Air ambulance doctor and paramedic reveal role in 999 response to Westminster terror attack

Tags

, ,

An air ambulance doctor today praised the bravery of the medics and civilians who rushed to help the victims of the Westminster terror attack.

Dr Tony Joy, of London’s Air Ambulance, was first on the scene with a fellow doctor and advanced paramedic when the charity helicopter landed in Parliament Square.

Dr Tony Joy

Junior doctors and nurses ran from St Thomas’s hospital to tend to the injured and dying on Westminster bridge while junior doctors’ leader Jeeves Wijesuriya helped treat the attacker New Palace Yard.

Dr Joy, 35, a consultant at the Royal London hospital, told the Standard: “I was aware that there were a number of people who had come to help. Absolute respect to all the clinicians and all the passers-by that were involved. Some people would have done that completely instinctively.

“They would have wanted to help and they would not have known how much of a risk they were putting themselves in. That to me takes real bravery and should be profoundly commended.”

He told told how he and his LAA colleagues prepared for a “mass casualty event” as they prepared to land. A total of 68 London Ambulance paramedics and emergency staff were also involved.

“We understood we were going to a road traffic collision with about 20 patients,” Dr Joy told Sky News. “That obviously focuses the mind. We prepared for a mass casualty event and thought about what that might entail.

“As we were overhead we could see that it was a complicated clinical scene over some distance over the bridge. We tried to gather some information but there wasn’t much clinical information at that time. We were there very early.

“When we arrived on the scene, our job is to provide clinical care to the most critically injured patients but also with incidents like this to support London Ambulance Service in setting up the strategic control of a very complicated major incident.”

The charity, which needs about £4 million a year to keep its two helicopters flying, has been inundated with more than £10,000 in donations overnight as people pay tribute to its work.
To donate £5, text SAVE to 70800.

Dr Joy said it was a “pretty awful day”  but a “privilege” to have been able to help people at their greatest time of need. “We prepare for it but we don’t expect it to happen,” he said. “It certainly focuses the mind.

“Our patients are very vulnerable. They didn’t expect it but they are having their worst-ever day. It is humbling to be involved in helping on the worst day of their lives.”

Ambulance chiefs today paid tribute to frontline staff for “an exceptionally good job” as they treated the victims.

LAS medical director Fenella Wrigley told the Standard: “Yesterday was something we always hoped would never happen, but which we were prepared for. We were able to provide specialist teams trained to respond to this type of incident.

“The staff did an exceptionally god job. They were calm and provided very good clinical care. I remain very proud and grateful to our staff for all they did under extremely difficult circumstances.”

Jon Goldie, a LAS paramedic manager who co-ordinated the response on the scene, said: “There were a variety of injuries. We quickly looked to establish where all the patients are who is the sickest and who needs immediate transfer to hospital.”

Malcolm Alexander, chairman of the LAS Patients Forum, said: “The London Ambulance Service was on the scene fast and LAS staff carried out their difficult tasks in an atmosphere of fear and uncertainty, providing Londoners and those visitors injured in the attack support and assistance.

“We wish to praise and acknowledge the hard work and dedication of London Ambulance Service on this most difficult of days and salute their dedication and service.”

Cycle tsar urged to block plans for ‘rumble strips’ on Hyde Park bike lane

Tags

, ,

London’s new cycling commissioner was today under pressure to halt plans to install cobble-stone speed humps in Hyde Park after a cyclist was clocked at 32mph.

Campaigners called on Will Norman, appointed by Mayor Sadiq Khan, and deputy mayor for transport Val Shawcross to force the Royal Parks to reconsider the £215,000 installation of 28 rows of raised granite setts next week on a key route between Speakers Corner and Hyde Park Corner. The route is part of the Central London Cycle Grid and is used by more  than 1,200 cyclists an hour in the morning.

Parks bosses decided to act after a survey last June recorded one cyclist riding at 32mph around 7pm on the Broad Walk, which is split 50-50 between a cycle path and pedestrian walkway. The Royal Parks wants cyclists to ride at a “considerate cycling speed” of 8-12mph though this is not legally enforceable.

The installation of similar cobbled “rumble strips” on Mount Walk in Kensington Gardens last year backfired – cyclists divert round them onto the grass or speed up to minimise the discomfort of riding over them.

