GP at Hand: 21,000 Londoners sign up for smartphone consultations (with doctors based across the country)

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GP at Hand call centre

Dr Zahra Damji at the GP at Hand HQ in Chelsea. Picture by Alex Lentati

Londoners using a new NHS service offering smartphone consultations with a GP are being advised by doctors living miles from the capital, the Standard has learned.

Babylon Health, the private company running the GP at Hand service, said the majority of its medics worked from home outside London.

It said more than 21,000 patients were now registered to use the service, which launched last November, offering 24/7 video consultations within two hours. Applications were being received “every two minutes”, it said.

The firm employs more than 50 doctors and claims to be inundated with job seekers. Babylon chief executive Ali Parsa said: “For every 10 GPs that apply for a job, we employ one. We employ them right across the country.

“You could be talking to a GP in Reading or the Shires or from South-East England. That allows us to keep our standards of who we have really high. I’m always gobsmacked by the quality of our GPs.”

Click here for previous coverage of GP at Hand in the Evening Standard.

Dr Matt Noble, medical director at Babylon, said: “GPs come from all over the place and from all walks of life. This is particularly popular for those for whom a traditional surgery life is not a good fit.”

The Standard was invited to its head office in Chelsea, where about 300 people work – many driving its technological innovations.

Patients signing up for GP at Hand are registered at a conventional GP practice in Lillie Road. This, plus four medical hubs in central London, are available for the 10 per cent of patients it says require an in-person consultation.

At present, NHS restrictions only enable people living in zones 1-3 to use GP at Hand. This requires them to leave their “local” GP. Their medical records have to be transferred, which can take one to three weeks, before treatment can be offered.

The service, which is free, is providing about 2,000 10-minute video consultations a week. About 30 per cent are outside conventional 8am-8pm GP opening hours.

One of its GPs, Dr Olivia de Rougemont, said: “I think the people I have consulted with really appreciate the ease and convenience and the fact they don’t have to wait two, three or four weeks for an appointment.

“Most things I can solve on the phone. I can see how sick you look. I can see if you are talking in full sentences, if you look pale, if you look sweaty. I can see rashes and swollen areas.

“Sometimes I ask patients to press certain areas to see what part hurts. I can get the patient to participate in the examination.”

About 15,000 GP at Hand patients are aged 20-39 – sparking concern that conventional surgeries will be left to deal with the elderly and patients with chronic or complex conditions.

Dr Emily Witt, a GP in Kilburn, said: “The idea behind GP at Hand is good. I think it’s important to have innovation in the NHS, and in GP surgeries.

“The problem is that when you register with GP at Hand you are then de-registered with your local GP, and the money then flows to GP at Hand. You can’t look after the sicker people if the money for the well people isn’t there.”

NHS England and Hammersmith and Fulham clinical commissioning group is conducting an indepedent review of GP at Hand before deciding whether to allow it to expand.

Mr Parsa said: “We see absolutely no reason why we cannot serve the whole nation the way we serve London. I have no doubt this is the future of healthcare. The genie is out of the bottle.”

  • An edited version of this story appears in tonight’s Evening Standard.
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Work ‘to start this year’ converting former Royal London hospital into £105m Tower Hamlets town hall

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Whitechapel town hall 2

Work will begin later this year to transform the former Royal London hospital into a £105m town hall, it has been announced.

The new civic centre will transform what was the biggest hospital in the country and continue the regeneration of Whitechapel. A Crossrail station is due to open across the road at the end of this year.

The renovation will retain the building’s grade II listed facade on Whitechapel Road. The entire ground floor will be for to public use and include the council chamber and a cafe. Open plan offices will be on the first floor. Modern extensions will be added to the rear.

Tower Hamlets announced the construction schedule as it appointed Bouygues UK as the preferred contractor to carry out the work. The building is due to open in 2022.

The building was bought from Barts Health NHS Trust for £9m three years ago by then borough mayor Lutfur Rahman in a scheme then dubbed “Lutfur’s palace”.
Mr Rahman was forced from office for electoral fraud several months later. He originally aimed to open it by next year.

The hospital dates from 1748 — and became Britain’s biggest a century later. In 2013 it was replaced by a £650m PFI-funded Royal London Hospital that sits further back from Whitechapel Road and which is the biggest hospital building in Europe.

Whitechapel town hall 1

The council said the new building would enable about 700 new homes to be built elsewhere in the borough by redeveloping existing council buildings.

The three-year development will generate an estimated 400 construction jobs a year.

About £78m will be recouped from the sale of old council buildings. At present, the council spends £5m a year leasing civic space at Mulberry Place in Docklands.

John Biggs, Mayor of Tower Hamlets, said: “We’re pleased to have appointed Bouygues UK to work with us to deliver a new town hall for the borough’s residents.”

