How privatisation costs us money.

Here's how saving money by using the private sector ended up costing the NHS nearly £9 million pounds;

University Hospitals NHS Foundation Trust

Millions of pounds of taxpayers' money was wasted on an NHS outsourcing contract, investigators have found.
Under the £726m deal, UnitingCare was meant to provide care for older and mentally ill people in Cambridgeshire.
But the consortium claimed the contract was not financially viable and pulled out of the deal in December.
A joint statement from the two organisations in the consortium said the National Audit Office's (NAO) findings provided "clarity".
Cambridgeshire and Peterborough Clinical Commissioning Group had been been in charge of care for older and mentally ill people but put these services out to contract because it was trying to save money.

The UnitingCare Partnership's business case estimated net savings of £178m to the local health economy by 2020.

'Astonishing array of errors'

But the NAO's investigation into the contract - which ended just eight months after it started - has criticised the planning and the lack of data setting out the true cost of the service.
The report found the consortium had not taken account of VAT costs and underestimated both the changeover and running costs of delivering the service in drawing up its bid for the contract.

The report also found negotiations between the CCG and the UnitingCare were continuing when the contract started.
As a result, one month into the contract UnitingCare asked for £34m in extra funding which triggered fresh negotiations.

The report said: "The wasted cost to the NHS of the contract set-up and bidder costs was £8.9m."
Amyas Morse, head of the National Audit Office, said: "This contract was innovative and ambitious but ultimately an unsuccessful venture, which failed for financial reasons which could, and should, have been foreseen.

"Limited oversight and a lack of commercial expertise led to problems that quickly became insurmountable."

Meg Hillier, chairman of the Public Accounts Committee, said the report "details an astonishing array of errors" in implementing service changes.

"Despite drafting in specialist expertise from the private sector and the NHS, the assumptions underlying the contract's cost structure were not tested.

"Instead, the contract - which was not remotely ready - was rushed through without due regard for protecting taxpayers' money."

A joint statement from the two organisations behind Uniting Care, the Cambridgeshire and Peterborough NHS Foundation Trust and Cambridge University Hospitals NHS Foundation Trust, said: "We believe that the report is balanced and provides clarity on the reasons why the contract ended."

The CCG is yet to comment.

That came from a BBC news article.

Neil Harris
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Deaths in mental health Units? Just don't count them and they'll go away.

This story from the Telegraph actually comes from some excellent Labour party research, or it would be if the Government was doing the research.

I would urge you to take a look at my other Blog which has highlighted failings at The Abraham Cowley Unit which is a Mental Health Unit based on St. Peter's Site but run by a different trust. I've recorded stories of a series of unacceptable deaths which have occurred at the Unit and these are to be found on the 'Pages' section at the right hand side of the Blog;

helpmesortoutstpeters.blogspot.com


It's very distressing to hear that these statistics are not being collected centrally because if you don't know the extent of the problem you are never going to try and do anything about it.

                              -----------//-----------

Daily  Telegraph
News

Government accused of failing mentally ill people by not collecting data
Laura Hughes,  Political Correspondent 
1 April 2016  

The Government has been accused of failing mentally ill people after it was revealed they have failed to collect basic data about death, suicides and waiting times.

Luciana Berger, the shadow mental health minister, has called on Ministers to address "appalling" levels of negligence after more than 50 freedom of information requests from Labour were dismissed with the response that the data
is “not collected centrally”.

Labour have said the lack of information is preventing the NHS from treating mental health with the same importance as physical health.

On each day this month Labour will release examples of areas in which the Department of Health said it did not collect information on a national scale.

Speaking before the campaign launch, Ms Berger said the government was unable to provide data for the number of children who have died in inpatient care, or the number of people referred to consultant-led mental health services who were seen within the 18 week target time.

The Labour MP said: “The Prime Minister promised to improve transparency and accountability in mental health, yet his Government is not even collecting basic data.

"It is absolutely appalling that Ministers have no idea how many new mums have taken their own lives because of mental health problems, how many people diagnosed with mental illness go to prison, or how many children have died in NHS mental health units.
 