The survey found about two-thirds of cyclists rode at what would be regarded as a typical commuting speed of up to 16mph. It clocked 6.6 per cent of riding above 20mph, 29.5 per cent at 16-20mph, 43.1 per cent at 12-16mph, 13 per cent at 10-12mph and 7.7 per cent at 10mph or below.

There were no reported collisions between cyclists and pedestrians but two “near misses” a week were spotted.

Cyclist Jon Stone called the plans “horrifically stupid” as it would lead to riders diverting onto Park Lane. Another said: “Ripping up one of London’s busiest bike tracks, turning it into shared pavement, [is] dangerous for all”.

Simon Munk of London Cycling Campaign said the plan was “outrageous”. Cycling blogger Danny Williams said the Royal Parks was “actively refusing to listen”.

Cycling campaigner Dominic Leggett wrote to Mr Norman and Ms Shawcross asking them to intervene. He said the changes were “not justified by any history of collisions, and discriminate against least able cyclists”. He described them as “idiotic, unnecessary changes that will make a good cycle route uncomfortable and unpleasant for most”.

A Royal Parks spokesman said: “If we have cyclists racing up and down a pathway at speed with pedestrians trying to cross that really doesn’t make for a pleasant visit, especially when we also have cases of pedestrians being shouted at for walking on pathways in the way of cyclists.”

Mr Norman’s spokesman was approached for comment.

‘Extraordinary’ NHS documentary Hospital to return to Imperial, BBC announces

Tags

bbc2-hospital

The TV documentary series that has exposed crisis bed shortages within the NHS and the cost of “health tourism” by foreign patients is to return for two more series, the BBC announced today.

Hospital, which is filmed across Imperial College Healthcare including St Mary’s and Charing Cross hospitals, has revealed how surgical teams are at times unable to operate due to the lack of intensive care beds.

Described by critics as “extraordinary” and “brilliant and brave”, it has also shown how the NHS remains able to perform near-miracles despite the extent of the pressure it faces.

Pioneering operations have included heart surgery on a 98-year-old man. It also showed how Imperial was left with an unpaid bill in excess of £330,000 after a Nigerian woman turned away from the US went into labour on a flight home via Heathrow. Two of her four babies died.

The second series will focus on maternity care and mental health at Imperial. The location for the third series is yet to be decided. The first six-part series, which ends tonight, has averaged 2.5 million viewers per episode.

Patrick Holland, Channel Editor, BBC Two, said: “The first series of Hospital was everything I want BBC Two to be. It is timely, brilliantly made and challenging TV. It was editorially brave to make a series with such a short turnaround but it felt so timely for the audience.”

Simon Dickson, executive producer at filmmakers Label1, said: “Edited and broadcast within a few short weeks of filming being completed, it’s Britain’s first fast turnaround blue-chip documentary series. The audience figures prove that people crave the freshness and insight it offers.”

Future series will also extend beyond the hospitals to look at primary and social care, to understand in greater detail the complex relationship between them and the NHS.

Michelle Dixon, director of communications at Imperial, said: “Hospital has given us the opportunity to show the amazing care and commitment of our staff as well as the growing challenges we face as we respond to the changing needs and demands of our patients.
“It’s so important to develop a shared understanding of what’s happening in the NHS and what’s at stake. While the first series has provided a great insight to a whole range of issues and services, there is still much more to see.”

NHS rich list 2016: meet the 90 Whitehall health chiefs who earn £150,000 or more

Tags

, , , , , ,

professor-sir-mike-richards

Professor Sir Mike Richards: NHS’s joint best-paid Whitehall bureaucrat

NINETY NHS officials working for central Government and its quangos earn £150,000 a year or more, the Cabinet Office has revealed.

The best paid were Professor Sir Mike Richards, chief inspector of hospitals at the Care Quality Commission, and Frances Gould, a microbiologist with Public Health England. Her salary increased to £239,999 to put her on a par with Sir Mike.

Dr Jonathan Fielden, the NHS England director of specialised commissioning, was next best paid, with a salary of £224,999. Dr Fielden was appointed to the post last year on a salary commensurate with his previous earnings as medical director at UCLH, the Cabinet Office notes reveal.

He is the most senior official in charge of the controversial plans to reduce the number of hospitals providing congenital heart surgery, which has placed the Royal Brompton at risk.

