David Sellu trial: 'Serious errors' caused patient's death
David Sellu has been a surgeon for four decades
A patient died because of "serious errors in judgment" by a senior doctor at a private hospital in north-west London, the Old Bailey has heard.
James Hughes received "exceptionally bad" care from David Sellu after routine knee surgery at the Clementine Churchill Hospital, jurors were told.
The operation, in 2010, went well but afterwards his bowel ruptured.
Mr Sellu, who denies gross negligence manslaughter, "simply ignored" the urgency of the case, the court heard.
After the initial operation on 5 February at the hospital in Harrow, Mr Hughes, a 66-year-old retired builder from County Armagh, developed abdominal pain and was transferred to the care of Mr Sellu.
The surgeon, of Croft Close in Hillingdon, west London, has been a surgeon for four decades and specialises in colorectal surgery.
Death 'avoidable'
Prosecutors told the court Mr Sellu suspected there had been a rupture, which is a potentially life-threatening condition that requires surgery.
But instead of immediately performing surgery he ordered a CT scan for the next day.
Had (Mr Sellu) operated earlier Mr Hughes would have had a very good chance of survival”
Bobbie Cheema QCProsecutor
The scan confirmed the medic's suspicions but he "failed" to carry out the surgery immediately and instead carried on with his own clinic, prosecutor Bobbie Cheema QC said.
Mr Hughes was sent to the operating theatre at 9pm on 12 February after being in pain for 40 hours, however, by this point, his condition had deteriorated so badly that intensive care specialists had to work to stabilise him, the court heard.
Ms Cheema told the jury that Mr Hughes was transferred to the intensive care unit after surgery but died the following day.
"That death was avoidable," she said.
"Had (Mr Sellu) operated the night before, or even earlier on February 12, Mr Hughes would have had a very good chance of survival."
Perjury charge
She added: "There was a series of missed opportunities and serious errors in judgment in the care of this patient and they combined to cause Mr Hughes' death.
"The standard of care was exceptionally bad."
Ms Cheema told the court that Mr Hughes felt he was not getting sufficient help from hospital staff and phoned a doctor friend who told him to call the surgeon who had operated on his knee.
That surgeon, John Hollingdale, visited Mr Hughes and examined him.
"He was concerned something was wrong... unrelated to his knee surgery and asked for an X-ray to be completed urgently," Ms Cheema said.
Mr Hollingdale was "surprised" to learn the test was to be delayed until the next day as the hospital had the facilities to perform the tests around the clock, Ms Cheema told jurors.
Mr Sellu is also accused of perjury in relation to allegations he lied at under oath Mr Hughes's inquest, which he also denies.
A new hospital inspection regime for England is getting under way, with the chief inspector promising to "expose poor and mediocre" care.
The Care Quality Commission agreed to overhaul its inspections following the Stafford Hospital scandal.
Inspectors will visit Croydon Health Services NHS Trust, in south London, later - the first of 18 inspections taking place before the end of 2013.
Mike Richards, the new chief inspector of hospitals, is leading the process.
The inspection teams are larger and more specialised than before - about 30 people are taking part in the Croydon visit, including a surgeon, senior nurses, a student nurse and members of the public.
There will also be a public meeting held in Croydon on Tuesday evening - something that will be happening during the other inspections too.
Another crucial difference is that the inspections will focus on the "whole patient experience".
Clearer picture
Each inspection will cover eight key services areas: A&E; medical care; surgery; critical care; maternity; paediatrics; end-of-life care and outpatients.
The inspections will be a mixture of announced and unannounced visits and they will include inspections in the evenings and at weekends.
That contrasts with the previous inspections which were grouped around essential standards so hospitals would find themselves inspected for issues such as nutrition and infection control rather than the entire system.
Sir Mike said: "These inspections are designed to provide people with a clear picture of the quality of the services in their local hospital, exposing poor or mediocre care as well as highlighting areas of good and excellent care.
"We know there is too much variation in quality in the NHS - these new in-depth inspections will allow us to get a much more detailed picture of care in hospitals than ever before."
The launch comes amid heightened focus on the performance and regulation of hospitals.
The public inquiry into the poor care at Stafford Hospital, published in February, identified failings in the way hospitals are monitored.
Weaknesses were once again highlighted in July when the government's Keogh Review led to 11 hospitals being placed in special measures. Only two of them were facing regulatory action from the CQC, suggesting problems were slipping under the radar.
Hospital inspection
Old system
New system
Inspections focused on themes rather than looking at whole hospital. Meant sites inspected for individual issues such as nutrition and dignity.
Inspectors will now spend at least two days looking at the whole hospital, with a special focus on key services such as A&E.
Inspections resulted in hospital either meeting or failing 16 essential standards.
School-style ratings of "outstanding", "good", "requires improvement" and "inadequate".
Inspection teams limited to four or five people, often not specialists in care.
Practising doctors and nurses invited on to panels along with patients to create 20-strong teams.