"How can ministers claim to be focussing on mental health when they don’t have an accurate picture of what is actually happening on the ground? 

“If Ministers couldn’t answer such basic questions on physical health there would be outrage. These findings cast further doubt over the Tory Government’s ability to deliver what they have promised and make mental health the real priority it deserves to be.”

Norman Lamb MP, the former Lib Dem mental health minister, told the Guardian he found working in Whitehall had felt like “operating in fog”.
In a speech last month David Cameron said the NHS was leading a “revolution in mental health treatment in Britain.”
 
His comments have been echoed by the Health Secretary Jeremy Hunt, who has spoken about the “transparency revolution” going on in Britain's health service.

The minister for mental health, Alistair Burt, said: “I have been working on this issue for some time and agree that there is further to go on mental health data as part of making the NHS the safest healthcare system in the world.

"We have made big improvements, publishing more statistics than ever before – such as recovery rates and waiting times for psychological therapies.

“We have brought in the first ever waiting times for mental health, setting the NHS challenging targets to drive improvements, and increased mental health funding to £11.7bn.

                                 ----------//----------

Neil Harris
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The '111' emergency service fails again.

For the last few years I've highlighted the catastrophe of the closure of the highly effective 'NHS Direct' phone line created by the 2002 Labour government.

The Conservative Liberal alliance closed it down and replaced it with the 111 service which is staffed by people who have no medical qualification.

There have been many examples of failure to spot serious conditions - this is just the latest. This inquest report makes it clear once again that 111 needs Nurses and Doctors available for patients; 


William Mead's 'fate was sealed' after NHS 111 call handlers failed to identify his deadly illness, says mother

The report called into question the NHS non-emergency helpline’s ability to identify deadly illnesses
Kate Ng  
The Independent

The mother of a one-year-old baby who died of sepsis said his "fate was sealed" after NHS 111 call handlers failed to identify his deadly illness. Melissa Mead, mother of William Mead, told BBC Radio 4: “When I dialled 111… we were told William’s condition was non-urgent and didn’t require any emergency treatment, and that we would get a call-back within six hours.

“But when the doctor called back after three hours, I think William’s fate was sealed. He died within 12 hours of that phone call. We found him just after 8 in the morning… he had been passed away for a little while [already].”

Her interview follows an NHS England report into William’s death in 2014, which found there were 16 missed chances to save his life.
The report, seen by the Daily Mail and the BBC, said he might still be alive today if NHS 111 call handlers had realised he was in a life-threatening situation.

The NHS 111 non-emergency helpline’s ability to identify deadly illnesses in children and babies has been called into question.
NHS 111 call handlers are not medically trained. The report suggested that if a doctor had taken the call instead of 111 staff, they would have most likely recognised the need for "urgent medical attention".

The report detailed the opportunities missed to save William’s life.

Out of 16 missed chances, the five main windows were:
 
William’s GP had not recorded all the relevant information in his notes
 
The severity of William’s symptoms had not been recognised
 
Inadequate advice was given to William’s parents about what to do if his condition worsened
 
The out-of-hours GP service had no access to the baby’s primary care records

 
The pathway tool used by NHS 111 call handlers was not sensitive enough to pick up “red-flag” warnings of sepsis

It also included failure by GPs, who saw William six times in the months prior to his death, to spot pneumonia which could have prevented his circumstances.

The report said: “Had any of these different courses of action been taken, William could probably have survived.”

Recommendations made by the report included training call advisors to spot when there is a need to probe further into the condition of the patient, and when to escalate cases.

It also called for better recognition of the signs and symptoms of septicaemia by GPs.

The report is the result of a year-long campaign by William’s parents, Paul and Melissa, to find out what really happened to cause their son’s death.

Director of nursing with NHS England in the south west, Lindsey Scott, told the BBC: “One of the significant learning points for us is how difficult it is for both professionals and parents to diagnose septicaemia.

“Everyone involved in this report is determined to make sure lessons are learned from William’s death, so other families don’t have to do through the same trauma.

“None of this detracts from our profound regret at the loss of William. For that loss, on behalf of all NHS organisations involved, I would like to apologise publicly to Mr and Mrs Mead,” she told BBC.

