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Tag Archives: NHS

NHS in England told to reveal avoidable deaths data

HospitalImage copyright Thinkstock

The NHS in England is to become the first healthcare system in the world to publish figures on avoidable patient deaths, the health secretary has said.

By the end of 2017, some 170 out of 223 trusts will publish data on deaths they believe could have been prevented.

It is estimated there are up to 9,000 deaths in hospitals each year caused by failings in NHS care.

The Department for Health said it wanted to ensure the NHS learned lessons from every case.

There is no standard definition of an avoidable death and each hospital trust makes its own judgment.

The data released by the organisations will include details of reviews and investigations into deaths, and information on any action taken as a result.

Bereaved relatives

As part of the release from more than three quarters of England‘s trusts, families of patients will also be given full explanations over relatives’ deaths.

These explanations, the department says, will be used to support bereaved relatives and carers, and will ensure they are treated with empathy, compassion and respect.

Out of a total of around 240,000 deaths in hospital, the government says there are between 1,200 and 9,000 deaths each year caused by problems with care.

Image copyright JusticeforLB
Image caption Connor Sparrowhawk had epilepsy and experienced seizures

Two cases highlighted by the government are that of 18-year-old Connor Sparrowhawk and one-year-old William Mead.

In 2013, Connor Sparrowhawk died in the care of Southern Health NHS Foundation Trust at Slade House in Oxford. The trust has accepted his death was “entirely preventable”.

Meanwhile, an NHS England report into the death of William Mead said he might have lived if 111 call handlers had realised the seriousness of his condition.

William, from Cornwall, died of blood poisoning after a chest infection.

‘Dignity in death’

Chris Hopson, chief executive of NHS Providers, which represents trusts in England, said it was “right” that patient safety was made a priority.

“It is important this work is carried forward in the spirit of learning and sharing good practice, rather than recriminations,” he said.

Some avoidable deaths are deemed to have occurred among terminally-ill patients who might have lived longer if they had spent their final weeks at home – and Mr Hopson added too many patients were still dying in hospital.

Announcing the roll-out, Health Secretary Jeremy Hunt said each trust was being asked to use the same methodology to determine whether a death was preventable or not.

But he added the data released could not be used to rank trusts against each other because of different reporting procedures used when mistakes happened.

He told BBC Radio 4’s Today: “It’s about hospitals creating a culture which makes it easy for staff on the frontline to say, ‘look, something went wrong; I think it could have had a different outcome and we need to learn from this so it doesn’t happen again’.”

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Lord Kerslake resigns as King’s College Hospital Trust chair

Lord Kerslake
Image caption Lord Kerslake said “our problems lie in the way that the NHS is funded and organised”

Lord Kerslake has resigned as the chairman of a major London hospital trust because of NHS funding problems.

The former head of the civil service says the government is being unrealistic about the challenges facing the health service.

He announced he was stepping down as chairman of King’s College Hospital NHS Foundation Trust on Sunday.

NHS Improvement described the hospital‘s financial performance as “unacceptable”.

A spokeswoman added: “It is the worst in the NHS and continues to deteriorate.”

In a statement, Lord Kerslake said of his decision to quit: “I do not do this lightly as I love King’s but believe the government and regulator are unrealistic about the scale of the challenge facing the NHS and the trust.

“I want to pay tribute to the staff and their excellent patient care.”

Image copyright PA
Image caption King’s College said Lord Kerslake had led the hospital “through a challenging period”

The House of Lords peer also paid tribute to the “world-class” care given at the hospital, especially after the Westminster and London Bridge terror attacks, in a self-penned Guardian article.

He added: “There are undoubtedly things that I and the trust could have done better, there always are, but fundamentally our problems lie in the way that the NHS is funded and organised.”

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Analysis: BBC health correspondent Hugh Pym

Lord Kerslake’s comments come after the board of NHS England said targets for waiting times could not be met next year even with the extra money allocated in the Budget.

Coming from a figure with such high level Whitehall experience the latest criticism of the government’s handling of the NHS carries some weight.

King’s College Hospital has been in long-running discussions with the regulator NHS Improvement about reducing its deficit.

It’s understood that it was close to being put into a financial special measures regime in which NHS Improvement staff would work alongside hospital management.

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Labour’s shadow health secretary Jonathan Ashworth said the resignation was “embarrassing for the government”.

