Report into death of Fenland man by German locum raises out-of-hours health care fears

THERE are worries about patient safety because of gaps in the monitoring of out-of-hours care, a health watchdog has today warned.The report comes during an investigation into an East Anglian healthcare provider and was triggered by the death of a Fenlan

THERE are worries about patient safety because of gaps in the monitoring of out-of-hours care, a health watchdog has today warned.

The report comes during an investigation into an East Anglian healthcare provider and was triggered by the death of a Fenland man.

The study, from the Care Quality Commission (CQC), raised fears of a "nationwide problem" with private GP companies working in England under NHS contracts.

It follows the death in February last year of David Gray, 70, from Manea, who was accidentally killed by a German doctor working his first out-of-hours shift in Britain.


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Mr Gray was given 10 times the normal dose of diamorphine by Daniel Ubani, who admitted being exhausted and only having a few hours sleep before beginning work for Ipswich-based Take Care Now (TCN).

Dr Ubani was given a nine-month suspended sentence in Germany for causing death by negligence in the UK.

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TCN has contracts for out-of-hours care with five health trusts, including Cambridgeshire, Suffolk and Yarmouth and Waveney.

Cynthia Bower, CQC's chief executive, said: "Our visits to the five trusts that commission TCN's services showed they are only scratching the surface in terms of how they are routinely monitoring the quality of out-of-hours services.

"If their monitoring is not robust enough, they may not be in a position to spot early indications of potential problems or poor care.

"We believe this may point towards a national problem."

She said more focus was needed on areas including the number of unfilled shifts, how many shifts were covered by non-local doctors, the induction and training they received; and the quality of clinical decisions.

The interim report says that TCN sometimes had difficulty filling shifts, particularly for doctors, which "puts pressure on other staff and could affect the quality of the service".

The Department of Health is now writing to health trusts across England asking them to urgently review their monitoring arrangements for out-of-hours services.

The report also says TCN needs to finish work on its medicines policy, but says TCN has now withdrawn the 100mg ampoules of diamorphine, reducing the chance of the original mistake being repeated.

It also says that patients with a possible stroke must be immediately transferred to the 999 service.

NHS Great Yarmouth and Waveney and NHS Suffolk have both welcomed the report and say they are monitoring the quality and safety of out-of-hours care.

David Cocks, chief executive of Take Care Now, said: "We welcome the CQC's interim progress report and are continuing to work with the CQC in its ongoing investigation."

Following the release of the report Chris Banks, Chief Executive of NHS Cambridgeshire, said: "We welcome the Care Quality Commission's interim report into the out of hours work of Take Care Now and the management of their contracts by Primary Care Trusts.

"We accept in full their recommendations and have already put in place strong performance management of Take Care Now and are working with our other out of hours providers to ensure a safe out of hours service across Cambridgeshire.

"Our thoughts are with Mr Gray's family at this difficult time and we will continue to work with the CQC to ensure that systems are improved, not only in Cambridgeshire, but across the country so that an incident like this does not happen again.

"It is important that people continue to seek medical help whenever they need it, and I would like to reassure people that we have done everything we can to ensure they receive a good quality of service out of hours."

A final report is due to be published early in 2010.

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