Coroner issues warning after four children die after treatment at Great Ormond St hospital

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A coroner today warned that children undergoing treatment for cancer could be at risk because of the failure of scientists to share test results.

Mary Hassell is to send a prevention of future deaths report to NHS England after hearing how four children died after botched stem cell transfers at Great Ormond Street hospital.

She told St Pancras coroner’s court today there was a lack of “benchmarking” of results to allow doctors to establish whether the procedures were working.

She said: “I’m very concerned that the clinicians treating children with cancer have been unable to unlock the results of Siopen trial [performed in Vienna in 2011]. That seems to me to be a very unsatisfactory state of affairs. I’m concerned for children in the future.”

She returned narrative verdicts in relation to the deaths of Sophie Ryan-Palmer, 12, of Feltham, Katie Joyce, four, from Hoddesden in Hertfordshire, Ryan Loughran, aged one, from Bournemouth, and Muhanna Alhayany, five, who had come from Kuwait for treatment.

Some parents sobbed in court as the coroner recounted the harrowing detail of each child’s fight for life. See below for part of the narrative from Ms Hassell.

Great Ormond St inquest1Great Ormond St inquest2

The children had various forms of cancer such as neuroblastoma and leukaemia and were given stem cell transplants, previously known as bone marrow transplants, in a bid to save their lives.

But the inquest was told that a flaw in the way the cells were frozen prevented them from regenerating each child’s weakened body.

Three of the four died at Great Ormond Street – Sophie on July 17 last year, Katie on October 6 last year and Muhanna on on August 28 last year. Ryan died on July 10 last year in a hospice in Winchester.

Ms Hassell said that only Sophie, who had acute lymphoblastic leukaemia, “might have” survived her underlying illness if she had not been given faulty stem cells. In the other three cases, “a more successful graft would not have changed the outcome”.

She said: “In conclusion, it’s unclear whether a safer graft would have changed the outcome for Sophie, but it might have.”

It was after Muhanna’s death that doctors began to wonder if there was a common link between the first three deaths. They had been puzzled why his blood count had failed to recover after the stem cell transfer.

In total, eight children at GOSH received unsuccessful stem cell transfers – the first time this had happened since the process was launched in 2003.

The fault was eventually discovered by Dr Michael Watts at University College Hospital. He found problems in the way the cells were being frozen.

“When Katie died in early October 2013, those treating her realised that there had been eight consecutive graft failures,” Ms Hassell said in her narrative.

“GOSH suspended the programme and informed the Human Tissue Authority. Four out of the eight children had died, Katie being the last.”

She continued: “The likelihood is that something changed at GOSH that year. It’s still not known what changed.

“Nevertheless, the controlled rate freezing profile in use at GOSH in 2013 did cause the engraftment failure in these four children.”

Ms Hassell said the cases highlighted the urgent need for hospitals in the UK and internationally to share results on stem cell transfers.

“Those treating children following a bone marrow transplant don’t know how many days to recovery is normal, so they don’t know what is abnormal.

“This could compromise the optimal care of some children with cancer.”

A spokeswoman for Great Ormond Street Hospital for Children NHS Foundation Trust said: “We understand that this has been an immensely distressing process for all of the families involved. These four young patients were extremely poorly children with complex conditions, and it is frustrating for everyone concerned, especially their families, for it still to be unclear exactly what caused the freezing problem and to what extent this might have contributed to one patient’s eventual outcome.

“As soon as we identified a potential problem with our stem cell freezing process in 2013, we stopped freezing cells onsite and used alternative facilities in other London hospitals while an investigation was undertaken.

“We had tested all of these cells prior to transplant, following UK national standards of testing, and the results of these tests had indicated the cells were alive and viable. Therefore at this stage there was no indication of any problem, and it was only after a period of time had elapsed that the pattern of delayed engraftment began to emerge among a group of patients.

“After a number of investigations we have now re-introduced freezing of cells at GOSH using an alternative method which, like our previous method, is in use in many hospitals across the country. We are closely monitoring this different method and are performing additional testing, over and above the national standards, to check the engraftment potential of the frozen cells.