Neil Harris
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Latest figures for NHS payrises.

This Daily Telegraph article has researched the current state of pay rises for NHS Chief Executives against a background of staff pay rises limited to 1% and a forthcoming dispute with junior doctors;

Daily Telegraph

By Laura Donnelly, Health Editor

02 Jan 2016

       

NHS hospital chief executives have been handed pay rises of up to £35,000, with the highest annual earnings reaching a record £340,000, a Daily Telegraph investigation has found.

Despite government pledges that the most senior NHS managers would have their pay frozen, 40 per cent of trusts increased executives’ wages by at least £5,000 during 2014-15.

Some managers’ earnings rose by almost a quarter, the findings from more than 200 NHS trust boards show. Patients’ groups accused the NHS of “scandalous excesses” at a time when the health service is facing the greatest financial crisis in its history.

The head of the Royal College of Nursing said it was “immensely demoralising” to find that some executives had been awarded rises larger than a full year’s salary for the average nurse.
The highest individual increase of £35,000 went to Sir Andrew Morris, at Frimley Health NHS Foundation Trust in Surrey, taking his earnings to £215,000. The 19 per cent rise followed a takeover of another nearby NHS trust. The finance director, Martin Sykes, also received a 19 per cent, or £25,000, increase in his earnings taking them to £155,000. Nicola Ranger, the director of nursing, enjoyed a 23 per cent boost, taking her earnings to £135,000.
Simon Barber, chief executive of 5 Boroughs Partnership trust in the North West, was paid £200,000 during 2014-15 – a rise of £25,000 thanks to a pay bonus. David Sloman, chief executive of the Royal Free London Foundation Trust received a £20,000 rise, taking his earnings to £240,000. And Lewisham and Greenwich trust in south-east London awarded £20,000 pay rises to its chief executive, Tim Higgingson, whose salary rose to £195,000, and to its director of nursing, Claire Champion, boosting her earnings to £150,000.

In total, 40 per cent of boards made at least one pay rise of between £5,000 and £15,000.

At least 10 senior managers received rises of at least £20,000, according to the analysis by the Telegraph.
 
Because trust boards do not publish precise pay figures, the lowest point of published ranges was used for all calculations, leaving a £5,000 margin.

The highest overall package went to Dr Tracey Batten, the chief executive of Imperial College Healthcare, who was paid £290,000 plus a £50,000 relocation payment to move from Australia.
 
Several of those with the highest earnings left the NHS in recent months. The second highest earner overall was Peter Morris, the chief executive of Barts Health trust, on £275,000 until he resigned in February amid a growing financial crisis. The trust is now facing a deficit of £135 million, the largest any trust has ever had.
 
Another of the highest earners, Dr Keith McNichol, who came from Australia to run Addenbrooke’s Hospital, resigned in September — just before a damning inspection report saw the trust plunged into special measures. A salary of at least £260,000 made him the fourth best paid chief executive.
 
Tim Smart, who earned £255,000 a year as chief executive of Kings College Hospital Foundation Trust, announced his retirement in April, just after an inspection which later saw the trust rated as “requiring improvement”.

Katherine Murphy, the chief executive of the Patients Association, said she was concerned that the NHS had developed a culture of “rewards for failure” with many of the highest salaries paid to chief executives who had left as serious problems emerged.
In March 2014, the Treasury promised most public sector workers a rise of one per cent in 2014-15, but said the most senior managers would see pay frozen, amid efforts to put the nation’s finances on a sustainable footing.
 
The NHS is facing the worst financial crisis in its history, with three quarters of trusts forecasting deficits, which are expected to reach £2.2  billion across the service by March.
The vast majority of overspending has been fuelled by a reliance on agency doctors and nurses, some on rates of more than £3,500 a day. Hospitals are also struggling to cope with rising demand from an ageing population.
 
Janet Davies, chief executive of the Royal College of Nursing, said: “Nursing staff have been repeatedly told that there isn’t enough money to improve their pay, even after years of pay restraint. To learn that many senior NHS staff are enjoying pay rises and bonuses while nurses struggle to make ends meet is immensely demoralising.”