King’s College Hospital described Lord Kerslake as a “passionate advocate and champion” of the trust who had a “heartfelt commitment to staff and patients”.

It added that he had led King’s “through a challenging period which has also seen some notable successes, our response to three major incidents in London, the launch of the helipad and delivering some of the highest patient outcomes of any Trust in the UK“.

NHS Improvement said it respected Lord Kerslake’s decision to step down and would “replace him with a highly experienced new chair to take charge of the trust’s position”.

A Department of Health spokeswoman added: “We know that King’s NHS Foundation Trust faces huge financial challenges and we will support them to tackle these issues and continue to deliver high quality care for patients under a new chairman.”

Anorexic student Averil Hart ‘let down’ by NHS

A student who died of a heart attack caused by anorexia could have been saved if the NHS had cared for her properly, a report has found.

Averil Hart, 19, of Colchester, died in Norwich in 2012 at Addenbrooke’s Hospital in Cambridge.

The Parliamentary and Health Service Ombudsman found she did not receive “appropriate care and treatment“.

Teen with anorexia ‘failed by every NHS body’ before death

Averil HartImage copyright Justice4Averil
Image caption Averil Hart, of Cambridge, died of a heart attack caused by anorexia in 2012

A teenager who died weeks after leaving for university was failed by “every NHS organisation that should have cared for her”, a review has found.

Averil Hart, of Colchester, died of a heart attack caused by anorexia in Norwich in 2012.

The Parliamentary and Health Service Ombudsman (PHSO) has found her death could and should have been prevented.

The NHS services involved say changes have been made, with one saying it accepted the report’s findings.

Miss Hart, the youngest of three sisters, became unwell after her A-levels at Colchester Royal Grammar School and spent 10 months as an in-patient at Addenbrooke’s Hospital in Cambridge.

She was then discharged to study creative writing at the University of East Anglia.

Miss Hart was found collapsed at the university in December 2012 and taken to the Norfolk and Norwich Hospital by ambulance but saw no specialist eating disorders clinician for three days after admission, by which time her condition had deteriorated further.

She was then transferred to Addenbrooke’s Hospital on 11 December.

Overnight her blood sugar fell to very low levels, but she did not receive appropriate treatment for this and became unconscious, suffering brain damage. She died three days later.

Image copyright Justice4Averil
Image caption The ombudsman said Averil’s death could have been avoided

The ombudsman found Miss Hart did not receive “appropriate care and treatment“.

“In addition, the local investigation into her death was wholly inadequate with the organisations involved being defensive and protective of themselves, rather than taking responsibility,” the ombudsman’s report said.

Miss Hart’s father Nicholas Hart, who lives in Newton, near Sudbury, said: “As a parent I suppose it is a great relief to finally know that the words you knew were true all along and that Averil’s death was avoidable.

“It is good to know that the report itself will enable other children and families to potentially not have to go through what we have been through.

“It was a needless death, it did not have to happen. It took only 10 weeks for her to go from fit and healthy to being at death’s door.

“She literally starved to death.”

Image copyright Justice4Averil
Image caption Averil Hart went to the University of East Anglia to study creative writing

Ombudsman Rob Behrens said: “Averil’s tragic death would have been avoided if the NHS had cared for her appropriately.

“Sadly, these failures, and her family’s subsequent fight to get answers, are not unique.”

“The families who brought their complaints to us have helped uncover serious issues that require urgent national attention – I hope that our recommendations will mean that no other family will go through the same ordeal.”

Dr Bill Kirkup, who led part of the investigation, said: “I hope this report will act as a wake-up call to the NHS and health leaders to make urgent improvements to services for eating disorders so that we can avoid similar tragedies in the future.”

A charity’s response

Andrew Radford, chief executive at the eating disorder charity BEAT, said: “The PHSO report is very clear: if the eating disorder had been recognised earlier and effective and timely care was put in place, Averil Hart’s death would have been prevented.

“We await a response from the Government and NHS England who must learn and take action following this tragedy; we cannot continue to fail people with eating disorders.

“We must see good, joined-up intensive home– and community-based treatment for people of all ages, and in all locations across the UK. This does require the NHS to reorganise but it will deliver improved outcomes for patients and considerable cost savings to the NHS.

“It is also clear there were multiple failings across the health service in the lead-up to this tragedy, and the behaviour of each responsible part of the NHS in evading and obfuscating justice is appalling, and piled even more distress on an already distraught family. This requires further investigation and action taken to ensure it cannot be repeated.”