“Throughout this whole process we have been open and honest with all four patients’ families and have shared all of the available information with them. As the evidence from our clinicians has testified, we have also worked hard to share our findings with the wider transplant community. We welcome the coroner’s recommendation to create a more standardised approach to the way the medical community shares knowledge nationally about autologous stem cell transplants in children with cancer, to raise awareness of any issues uncovered and ensure a similar problem does not occur again.”

Investigation launched after hospitals suffer worst A&E delays in country

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An independent investigation has been ordered into soaring A&E delays in west London following the closure of two casualty units.

NHS England is examining whether the decline in performance at Northwick Park and Ealing hospitals is linked to the axing of the A&Es at Hammersmith and Central Middlesex.

The probe was requested by local GPs after London North West Healthcare NHS Trust, which runs Northwick Park and Ealing, recorded the worst delays in the country for patients waiting to be treated at main A&Es.

In the week to October 19, it saw just 67.8 per cent of patients within four hours. The following week, it was 73.3 per cent. Over the four weeks,  2,813 patients have waited more than the four-hour NHS target to be seen.

Today NHS England figures showed that London North West Healthcare Trust had fallen back to second worst in the country for the week ending November 16, with only 68.7 per cent of patients attending its “type 1″ (ie main) A&Es being seen in four hours. Only the trust that now runs the scandal-hit Stafford hospital was worse.

In an interview with the Standard, Dr Mark Spencer, clinical lead for the Shaping a Healthier Future programme behind the A&E changes in North West London, claimed the increased delays were not a result of the closures but were due to more people seeking emergency treatment.

“Undoubtedly we are not happy with the performance,” he said. “At the moment, a lot of this is unexplained. We need to look at that. If we are wrong, we will find out how we got it wrong and not do it again.

“It’s not good care. If you had a relative stuck on a trolley for four hours you would be pretty cheesed off. Whether it has an impact on mortality is hard to say.”

The A&E closures at Hammersmith and Central Middlesex, on September 10, were the first in a series of changes to emergency care approved by Health Secretary Jeremy Hunt a year ago.

The next changes will see Ealing and Charing Cross rebuilt as £80 million “local hospitals” performing day surgery, with their A&Es becoming “emergency centres” run by GPs and emergency nurse practitioners.

See here for my summary of the issues on London Live this morning. The story also appears in the Evening Standard and on its website today.

The Department of Health insists that the hospitals will continue to provide “A&E services” but campaigners believe the units are being downgraded.

A Department of Health spokesman said: “Local people can be reassured that, as the Health Secretary made clear to Parliament last year, Ealing hospital will continue to provide A&E services.”

But Ealing council leader Julian Bell saying an emergency department run by GPs and without an intensive care unit and blue-light ambulances “isn’t an A&E that the public would recognise”.

Dr Spencer insisted Northwick Park was now “safer” than before as it was relying on fewer agency staff and locum doctors, and the number of emergency consultants “on the shop floor” had increased.

He said there were no plans to suspend or scrap Shaping a Healthier Future, which aims to deliver care via GPs and in the community to tackle the epidemic in obesity and heart disease.

Dr Spencer said: “While I remain concerned that people are not getting the best care at the moment, it doesn’t mean we don’t think this is the right direction of travel. We always said Shaping a Healthier Future is a slow process.”

Soldiers and police back on ambulance duty as second paramedic strike hits London

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Soldiers and police are to drive ambulances in London when paramedics take strike action on Monday [November 24].

London Ambulance Service (LAS) expects to be under “significant pressure” when staff take part in the latest phase of a national protest over NHS pay. Ambulance chiefs today pleaded with people only to call 999 with a “life-threatening emergency”.

The Ministry of Defence is providing 120 military personnel, while the Met police is providing 150 officers. A further 12 soldiers and 40 police will be held in reserve and can be called upon if required.

The walk-out, involving GMB and Unison members, will last from 7am to 11am but the effect is expected to last throughout Monday – typically the busiest day of the week for the London Ambulance Service.

Industrial action last month saw 77 per cent of ambulance crews and 14 per cent of control room staff take part. Similar levels are expected on Monday.

The soldiers and police will operate in pairs, with one driving the ambulance and the other providing navigation. A paramedic, or doctor or nurse volunteering from elsewhere in the NHS, will be carried in the back to treat patients. Ambulances driven by police will be able to go through red lights, but not those driven by soldiers.

