Thousands die of thirst and poor care in NHS
Up to 40,000 patients die annually because hospital staff fail to diagnose a treatable kidney problem, a figure that dwarfs the death toll from superbugs like MRSA
A floor sign at an NHS hospital reminds staff and public to wash their hands to stop the spread of infection Photo: Alamy
6:35AM BST 22 Apr 2014
623 Comments
At least 1,000 hospital patients are dying needlessly each month from dehydration and poor care by doctors and nurses, according to an NHS study.
The deaths from acute kidney injury could be prevented by simple steps such as nurses ensuring patients have enough to drink and doctors reviewing their medication, the researchers say.
Between 15,000 and 40,000 patients die annually because hospital staff fail to diagnose the treatable kidney problem, a figure that dwarfs the death toll from superbugs like MRSA.
The report comes less than a year after the NHS watchdog NICE was forced to issue guidelines on giving patients water after it found that 42,000 deaths a year could be avoided if staff ensured the sick were hydrated.
It highlighted how old and vulnerable patients can be left on wards without fluids, quickly becoming too weak from dehydration to request a drink from nurses, which hastens their deterioration.
The latest research said the condition, often called “the silent killer” because it goes unnoticed by medical staff, may affect as many as one in seven hospital patients and costs the NHS £1 billion a year.
The infection causes a loss of kidney function and can develop very quickly. It can occur in people already ill from conditions such as heart failure or diabetes, and those admitted to hospital with infections.
It can also develop after major surgery, such as some kinds of heart surgery, because the kidneys can be deprived of normal blood flow during the procedure. Severe dehydration is one of the main causes of the condition.
“Many of the failings identified in the report related to basic medical care, such as checking of electrolytes, performance of physiological observations and adequate senior review,” the researchers found.
The condition, which costs the NHS more than breast, lung and bowel cancer combined, is responsible for nearly eight times as many deaths as the superbug MRSA at its peak, according to the study commissioned by NHS Improving Quality.
The study, carried out by kidney disease experts and Insight Health Economics, found that the condition is five times more prevalent in English hospitals than previously thought.
Report co-author Professor Donal O'Donoghue, consultant renal physician at Salford Royal NHS Foundation Trust, said: "We know that at least a thousand people a month are dying in hospital from acute kidney injury due to poor care.
"These deaths are avoidable. This is completely unacceptable and we can't allow it to continue. Good basic care would save these lives and save millions of pounds for the NHS.
"Doctors and nurses need to make elementary checks to prevent AKI. In general, people who are having surgery shouldn't be asked to go without water for longer than two hours.
"Sometimes that is unavoidable but then medical staff need to check their patients are not becoming dehydrated. They also need to be aware that some common medications increase the risk of AKI."
Joyce Robins from Patient Concern said: "These figures are really alarming. Too often we are hearing of cases where patients, especially the elderly, are not being properly hydrated - about cases where patients are left begging for water and being told to wait."
She said: "Some cases can be complex but in too many others we are seeing basic care being neglected. Ensuring patients are fed and hydrated is the very minimum we should be able to provide in the 21st century NHS - this is a deeply disturbing refection of the care being provided."
The infection usually develops before patients enter hospital and is often down to problems like dehydration, or an adverse reaction from seriously ill patients to over-the-counter medicines such as ibuprofen, as a result of their condition.
The study into the economic impact of the condition in England found it was present on admission to hospital in nearly 75 per cent of cases. The authors said efforts to prevent infection will need to focus on primary and community care.
Once in hospital, the infection can easily be diagnosed by a simple blood test or urine measurement, both of which are standard practice, but clinical staff are not always sure what warning signs to look for, the researchers found.
After being diagnosed, the condition can often be treated by addressing the underlying problem, for example by ensuring the patient stays hydrated or by switching their medication, with only 10 per cent of patients requiring dialysis.
Older people are particularly vulnerable to the infection but younger patients are also affected. The study found that one in 25 of all hospital inpatients under the age of 40 develops the condition.
Retired maths teacher Maura Murray, 72, from Epsom, Surrey, endured a nightmare ordeal after becoming dehydrated in hospital and developing the condition.