The trusts with the most highly paid chief executives defended the sums paid, saying they were among the largest trusts in the country, with rates in line with those for similar roles in other NHS organisations.
 
A spokesman for Frimley Health said: “Recent salary adjustments in executive pay at Frimley Health were a reflection of the added responsibility associated with the acquisition of Heatherwood and Wexham Park Hospitals NHS Foundation Trust. These were independently assessed by the Hay Group and set by a committee of non-executive directors.”

When Frimley Park took over Heatherwood and Wexham Park Hospitals the trust doubled in terms of staff, infrastructure, and patient numbers.
 
The 5 Boroughs Partnership NHS Foundation Trust said its chief executive had received a 1 per cent pay increase, plus a performance-related bonus which recognised that the trust had achieved quality and financial targets.
 
A spokesman for the Royal Free said it became one of the largest trusts in the country after taking over Barnet and Chase Farm hospitals in July 2014.
It said pay was agreed by a committee of non-executive directors based on value for money.
 
Lewisham and Greenwich trust said salaries were reviewed after a hospital merger, with the director of nursing taking on added responsibility as deputy executive.

Neil Harris
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The Parliamentary Ombudsman condemns the NHS failure to investigate deaths properly.

This Guardian article highlights a report by The Parliamentary Ombudsman. However I would point out that my own complaint to her was dealt with very unsatisfactorily.

The Patients Association has recommended against complaining to The Ombudsman due to the ineffectiveness of her organisation.

  
The Guardian

Denis Campbell Health policy editor

Tuesday 8 December 2015

 

Three out of four investigations by hospitals into complaints that patients suffered avoidable injury or death fail to identify serious failings in care, leaving distraught families in the dark, the NHS ombudsman has warned.

Inquiries by hospital staff are so often inadequate that many complainants seeking to understand what went wrong are met with “a wall of silence from the NHS”, according to Dame Julie Mellor.
Mellor, the parliamentary and health service ombudsman, has demanded an urgent overhaul of how hospitals examine serious complaints made against them, in which mistakes allegedly led to patients being harmed or even killed.

Frontline staff in the NHS and public services shouldn’t fear complaints            

Organisations should welcome complaints as it shows they are open to feedback. But people need to feel their concerns are acted upon.

             

Her review of the quality of internal hospital investigations uncovered a series of major weaknesses. In 73% of cases in which she found evidence of clear failings, the NHS hospitals trust concerned had concluded that no failings occurred.
“Parents and families are being met with a wall of silence from the NHS when they seek answers as to why their loved one died or was harmed,” said Mellor.
“Our review found that NHS investigations into complaints about avoidable death and harm are simply not good enough. They are not consistent, reliable or transparent, which means that too many people are being forced to bring their complaint to us to get it resolved.”

In just over half (52%) of the cases she examined, the investigation had been led by a doctor who was not independent of the events complained about.

For example, when a baby girl was left with brain damage after a blood transfusion went wrong, the hospital appointed a close colleague of the paediatrician at the centre of the complaint to investigate. The girl’s family had to wait three years before learning what mistakes had been made.

Hospitals also failed to categorise 20 out of 28 cases of avoidable harm examined as serious incidents, which meant they were not properly investigated.

NHS investigations into care complaints 'appalling'

More than a third of investigations into deaths or avoidable harm at hospitals found to be inadequate in ombusdsman’s review 

           

Mellor said hospitals’ inquiries into serious injuries or deaths too often fail to gather enough evidence, are inconsistent in how they look for proof of errors, and do not look closely enough at material to see what went wrong and why.

Almost a fifth (19%) of inquiries did not gather important evidence such as the patient’s medical records, statements and interviews, Mellor found.

In investigations that found there had been failings, more than a third (36%) failed to get to the bottom of why they had occurred, even though 91% of complaints managers said they were confident they could find out what happened.

Hospital bosses admitted that too many investigations are substandard.
“We know we don’t always get this right and it’s crucial that we learn and improve every time,” said Rob Webster, the NHS Confederation chief executive.
“The Care Quality Commission, ombudsman and others are highlighting major inconsistencies and shortcomings in the handling of complaints and those problems cannot be allowed to continue. So we urgently need to learn from what is working and fix what doesn’t, to ensure patients have complete confidence in the National Health Service.”