Ambulance managers with clinical training will be deployed on the front-line. Private ambulances will also be used to transfer patients to hospital.

Jason Killens, LAS director of operations, said: “Only people in a life-threatening emergency will get an ambulance response between 7am and 11am on Monday.

“People with injuries such as minor broken bones, women in routine labour, some patients with breathing difficulties or those involved in minor road traffic accidents will be given clinical advice, provided with alternative transport or told to make their own way to hospital.”

He asked Londoners who were not seriously ill to call the NHS 111 helpline for medical advice. “We have plans in place for our most seriously ill and injured patients,” he said.

“However, people who need an ambulance response, but are not in a life-threatening situation, should expect to wait longer or may not get an ambulance at all,” he said.

“We’d like to thank Londoners for their support in helping us get to the most seriously ill and injured patients.”

This story also appears in the Evening Standard today.

Stand-in doctors paid £1,760 a shift to work in London A&Es

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Queen's hospital

A debt-ridden hospital trust is being forced to pay stand-in doctors up to £1,760 a day to ease chronic staff shortages in its accident and emergency departments.

Queen’s hospital in Romford and King George in Ilford are spending about £100,000 a week on A&E agency staff – despite being £38 million in debt.

Hospital chiefs say they have no option as they battle to cope with A&E attendances soaring to about 250,000 a year and with national staff shortages meaning that only half its 18 emergency consultant posts are filled.

An edited version of this story appears in today’s Evening Standard.

The figures came to light during a public accounts committee investigation into the dire state of NHS finances. MPs fear the rates highlight how some locum staff are able to reap massive rewards from the NHS by refusing to take staff jobs.

Matthew Hopkins, chief executive of Barking, Havering and Redbridge NHS Trust, which runs Queen’s and King George, admitted locum consultants were being paid £110 an hour to work in the A&Es.

Last year it ran up a £7.1 million bill for temporary A&E staff, with doctors earning £1,000 or more on 217 occasions.

Mr Hopkins said the trust was forced to pay “very competitive” rates to attract temporary staff but struggled to recruit and retain nurses and doctors to an unfashionable part of London.

Only 17 of its 36 middle grade A&E doctor posts are filled, while 20 per cent of emergency staff quit each year. Only about three-quarters of posts are filled on its A&E wards on an average day.

Mr Hopkins said its locum consultants normally worked full-time in other hospitals and were doing overtime. They would work a 16-hour shift for £1,760, he said.

Barking, Havering and Redbridge is the only NHS trust in London in “special measures”. It has breached the NHS target for treating patients attending A&E within four hours in 50 of the last 53 months. Last week, 935 patients waited more than four hours to be seen.

The trust has been forced to put plans to close the A&E at King George on hold until its A&E performance improves and the emergency department at Queen’s can be expanded. Queen’s receives about 110 ambulances a day – more than any other London hospital.

Mr Hopkins said: “We are struggling to make sure people are treated within the four-hour standard. We absolutely have to get that right before we can countenance progressing a significant change [at King George].”

He added: “If we had one A&E, we would have enough A&E doctors. The fact we have got two A&Es means I’m stretching my staff across two sites.”

No NHS money has yet been provided to pay for the new facilities at Queen’s but the trust has been promised £8 million in emergency winter funding.

Mr Hopkins told MPs that the NHS in his part of east London was underfunded by about £25 million a year, and that the trust’s cumulative debt over the last decade was in excess of £200 million.

Crossrail driver expresses sorrow for death of cyclist as he pleads not guilty

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A Crossrail lorry driver today expressed his sorrow in court to the widow of a cyclist killed in collision with the HGV he was driving.

Anthony Howsego, 58, of Romford, took the unusual step of passing on his condolences to Diane Holt via his lawyer as he pleaded not guilty to causing the death by careless driving of her husband Brian Holt, a hospital porter from Stepney, on November 5 last year in Mile End Road.

Mr Holt, who worked at Mile End hospital, was one of six cyclists killed in a fortnight in London last November. His is the only case to result in a criminal prosecution.

Ian Bridge, the barrister representing Howsego, told Snaresbrook crown court today that he was aware Mrs Holt was in the public gallery.

