeon who burned his initials on to the livers of two patients during transplant surgery has been given a 12-month community order and fined £10,000.

Simon Bramhall, 53, used an argon beam – used to stop livers bleeding during operations and to highlight an area to be worked on – to sign “SB” into his patient’s livers. The marks left by argon do not impair the liver’s function and disappear by themselves.

In December, the liver, spleen and pancreas surgeon admitted two counts of assault by beating. The offences relate to the incidents on 9 February and 21 August 2013. Prosecutors accepted his not guilty pleas to the more serious charges of assault occasioning actual bodily harm.

Bramhall was first suspended from his post as a consultant surgeon at Birmingham’s Queen Elizabeth hospital in 2013 after another surgeon spotted the initials during follow-up surgery on one of his patients. A photograph of the 4cm-high branding was taken on a mobile phone.

Bramhall tendered his resignation the following summer amid an internal disciplinary investigation into his conduct. Speaking to the press at the time, he said marking his initials on to his patients’ livers had been a mistake. He now works for the NHS in Herefordshire.

Opening the facts of the case against Bramhall, Tony Badenoch QC, prosecuting, said one of the surgeon’s victims had been left feeling violated and suffering psychological harm.

“This case is about his practice on two occasions, without the consent of the patient and for no clinical reason whatever, to burn his initials on to the surface of a newly transplanted liver,” said Badenoch.

Badenoch said of the initial transplant operation: “Mr Bramhall had to work exceptionally hard and use all of his skill to complete the operation. At the end of the operation he performed a liver biopsy using the argon beam coagulator, and then used it to burn his initials.”

The court heard that a nurse had asked what the marks were and Bramhall replied: “I do this.” The surgeon later told police he had “flicked his wrist” and made the mark within a few seconds.

“He knew that the action could cause no harm to the patient. He also said that in hindsight this was naive and foolhardy – a misjudged attempt to relieve the tension in theatre,” Badenoch said

The judge, Paul Farrer QC, ordered Bramhall to carry out 120 hours of unpaid work. He told Bramhall: “Both of the operations were long and difficult. I accept that on both occasions you were tired and stressed and I accept that this may have affected your judgment. This was conduct born of professional arrogance of such magnitude that it strayed into criminal behaviour.

“What you did was an abuse of power and a betrayal of trust that these patients had invested in you. I accept that you didn’t intend or foresee anything but the most trivial of harm would be caused.”

The Queen Elizabeth hospital said in a statement: “The trust is clear that Mr Bramhall made a mistake in the context of a complex clinical situation and this has been dealt with via the appropriate authorities, including the trust as his then employer. We can reassure his patients that there was no impact whatsoever on the quality of his clinical outcomes.”

Bramhall was issued with a formal warning by the General Medical Council in February 2017. The body said his conduct had not met the standards required of a doctor.

“While this failing in itself is not so serious as to require any restriction on Mr Bramhall’s registration, it is necessary in response to issue this formal warning,” it said at the time.

Surgeon who burned initials into livers of two patients fined £10,000

A surgeon who burned his initials on to the livers of two patients during transplant surgery has been given a 12-month community order and fined £10,000.

Simon Bramhall, 53, used an argon beam – used to stop livers bleeding during operations and to highlight an area to be worked on – to sign “SB” into his patient’s livers. The marks left by argon do not impair the liver’s function and disappear by themselves.

In December, the liver, spleen and pancreas surgeon admitted two counts of assault by beating. The offences relate to the incidents on 9 February and 21 August 2013. Prosecutors accepted his not guilty pleas to the more serious charges of assault occasioning actual bodily harm.

Bramhall was first suspended from his post as a consultant surgeon at Birmingham’s Queen Elizabeth hospital in 2013 after another surgeon spotted the initials during follow-up surgery on one of his patients. A photograph of the 4cm-high branding was taken on a mobile phone.