Professor Dame Sally Davies, the chief medical officer, earns £209,000. Profesor Sir Bruce Keogh, the NHS England medical director, gets £194,999 – the same amount as Dr Andy Mitchell, who is standing down as medical director of NHS England’s London region, and NHS England chief executive Simon Stevens, who took a 10 per cent voluntary pay cut on his appointment.

Dr Anne Rainsberry, chief executive of NHS England (London), earns £165,000. Steve Russell, the former Barking, Havering and Redbridge trust deputy chief executive who heads NHS Improvement in London, receives £174,999. Duncan Selbie, chief executive of Public Health England, earns £189,999.

Seven of the 90 executives earned in excess of £200,000. In addition to the 90 taking home at least £150,000, a further three are paid the equivalent rate but work part time. The total pay bill for the 93 was £15,884,907.

The High Earners list does not take account of the earnings of senior executives at NHS trusts across the country, where most chief executives (and often several senior colleagues)  will be paid in the region of £150,000 or more. See here for some of London’s best paid hospital bosses.

Separate information released by the Cabinet Office reveals that Health Secretary Jeremy Hunt has three special advisors, earning between £66,000 and £75,000 (below).

jeremy-hunt-spads

Salaries earned by Jeremy Hunt’s special advisors

The annual High Earner figures, which names people earning £150,000 or more across Government, are available here: https://www.gov.uk/government/publications/senior-officials-high-earners-salaries

TV documentary to show reality of life on frontline of London’s NHS hospitals

Tags

the-stars-of-the-tv-documentary-hospital

Medics on TV (from second left): Rick Gibbs, consultant vascular surgeon, Ali Sanders, chief of service emergency care, Andrew Chukwuemeka, chief of service cardiology and cardiothoracics, Helgi Johannsson, chief of services for theatres and anaesthetics, Ruchi Syed, consultant paediatrician, Colin Bicknell, consultant vascular surgeon, Angus Lewis, consultant orthopaedic surgeon, Sadie Syed, consultant anaesthetist

The extent of the pressures on front-line NHS staff will be revealed after documentary makers won permission to film behind the scenes at one of London’s biggest hospital trusts.

A six-part series, Hospital, which starts on January 11 on BBC2, will show how staff at Imperial College Healthcare cope with competing demands from a growing number of sick patients while seeking to deliver high-quality care.

It follows staff and patients at Imperial’s five hospitals – Charing Cross, Hammersmith, Queen Charlotte’s and Chelsea, St Mary’s and the Western Eye. It shows patients being treated across a range of services, from cancer to cardiothoracic surgery and pioneering neonatal care for newborn babies.

Michelle Dixon, Imperial’s director of communications, said: “It’s not an easy decision to allow camera crews in to follow all aspects of daily life in our hospitals. But we think it’s really important to share the opportunities and challenges, the highs and the lows, with our patients and local communities. It’s their service as much as ours and the only way we can ensure we maintain and build on the very best of the NHS is by working together.

“The series will show the huge range of day-to-day activities, from the small acts of kindness that make a huge difference to an individual to ground-breaking research trials that change practice world-wide.

“We’re extremely grateful to the many patients, and their families and carers, as well as the staff who allowed us to show their experiences as part of the series.”

Imperial is the latest London NHS trust to grant access to TV cameras as part of an effort to educate the public in the dilemmas of providing care to a growing and increasingly sick population.

Earlier this year Ambulance showed how the London Ambulance Service copes with soaring pressures that often result in 999 callers being refused an emergency crew. St George’s, in Tooting, followed King’s College hospital, in Denmark Hill, in having its emergency department feature in 24 Hours in A&E.

The Hospital series is made by Label1, a new independent television production company whose founders have a track record in creating ground-breaking factual programmes.

  • An edited version of this article appears in tonight’s Evening Standard

Pedestrian and cyclist deaths deterring foreign students from studying in UK, warns university chief

Tags

, , ,

The head of a London university attended by a cyclist killed in a HGV crash today said the UK’s record on road safety was damaging the nation’s ability to attract foreign students.

Professor Aldwyn Cooper has written to Mayor Sadiq Khan about the danger posed by lorries in the wake of the “absolute tragedy” of the death of Italian prince Filippo Corsini in Knightsbridge in October.

filippo-corsini

Filippo Corsini: a highly-qualified cyclist who rode from Brighton to London for fun

Professor Cooper, vice chancellor of Regent’s University London, warned there was global awareness of the number of cyclist and pedestrian deaths – adding to fears about post-Brexit changes to visa rules.