Mr Bridge told the court: “I want to put on the record my client’s condolences in expressing in court how sorry he is that he has been involved in this situation.”

Judge Nigel Peters QC set a trial date of February 18 next year. The trial is expected to last three days. Howsego, who was driving a Volvo lorry at the time, was granted unconditional bail.

Diners ‘never had it so good’ as chef predicts more Michelin three-star restaurants in London

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London restaurants are booming to the extent they are now the equal of West End theatres as a tourist attraction, according to one of the capital’s best chefs.

Michelin-starred Jason Atherton, 43, whose restaurants include Pollen Street Social and Berners Tavern, said diners “have never had it so good” in terms of the quality and variety of food on offer.

He said there were a number of young chefs worthy of the accolade of three Michelin stars and claimed prices were “60 per cent cheaper” than Paris for the same quality of food.

Chef Jason Atherton: Diners have "never had it so good"

Chef Jason Atherton: Diners have “never had it so good”

“The power of food and beverage to the traveller today is so significant that people plan their trips around what restaurants they are going to go to,” he told me.

“It’s just incredible. If you cast your memory back 20 years ago, your night out would consist of bars, and you’d probably have eaten at home. Absolutely now the first meeting point is the restaurant. The other stuff comes much later on in the evening. Or you go to places like Zuma where they’ve provide everything – the cocktails, the bars, the whole thing. London’s restaurants are a massive draw.”

Atherton is to cook a six-course tasting menu showcasing British produce for the winner of a VisitLondon.com competition offering the ultimate tourist experience of the capital.

He hopes to take the winner on a “whistle-stop gastronomic tour of London”, visiting Borough market, Monmouth coffee, Neal’s Yard and La Fromagerie cheese shop.

He said the fear that restaurant trade declined in the summer was now an “old wives’ tale”. He said: “The amount of people coming through Heathrow and spending two or three days in London is so massive now that you can fill your restaurant 52 weeks a year if you are smart.”

London has only two Michelin three-star restaurants – Restaurant Gordon Ramsay and Alain Ducasse at the Dorchester – but Atherton said the number could soon increase.

“I think there are a lot of young chefs in the mix now – Claude Bosi [at Hibiscus], Brett Graham [at The Ledbury], Phil Howard at The Square. Le Gavroche deserves to go back up to three [stars]. You have so many great restaurants that are hovering around the two-star mark.”

He added: “Chefs and restaurateurs will never give up opening new restaurants because we have always got a new idea. I think that is super-exciting. Pollen Street is now four years old. I’m shutting it down next August for three weeks. Everyone thinks I’m crazy because I have only just paid it off. I’m spending £1 million to relaunch it. There are a few really important changes I think we need to make. I’m just making sure the restaurant is relevant to the way London is moving.

“There are only two cities in the world that have the diversity and the depth in numbers – London and New York. Japan has more three-star Michelin restaurants but it’s all Japanese food, and a bit of French. If you go to New York you can get great Korean food, great Japanese food, great fusion food, great Jewish food. It’s exactly the same in London. It’s all here – whatever you want.

“London is cheap. There is no way of communicating this, but if you put at the side [of the bill] what it cost to make that dish, I think you would be shocked. We have got sea bass on the menu at £32. I pay £11 a portion just to buy it raw. Then I have got to make the sauce, pay the chef, the rent, someone to collect the coats… It goes on and on.

“What we have become really good at in the last decade is that mide-market that we were really bad 20 years ago – the rise of Polpo, Arbutus, Bubble Dogs, where they do that really fine bistro cooking.

“Even ourselves, at Little Social, you can have a three-course lunch for £19.50. You can’t eat in Paris or Japan for £19.50 – you wouldn’t even get a bus ticket. I think in London, we’ve never had it so good just now.”

Fine dining: Pollen Street Social restaurant

Fine dining: Pollen Street Social restaurant

First driver charged after six cyclists died in London in a fortnight

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The driver of a Crossrail construction lorry has become the only motorist to be charged in connection with last year’s spate of six cyclists killed in London in a fortnight, I can reveal.

Anthony Howsego, 57, of Romford, will appear at Snaresbrook Crown Court on Friday [Nov 14] for a pre-trial hearing after allegedly causing the death by careless driving of hospital porter Brian Holt.