“This tragedy demonstrates, once again, the devastation eating disorders can cause.”

A spokeswoman for the Norfolk and Norwich Hospital said: “We met Averil’s family in 2014 to offer our sincere condolences for their sad and devastating loss.

“Since then we have taken into account the learning from this tragic event and our structure and processes have been reviewed.”

A spokesman for Cambridge University Hospital said: “The trust would like to repeat the apologies previously made to Averil Hart’s family and accepts the findings and recommendations in the ombudsman’s report.

“When Averil was transferred to Addenbrooke’s in December 2012, she was already very unwell but her death, at that time, may have been avoided had failures in her care not taken place.

“A thorough investigation has been carried out, lessons have been learned from what happened to Averil and a number of changes made.”

The Norfolk Community Eating Disorder unit, which was tasked with providing community care to Miss Hart, has been approached for a response but is yet to respond.

The University of East Anglia declined to comment on the report claiming it had “been informed that legal action is pending subject to the outcome of an inquest”.

Long A&E waits: 3m a year wait over four hours

A&EImage copyright Getty Images

The number of long A&E waits across the UK has more than doubled in the past four years as hospitals struggle to cope with demand, BBC analysis shows.

Northern Ireland has the worst performance, although England has seen the fastest deterioration, the figures show.

Over 3m patients who visited UK A&Es waited over four hours in the past 12 months – up by 120% since 2012-13.

By comparison the number of visits has only risen by just over 7% to 26.9m.

If you can’t see the NHS Tracker, click or tap here.

Doctors and nurses said the findings showed the NHS could no longer cope with what was being asked of it and patients were being put at risk.

And Dr Taj Hassan, president of the Royal College of Emergency Medicine, said the A&E system had been “stretched to its very limits”.

“Staff are working really hard. But we’ve reached a point where we cannot meet demand.

“Life-threatening cases are prioritised. But a crowded emergency department adds risk. We get delays to assessment, pain relief and antibiotics.”

Royal College of Nursing general secretary Janet Davies agreed, describing the system as “full to bursting”.

“Nursing staff in A&E units have been telling us for some time that they are working under intolerable pressure, and that it’s hard for them to do more than firefight,” she added.

How far short is the NHS of the target?

There are minor variations in the way the target is measured across the four nations, although they are considered broadly comparable.

The data compiled by the BBC shows a significant difference in performance against the four-hour target for treating or admitting patients.

In Northern Ireland, which has seen the biggest rise in people coming to A&E units, just 75% of patients were seen in four hours in 2016-17, whereas Scotland saw 93.9% – only marginally lower than the 95% target.

In fact Scotland is the only part of the UK performing better than it was four years ago.

England has seen the biggest rise in long waiters – a 155% increase. In Scotland the number of long waiters actually fell by 9%.

Regionally in England the West Midlands has the worst performance followed by the North West – patients visiting A&Es in those areas are more than twice as likely to wait over four hours than those in the North East, the best-performing region.

‘You feel like you are failing patients’

The BBC has been speaking to a number of hospital staff this week about their experiences. Many wanted to remain anonymous given the political sensitivity about the performance of the health service.

But all agreed the pressures were as great as they had ever experienced. One nurse, who works in an A&E unit in south Wales, said his department faced relentless “24/7” pressure.

“I know of colleagues who leave a shift and then come back the next day and find the patient is still there. We have seen them in A&E but there are not beds in hospital. It causes overcrowding and all sorts of delays.

“Ambulances queue outside A&Es as the staff are too busy to take patients off them. I’ve worked in A&Es for over 10 years and this is as bad as I can remember.”

Another nurse, from London, said: “You feel you are failing patients. This is not the sort of care we want to provide, or patients deserve.

“We obviously prioritise the most serious cases, but when it is this busy there is always a risk you miss something. I sometimes finish my shift and end up worrying about my patients.”

Is there a solution?

Unless the NHS can get its existing network of hospitals to see patients more quickly, the health service would need another 20 A&Es to hit the target again.

But each nation believes the answer to the problem lies in trying to control the numbers turning up at A&E and ensuring they pass through hospital more quickly when they do need treatment by freeing up beds.

This is done by making sure there are spare beds in care homes and care services in the community, to hand over frail patients to.