Bramhall tendered his resignation the following summer amid an internal disciplinary investigation into his conduct. Speaking to the press at the time, he said marking his initials on to his patients’ livers had been a mistake. He now works for the NHS in Herefordshire.

Opening the facts of the case against Bramhall, Tony Badenoch QC, prosecuting, said one of the surgeon’s victims had been left feeling violated and suffering psychological harm.

“This case is about his practice on two occasions, without the consent of the patient and for no clinical reason whatever, to burn his initials on to the surface of a newly transplanted liver,” said Badenoch.

Badenoch said of the initial transplant operation: “Mr Bramhall had to work exceptionally hard and use all of his skill to complete the operation. At the end of the operation he performed a liver biopsy using the argon beam coagulator, and then used it to burn his initials.”

The court heard that a nurse had asked what the marks were and Bramhall replied: “I do this.” The surgeon later told police he had “flicked his wrist” and made the mark within a few seconds.

“He knew that the action could cause no harm to the patient. He also said that in hindsight this was naive and foolhardy – a misjudged attempt to relieve the tension in theatre,” Badenoch said

The judge, Paul Farrer QC, ordered Bramhall to carry out 120 hours of unpaid work. He told Bramhall: “Both of the operations were long and difficult. I accept that on both occasions you were tired and stressed and I accept that this may have affected your judgment. This was conduct born of professional arrogance of such magnitude that it strayed into criminal behaviour.

“What you did was an abuse of power and a betrayal of trust that these patients had invested in you. I accept that you didn’t intend or foresee anything but the most trivial of harm would be caused.”

The Queen Elizabeth hospital said in a statement: “The trust is clear that Mr Bramhall made a mistake in the context of a complex clinical situation and this has been dealt with via the appropriate authorities, including the trust as his then employer. We can reassure his patients that there was no impact whatsoever on the quality of his clinical outcomes.”

Bramhall was issued with a formal warning by the General Medical Council in February 2017. The body said his conduct had not met the standards required of a doctor.

“While this failing in itself is not so serious as to require any restriction on Mr Bramhall’s registration, it is necessary in response to issue this formal warning,” it said at the time.

Surgeon who burned initials into livers of two patients fined £10,000

A surgeon who burned his initials on to the livers of two patients during transplant surgery has been given a 12-month community order and fined £10,000.

Simon Bramhall, 53, used an argon beam – used to stop livers bleeding during operations and to highlight an area to be worked on – to sign “SB” into his patient’s livers. The marks left by argon do not impair the liver’s function and disappear by themselves.

In December, the liver, spleen and pancreas surgeon admitted two counts of assault by beating. The offences relate to the incidents on 9 February and 21 August 2013. Prosecutors accepted his not guilty pleas to the more serious charges of assault occasioning actual bodily harm.

Bramhall was first suspended from his post as a consultant surgeon at Birmingham’s Queen Elizabeth hospital in 2013 after another surgeon spotted the initials during follow-up surgery on one of his patients. A photograph of the 4cm-high branding was taken on a mobile phone.

Bramhall tendered his resignation the following summer amid an internal disciplinary investigation into his conduct. Speaking to the press at the time, he said marking his initials on to his patients’ livers had been a mistake. He now works for the NHS in Herefordshire.

Opening the facts of the case against Bramhall, Tony Badenoch QC, prosecuting, said one of the surgeon’s victims had been left feeling “violated” and suffering psychological harm.

“This case is about his practice on two occasions, without the consent of the patient and for no clinical reason whatever, to burn his initials on to the surface of a newly transplanted liver,” said Badenoch.

Badenoch said of the initial transplant operation: “Mr Bramhall had to work exceptionally hard and use all of his skill to complete the operation. At the end of the operation he performed a liver biopsy using the argon beam coagulator, and then used it to burn his initials.”

A nurse asked what the marks were and Bramhall was said to have replied: “I do this.” The court heard that Bramhall later told police he had “flicked his wrist” and made the mark within a few seconds.