It comes as the Stop Killing Cyclists campaign group prepares to hold a “die-in” protest in Oxford Street on Saturday [Nov 15] to mark the anniversary. A total of 14 cyclists died in London last year, sparking the first “die in” outside TfL’s Palestra building. Ten cyclists have died in road collisions this year.

Mr Holt, 62, from Stepney, died at the scene of the collision in Mile End Road on November 5, 2013. He had taken up cycling to and from work at Mile End Hospital in order to get fit.

Howsego was charged in July but the decision to prosecute only came to light during a Standard investigation to mark the anniversary of the six deaths.

His four-axle tipper truck was heading east after collecting waste from a construction site at Crossrail’s new Liverpool Street station. Transport for London’s board was told at the time that Mr Holt was thought to have been attempting to cycle across the road, which is part of the Mayor’s CS2 cycle superhighway.

The incident was the second cyclist death in succession to involve a Crossrail contractor’s HGV. Maria Karsa, a nursing assistant at the Royal London hospital, died a week after a collision at Aldgate in September last year.

Four of the six deaths last November – those of Francis Golding, 69. Venera Minakhmetova, 24, Khalid al-Hashimi, 21, and Roger de Klerk, 43 – concluded with coroner’s inquests, with no charges brought against the drivers involved.

Police also decided there was no case to answer for the lorry driver involved in the death of Richard Muzira in Camberwell. An inquest date has yet to be set. His family are understood to have accepted the decision not to prosecute.

At the time, Boris Johnson faced an outcry from cyclists to speed-up plans to make London safer for cyclists. But the Mayor, speaking after the fifth death, warned “there’s no amount of traffic engineering that we invest in that is going to save people’s lives” unless cyclists obeyed the rules of the road.

It subsequently transpired that Mr al-Hashimi was almost twice over the legal limit for drink-driving when he rode off the pavement into the path of an oncoming 205 bus in Whitechapel, after cycling the wrong way up a one-way street.

Coroner Mary Hassell ruled that Mr Golding’s death was the result of a “moment’s inattention” on his part. He died three days after colliding with a left-turning coach in Bloomsbury.

The same coroner ruled the “fundamental cause” of Russian computer consultant Ms Minakhmetova’s death was her cycling through a red light at Bow roundabout into the path of a HGV.

Roger de Klerk, an IT consultant from Forest Hill, died in collision with a 410 bus near East Croydon station. An inquest last month found he fell in front of the bus when his bike wheels slipped on, or became trapped in, tram lines.

Ms Karsa and Mr Holt were both employees of Barts Health, the UK’s biggest NHS Trust. Since their deaths, Barts has been at the forefront of a campaign to improve cycle safety.

London’s Air Ambulance: 25 years of saving lives of critically ill patients

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Video report by Ross Lydall
News story by Mark Blunden (first published January 2014)

Patients treated by London’s Air Ambulance have celebrated 25 years of the capital’s flying emergency service.

More than 30,000 people had the helicopter dispatched to them after suffering injuries that took them to the brink of death.

London’s Air Ambulance treats the most critically-injured victims of incidents, including bombings, shootings, stabbings, car crashes and industrial accidents.

David Cameron led the tributes, praising the charity as “very close to the hearts of all Londoners”.

The charity is raising money for a second aircraft to extend its daylight flying hours and recruit more pilots and specialist aviation firefighters.

It was established in 1989 after a Royal College of Surgeons report found too many people were dying on the capital’s streets.

The air ambulance has since pioneered procedures including roadside open chest surgery, anaesthesia and blood transfusions.

Angela Barlow, 35, was one of its patients. Aged 11, she needed roadside surgery from a life-threatening brain injury suffered when she was hit outside her Plaistow home.

She said: “The work of London’s Air Ambulance is vital and our family will always be thankful to this life-saving charity.

“I made a miraculous recovery, I can´t imagine what our lives would be like if it turned out to be different.”

A helicopter was dispatched after motor racing champion Sir Stirling Moss fell three storeys down a lift shaft at his Mayfair home.

Sir Stirling, 84, broke several foot bones and chipped four vertebrae after landing on the concrete floor.