Regulator uses 1,200 indicators to identify which trusts need repeat inspections.
Indicators trimmed to about 150 to give more weight to key measures such as surveys and death rates.
Health Minister Norman Lamb said: "Our priority is to make sure that people get better care. That's why we asked the CQC to appoint a new Chief Inspector of Hospitals to shine a spotlight on quality and drive up standards across the board."
The programme of inspections continues on Thursday when inspectors go into Airedale NHS Foundation Trust followed by inspections at Taunton and Somerset NHS Foundation Trust and The Royal Wolverhampton NHS Trust next week.
By the end of 2015 the CQC aims to have inspected all acute hospitals.
Results will be published about a month after each inspection.
Chances were missed to help a child who was murdered by his mother and her partner after suffering "terrifying and dreadful" abuse, a report has found.
A serious case review found Daniel Pelka, four, was "invisible" at times and "no professional tried sufficiently hard enough" to talk to him.
He was starved and beaten for months before he died in March 2012, at his Coventry home.
The review said "critical lessons" must be "translated into action".
The court heard Daniel saw a doctor in hospital for a broken arm, arrived at school with bruises and facial injuries, and was seen scavenging for food.
A teaching assistant described him as a "bag of bones" and the trial heard he was "wasting away". At the time of his death the schoolboy weighed just over a stone-and-a-half (10kg).
Much of the detail that emerged in the trial about the level of abuse Daniel suffered was "completely unknown" to the professionals involved, the review found.
No-one has been disciplined as a direct result of Daniel's death.
The report by Ron Lock did not blame or identify any individual agency but he said the professionals involved were "too optimistic" about what they saw.
"Workload was a potential issue - child protection is a very complex matter - and perhaps when they felt reassured they moved on to the next case," Mr Lock told BBC News.
"But they need to be stronger and have a much more inquiring mind. They needed to act on what was in front of them."
The review's key findings include:
Police were called to 26 separate incidents at the family home, many involving domestic violence and alcohol abuse
Excuses made by Daniel's "controlling" mother were accepted by agencies
Professionals needed to "think the unthinkable" and act upon what they saw, rather than accept "parental versions"
Daniel's "voice was not heard" because English was not his first language and he lacked confidence
No record of "any conversation" held with Daniel about his home life, his experiences outside school, or of his relationships with his siblings, mother and her partners
None of the agencies involved could have predicted Daniel's death
There were "committed attempts" by his school and health workers to address his "health and behavioural issues" in the months before his death
But "too many opportunities were missed for more urgent and purposeful interventions"
Two of those chances were when Daniel was taken to an accident and emergency department with injuries
Bruises
In March 2008, when Daniel was eight months old, he was treated for a minor head wound. In January 2011, when he was three-and-a-half, he was taken to A&E with a fractured arm.
The review said the hospital "rightly raised immediate concerns about the [fractured arm]" and a meeting was held to decide if it was caused by a fall from a settee, as Daniel's mother claimed, or was the result of abuse.
The meeting decided Luczak's explanation was "plausible".
But the review said the reasons for other bruises found on Daniel at the time, which his mother claimed came from bicycle accidents, were not "fully explored".
The Children and Families Minister Edward Timpson said the report made "shocking reading" and "laid bare" the lack of intervention by professionals.
Mr Timpson said he had written to the Coventry Safeguarding Children Board asking for a clearer analysis as to why the mistakes occurred.
'Invisible' Daniel
Amy Weir, the board's chair, said she found the report "disheartening, disappointing and generally worrying".
Ms Weir said the idea of Daniel being "invisible" was "at the heart of this case".
"I think for Daniel there's something which we've never fully been able to get to grips with," she said.
"The issue about Daniel mainly being Polish speaking" should have been overcome and there were "significant issues" about his mother and her ability to try to "hoodwink the professionals", she added.
Assistant Chief Constable Garry Forsyth, of West Midlands Police, said: "We accept that Daniel was not 'given a voice'."
He said the report "raised the lack of consistency" in officers dealing with separate domestic abuse reports and the force needed "a more holistic approach".
The report said that due to such inconsistency, Daniel's lack of language and low confidence was not picked up and would have made it "almost impossible for him to reveal the abuse he was suffering".
"Overall, the 'rule of optimism' appeared to have prevailed," it said.
The review said Daniel could have been offered greater protection if the professionals involved had applied a "much more enquiring mind".
It also identified school staff did not link Daniel's physical injuries with their concerns about his apparent obsession with food, which his mother claimed was caused by a medical condition.
"If we were aware of the bigger picture of his life or had doubts about her, we would of course have acted differently.
"We want to see changes where schools are aware of concerns from other agencies which affect our pupils."
Sharon Binyon, medical director of the Coventry and Warwickshire Partnership NHS Trust, believes the service as a whole did not do enough.
"Coventry has one of the lowest numbers of health visitors per child in the country. That was recognised and we're working with NHS England," she said.