“He knew that the action could cause no harm to the patient. He also said that in hindsight this was naive and foolhardy – a misjudged attempt to relieve the tension in theatre,” Badenoch said

The judge, Paul Farrer QC, ordered Bramhall to carry out 120 hours of unpaid work. He told Bramhall: “Both of the operations were long and difficult. I accept that on both occasions you were tired and stressed and I accept that this may have affected your judgment. This was conduct born of professional arrogance of such magnitude that it strayed into criminal behaviour.

“What you did was an abuse of power and a betrayal of trust that these patients had invested in you. I accept that you didn’t intend or foresee anything but the most trivial of harm would be caused.”

The Queen Elizabeth hospital said in a statement: “The trust is clear that Mr Bramhall made a mistake in the context of a complex clinical situation and this has been dealt with via the appropriate authorities, including the Trust as his then employer. We can reassure his patients that there was no impact whatsoever on the quality of his clinical outcomes.”

NHS beds crisis: sick patients can sit in A&E, says health minister

The NHS minister, Philip Dunne, has been accused of “belittling” the beds crisis by telling MPs that patients who need to be admitted can sit on seats in A&E units while they wait for a bed.

Philip Dunne was responding to the disclosure that patients have been forced to sleep on the floor in at least one hospital because the NHS’s beds shortage was so acute.

Doctors’ associations and Labour seized on Dunne’s remark, which he made in answer to an urgent question in the House of Commons about how the NHS was managing the winter crisis.

“The seats comment sounds flippant and belittling of the problem that exists,” said Dr Nick Scriven, the president of the Society for Acute Medicine, which represents hospital doctors specialising in acute and general medicine.

“If that is what he truly thinks, it shows a worrying lack of appreciation of reality in our emergency departments and acute medical units.”

Q&A

Why is the NHS winter crisis so bad in 2017-18?

A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied.

NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.

Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine.

The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries.

Read a full Q&A on the NHS winter crisis

Dunne was responding to Labour MP Tracy Brabin, who described how one of her constituents had taken photographs of people “sleeping on the floor” in a hospital as winter pressures led to severe overcrowding.

“These were poorly people in chairs waiting for hours, not being given a bed or a trolley,” she said. “What I didn’t hear in his response was an apology. Is now the time for the minister to apologise to those affected?”

Dunne replied: “[Brabin] will have heard last week the apology from the secretary of state [Jeremy Hunt] to those patients who are having operations postponed, and I absolutely am prepared to apologise today to those patients who are not able to be treated as quickly as we would like them to.”

He added: “There are seats available in most hospitals where beds are not available and I can’t comment individually what happened in her case but I agree with her it’s not acceptable.”

Brabin said Dunne’s remark was “appalling and ignorant” and showed ministers were out of touch with how bad the situation was facing hospitals.

“This is an appalling and ignorant remark from a minister entirely out of touch with the reality of the NHS winter crisis,” said Justin Madders, the shadow health minister.

“Placing sick patients in chairs because of acute bed shortages is clearly not acceptable in the 21st century. And yet with numerous trusts this winter at times reporting 100% bed occupancy, hospitals simply cannot cope and are being forced into these intolerable situations.”

Hospitals are supposed to have no more than 85% of their general and acute beds filled at any one time, in order to ensure patient safety, for example by minimising the spread of potentially fatal infections such as MRSA. However, this winter has seen some hospitals hit 100% bed occupancy and many others become 98% or 99% full as they struggle to cope with a sudden influx of patients, many with breathing problems.

The NHS-wide lack of beds and A&E crisis has forced NHS England to tell hospitals to postpone tens of thousands of planned operations, and even outpatient appointments, until the end of February.

I’m an A&E doctor. This is how we’re forced to let our patients down | Anonymous

I’ve arrived five minutes early for my shift in a hospital A&E department. I walk through the corridor behind the department, already crammed with hospital trolleys. I shut them out of my mind. I’ve still got five minutes of breathing space before they become my immediate reality.

