Following news that the Metropolitan Police have been asked to investigate allegations of a cover up of failures in patient care at Morecambe Bay NHS Trust, there are renewed fears that another scandal such as the one which engulfed the Mid Staffordshire Hospital Scandal might occur.
At Mid Staffs hospital trust an abnormal death rate was recorded among patients admitted as emergencies between 2005 and 2008.
Although the exact figure has never been recorded, it is estimated between 400 and 1,200 additional deaths were reported above the average NHS death rate for emergency care wards.
A succession of inquiries into the Mid Staffs trust also revealed a culture of care which lacked compassion, in which many patients were denied basic care.
Some patients were reported to be so thirsty they resorted to drinking water from flower vases on the wards, while others did not receive pain relief in time to relieve their distress and other patients were found crying for help on wards at the hospital.
In 2008, the Healthcare Commission launched an inquiry after the “excessive” death rates at Mid Staffs were flagged up – and in 2009, the then Health Secretary Andy Burnham announced a public inquiry, which fell to the new Coalition government to launch in 2010.
Robert Francis QC examined more than one million pieces of evidence and listened to more than 160 witness testimonials. The main witness was the former Chief Executive of Mid Staffs trust, Sir David Nicholson – now CEO of the NHS.
He maintained, however, that the failings in care at Mid Staffs did not represent a systemic failure in care in the NHS – a statement which counsel for the inquiry termed “naïve” and “dangerous”.
The subsequent Francis report found that the Department of Health had been “too remote” in its management of the NHS – and NHS managers had ignored the complaints of patients with concerns over care.
Local MPs and GPs had also failed to fight their corner regarding patient care in the NHS – and the Royal College of Nursing was also singled out for not supporting the efforts of nursing staff who tried to highlight the failures in care at their own trusts.
The Francis report called for a criminal charge to be brought against those who cover up data involving failings in patient care – and for doctors to be more transparent when mistakes are made regarding patient care.
However, new inquiries into mother and baby deaths at Cumbria and the police investigation into University Hospitals of Morecambe Bay NHS Foundation Trust have reawakened concerns that Mid Staffs was not an exception – and more cover ups in the NHS may well emerge.
Families who lost loved ones in the Mid Staffs scandal received on average £11,000 in compensation – but many families continue to question how a culture of care in the NHS could develop to the point that patients on the wards were left to go thirsty and hungry and without essential pain relief.
The Francis report has called for compassion to be made central to the recruitment, training and education of nursing staff – but what may yet emerge from the inquiry at Cumbria and the police investigation at Morecambe Bay may once again cast a shadow over patient care in the NHS.
An SEN statement is a statement of educational needs which sets out the extra support which the local education authority (LEA) has agreed to make available to an individual child who may have learning or physical disability – or who might even have other educational needs, such as being gifted.
It is important to find out about SEN statements as soon as possible – some parents may notice their child does not develop as fast as other youngsters even at pre-school age.
In this case, speaking to your GP and asking for an assessment can help address any issues which may not previously have been evident. In very young children, for example, the symptoms of cerebral palsy may take a while to diagnose and it is only when children consistently begin to miss their normal development targets that health experts will intervene and carry out tests and scans to assess whether there has been a brain injury at birth or during pregnancy.
Not all children who are slow starters will require SEN support, however – children do tend to take things at their own pace, so parents should not be alarmed unduly unless there are very obvious issues which need addressing, such as mobility problems or speech/sight/hearing issues.
In the case of school-age children, speaking to the school is the first step to finding out whether your child will require an SEN statement.
SEN statements have to be applied for to the LEA and there are six parts to the SEN statement setting out the type of help and educational support your child might receive.
In children under school age, parents can still request an LEA to make a statutory assessment of their child’s future educational needs.
In school age children, parents should ask to speak to the school SENCO worker (SEN coordinator) in the first instance, who will use the SENCO Code of Practice to assess a child’s needs and make a decision about whether statementing would help address educational or health issues which may affect learning abilities.
SEN statements and timescales
Once an application for an SEN statement has been made by parents, the LEA has six weeks to make a decision about whether it will make an SEN assessment – if so, the LEA will look at all the issues surrounding the child, including health as well as educational needs.
The assessment process has to be completed within 12 weeks and the LEA will write to you with the decision. If no SEN statement has been agreed, you can appeal this decision.
Even when statementing for a child has been approved by an LEA, sometimes parents are disappointed with the specifics of an SEN statement – not only the type of help which can be offered, but more often than not the school specified may not be their first choice.