Anna Bradley, the chair of Healthwatch England, a patient group, said: “Hundreds of thousands of incidents of poor care go unreported every year across the NHS precisely because people fear they either won’t be taken seriously or that nothing will change as a result.”

 

Peter Walsh, the chief executive of the patient safety charity Action Against Medical Accidents, said the new independent patient safety investigation service, set up by Jeremy Hunt to promote airline-level safety in the NHS, should improve investigations.
“The ombudsman’s findings are doubly worrying, as they were only reviewing cases where there had already been a complaint under the NHS complaints procedure. If this is how the NHS investigates when there is a formal complaint, one has to wonder how it investigates when it is left entirely to its own devices,” said Walsh.
“Unfortunately, in our experience it is not uncommon for NHS bodies to carry out investigations without even informing the patient or family affected by an incident.”

Neil Harris
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A failure to investigate deaths at the Southern health NHS Foundation Trust.

Yesterday I posted a story about a disabled man who was given a 'Do Not Rescusitate' notice by Doctors because he was..... disabled.

This is a 'Guardian' article about the scandal at "The Southern Healthcare Trust", where deaths of vulnerable people in the Trusts care have not been properly investigated;

The Guardian 9/12/15.

An NHS hospital trust failed to properly investigate the deaths of more than 1,000 patients with learning disabilities or mental health problems over four years, an independent inquiry has found.

A leaked copy of the inquiry’s report severely criticises a “failure of leadership” at Southern health NHS foundation trust and accuses senior managers of not looking into and learning from deaths.

NHS England commissioned Mazars, an audit firm, to examine the 10,306 patient deaths which occurred at the trust between April 2011 and March 2010.

While most of those deaths were expected, 1,454 were unexpected.

The Mazars report, obtained by the BBC, concludes that failures by the trust’s board and senior executives meant that no “effective” management of deaths or investigations took place and there was a lack of “effective focus or leadership from the board”, the BBC said.

The Mazars inquiry team found that when trust board members did ask questions, executives reassured them that investigations were thorough. However, the report concluded: “This is contrary to our findings.”

It also found that the culture of the NHS trust, which is led by chief executive Katrina Percy, “results in lost learning, a lack of transparency when care problems occur, as well as assurance to families that a death was not avoidable and has been properly investigated”.

Of the 1,454 unexpected deaths, the trust regarded 272 as critical incidents but classed only 195 of them – or one in seven – as a serious incident that needed to be investigated.
But while it looked into 30% of the deaths among adults with mental health problems, it did so with only 1% of those with learning disabilities and 0.3% of over-65s with mental health problems.

 

Patients with a learning disability died at an average age of 56, which is seven years earlier than the usual life expectancy.

“These are shocking revelations that if proven, reveal deep failures at Southern health NHS foundation trust,” said Luciana Berger, Labour’s shadow minister for mental health.
“For there to have been so many unexpected deaths in one trust is of deep concern itself, but for so many of those deaths not to have been investigated is extremely alarming. It raises serious questions about the leadership and culture of care at the trust.”

NHS England ordered the inquiry after Connor Sparrowhawk an 18-year-old with learning disabilities, drowned in a bath at the trust’s Slade House unit after suffering an epileptic seizure. Coroners had also criticised the trust at inquests for producing reports into deaths that were inadequate or very late, but that had failed to prompt the improvements that were needed and staff often made little effort to engage with the relatives of those who had died, the Mazars report found.
Sara Ryan, Sparrowhawk’s mother, told the BBC: “There is no reason why in 2015 a report like this should come out. It’s a total scandal. It just sickens me.”

The trust provides community services, mental health, learning disability and social care services to about 45,000 people in Hampshire, Dorset, Wiltshire, Oxfordshire and Buckinghamshire.

The Mazars report said that the trust was unable to show that it had a good system in place for learning from deaths and did not use effectively the extensive data it collected on deaths.