The trolleys are staffed by paramedics. They brought the patients in, there’s nowhere for them to go, and there are no hospital staff to look after them. So the paramedics wait with the patients, checking on their pain and repeating their vital signs – instead of being out there responding to the soaring number of emergency calls.

Q&A

Why is the NHS winter crisis so bad in 2017-18?

A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied.

NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.

Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine.

The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries.

Read a full Q&A on the NHS winter crisis

Most of the patients in the corridor today are elderly. Some clearly have dementia, and are confused as to where they are. There’s no dignity, no warmth and a very long wait ahead before the hospital starts seeing and treating them. It turns out that I didn’t manage to shut them out of my mind at all.

As I walk into the changing rooms there is chaos everywhere. A crisis has hit all the staff. The cleaners have needed to help with getting cubicles and bed areas turned around faster and faster, so the staff areas have moved to the bottom of their list. There are literally no clean scrubs or uniforms left for any of us to wear. “Don’t worry, whatever you’ve got on is fine, just start seeing patients.” The bosses are as stretched and as desperate as anyone else.

I am allocated to the “minors” area. This area was designed for ambulatory patients who could be walked into a room, seen and walked back out to the waiting room to wait for results. It is already full of patients on hospital beds, pushed two together in three out of the five consultation rooms. Some are elderly, confused, alone. Some are young, injured or very unwell. One is a mental health patient with severe anxiety. This is not the place to make her feel better. Far from it.

Over the PA system, pre-alerts for ambulances carrying critically unwell patients are announced – the ones whose condition is life-threatening. In 11 minutes, four ambulances carrying patients who need immediate resuscitation arrive. This would saturate the system on a good day. Today they have nowhere else to go.


The inadequate care we are providing is the inevitable reality of the government’s funding decisions

I hear a call for “security urgently” over the PA system. The call is repeated two minutes later. We all know it’s for show. The security team are stretched and scattered all over the hospital, and can rarely answer those calls. This time a staff member had been attacked by an intoxicated patient.

As I walk back down the jammed corridor, increasing numbers of screaming and crying patients line the lanes, creating an emotional and physical obstacle course that every staff member walks down. It’s truly sickening.

What’s worse is that this situation was entirely predictable. The inadequate care we are providing is the inevitable reality of the government’s funding decisions. If you strip back funding, force hospitals to make savings they can’t afford, devastate primary and social care, and fail to invest in staffing or resources to match demand, we are forced to tell our patients: “I’m so sorry, we can’t look after you safely today.”

And for many of us, we’re tired of apologising on behalf of the ministers who have made these decisions. It’s just too much. We are too tired to keep trying to smile. We are struggling to try to make it work. We’re sorry we’ve let you down, but we’re broken and we need your help.

The anonymous writer is an A&E doctor who works in a hospital in south-east England

I’m an A&E doctor. This is how we’re forced to let our patients down | Anonymous

I’ve arrived five minutes early for my shift in a hospital A&E department. I walk through the corridor behind the department, already crammed with hospital trolleys. I shut them out of my mind. I’ve still got five minutes of breathing space before they become my immediate reality.

The trolleys are staffed by paramedics. They brought the patients in, there’s nowhere for them to go, and there are no hospital staff to look after them. So the paramedics wait with the patients, checking on their pain and repeating their vital signs – instead of being out there responding to the soaring number of emergency calls.

Most of the patients in the corridor today are elderly. Some clearly have dementia, and are confused as to where they are. There’s no dignity, no warmth and a very long wait ahead before the hospital starts seeing and treating them. It turns out that I didn’t manage to shut them out of my mind at all.

As I walk into the changing rooms there is chaos everywhere. A crisis has hit all the staff. The cleaners have needed to help with getting cubicles and bed areas turned around faster and faster, so the staff areas have moved to the bottom of their list. There are literally no clean scrubs or uniforms left for any of us to wear. “Don’t worry, whatever you’ve got on is fine, just start seeing patients.” The bosses are as stretched and as desperate as anyone else.