“I’d had an operation for a broken leg but I was so ill for ten days after being discharged that my husband took me to accident and emergency at Epsom, where they recognised my kidneys weren’t functioning properly,” she said.
The grandmother was put on a drip that fed fluids intravenously. But when weekend staff were unable to change her canula for the intravenous tube, she was left to dehydrate on the ward.
“They kept saying to me, ‘you must drink’ but I was vomiting so much I couldn’t keep anything down. I was trying but I couldn’t do anything about it and no one was noticing,” she said.
“When you’re feeling very poorly, you haven’t got the energy to shout and fight them, you can’t do anything about it.”
The result was that Mrs Murray’s kidney function dipped to just 10 per cent, a life-threatening level. After treatment, her function is now at 19 per cent, which has left her with permanent health problems such as anaemia.
“I feel very cross, it was such an awful shock to think that something like that could happen because of the staff’s ineptitude. When you go into hospital, you trust them to care for you. I hope no one has to suffer like I did,” she said.
Marion Kerr, health economist at Insight Health Economics, said: "AKI costs the NHS more than £1 billion every year. That's more than we spend on breast, lung and bowel cancer combined.
"Every day more than 30 people are dying needlessly. Compare that to MRSA which was killing about four people a day at its peak.
"Simple improvements in basic care could save the NHS £200 million pounds a year and, more importantly, save thousands of lives."
A spokesman for NHS England said: "We have taken steps to ensure the NHS puts in place coherent long-term plans to reduce avoidable deaths in our hospitals, and to improve the way data is used in decision making.
"Health research based on real-life evidence like this is vitally important for NHS commissioners in choosing where to target their resources, and we thank Insight Health Economics and NHS Improving Quality for carrying it out."
Charlotte Leslie MP, Conservative member of the Commons health select commitee said: "This is really concerning - it highlights a lack of fundamental care in some of our hospitals and suggests that in some places basic standards are not being met."
"We saw in Mid-Staffs that the unthinkable can happen. We have to look again at nursing training, at continuity of medical care and that the management focus is on having sufficient frontline staff to look after patients."
A Department of Health spokesperson said: “The Health Secretary is clear in his ambition to make the NHS the safest health service in the world.
“Hospitals are ‘signing up to safety’ as part of their commitment to save more lives and reduce harm.
“Following the Francis Inquiry into care at Mid Staffordshire, we are also introducing new fundamental NHS standards covering the basics of care, including proper hydration.
"Increased effort is being put into training doctors and nurses about how to spot and treat Acute Kidney Failure and NICE has issued strong guidance on preventing this condition."
The latest research said the condition, often called “the silent killer” because it goes unnoticed by medical staff, may affect as many as one in seven hospital patients and costs the NHS £1 billion a year.
The infection causes a loss of kidney function and can develop very quickly. It can occur in people already ill from conditions such as heart failure or diabetes, and those admitted to hospital with infections.
It can also develop after major surgery, such as some kinds of heart surgery, because the kidneys can be deprived of normal blood flow during the procedure. Severe dehydration is one of the main causes of the condition.
“Many of the failings identified in the report related to basic medical care, such as checking of electrolytes, performance of physiological observations and adequate senior review,” the researchers found.
The condition, which costs the NHS more than breast, lung and bowel cancer combined, is responsible for nearly eight times as many deaths as the superbug MRSA at its peak, according to the study commissioned by NHS Improving Quality.
The study, carried out by kidney disease experts and Insight Health Economics, found that the condition is five times more prevalent in English hospitals than previously thought.
Report co-author Professor Donal O'Donoghue, consultant renal physician at Salford Royal NHS Foundation Trust, said: "We know that at least a thousand people a month are dying in hospital from acute kidney injury due to poor care.
"These deaths are avoidable. This is completely unacceptable and we can't allow it to continue. Good basic care would save these lives and save millions of pounds for the NHS.
"Doctors and nurses need to make elementary checks to prevent AKI. In general, people who are having surgery shouldn't be asked to go without water for longer than two hours.