It also found that the trust looked into too few deaths involving either those with a learning disability or older people with mental health problems and failed to involve relatives in almost two out of three of the investigations it did undertake.
Southern accepted that its response to patient deaths was not good enough but denied that its death rate was higher than would be expected.

“We fully accept that our reporting processes following a patient death have not always been good enough. We have taken considerable measures to strengthen our investigation and learning from deaths including increased monitoring and scrutiny,” it said in a statement.

“We would stress the draft report contains no evidence of more deaths than expected in the last four years of people with mental health needs or learning disabilities for the size and age of the population we serve.”

The trust has “serious concerns” about the way Mazars had
interpreted the evidence. It added that while it had “had one or more contacts” with the patients in the previous 12 months, “in almost all cases referred to in the report, the trust was not the main provider of care”.

Jan Tregelles, the chief executive of the charity Mencap, said: “Twelve hundred people with a learning disability are dying avoidably in the NHS every year. This is a national scandal.”

All such deaths need to be properly analysed so that other avoidable deaths can be prevented, she added.

Neil Harris
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D.N.R. orders yet again.

This is a continuing problem in The NHS; the use of "Do Not resuscitate" orders on peoples files when this has not been discussed with either patients or their families/carers.

This is just the worst situation....a doctor making a judgement based on a persons disability.

It could be you!

Kent hospital apologises for putting do not resuscitate order on Downs Syndrome man before he died

December 8, 2015 | by SWNS Reporter               

 

A man with Down’s Syndrome was given a ‘do not resuscitate’ order by hospital staff, who listed his learning difficulties among the reasons for doing so.

Andrew Waters (SWNS Group)

 

East Kent Hospitals NHS Trust have admitted breaching the human rights of Andrew Waters, 53, by placing the ‘DNR‘ notice on him.

Mr Waters’ family were not consulted or informed and only found out after he was discharged from hospital and they found the crumpled note in his bag.

The order was placed on him when he stayed at the Queen Elizabeth, the Queen Mother Hospital in Margate, Kent, in 2011 because of problems related to his dementia.
Hospital staff decided he should not be resuscitated if he developed heart or breathing problems.
Mr Waters died in May but the order did not have a bearing.

His brother, Michael Waters, said: “For someone to make that decision, without consulting a family members or any one of his carers, was just totally unacceptable.
“No-one has the right to make such a decision in such a disgraceful way, to put those reasons down.
“We were there at hospital and involved in his care at every point.
“The form was a folded up piece of paper found in his bag after discharge, by his carers.
“There was nothing wrong with Andrew’s health at the time which would have an effect on his resuscitation.”

A statement from the Trusts apologised unreservedly for the distress caused to Mr Waters’ family.
It read: “The trust accepts that it breached its duty owed to the patient.“Actions have been taken to ensure this does not happen again and the trust has now reached a resolution with the family.”
Michael Waters welcomed the apology and the trust’s admission that they breached Andrew’s human rights.
Michael said: “It’s taken a long time for the hospital to admit this, which we’ve found hard.
“All we ever wanted from this case was a simple apology.
“People with Down’s Syndrome deserve the right to live like you and me.”


Rosie Neale, 55, who runs a support group called Little Buddies for families and carers of Down’s Syndrome sufferers in Kent yesterday condemned the DNR decision.
She said: “It is just dreadful. I just think it is wrong. They have got a right to live like everybody else.”
Rosie, whose 12 year-old daughter Emily suffers from Down’s Syndrome, added: “I have been quite lucky with my daughter.
“She has not been ill very much. But my experience of being told that my daughter had Down’s Syndrome was not very good. It was just come in, have a look at what’s wrong.”

The lawyer who brought the case says trust breaks down between doctors and families if the reasons behind resuscitation orders are not communicated effectively.
Leigh Day solicitor Merry Varney, also fought the case of Janet Tracey, which established last year that doctors had a legal duty to consult and inform patients about DNR orders.
She said: “Sometimes they can be really aimed at trying to give a patient a dignified death.
“This is not about giving up on someone or writing them off.
“But that’s generally what I hear people say they feel, if they find out about these after the decision has been made.
“I still receive around three calls a fortnight from families or patients who are concerned about what a DNR means and whether it means not to treat more generally.
“Unfortunately, the portrayal of cardio-pulmonary resuscitation in TV dramas sometimes suggests it’s a quick fix and works for everyone.
“That’s simply not the case – and there’s a real onus on healthcare professionals to communicate that.”