Image copyright Getty Images

In Scotland, for example, NHS budgets have been pooled with council funds to create a closer working relationship between hospitals and care in the community, which is one of the reasons why ministers there believe they have performed better than the rest of the UK.

In England an extra £1bn is being invested in social care this year, while £435m has been freed up to help with winter planning, including putting GPs in A&Es to deal with the more minor cases.

A Department of Health spokesman said ministers acknowledge the NHS was “under pressure due to the ageing population”, but he pointed out that despite the deterioration, nine in 10 patients were still dealt with in four hours.

Chris Hopson, chief executive of NHS Providers, which represents hospitals, said the money had come too late.

“We are not where we would want to be as we head into winter. We cannot say with certainty how tough this winter will be, but the likelihood is that services will be sorely tested.”

A spokesman for the Welsh Government said there were signs performance was improving when you compared this year to last year instead of four years ago.

But he admitted winter would be “challenging”.

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How old is too old?

Shopping basket

A major retailer has announced it will be the first to sell food after its “best before” date. But for many people, eating an item a few days – or even years – out of date is nothing new.

For Brian Boyes, who lives in Pau in France, age is no barrier to enjoying food or drink, that has been languishing in the store cupboard – even an 18-year-old bottle of Ribena.

“It was perfectly alright,” he insists, noting that the bottle was made of glass and the seal had not been broken. He said he suffered no side effects.

Every year, the UK wastes 15m tonnes of food, with close to half of this going straight from our cupboards to our bins.

East of England Co-op, which is independent of the Co-operative Group, is the first major retailer to start selling food after the “best before” date.

Dan Cluderay is the founder of Approved Food, an online discount food retailer based in Sheffield. He says the Co-op’s action is “a great step” towards tackling waste in the UK.

According to the NHS, “best before” dates are more to do with the taste and texture of food than its safety.

The Food Standards Agency echoes the advice given by the NHS, saying “best before” food is safe to eat but may lack the expected taste.

So what do people think of this change in the food market?

Image caption Diana plans her meals around reduced-price foods

Diana Catton, from Lincoln, goes straight to the reduced-price counter when she is shopping and plans her meals around it. Having a low income means she has to budget carefully.

“Depending on the item, I may even eat things which are a couple of days past their use by date, particularly hard cheese and vegetables such as potatoes and other root vegetables,” she said.

“I also use my common sense by looking at and smelling the item. For a large part of my younger life I did not have access to a fridge, and there were no use by dates on food, so this was normal behaviour. As far as best by dates are concerned, I routinely ignore them.

“If a tin has blown or is dented I discard it, and if I can see evidence of spoilage in other dried goods I bin them.”

Image copyright JULIA WAESCHENBACH
Image caption Brendan Hunter ate 12-year-old rice pudding

While clearing out the cupboards at his mother-in-law’s home, Brendan Hunter found tins of rice pudding dating back to 2005. Brendan, who lives in Banbury, Oxfordshire, said he happily tucked in. They “tasted great”, he said.


‘Use by’ Vs ‘best before’

Best before

  • “Best before” dates are about quality, not safety.
  • When the date has passed, it doesn’t mean that the food will be harmful, but it might begin to lose its flavour and texture.
  • The “best before” date will only be accurate if the food is stored according to the instructions on the label.

Use By

  • “Use by” dates are the most important date to consider, as these relate to food safety.
  • “Use by” dates are found on food that goes off quickly, such as smoked fish, meat products and ready-prepared salads.
  • Don’t use any food or drink after the end of the “use by” date on the label, even if it looks and smells fine.
  • For the “use by” date to be a valid guide, you must follow storage instructions.
  • Once a food with a “use by” date on it has been opened, you also need to follow any instructions such as “eat within three days of opening”.
  • If the “use by” date is tomorrow, then you must use the food by the end of tomorrow, even if the label says “eat within a week of opening”.

source: NMS


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Image copyright PRESS ASSOCIATION
Image caption Sam says crisps don’t taste as good after the ‘best before’ date

Sam, from Sussex, had treacle from 2013 which clearly stated “dispose of on expiry”.

He told us processed items such as crisps did not taste great after the “best before” date but could still be used, adding: “The amount people waste is insane. A potato can last a month after purchase quite happily, and will sprout, go soggy or brown if not.