He told the Standard: “This is making London bad news for students, bad news for parents, bad news for tourists. This last year we have had [almost] 20 people in London, on bicycle or foot, killed by lorries.

“If you look at universities at the moment, we are under such considerable pressures, due to concerns about immigration and visa controls. A lot of people in other countries around the world are starting to see Great Britain as a less attractive place to come and study. Anything that diminishes that motivation is very bad news.

“We are the gold standard for higher education in the world. It’s not just in London where this problem exists. Leeds, Manchester, Bristol – they have all got these kinds of problems.”

At least 13 pedestrians and three cyclists have been killed in HGV collisions in London this year, according to the Vision Zero London road safety campaign. A total of 409 pedestrians and 100 cyclists were killed in UK road crashes last year.

Mr Corsini, 21, who was studying for a BA in international business, was on his way to the university, in Regent’s Park, when he collided with the HGV on October 31. He died at the scene from “catastrophic injuries”.

Professor Cooper said he was an “amazing young man”. He said: “Filippo was a very highly-qualified cyclist. He trained under one of the top cycling coaches in Italy. He spent a lot of time cycling. The day before he was killed, he had cycled from Brighton to London for fun. Almost the last words he had for his sister were: ‘I love cycling.’”

The 42-year-old lorry driver was arrested on suspicion of causing death by careless driving and was bailed until early December. His bail has been extended until late February while investigations continue, a Met police spokesman said.

Last week the university was contacted unexpectedly by City Hall asking it to endorse the Mayor’s part-shelved plans to route the CS11 cycle superhighway on the park’s Outer Circle to improve safety for cyclists and pedestrians.

Professor Cooper replied by urging Mr Khan to bring forward plans to introduce a “star rating” for lorries based on the driver’s view of cyclists and pedestrians.

He also wants speed restrictions – enforced by police – for all road users in the park, saying two students were hurt by “speeding” cyclists who ignored red lights last year.

He said in a statement last week: “I have been in correspondence with the Mayor, Sadiq Khan, since the tragic death of one of our students six weeks ago while cycling to the university.  I know that the Mayor is committed to making London a far safer city for cyclists and pedestrians. Cycle Superhighway Route 11 should facilitate this. Of equal importance are controls on lorries. There are plans for this by 2020, but the sooner such limitations are imposed, the better.”

A spokesman for Mr Khan said: “Every time someone is killed by a lorry on London’s roads it is an appalling tragedy. That’s why the Mayor is introducing a world-first ‘Direct Vision’ standard for lorries in the capital, banning the most dangerous HGVs from London’s roads completely by 2020.”

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

Now that’s what you call a Christmas present: Met detective donates kidney to sister

Tags

,

tristan-and-amy-together-post-op-jpg

Tristan Hunter and sister Amy Hennessey after the kidney swap operation

A Metropolitan police officer today told how he gave the gift of life to his sister just in time for Christmas.

Tristan Hunter, 32, donated a kidney to sibling Amy Hennessey, 38 – with the organ swap taking place four months before he is due to become a father for the first time.

He agreed to become a “live donor” after seeing how his primary teacher sister was growing increasingly unwell, with her kidneys down to 6-8 per cent effectiveness. Her kidneys were damaged in childhood and she was on the verge of requiring dialysis.

Mr Hunter, a CID officer, told the Standard: “I had a bit of time to think about it, but once I made my mind up I was sure. It was after I tested positive [as a matching donor] and no-one else was coming forward for Amy. It wasn’t like a really easy decision to make but I’m really glad I have done it now.”

Their story is being told today by the Royal Free hospital, Hampstead, when it posts details on Twitter of the nine-hour double operation in “real time”.

royal-free-transplant-2

The operation took place last month and both brother and sister are recovering well. They agreed to tell their story to raise awareness of the shortage of organ donors as part of the #YesIDonate campaign.

Mr Hunter, from Swanley, Kent, and his wife Jenny are expecting their first child in March. The operation was brought forward to fit in with his availability. He is due to return to work in the New Year, six weeks after the operation.

“I didn’t want to be really ill when she was seven months’ pregnant,” he said. “The timing was really important to me. She is due in March. If I’m better by Christmas, that is fine by me.