When this occurs, parents have 15 days from the date the SEN statement was issued to respond and launch an appeal. If you want to specify a different school you can do this and ask for a meeting with the LEA – at this point you will have another 15 days in which to prepare any further objections or evidence and after the meeting, the LEA should respond again within eight weeks.
Once a decision has been made again, parents have two months in which to launch a formal appeal if they disagree with the statementing decision.
Appealing an SEN statement decision can be extremely stressful and many parents engage the help of specialist children’s lawyers who can guide them through the appeal process and make the best case for their child at an appeal.
The Department for Education website also has details of SEN statements and frequently asked questions about statementing.
SEN statements are updated annually to take into account your child’s changing needs and so parents need to be aware of the deadlines for applying and responding. The statementing process takes around six months and for many parents this can add to the stress of trying to support a child with special needs.
The local Parent Partnership Service (PPS) can help advice on statementing and you can search for your nearest PPS service online.
Caring for a loved one with cerebral palsy can be a challenging and at times overwhelming experience, as in some cases the carer is very much a lifeline for the cerebral palsy patient – as well as being the main source of human companionship and mental stimulation or entertainment.
Not all people with cerebral palsy require 24/7 care, however – and many children born with varying degrees of disability as a result of cerebral palsy adapt and carry on, enjoying active and fulfilling lives.
Some of the daily tasks a carer for a cerebral palsy patient may have to carry out include:
For many parents and grandparents, welcoming a child with cerebral palsy into the family is a profoundly life changing experience but they often discover they have the resources to cope and the experience is more positive than they might have expected.
With a severely disabled child, there will be both physical and emotional challenges and it is important to get the help you need, and also talk about how you feel with family and friends – and especially your partner.
The inevitable “Why did it have to happen?” question may be tinged with guilt. Some parents may blame themselves, and again this is only natural. But speak to your GP if you find you are unable to shake off feelings of guilt or sadness, as counselling may be available at your GP surgery.
Children with cerebral palsy often deal with their disability extremely well – and like all children, will most likely turn out to be positive and resilient. As your child grows and develops at their own pace they will make their likes and dislikes and interests and feelings known, just like other children.
Your child will develop a unique personality and many children with cerebral palsy make an enormous contribution to family life and have a real zest for making the most of their own lives, getting involved in activities like sports or theatre groups.
If your child was born with cerebral palsy as a result of medical negligence, this can make the early years particularly difficult if you have to pursue a claim for medical negligence.
These are made through a personal injury solicitor – and these often have contacts with agencies and organisations who can help you deliver the care your child needs, including support for the whole family.
When your child starts school, you may have to apply for a Special Educational Needs (SEN) statement to ensure that any extra help available is put in place. Statementing can be a stressful process if there are limited resources available in your LEA so again contacting an education solicitor who can guide you through the process and handle any appeals can relieve the pressure of applying for SEN. The government’s own website GOV.UK also has more information about statementing.
In most cases, children with cerebral palsy are no less intelligent as a result – but communication may be difficult and they may also have other physical impairments such as sight and hearing impairment and problems with speech. There are many toys now available for children with cerebral palsy – and for children with sight problems, these can help offer stimulation using touch, textures and sounds. Specialist online toy shops offering toys for children with cerebral palsy include Toy Shop UK.
The UK organisation Scope offers support to families who have a loved one with cerebral palsy – and for families whose relatives or friends may have just had a child who has been born or newly diagnosed with cerebral palsy, being there to talk and lend a hand with caring for the new arrival can help with acceptance and adjustment to the situation. Scope can also advise on local groups in your area where families caring for a loved one with cerebral palsy can meet up and share their experiences.
Caring for someone with cerebral palsy can mean you become extremely close to them and it is important for both of you to have a break from the situation, so that your child can become independent and you can also refuel. There is no guilt in having a break from your caring duties – and your child will become much more their own person if they also socialise without you occasionally and are allowed to have some independence, especially when they are older.
Birth injuries to new-borns are fortunately extremely rare, but even a forceps delivery may cause some trauma such as bruising or a head/brain injury if care is not taken by medical staff.
More serious birth injuries involving brain injury can occur if the baby is starved of oxygen during delivery. This can happen if a delivery is delayed, an emergency Caesarean does not take place when needed urgently – or the umbilical cord is wrapped round the baby’s neck at birth and starves the baby of oxygen for a period of time.
The Apgar score test is used to test a baby’s appearance, breathing and reflexes one minute after birth and again five minutes after birth. It is also performed 10 minutes after birth if the initial scores cause concern. A score of around five might indicate your baby needs a little support such as help with breathing and this would be usual if a baby were premature or of low birth weight.