“I have intentionally bought end-of-life mincemeat reduced, topped it with brandy and stuck it back in the cupboard till the following year – it’s tastes better!”

For Derek Brown, from Sutton, as long as food looks and smells OK he is happy to eat it. He thinks items with an expired “best before” date are healthy and can help build up the immune system.

He said: “I buy food on the best before date and put it in the freezer.

“I eat margarine months after the best before date after keeping it in the fridge.

“I honestly believe it is safe indeed healthy to consume bacteria which can help build up the body‘s defences.”

Judith Beatty, from Twickenham, says her late father who lived until the age of 98, was told he had food past the expiry date in his fridge. She said: “He replied that when serving during World War Two he was issued with tins of bully beef stamped ‘WW1’ and it hadn’t done him any harm.”

Image caption Sophie removes the mould from bread before eating

Sophie Ukaoma, a 25-year-old mother and student of biomedicine, says she has no problem buying food past its sell by date. She says she often cuts out the mould in bread and eats the rest. Pasta, potatoes and seasonings are also among the list of items she is happy to use.

She said: “My mother-in-law bought me chilli powder and seasonings from Nigeria seven months ago, I still use them regularly.”

Plans submitted for new use of landmark building

PLANS to transform one of Bradford’s most important Victorian buildings have been formally submitted to planning chiefs.

The proposals to turn the old Bradford Register Office in Manor Row into offices for disability charity Bradnet and prospective tenants NHS, subject to contract, have been lodged with the Council’s planning department.

In April, it was announced the charity had completed a deal to buy the Grade II-listed building from Bradford Council, with help from a £260,000 grant from the Lottery-funded trust Power to Change, which supports community businesses.

It also offered Bradnet up to £10,000 to help it develop its business plans.

The register office closed in October 2014 after the Council bosses decided it was surplus to requirements and moved the service into City Hall.

The authority had put the Grade II listed building up for sale for £600,000 and later put it up for auction.

But Bradnet applied to have the building registered as an asset of community value, a process which allows community groups interested in buying buildings more time to get the funds together.

Bradford West Area Committee backed this call and ordered that the building be removed from the auction.

Anyone interested in buying the building was then given a set time to submit tenders.

Asif Hussain, Bradnet’s chief executive, said: “We are absolutely delighted and hugely privileged to have acquired this wonderful landmark building.”

He said the development marks a “massive step change” from the charity’s premises in Laisterdyke to the central city location on Manor Row.

Mr Hussain added that he hoped the charity would be able to work with different partners to create a community hub and thanked all those who have helped Bradnet get to this point.

The charity is due to move in to the building before Christmas and it’s hoped work on the building will be able to begin in January.

A design and access statement for the development outlines the three-storey building will be turned into offices, board rooms, reception spaces, administration facilities, kitchens, training rooms, bathrooms, plus an NHS ‘wellbeing’ cafe.

It says all works are “intended to be constructed to the highest standards”.

The report adds: “We believe that the change of use of the existing vacant property into functioning offices meets with the context of local planning policy and unitary development plan and will provide a level of regeneration in the immediate area.

“The proposed works will seek to respond to the Bradford Heritage practice guide and look at the existing assets and evaluate them for extent, significance and any works which impact in the existing asset or feature both externally and internally.”

The site also includes a car park which has not been used since the building was vacated in 2014.

The design and access statement sets out this will be reinstated and made good where necessary to provide private parking for both Bradnet and NHS office workers.

Bradnet works to support people with disabilities through independent living, outreach and short trips. Its aim is to break down the barriers its users can face to help them lead as full a life as possible.

Patients must do their bit to help the struggling NHS

THE National Health Service of today faces huge challenges.

In many ways, it is the victim of its own success. Improvements in treating disease and illness have helped to create an ageing population which means more people than ever before now need its services.

It does such a brilliant job that many people now expect it to solve all their problems, eating, drinking and smoking too much as well as failing to exercise enough in the belief that, if they’re ill, the NHS will sort it out later.

Our expectations have increased in other ways, too: we demand faster treatment, instant access to emergency care and support for all sorts of health issues which were not part of the service’s original remit of tackling disease.

Add to that the rising cost of new and advanced treatments and medicines, equipment, technology, energy, buildings and simply keeping up with that increased demand and its easy to see why it is predicted by some that there will be a shortfall in funding of £30 billion by 2020.