"Sometimes that is unavoidable but then medical staff need to check their patients are not becoming dehydrated. They also need to be aware that some common medications increase the risk of AKI."
Joyce Robins from Patient Concern said: "These figures are really alarming. Too often we are hearing of cases where patients, especially the elderly, are not being properly hydrated - about cases where patients are left begging for water and being told to wait."
She said: "Some cases can be complex but in too many others we are seeing basic care being neglected. Ensuring patients are fed and hydrated is the very minimum we should be able to provide in the 21st century NHS - this is a deeply disturbing refection of the care being provided."
The infection usually develops before patients enter hospital and is often down to problems like dehydration, or an adverse reaction from seriously ill patients to over-the-counter medicines such as ibuprofen, as a result of their condition.
The study into the economic impact of the condition in England found it was present on admission to hospital in nearly 75 per cent of cases. The authors said efforts to prevent infection will need to focus on primary and community care.
Once in hospital, the infection can easily be diagnosed by a simple blood test or urine measurement, both of which are standard practice, but clinical staff are not always sure what warning signs to look for, the researchers found.
After being diagnosed, the condition can often be treated by addressing the underlying problem, for example by ensuring the patient stays hydrated or by switching their medication, with only 10 per cent of patients requiring dialysis.
Older people are particularly vulnerable to the infection but younger patients are also affected. The study found that one in 25 of all hospital inpatients under the age of 40 develops the condition.
Retired maths teacher Maura Murray, 72, from Epsom, Surrey, endured a nightmare ordeal after becoming dehydrated in hospital and developing the condition.
“I’d had an operation for a broken leg but I was so ill for ten days after being discharged that my husband took me to accident and emergency at Epsom, where they recognised my kidneys weren’t functioning properly,” she said.
The grandmother was put on a drip that fed fluids intravenously. But when weekend staff were unable to change her canula for the intravenous tube, she was left to dehydrate on the ward.
“They kept saying to me, ‘you must drink’ but I was vomiting so much I couldn’t keep anything down. I was trying but I couldn’t do anything about it and no one was noticing,” she said.
“When you’re feeling very poorly, you haven’t got the energy to shout and fight them, you can’t do anything about it.”
The result was that Mrs Murray’s kidney function dipped to just 10 per cent, a life-threatening level. After treatment, her function is now at 19 per cent, which has left her with permanent health problems such as anaemia.
“I feel very cross, it was such an awful shock to think that something like that could happen because of the staff’s ineptitude. When you go into hospital, you trust them to care for you. I hope no one has to suffer like I did,” she said.
Marion Kerr, health economist at Insight Health Economics, said: "AKI costs the NHS more than £1 billion every year. That's more than we spend on breast, lung and bowel cancer combined.
"Every day more than 30 people are dying needlessly. Compare that to MRSA which was killing about four people a day at its peak.
"Simple improvements in basic care could save the NHS £200 million pounds a year and, more importantly, save thousands of lives."
A spokesman for NHS England said: "We have taken steps to ensure the NHS puts in place coherent long-term plans to reduce avoidable deaths in our hospitals, and to improve the way data is used in decision making.
"Health research based on real-life evidence like this is vitally important for NHS commissioners in choosing where to target their resources, and we thank Insight Health Economics and NHS Improving Quality for carrying it out."
Charlotte Leslie MP, Conservative member of the Commons health select commitee said: "This is really concerning - it highlights a lack of fundamental care in some of our hospitals and suggests that in some places basic standards are not being met."
"We saw in Mid-Staffs that the unthinkable can happen. We have to look again at nursing training, at continuity of medical care and that the management focus is on having sufficient frontline staff to look after patients."
A Department of Health spokesperson said: “The Health Secretary is clear in his ambition to make the NHS the safest health service in the world.
“Hospitals are ‘signing up to safety’ as part of their commitment to save more lives and reduce harm.
“Following the Francis Inquiry into care at Mid Staffordshire, we are also introducing new fundamental NHS standards covering the basics of care, including proper hydration.
"Increased effort is being put into training doctors and nurses about how to spot and treat Acute Kidney Failure and NICE has issued strong guidance on preventing this condition."