I am allocated to the “minors” area. This area was designed for ambulatory patients who could be walked into a room, seen and walked back out to the waiting room to wait for results. It is already full of patients on hospital beds, pushed two together in three out of the five consultation rooms. Some are elderly, confused, alone. Some are young, injured or very unwell. One is a mental health patient with severe anxiety. This is not the place to make her feel better. Far from it.

Over the PA system, pre-alerts for ambulances carrying critically unwell patients are announced – the ones whose condition is life-threatening. In 11 minutes, four ambulances carrying patients who need immediate resuscitation arrive. This would saturate the system on a good day. Today they have nowhere else to go.


The inadequate care we are providing is the inevitable reality of the government’s funding decisions

I hear a call for “security urgently” over the PA system. The call is repeated two minutes later. We all know it’s for show. The security team are stretched and scattered all over the hospital, and can rarely answer those calls. This time a staff member had been attacked by an intoxicated patient.

As I walk back down the jammed corridor, increasing numbers of screaming and crying patients line the lanes, creating an emotional and physical obstacle course that every staff member walks down. It’s truly sickening.

What’s worse is that this situation was entirely predictable. The inadequate care we are providing is the inevitable reality of the government’s funding decisions. If you strip back funding, force hospitals to make savings they can’t afford, devastate primary and social care, and fail to invest in staffing or resources to match demand, we are forced to tell our patients: “I’m so sorry, we can’t look after you safely today.”

And for many of us, we’re tired of apologising on behalf of the ministers who have made these decisions. It’s just too much. We are too tired to keep trying to smile. We are struggling to try to make it work. We’re sorry we’ve let you down, but we’re broken and we need your help.

The anonymous writer is an A&E doctor who works in a hospital in south-east England

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Nurses leave packed A&E units to treat patients in ambulances

Hospitals have become so overwhelmed by the number of patients needing care that nurses have been leaving their A&E unit in order to treat patients stuck in the back of ambulances outside.

Nurses have begun using the highly unusual practice – branded “shocking” by their own union – in a bid to ensure that patients’ health is not suffering in the face of the NHS winter crisis.

One nurse in the south-east of England told how she did that during her shift on New Year’s Day – triaging patients arriving at A&E – because the chaos in the unit meant some patients were being forced to wait up to six hours inside ambulances outside the hospital.

“During my shift I treated patients, including taking bloods and prescribing antibiotics while they were in the back of the ambulance as there was no space in the hospital,” said the nurse, who spoke on condition of anonymity.

“One patient arrived early afternoon and was still in the ambulance when I handed over to to the night shift. I did question whether this was safe.”

She acted out of concern that patients’ health could deteriorate because they were spending so long in the vehicles without being assessed and treated by hospital staff, she said.

“It’s shocking news that some nursing staff are having to treat patients in the backs of ambulances,” said Janet Davies, general secretary and chief executive of the Royal College of Nursing (RCN).

“If paramedics have made a decision that a patient needs to be treated in hospital, then that is where they should be, not stuck outside in a vehicle.

Q&A

What are your experiences of the NHS this winter?

We will be monitoring the situation in hospitals over the next few months and want to hear your experiences of the NHS this winter. We are keen to hear from healthcare professionals as well as patients about the situation. Have operations been cancelled? Has pressure led to certain wards being closed? How are staff coping? Help us document what is going on across the UK.

“It also stops the ambulance getting to its next call, thereby creating yet more delays.”

“This is yet another symptom of an NHS operating under severe pressure. There are fault-lines running through the entire system of getting patients into and out of hospital.”

Separately, staff at the Royal Bournemouth hospital in Dorset have told how paramedics have been triaging patients in the hospital’s A&E unit – a task nurses always perform – so that they can offload their patients more quickly and start answering other 999 calls more quickly.

The hospital has been under such pressure this week this it has asked patients to stay away unless they are having a genuine medical emergency.