All of which is nothing new. You would have to be living on Mars not to be aware that the NHS is struggling for cash, with almost daily reporting of its plight across the press and media.

It would seem to be a completely natural reaction, therefore, for most people to want to do their bit to protect this incredible asset.

And yet millions of people every year contribute to a staggering waste of NHS resources, apparently without considering the consequences of their actions.

Figures released this week by NHS Digital, which collates and analyses vast amounts of data about the service to help it work more efficiently, show that more than one in five hospital outpatient appointments were missed in England last year.

That figure has substantially worsened on a decade ago, when the number of unattended appointments was one in six.

Of the 21 per cent of appointments unattended in 2016/17, about a third (nearly eight million) were due to patients simply not turning up, with another third due to patients cancelling them. The remaining shortfall was due to cancellations by the hospitals.

The figures for Bradford Teaching Hospitals Foundation Trust followed roughly the same trend, with non-attendances rising from 19.4 per cent in 2015/2016 to 20.4 per cent a year later.

Overall, the number of outpatient appointments at Bradford hospitals rose from 481,958 to 484,194, with unattended appointments increasing from 119,002 to 124,720.

The North of England generally, however, had the best record for patients turning up at 80.9 per cent, compared to London, which had the lowest attendance rate of 77.3 per cent.

Nationally, the total number of outpatient appointments has nearly doubled since 2006-07, rising from 63.2 million appointments to 118.6 million in 2016-17.

Older patients, between the ages of 60 and 79, accounted for 31.5 per cent of all attended appointments. Women accounted for a greater proportion of those who attended appointments (57.8 per cent), compared with men (42.2 per cent). Young men aged 20-24 were the worst group for not turning up.

The increase in missed appointments, at both hospitals and GP surgeries – which also cost the NHS around £162 million every year – comes despite a drive launched by the NHS in 2014 to tackle the problem by targeting patients with e-mail messages and text reminders.

The NHS has also been rolling out systems which allow patients to check, book and cancel appointments at their own convenience and order repeat medication online while more GPs have been using smartphones and tablets to connect with patients, with outpatient consultations via Skype becoming increasingly common for patients who don’t need a physical examination.

At the launch of the technology-driven initiative, Beverley Bryant, of NHS England, said: “It’s important that people realise that not turning up to appointments can have a big impact on the care and treatment we are able to give other patients. It wastes doctors’ and nurses’ time too, which costs taxpayers money.”

A spokesman for Bradford Teaching Hospitals Foundation Trust said: “The reasons behind these statistics are multifactorial. Work to improve access to outpatient services has been ongoing for some time.

“We have improved our administration processes and now give patients much more notice of appointments. SMS text reminders have been introduced and we have robust mechanisms in place to minimise the risk of hospital cancellations.

“Missed appointments are monitored and a reduction has been seen this year due to the implementation of the SMS text service. We continue to work with the Clinical Commissioning groups (CCGs) looking at demographic areas to see if further work is required within communities to improve the rate of missed appointments.”

He said failing to show up to appointments had an impact on hospitals’ capacity but constant efforts are made to mitigate the effects.

“Empty appointment slots are re-utilised to minimise waste in the system,” he said. “Patients who continually cancel their appointments will delay their treatment and this could impact on their clinical outcome, so it is important to attend appointments.

“Patients can help play their part by simply advising us that an appointment date is no longer suitable as this means other patients can be offered earlier appointments and doctors’ and nurses’ expertise isn’t wasted.”

A study of 20,000 NHS patients in 2015 found that adding a message to texts and e-mails setting out exactly how much money would be wasted by failing to turn up for their specific appointment was likely to have a bigger impact.

The study tested a variety of ways to encourage patients to keep or reschedule their appointments and it found asking patients to behave decently – such as a plea to be fair to others by cancelling or re-arranging – or just stating that not showing up would cost the NHS money, made little difference.

Lord Darzi, director of the Institute of Global Health Innovation which carried out the study, said: “The NHS is busier than ever and hospitals need to make every single penny count for patients. But we all have a role to play in keeping the NHS sustainable for the future, and it’s clear that people feel a sense of responsibility. Telling patients the cost of missing an appointment shows clear benefits by filling more appointment slots while saving money.”

The increase in non-attendances in the latest figures, however, suggest the message still isn’t getting through to a huge number of people.

