2011 05 Health Care

Wednesday 1 June 2011

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British Pregnancy Advice Service v Secretary of State for Health (COSTS) [2011] EWHC 637 (Admin) (Supperstone J): The Court held the Secretary of State for Health had been entitled to his costs in a claim concerning the interpretation of the Abortion Act 1967 s.1(3) and s.1(3A) where his interpretation had been preferred. The fact that the claim concerned a matter of public interest brought by a charitable body seeking to improve the services it provided was not a sufficient reason to make no order for costs. Click here for transcript.

W & M v S, A NHS Primary Care Trust and Times Newspapers Ltd [2011] EWHC 1197 (COP) (Baker J): M was in a minimally conscious state. Her mother, W, had applied to the Court of Protection for approval of the withdrawal of artificial nutrition and hydration. The litigation friends for M and W applied for a reporting restriction order preventing identification of M, W, and of M's sister and partner, of any witnesses in the proceedings, of those treating and caring for M, and of the PCT currently treating her, the Trust which had formerly treated her and the establishment in which she was being cared for. The terms of application were initially opposed by the Times Newspapers Ltd (“the Times”). The Times and the other parties were able to reach agreement. Since the Times was only representing one section of the media, the Court was required to carry out a balancing exercise between Articles 8 and 10 in order to decide the application. On Article 10 was the freedom to report proceedings in open court is in the public interest and the particular issue is likely to be whether nutrition should be withheld from a patient whose consciousness is above the vegetative state and this potentially raises issues of utmost importance which the media should be fully free to report concerning the public interest. On Article 8 was that any identification of M in the media would infringe her right to respect for family and private life, any identification of her family members would also interfere with her rights and with their rights, and there was evidence that identification might lead the family members to abandon the proceedings which would potentially be an extremely serious breach of their rights under Article 6. The balance fell in granting the orders sought. Freedom of expression enjoyed by the press would be restricted but the order would not prevent reporting of the issues, evidence and arguments. Click here for transcript.

R (on the application of Carol Mack) v HM Coroner for Birmingham and Solihull(2011) Court of Appeal 10/05/2011 (Lord Neuberger of Abbotsbury MR, Toulson LJ, Etherton LJ): An inquest into a hospital death was quashed because the coroner had given no rational explanation for not calling as a witness the consultant gastroenterologist who had been responsible for the patient for the 10 days he spent in a clostridium difficile ward before he had a cardiac arrest and died. The clinician he had called was not well placed to give evidence about the considerable concerns about the patient's treatment in that period. No transcript yet available.

Carole Mack was represented in the High Court and the Court of Appeal by Stephen Simblet,

The Care Quality Commission (CQC) published reports on the 26 May 2011 Dignity and Nutrition for older people in a review of 100 NHS Hospitals through England. The first 12 reports from an inspection programme which examines whether elderly people receive essential standards of care.

The programme focuses on whether people are treated with dignity and respect, and whether they get food and drink that meets their needs. A national report into the findings of the programme will be published in September.

These first 12 inspection reports identify three hospitals as failing to meet the essential standards required by law; Worcestershire Acute Hospitals NHS Trust, The Ipswich Hospital NHS Trust and Royal Free Hampstead NHS Trust. Less serious concerns were identified in a further three hospitals, with the remaining six found to be meeting essential standards. All the hospitals where concerns have been identified must now tell the regulator how and when they will improve. The three hospitals failing to meet essential standards could face enforcement action by the regulator if improvements aren’t made.

Whilst the reports document many examples of people being treated with respect and given personalised, attentive care, some tell a bleak story of people not being helped to eat and drink, with their care needs not assessed and their dignity not respected.

Recurring concerns relating to nutrition included:

•people not being given the assistance they needed to eat – meaning they struggled to eat and in some cases were physically unable to eat meals

•their nutritional needs not being assessed and monitored – for example, not being weighed throughout their stay, making it impossible to determine if they were losing weight; or identified as malnourished without an action plan being put in place to address this

•people not being given enough to drink – water left out of reach or no fluids given for long periods of time. In one case, a member of clinical staff described having to prescribe water on medicine charts to ensure patients got enough to drink.

Recurring concerns around dignity and respect included:

•People not involved in their own care – their treatment not explained to them; being told what would happen to them without consent being sought or concerns addressed; staff addressing patients’ relatives rather than the patient themselves

•Staff not treating people in a respectful way – spooning food into people’s mouths from above without engaging with them; discussing personal patient information in open areas.

•Staff speaking to people in a condescending or dismissive way. One man told us that staff “talk to me as if I’m daft. “

However, inspection teams also observed examples of excellent care delivered by nurses and other healthcare staff who took the time to explain every aspect of a patient’s care to them in a way they could understand, interacted with each patient as an individual, spoke to them with respect and ensured their dignity was maintained. And in many hospitals, nutrition and hydration were recognised as an important part of the patient’s recovery, and real efforts were made to ensure that people got meals they enjoyed in a pleasant environment and the help they needed to eat it.

To read the first 12 reports click here.

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