Richard Renaut, the hospital’s chief operating officer, said on Thursday: “Our emergency department remains incredibly busy and so we encourage you to call NHS 111 and seek advice if you are unsure where to get treatment”.

Nurses in the south-east have given the RCN vivid anonymous personal testimonies about the difficult circumstances their hospitals have found themselves in this week during what senior doctors and NHS bosses say is the worst winter crisis in years. Prof Keith Willett, NHS England’s director of acute care, said that pressures are the greatest since the 1990s.

Nurses have described how some patients have had to spend 15 hours in A&E while they wait for a bedand resuscitation units have also run out of space, sparking fears about the safety of patients whose health is already seriously damaged.

“Several patients should have gone into resuscitation and there was no space,” one nurse said.

“If they had had a cardiac arrest or become compromised, we still didn’t have any space. I felt I was playing a game of roulette with people’s lives.”

Meanwhile, patients in Oxfordshire who have kidney disease are facing much longer trips than usual to undergo vital dialysis treatment, because six beds at the Horton hospital in Banbury are now being used to accommodate patients who have arrived as medical emergencies at A&E.

The patients affected now have to travel to Oxford’s Churchill hospital to undergo their treatment, which many dialysis patients have two or three times a week.

Since Tuesday, Oxford University Hospitals NHS foundation trust, which runs both hospitals as well as the John Radcliffe in the city, has been on “black alert” – the NHS’s highest state of alert.

Nurses leave packed A&E units to treat patients in ambulances

Hospitals have become so overwhelmed by the number of patients needing care that nurses have been leaving their A&E unit in order to treat patients stuck in the back of ambulances outside.

Nurses have begun using the highly unusual practice – branded “shocking” by their own union – in a bid to ensure that patients’ health is not suffering in the face of the NHS winter crisis.

One nurse in the south-east of England told how she did that during her shift on New Year’s Day – triaging patients arriving at A&E – because the chaos in the unit meant some patients were being forced to wait up to six hours inside ambulances outside the hospital.

“During my shift I treated patients, including taking bloods and prescribing antibiotics while they were in the back of the ambulance as there was no space in the hospital,” said the nurse, who spoke on condition of anonymity.

“One patient arrived early afternoon and was still in the ambulance when I handed over to to the night shift. I did question whether this was safe.”

She acted out of concern that patients’ health could deteriorate because they were spending so long in the vehicles without being assessed and treated by hospital staff, she said.

“It’s shocking news that some nursing staff are having to treat patients in the backs of ambulances,” said Janet Davies, general secretary and chief executive of the Royal College of Nursing (RCN).

“If paramedics have made a decision that a patient needs to be treated in hospital, then that is where they should be, not stuck outside in a vehicle.

Q&A

What are your experiences of the NHS this winter?

We will be monitoring the situation in hospitals over the next few months and want to hear your experiences of the NHS this winter. We are keen to hear from healthcare professionals as well as patients about the situation. Have operations been cancelled? Has pressure led to certain wards being closed? How are staff coping? Help us document what is going on across the UK.

“It also stops the ambulance getting to its next call, thereby creating yet more delays.”

“This is yet another symptom of an NHS operating under severe pressure. There are fault-lines running through the entire system of getting patients into and out of hospital.”

Separately, staff at the Royal Bournemouth hospital in Dorset have told how paramedics have been triaging patients in the hospital’s A&E unit – a task nurses always perform – so that they can offload their patients more quickly and start answering other 999 calls more quickly.

The hospital has been under such pressure this week this it has asked patients to stay away unless they are having a genuine medical emergency.

Richard Renaut, the hospital’s chief operating officer, said on Thursday: “Our emergency department remains incredibly busy and so we encourage you to call NHS 111 and seek advice if you are unsure where to get treatment”.

Nurses in the south-east have given the RCN vivid anonymous personal testimonies about the difficult circumstances their hospitals have found themselves in this week during what senior doctors and NHS bosses say is the worst winter crisis in years. Prof Keith Willett, NHS England’s director of acute care, said that pressures are the greatest since the 1990s.