"Since the time of Daniel's death the number of health visitors has now doubled and we expect to see it trebled by 2015."
Police were called to several domestic incidents involving Mariusz Krezolek and Magdelena Luczak
Peter Wanless, the NSPCC's chief executive officer, said ultimately Daniel's mother and her partner were responsible for his death but it was right to look at what could have been done differently.
"Processes were followed correctly much of the time but processes alone do not save children," he said.
Geoffrey Robinson, MP for Coventry North West, described Daniel Pelka's death as "a great disgrace" for the city and called on the council's chief executive, Martin Reeves, to consider his position.
Mr Reeves, said the city had "never faced such a tragic case" and staff needed to "learn quickly" from the review.
"The best legacy for Daniel is to make sure we move forward and I want to have a part to play in that future," he said.
"This can't be about a witch hunt or vilification of professionals."
The era of NHS patients being shunted around hospitals needs to end, an expert group says.
The Future Hospital Commission - set up by the Royal College of Physicians - said a radical revamp in structures was needed to bring care to the patient.
This was particularly true for frail people with complex needs, who often faced multiple moves once admitted to hospital, the report said.
It also recommended closer working with teams in the community.
The commission said this could involve doctors and nurses running clinics in the community and even visiting people in their own homes - as is already happening in a few places.
'Bold and refreshing'
It also called for an end to the concept of hospitals discharging patients.
Sir Mike Rawlins: "Hospital shouldn't stop at the walls of the building"
Instead, it argued that many of those seen in hospitals in the 21st Century needed ongoing care that did not end when they left hospital.
So the report recommended that planning for post-hospital care should happen as soon as someone is admitted.
Key to that will be a new hub that should be created in every hospital, called a clinical co-ordination centre, which would act as a central control room, helping to ensure information about patients is shared and their care planned properly.
Once in hospital, patients should not move beds unless their care demanded it, the report said.
That contrasts with the multiple moves many patients with complex conditions often find themselves facing as they are passed from specialism to specialism.
It said this would require a greater emphasis on general wards with specialists visiting patients rather than the other way round.
The longest Suzie Hughes, who has the auto-immune condition Lupus, has spent in hospital is 21 days.
During her stay, she was moved five times for non-clinical reasons.
"I would find myself being wheeled down the corridor with my flowers and chocolates. Nurses would be with me and I kept thinking, 'What a waste of their time.'
"And each time I arrived on a new ward I had to explain my condition again. The information does not get passed on and it results in delays."
The authors - drawn from across the NHS and social-care spectrum - also called for an end to the two-tier weekday and weekend service in many facilities.
They even said it would be preferable to work at 80% capacity across the seven days if extra resources were not available in the short-term.
Commission chairman Sir Michael Rawlins said it was about providing the care patients "deserved".
Alzheimer's Society chief executive Jeremy Hughes said too often hospitals were stressful places with patients being moved "from pillar to post".
"We need nothing less than a revolution... in order to ensure our NHS is fit for the future," he added.
Health Secretary Jeremy Hunt said the report was "bold and refreshing".
"I agree completely that we must make services more patient-centred both inside and outside hospital."
Shadow health secretary Andy Burnham said: "We must turn this system around and help support people where they want to be - at home with their family around them."
Sepsis is often referred to as either blood poisoning or septicaemia, although it could be argued that both terms are not entirely accurate. Sepsis is not just limited to the blood and can affect the whole body, including the organs.
Septicaemia (another name for blood poisoning) refers to a bacterial infection of the blood, whereas sepsis can also be caused by viral or fungal infections.
Sepsis is a life-threatening illness caused by the body overreacting to an infection.
The body’s immune system goes into overdrive, setting off a series of reactions that can lead to widespread inflammation (swelling) and blood clotting.
Uncomplicated sepsis is caused by infections, such as flu or dental abscesses. It is very common and does not usually require hospital treatment.
Severe sepsis occurs when the body’s response to infection has started to interfere with the function of vital organs, such as the heart, kidneys, lungs or liver.
Septic shock occurs in severe cases of sepsis, when your blood pressure drops to a dangerously low level, preventing your vital organs from receiving enough oxygenated blood.
If it is not treated, sepsis can progress from uncomplicated sepsis to septic shock and can eventually lead to multiple organ failure and death.
If you think you have sepsis, it is important to get it diagnosed and treated as quickly as possible.
If you think that you or someone in your care has severe sepsis or septic shock, phone 999 and ask for an ambulance.
If sepsis is detected early and has not yet affected vital organs, it may be possible to treat the infection at home with antibiotics. Most people with uncomplicated sepsis make a full recovery.
Severe sepsis and septic shock are considered medical emergencies and normally require admission to an intensive care unit, where the body’s organs can be supported while the infection is treated.
Because of problems with vital organs, people with severe sepsis are likely to be very ill, and approximately 30-50% will die as a result of the condition.
David Sellu has been a surgeon for four decades