ENDS

Prime Minister’s Questions: The key bits and the verdict

Damian Green and Emily Thornberry

With Theresa May in the Middle East – stand-ins Damian Green and Emily Thornberry faced each other at Prime Minister‘s Questions. How did they do?

The pair clashed over nursing numbers in the NHS – and why so many are quitting. Standard fare, you might think, but with Labour’s Emily Thornberry in typically theatrical form at the despatch box it was far from a standard PMQs.

The shadow foreign secretary kicked off with a risky joke about waving the Cross of St George at an England rugby match – risky because she was sacked by Ed Miliband in 2014 for allegedly sending a “snobby” tweet about a terraced house with three England flags and a white van parked outside.

Will Ms Thornberry see getting away with this joke – despite a glancing jibe from Mr Green – as a sign that she has fully laid that episode to rest?

She then attempted to throw Mr Green off balance with a first question about standards in public life. The First Secretary of State is currently being investigated by the Cabinet Office over allegations about his past behaviour.

“The First Secretary looked rather perturbed by my line of questioning but he doesn’t need to worry I really am not going there,” Ms Thornberry reassured Mr Green. So why bring it up? She didn’t say.

She then hit him with a question about a question he had asked John Prescott 17 years ago – when Prescott was standing in for Tony Blair at PMQs – about nursing numbers.

Mr Green hit back with a flurry of statistics – but got more of a purchase on the issue when Ms Thornberry claimed an A&E department in his own constituency was facing closure. He accused Ms Thornberry of getting her facts wrong.

Ms Thornberry nearly fluffed her finale – stumbling over the words “winter fuel allowance,” eliciting supportive shouts from her Labour colleagues, before recovering to accuse the government of getting its priorities wrong by spending extra on Brexit rather than the NHS.

Mr Green ended with a fairly standard rebuttal, accusing his Labour opposite number of “talking down” the NHS.

What other subjects came up?

Conservative MP Nadine Dorries brought up allegations about Labour MP Tulip Saddiq, who has apologised for comments about a pregnant Channel 4 journalist.

The SNP’s leader at Westminster Iain Blackford asked about arms sales to Saudi Arabia, with the PM travelling to the region.

Another potentially awkward moment for Damian Green as Labour’s John Mann asked about sexual harassment allegations at Westminster.

The SNP’s Tommy Shepherd brought up that perennial favourite – House of Lords reform.

So what was the verdict?

Woman wins landmark bereavement case

Jakki Smith and John BullochImage copyright PA
Image caption Jakki Smith and John Bulloch were together for 16 years

A woman has won her legal battle for better rights for unmarried people who lose their long-term partners.

NHS worker Jakki Smith, from Chorley, Lancashire, took the government to court for breaching her human rights in denying her bereavement damages.

A fixed sum of £12,980 is paid out if a person dies as a result of negligence – but only to spouses or civil partners.

Her partner of 16 years, John Bulloch, died aged 66 in 2011 after an infection was missed by medics.

‘Historic decision’

Mr Bulloch, a former prison governor, underwent the removal of a benign tumour on his right foot in August 2011 and fell ill while on holiday in Turkey.

The Court of Appeal allowed Ms Smith’s challenge against a High Court ruling dismissing her claim.

In court, her legal team had argued the current legislation was in breach of the European Convention on Human Rights.

Her lawyer, Zac Golombeck, said the ruling was an “historic decision” and “long overdue.”

The Law Commission previously recommended co-habiting couples should be eligible for bereavement damages and the government also produced a draft bill in 2009, although it was never progressed, he added.

Ms Smith, 59, who was not in court, said she was “over the moon” as she had found it “hurtful and unfair” that her relationship could be considered “less meaningful”.

“John and I had planned a life together, we were in it for the long run and the fact that our bond wasn’t recognised, simply because we hadn’t chosen to marry, was very upsetting.”

Ms Smith said she would not get any money from the decision as there is no possibility of a retrospective payment.

Image copyright PA
Image caption John Bulloch died in 2011 after an infection was missed by medics

Ms Smith said: “Nothing will bring John back, but he was a firm believer in everyone being treated equally and I think he would have agreed with me that this is worth fighting for.

“Just because John and I hadn’t said vows to each other and didn’t wear wedding rings didn’t mean we weren’t completely committed to each other.”My fight has never been for the money, it’s about having meaningful relationships recognised.

“I just hope what has happened helps other people who may find themselves in this tragic situation.”