Nurses have described how some patients have had to spend 15 hours in A&E while they wait for a bedand resuscitation units have also run out of space, sparking fears about the safety of patients whose health is already seriously damaged.

“Several patients should have gone into resuscitation and there was no space,” one nurse said.

“If they had had a cardiac arrest or become compromised, we still didn’t have any space. I felt I was playing a game of roulette with people’s lives.”

Meanwhile, patients in Oxfordshire who have kidney disease are facing much longer trips than usual to undergo vital dialysis treatment, because six beds at the Horton hospital in Banbury are now being used to accommodate patients who have arrived as medical emergencies at A&E.

The patients affected now have to travel to Oxford’s Churchill hospital to undergo their treatment, which many dialysis patients have two or three times a week.

Since Tuesday, Oxford University Hospitals NHS foundation trust, which runs both hospitals as well as the John Radcliffe in the city, has been on “black alert” – the NHS’s highest state of alert.

Patients in Africa twice as likely to die after an operation than global average, report shows

Patients undergoing surgery in Africa are more than twice as likely to die following an operation than the global average, despite generally being younger, healthier and the surgery they are undergoing being more minor, research has revealed.

The study, which covered 25 countries, revealed that just over 18% of in-patients developed complications following surgery, while 1% of elective in-patients died in hospital within 30 days of their operation – twice the global average.

Prof Bruce Biccard, a co-author of the latest study from the University of Cape Town, said that one of the major problems is likely to be an insufficient number of medical staff, resulting in difficulties in spotting or tackling complications following operations. “[The reason] that people do so terribly in Africa from a surgical point of view is that there are just no human resources,” he said.

The research, Biccard added, offers a crucial snapshot of issues around surgery in low and middle income countries. “Data from Africa is almost non existent,” he said.

Writing in journal the Lancet, the international team of researchers describe how they collected data from 11,422 adult patients at 247 hospitals spread over 25 countries – including Ethiopia, Egypt, Nigeria and Zambia – to assess patient outcomes following surgical procedures which required an overnight stay. Each hospital collected data during one week of their choosing between February and May 2016, although data on complications and death were not available for every patient.

The results reveal that 2.1% of those who underwent any surgery, and 1% of those who had elective surgery, died in hospital within 30 days of their operation. Only a minority of deaths occurred on the day of the operation itself.

Just over 18% of all patients developed complications, ranging from stroke to pneumonia, almost one in 10 of whom died. “It is likely that many of these deaths were preventable,” the authors note.

However the study also revealed that the number of operations across the continent was very low and fewer than 43% of surgeries in Africa were elective, with the majority of patients instead undergoing urgent or emergency operations. Meanwhile, caesarean deliveries accounted for 33% of surgeries across Africa – a remarkably high proportion.

Together, says Biccard, that highlights another problem: that many individuals who need surgery might not have access to it. “The real sad thing is that there is a lot of surgery obviously that is not happening,” he said. “That is probably a huge killer in Africa,” he added.

The authors suggest that the findings are probably a reflection of a scanty workforce, limited numbers of hospital beds, and poor systems to check up on patients follow surgery, noting that there are only about 0.7 specialist surgeons, obstetricians and anaesthesiologists per 100,000 population. The recommended figure to decrease the risk of death following surgery is 20–40 such specialists per 100,000 population. “There is no way we are going to be able to train enough physicians to fill this deficit in human resources,” said Biccard, suggesting that either systems for focusing care on high-risk patients need to be developed, or non-physicians would need to be helped to identify patients who might be at risk.

The authors also note that 14 African countries did not take part in the study, but that with some of those politically unstable, in conflict, or having few doctors, surgical outcomes could be even worse.

Dr David Walker, a consultant in anaesthesia and critical care medicine at University College London Hospitals, who was not involved in the study, said that issues of care of patients around the time of surgery was a global issue.