He said: “London’s Air Ambulance helped me in my time of need. Accidents can happen to any of us and this charity is vital for anyone seriously injured in London.

“So few Londoners realise that this fantastic service is provided by a charity and it is our duty to ensure they continue this work for the next 25 years.”

Dr Gareth Davies, the charity’s medical director and chair of the trustees, said: “There are people who have survived serious injury in London that would not have in other countries.

“Trauma or serious injury is the biggest killer for people aged under 45, including children. It is down to the belief and passion from everyone who comes into contact with the service – employees, volunteers and supporters – that enables us to help save these lives and London should be very proud of this.”

To donate, visit: http://www.londonsairambulance.co.uk/donate

Cardiac arrest survival rates rise as almost 2,000 Londoners help to save lives

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Paul Cowling and Community Resuscitation Officer Ricky Lawrence

Almost a third of Londoners who suffer a cardiac arrest where their heart can be shocked back to life are surviving – the highest rate since records began.

A total of 187 out of 578 patients – 32.4 per cent – were discharged alive from hospital in 2013/14, up from 28.4 per cent the previous year. This is the best since survival data was first logged 15 years ago.

The figures were released today by the London Ambulance Service as it praised the 1,967 bystanders who attempted cardiopulmonary resuscitation – known as CPR, or chest compressions – on victims as they waited for emergency crews to arrive.

It linked the improved survival rates to the increased availability of electronic defibrillators. They can be found at more than 2,000 sites including Tube stations and department stores. See below for a video of paramedic Pete Fisher helped save footballer Fabrice Muamba’s life:

LAS medical director Fionna Moore said: “Not only are our staff doing an excellent job resuscitating and stabilising patients, but the public are helping to save lives on the streets of London too. We’ve seen more bystanders than ever before providing basic life support to cardiac arrest patients.

“Chances of survival increase considerably when CPR is carried out and it’s great news that more people are willing to get involved and help in this way.”

One survivor, Paul Cowling, 25, from Stockwell, (pictured above), was shocked 15 times in 75 minutes with a defibrillator after collapsing while playing football on Tooting Common last November.

He visited ambulance HQ yesterday to receive CPR training from community resuscitation officer Ricky Lawrence.

The 187 survivors were part of a sub-group of patients who suffered a Utstein cardiac arrest. This is an internationally-recognised measure used for patients whose arrest happens out of hospital, is witnessed by a passer-by and where resuscitation is possible with a defibrillator due to the heart being in a “shockable” rhythm.

The total number of cardiac arrest survivors in London last year was 436 out of 4,239 patients – 10.3 per cent, up from 9.3 per cent the previous year.

Some 77.7 per cent of cardiac arrests happened in the home. They are most common on Monday mornings, with men twice as likely as women to be affected.

A cardiac arrest is when the heart stops pumping blood around the body. This is different to a heart attack, which is when an artery becomes obstructed, restricting the flow of blood to the heart.

Smiles better? Children at Royal London use happy and sad faces to rate their care

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Monkey Imag Edited

Child patients are using “smiley faces” to rate the performance of doctors and nurses treating them at one of London’s biggest hospitals.

An expansion of the NHS friends and family test has been launched at the Royal London, in Whitechapel, to include the views of young people treated on paediatric wards.

All children treated in the NHS will be asked to rate their care – saying whether they would recommend it for their friends and family – from next April.

The Picker Institute Europe charity is collaborating with Barts Health, which runs the Royal London, to adapt the test to be more meaningful to children. It found they were more likely to understand the phrase “if they needed similar treatment or care to me” than the adult test question of “Would you recommend the hospital?”.

Similarly, children struggled to say whether they were “likely” or “unlikely” to recommend a hospital and preferred to provide feedback using an “agree/disagree” scale, accompanied by a cartoon monkey with colour-coded happy or unhappy faces.

The project, also being trialled at Southampton Children’s Hospital, is expected to be rolled out across the NHS.

Amy Tallett, of Picker Institute Europe, said: “This work has been key to ensuring that children are asked about their hospital experiences using a question that they fully understand.”

Sally Shearer, director of child nursing at Barts Health, said: “The experts in shaping accessible and appropriate services for children and young people are the children and young people themselves.”

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