There are recognised birth injuries, however, among new-borns and sometimes these result in personal injury claims if the injury could have been avoided or occurred as the result of medical negligence.
Some widely accepted birth injuries include:
Birth injuries can occur in a wide range of circumstances – and not all of them may be the result of medical negligence.
Breech births – when the baby is in the wrong position – can be rectified before delivery, but sometimes babies may just turn themselves round again. Breech babies are sometimes the result of a twin conception when only one twin survives the pregnancy and the other may fail to develop at an early stage of gestation – as many as one in 8-10 single births are thought to have started as twins. Turning baby in breech position can also mean that care needs to be taken to ensure that the umbilical cord does not become wrapped round the baby’s neck and impair breathing.
Births involving first-time mothers or mothers giving birth to large babies – or who need an emergency Caesarean – may also result in some degree of birth injury. Many birth injuries rectify themselves and are a case of bruising or minor grazes or cuts during assisted births, when forceps or vacuum extraction (VE) is required to help the delivery along, especially if the baby is in distress.
In the case of cerebral palsy, the symptoms of birth injury may not become evident for a few months after the event – and if the Apgar score was reasonable or no incidence of medical negligence can be pinpointed, then it can be very difficult to assess how the birth injury occurred.
The most commonly heard of cases involving birth injury usually relate to oxygen deprivation during birth, or at some stage during pregnancy if the mother has undergone surgery during pregnancy and was herself deprived of oxygen. This is a common cause of cerebral palsy being diagnosed shortly after birth – and the difficulties a child with severe disability as a result of brain injury or cerebral palsy may face means that compensation cases can become extremely involved.
Birth injuries may simply be caused by circumstances, however – the size and shape of a woman’s pelvic area, combined with the size of her baby and intervention by the supervising medical team can all combine to result in minor injury to a bay during delivery. Emergency Caesareans can cause injury both to mother and baby if an incision is not carefully placed or the baby is lying awkwardly in the womb. However, small nicks and grazes usually heal well and good infection control can prevent postnatal complications in mothers and babies.
Watching your baby’s development is one of the most thrilling experiences for new parents – but sometimes you may be worried about a baby’s behaviour or the fact they may seem to be slower than your friends’ babies.
Babies tend to develop at their own sweet pace – and the slow starter may often turn out to be the go getter in later years. However, there are certain stages of a babies’ development when motor functions and their ability to sit or hold themselves upright should kick in naturally.
Cerebral palsy is caused by a brain injury either during gestation, at delivery or as a result of an adverse event after birth – such as medical negligence during surgery or day-to-day care which results in brain injury. Cerebral palsy is characterised by abnormal muscle movements in limbs and even the face.
There are three main types of cerebral palsy:
In newborns, the early stages of development usually occur at around three months, six months, nine months and one year, by which time baby should be able to sit up happily by themselves and begin to walk.
Just because your baby is little slower at sitting up (around 6 months) or beginning to stand by themselves and take a few steps (9-12 months), it does not necessarily mean that there is something wrong.
Some health experts believe that girls may be quicker in early stage development – and that with twins, one twin may develop faster than the other, who might well be sitting contentedly watching their twin crawl all over the place without showing any interest in joining in for a while.
However, with cerebral palsy certain basic functions such as being able to support the weight of their own head and reflex actions may be absent – and premature births and multiple births, or births where the parents are under the age of 20, may have a higher risk for cerebral palsy.
Cerebral palsy is caused by signals from the brain to the spinal column not being transmitted properly as a result of brain injury either during pregnancy, at birth, or after birth. Sometimes the causes of cerebral palsy may be genetic, although this is rare.
Premature and low birth weight babies may have a higher risk for cerebral palsy, as in the last weeks of gestation the brain continues developing grey matter, which retains information, memories and skills.
If a brain injury has occurred in a newborn, depending on which part of the brain has been injured, symptoms to watch out for include:
If a baby is suspected of having the symptoms of cerebral palsy, doctors will carry out tests to reflexes, motor skills development, hearing and eyesight – and then a series of scans (eg MRI and CT) will help confirm whether brain injury has occurred.
Currently there is no test for cerebral palsy during pregnancy – although the Apgar score test for newborns can indicate whether there is any concern after delivery. The Apgar scale is used at one minute and five minutes following delivery – and again at 10 minutes after delivery if there is any cause for concern.
More information about the Apgar scale for newborns is available at the Baby Centre.