“It seems to be, no matter where in the world you have surgery, complications for many are an inevitable consequence of hospitalisation,” he said. “Importantly, when complications occur there may be considerable disparity in patient outcomes after those complications: so it [often] isn’t the complication that kills you, it is the failure to rescue – how [the patient is looked after following the complication].”

The latest study, he adds, suggests that poor access to timely surgery is a “forgotten epidemic” in Africa. “It reminds us also about the importance of the surgical journey – looking after patients from the minute they present in hospital, through surgery and, really importantly, the ability to care for patients in the post-operative period,” he said.

Patients in Africa twice as likely to die after an operation than global average, report shows

Patients undergoing surgery in Africa are more than twice as likely to die following an operation than the global average, despite generally being younger, healthier and the surgery they are undergoing being more minor, research has revealed.

The study, which covered 25 countries, revealed that just over 18% of in-patients developed complications following surgery, while 1% of elective in-patients died in hospital within 30 days of their operation – twice the global average.

Prof Bruce Biccard, a co-author of the latest study from the University of Cape Town, said that one of the major problems is likely to be an insufficient number of medical staff, resulting in difficulties in spotting or tackling complications following operations. “[The reason] that people do so terribly in Africa from a surgical point of view is that there are just no human resources,” he said.

The research, Biccard added, offers a crucial snapshot of issues around surgery in low and middle income countries. “Data from Africa is almost non existent,” he said.

Writing in journal the Lancet, the international team of researchers describe how they collected data from 11,422 adult patients at 247 hospitals spread over 25 countries – including Ethiopia, Egypt, Nigeria and Zambia – to assess patient outcomes following surgical procedures which required an overnight stay. Each hospital collected data during one week of their choosing between February and May 2016, although data on complications and death were not available for every patient.

The results reveal that 2.1% of those who underwent any surgery, and 1% of those who had elective surgery, died in hospital within 30 days of their operation. Only a minority of deaths occurred on the day of the operation itself.

Just over 18% of all patients developed complications, ranging from stroke to pneumonia, almost one in 10 of whom died. “It is likely that many of these deaths were preventable,” the authors note.

However the study also revealed that the number of operations across the continent was very low and fewer than 43% of surgeries in Africa were elective, with the majority of patients instead undergoing urgent or emergency operations. Meanwhile, caesarean deliveries accounted for 33% of surgeries across Africa – a remarkably high proportion.

Together, says Biccard, that highlights another problem: that many individuals who need surgery might not have access to it. “The real sad thing is that there is a lot of surgery obviously that is not happening,” he said. “That is probably a huge killer in Africa,” he added.

The authors suggest that the findings are probably a reflection of a scanty workforce, limited numbers of hospital beds, and poor systems to check up on patients follow surgery, noting that there are only about 0.7 specialist surgeons, obstetricians and anaesthesiologists per 100,000 population. The recommended figure to decrease the risk of death following surgery is 20–40 such specialists per 100,000 population. “There is no way we are going to be able to train enough physicians to fill this deficit in human resources,” said Biccard, suggesting that either systems for focusing care on high-risk patients need to be developed, or non-physicians would need to be helped to identify patients who might be at risk.

The authors also note that 14 African countries did not take part in the study, but that with some of those politically unstable, in conflict, or having few doctors, surgical outcomes could be even worse.

Dr David Walker, a consultant in anaesthesia and critical care medicine at University College London Hospitals, who was not involved in the study, said that issues of care of patients around the time of surgery was a global issue.

“It seems to be, no matter where in the world you have surgery, complications for many are an inevitable consequence of hospitalisation,” he said. “Importantly, when complications occur there may be considerable disparity in patient outcomes after those complications: so it [often] isn’t the complication that kills you, it is the failure to rescue – how [the patient is looked after following the complication].”

The latest study, he adds, suggests that poor access to timely surgery is a “forgotten epidemic” in Africa. “It reminds us also about the importance of the surgical journey – looking after patients from the minute they present in hospital, through surgery and, really importantly, the ability to care for patients in the post-operative period,” he said.