“It’s all gone as well as could be expected so the whole family is really pleased. We can all enjoy a great Christmas together.”

royal-free-transplant-kids

Tristan and Amy as children

Mrs Hennessey, from Enfield, said she expected a Christmas reunion at their parents’ home in Coventry to be “quite emotional”.

She said: “I was just completely overwhelmed. I can’t believe he would do it. It was just an amazing thing. He has given me a new lease of life. I am going to have to get him something really special for Christmas in return.”

Blood and DNA tests found Mr Hunter to be a 100 per cent match for his sister. An aunt also offered to donate a kidney but she was only a 50 per cent match.

Mrs Hennessey suffered reflux as a baby, which badly damaged her kidneys. Her twin boys Freddie and Alfie, now 10, had to be born at 29 weeks when she suffered renal failure.

Consultant transplant surgeon Colin Forman used a keyhole procedure to remove Mr Hunter’s kidney. The organ was taken out via an incision under the tummy button 90 minutes later.

It was then cleaned and prepared on ice by fellow consultant transplant surgeon Bimbi Fernando. He began operating on Mrs Hennessey an hour later. The kidney was “reanimated” with her blood after two hours and the procedure was completed in under four hours.

The Royal Free performs about 120 kidney transplants a year. Mr Fernando said: “We are desperately short of organ donors. Three people per day are dying on the UK transplant list, of all kinds of organ failure. It’s essential we open our donor pool, for both deceased donors as well as live donors.

“If you know someone who needs an organ… I would urge you to think about being an organ donor. It will have an impact not only on the recipient’s life but, if you are close to them, it will also impact on your life as well positively.”

www.organdonation.nhs.uk/

Emergency crews sent to 6,000 drunk Londoners at Christmas – delaying care for injured children and pensioners

Tags

drunks-child

Children with broken limbs and elderly people who had injured themselves falling had to wait up to 30 minutes for an ambulance because crews were busy dealing with thousands of Christmas drunks.

London Ambulance Service today revealed the impact of the 6,244 alcohol-related incidents it attended last December as it urged revellers not go to extremes over the party season.

A social media campaign showed how the 1,502 calls to unconscious drunks “trumped” 999 calls from injured children, elderly fallers and some car-crash victims and meant they got a faster response.

Crews arrived in seven minutes to people who had lost consciousness due to drinking but took on average 23 minutes to reach a child with a fracture or suspected fracture and 31 minutes to get to a pensioner who had fallen.

With the festive season expected to get underway tonight ahead of the busiest night of the year for emergency services next Friday, LAS chiefs sent out the message that “getting drunk is not a game”.

drunks-driver

The LAS receives about 5,000 calls a day, an unprecedented level of demand that forces emergency dispatchers to prioritise those believed to be most at risk.

Alcohol-related calls accounted for seven per cent of all LAS responses last December, were the most common reason for help being summoned for people aged 21 to 30 and cost the LAS at least £1.25 million to deal with.

Priority is given to patients unconscious and not breathing – even if they have simply passed out through excessive drinking. Crews have to reach “category A” patients within eight minutes.

Dr Fenella Wrigley, medical director at LAS, said: “Every ambulance crew responding to someone who has simply had too much to drink, is an ambulance crew not responding to an ill or injured person who needs them.

“Patients reported to be collapsed and unconscious trigger the fastest ambulance response. It’s not possible to tell over the phone whether they have a serious illness or injury, or have simply had too much to drink, so we have to prioritise them immediately.

“Meanwhile, other patients such as a child with a broken arm, an uninjured elderly faller or someone involved in a road traffic collision will wait longer for an ambulance.

“We want Londoners to have a great time during this party season but, we also need them to look after themselves and their friends. By eating a meal before they go out, drinking responsibly and taking care of themselves, they can make sure our ambulance crews are free to respond to other incidents.”

Uphill battle for London Ambulance Service to escape ‘special measures’ as chief executive quits

Tags

,

London Ambulance Service’s attempts to get out of special measures were today dealt a blow when its chief executive announced she was quitting.

Dr Fionna Moore, 66, a widely-respected medic who is credited with helping to improve staff morale, is to retire at the end of the year.

fionna-moore-las

The LAS has faced unprecedented demand – about 5,000 999 calls a day – at a time of staff shortages, meaning it has consistently failed to hit response times. It was placed in special measures a year ago after a critical report by the NHS watchdog, the Care Quality Commission.