Yesterday that two orders not resuscitate were placed on Andrew Water’s medical records without the knowledge of his family.
The Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders were placed on his medical records giving his disability, Down’s Syndrome, as one of the reasons.

Mr Waters, who died from an unrelated cause in May, took legal action against the Queen Elizabeth the Queen Mother Hospital through a litigation friend, his brother Michael.

In August 2011 Mr Waters, who suffered from dementia, was admitted to the hospital where it was decided he required a feeding tube.
Without consultation with his family or with carers from his residential home, a DNACPR order was placed on his file.
Despite holding a ‘best interests meeting’ to discuss Mr Waters’ feeding tube, resuscitation was not discussed and his family were not informed of the order, even on his discharge.
In September 2011 he was again admitted to Queen Elizabeth the Queen Mother Hospital in Margate, Kent.
Throughout his time at the hospital his family visited virtually every day, yet on admission a DNACPR order was again imposed without any discussion or consultation.
The rationale for the DNACPR order was stated to be:”Downs Syndrome, unable to swallow (PEG fed), bed bound, learning difficulties.”
It inaccurately recorded the family as “unavailable” and was marked as indefinite in duration.
Following his final discharge back to the residential home where he lived, staff at the home found the DNACPR in Andrew’s possession.
The manager of his residential care home contacted Andrew’s Community Learning Disabilities Nurse who telephoned the hospital and challenged the doctor about the order.
She then informed Andrew’s family as she felt they needed to know, not least as Andrew had by that time been admitted back into hospital.

His family were shocked to learn about the imposition of the DNACPR, not only in light of the comments on the form itself but also the fact a decision to withhold potentially life sustaining treatment had been made with no consultation with the family, let alone their agreement.
Initially, apologies were offered from the Trust but without any actual acknowledgment of any wrongdoing.

Andrew’s brother, Michael Waters : “I still feel very angry about this, especially the fact that my brother’s Down’s Syndrome was put as the reason for the DNACPR.
“As a family we are also upset that the doctor concerned has still not offered any personal apology despite this admission from the Trust.”

Jan Tregelles, CEO of Mencap, said: “Many families who have lost their loved ones to poor care within the NHS have told us about the inappropriate use of Do Not Attempt Resuscitate (DNAR).
“There have been circumstances where DNAR notices have been applied without the knowledge or agreement of families.
“DNAR orders have also been applied hastily, in inappropriate situations, solely on the basis of a person’s learning disability.
“This is unacceptable and highlights the failures of care that are a daily reality for many people with a learning disability trying to get access to good quality healthcare.
“1,200 people with a learning disability are dying avoidably in the NHS every year.
“The Government must take action to ensure that people with a learning disability get the right healthcare within the NHS and put an end to this scandal of avoidable deaths.”

Merry Varney from the Human Rights team at Leigh Day said:
“The acknowledgment that it was unlawful and in violation of human rights to impose a DNACPR order on Andrew without first discussing it with his relatives is welcomed.
The decision to impose a DNACPR order is a critical and sensitive one, and it is important that family and carers of patients who lack the mental capacity to make their own wishes known, are involved in the decision making process.
“The Trust had initially argued that there was no unlawfulness as the DNACPR was not acted upon and because “there is no indication that [Andrew] was even aware that the decision had been made or understood its significance.”
“Although it is disappointing not to have reached this agreement whilst Andrew was alive, the family welcome the Trust’s acceptance that their actions amounted to a violation of the human rights of a vulnerable adult and hope that no other family will have to endure the nasty surprise of discovering a DNACPRR decision has made unilaterally.”
Down’s Syndrome sufferer Jack Adcock, six, died after a hospital doctor at Leicester Royal Infirmary called off life-saving treatment after mistakenly thinking he was under a Do Not Resuscitate order.

Neil Harris
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