The CQC regards “leadership” as a priority when assessing whether an organisation is able to put in place the changes required to improve. Inspectors are due to return in February. LAS chiefs have been warned to “pick up the pace” of improvement if they wish to emerge from the lowest category.

Dr Moore became interim chief executive in January 2015, following the departure of Ann Radmore. She treated patients at the Southall and Paddington train crashes and was London’s first trauma director.

She plans to work part-time, performing clinical shifts with LAS and London’s Air Ambulance and working in emergency medicine three days a week.

Dr Moore said: “I took on the chief executive role intending to do it for two years, to stabilise the service at what was a challenging time. I always wanted time at the end of my career to step-back from management responsibilities and focus on my first passion, the clinical care of patients.”

Dr Moore was appointed to the chief executive’s post after an unprecedented campaign in her favour from staff.

LAS chairman Heather Lawrence said: “Her leadership has helped steer the service through a challenging period and in the last two years she has overseen one of the biggest recruitment drives in NHS history, the development of the advanced paramedic practitioners programme, an improved fleet and focused on the personal development and recognition for everyone who works for the service.”

Ealing and Charing Cross to become ‘local hospitals’ as St Mary’s fears for future of major trauma centre

Tags

, , , , , ,

Health chiefs today published plans for a £500m shake-up of care that will eventually see two hospitals, including one of the most famous in London, downgraded to “local” status.

NHS officials in North-West London want to remove critical care, blue-light ambulances and potentially all surgery from Ealing hospital. A second phase of changes would see Charing Cross, in Fulham, also become a “local hospital” to help save £1.1 billion over the next decade.

st-marys-proposed-redevelopment

The proposals, which involve expanding Northwick Park, West Middlesex and Hillingdon hospitals, have had to be split in two because of uncertainty around the redevelopment of St Mary’s hospital (above) due to Irvine Sellar’s adjacent “Paddington Cube” development.

This means that the plan is to downgrade Ealing – which has already lost its maternity and paediatric departments – by 2022, with no changes starting at Charing Cross until at least 2021.

Westminster council’s planning committee is due to consider the cube application tonight. Labour councillors have called for them to be rejected after Imperial College Healthcare NHS trust, which runs St Mary’s and Charing Cross, and the London Ambulance Service warned proposed road closures could make ambulance access to St Mary’s “unsafe” and would threaten the viability of its major trauma centre (see excerpt from planning documents below).

st-marys-cube-concerns

UPDATE DECEMBER 7: Westminster council last night granted planning permission for the Paddington Cube after an 11th hour deal to guarantee ambulance access to St Mary’s. See here for the Evening Standard story: http://www.standard.co.uk/news/london/renzo-pianos-775m-cube-building-given-green-light-to-transform-tatty-paddington-a3414026.html

Today’s proposals, for which NHS approval and Government funding is being sought, are part of the sustainability and transformation plan for the eight nowth-west London boroughs from Westminster to Hillingdon. It is thought to be one of the first STPs in the country to reach the funding stage. They build on the controversial Shaping a Healthier Future centralisation in north-west London.

A draft business case proposes investing £300m in refurbished hospital sites, £140 million on “out of hospital hubs” – which will include GPs and community and mental health services – and £69m in GP surgeries. Urgent Care Centres would be retained at all hospitals that currently have an A&E.

ealing-shakeup

The report said: “In keeping with the Secretary of State’s explicit request, Ealing and Charing Cross hospitals will continue to offer an A&E service although it may be in a different shape or size from that currently offered.”

img_1142

Coverage of the story in the Evening Standard

A further £314 million would be required to make changes at Charing Cross, which are being fiercely resisted by Hammersmith and Fulham council. Update: Ealing councillors say they are opposed to the changes proposed for Ealing hospital. One health source said: “We are definitely intending to deliver the model of care at Charing Cross as well.”

The aim of the changes is for more people to be cared for at home, and to increase the number able to die at home rather than in hospital. GPs will be told to prescribe more statins, the cholesterol-lowering drugs, to reduce the risk of cardiovascular disease in people with diabetes.

Health chiefs say that earlier changes, which saw the closure of the A&Es at Central Middlesex and Hammersmith hospitals, helped to improve community care – resulting in fewer patients having to be admitted to a hospital bed.