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

First details emerge of number of ‘avoidable deaths’ in London hospitals

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Avoidable deaths

At least 40 patients suffered “avoidable” deaths in London hospitals last year, the Standard can reveal.

A further 200 suffered problems with their care that may have contributed to their demise. At least four women died during or shortly after childbirth.

The full extent of avoidable deaths may be far higher as a number of hospitals have only published figures for the first three months of 2017/18 so far.

NHS trusts were ordered to disclose the deaths by Health Secretary Jeremy Hunt as part of a drive to make the health service the best in the world at learning from mistakes.

An Evening Standard analysis of the first declarations made by London trusts found:

* More than 10,000 inpatient deaths have been declared since last April.
* About a third of these have been reviewed, though only a fraction in detail.
* St George’s, in Tooting, declared 12 avoidable deaths.
* Barts Health, the country’s biggest NHS trust with five hospitals, declared nine.
* King’s College, Chelsea and Westminster and Lewisham and Greenwich each declared three.
* Major trusts such as Imperial, UCLH and London North West Healthcare declared none.

Concerns have been expressed at the lack of a uniform system of assessing the deaths. Some trusts were said to be more committed than others to investigating the deaths.

The Department for Health had suggested that between 1,200 to 9,000 deaths a year in England were avoidable, but the London figures suggest this may be an over-estimate.

Dr Ollie Minton, a consultant in palliative medicine, who helped compile the figures at St George’s, said the London-wide total of 40 deaths was “probably too low” when compared with the number of serious incidents known to happen.

He told the Standard: “But it wouldn’t surprise me if it wasn’t much more than that, as not all serious incidents lead to death.

“If you try and say there are zero deaths, I would find that more worrying than helpful.”

St George’s had 1,208 deaths between April and September, and has reviewed 1,008. Of these, 40 were to some degree avoidable. None were “definitely avoidable” but six had “strong evidence of avoidability” and six were “probably avoidable”.

Dr Minton said: “This is labour-intensive but well worthwhile. It is still helpful [when reviewing a death] to see that there is nothing we would have done differently.”

Dr Nigel Kennea, chairman of the mortality monitoring committee at St George’s, said “exceptional winter pressures” had contributed to a higher number of deaths. He said: “I have not seen such an increase since the winter of 2014.”

Barts Health reviewed 410 deaths and found nine to be avoidable. Chief medical officer Dr Alistair Chesser said: “We are ensuring that all deaths that occur in the trust are discussed in these meetings. Some don’t need much discussion. Some do need more rigour.

“Of the 410 deaths we looked at, nine were potentially avoidable, which is about two per cent. Other trusts are reporting something between zero and five per cent. I would be worried if we were reporting zero. Every trust has risks attached to it.”

Guy’s and St Thomas’ reviewed 498 deaths. Of these, “strong evidence of avoidability” was found in once case, 10 were “probably avoidable but not very likely” and in 24 there was “slight evidence of avoidability”.

The maternal deaths happened at St George’s, Barts. Guy’s and St Thomas’ and University College hospital.

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

Boris bikes arrive in Brixton as Mayor’s cycle hire scheme has 4th expansion

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Boris bikes in Brixton

Boris bikes today arrived in Brixton, several months late and after years of campaigning by cyclists.

The fourth expansion of the bike hire scheme came after Lambeth council paid Transport for London £750,000 to cover the cost of seven new docking stations, able to hold 200 bikes. An extra 200 of Pashley’s UK-built bikes are being added to the fleet.

Set up by Boris Johnson in central London in 2010, the Santander-sponsored scheme goes as far south as Lambeth town hall. It was extended east to Canary Wharf for the 2012 Olympics and then west to Hammersmith, Fulham and Wandsworth in 2013. It reached the Olympic Park two years ago.

Last year the bikes were hired a record 10.4 million times. Last month was a record for January, with more than 645,000 hires.

Mayor Sadiq Khan said: “It’s yet another boost for our record-breaking scheme and for our work to make cycling more accessible, improve London’s air quality and tackle congestion.”

Wil Norman and Keith Moor

Will Norman and Santander’s Keith Moor launch the Serco bikes in Green Park

Jennifer Brathwaite, Lambeth cabinet member for environment, claimed the borough was becoming “the most cycle-friendly in London”.

She said: “I’m delighted that Santander Cycles are finally here in Brixton. This is something we’ve been working on for a long time with TfL.  We will continue to campaign for similar cycle hire options further south in the borough so that even more residents can benefit.”

The scheme covers 100 sq km of London, making it the second largest cycle hire scheme in Europe. There are now more than 775 docking stations and 11,700 bikes.

City Hall revealed that last year:
* The docking station in St Peter’s Terrace, Fulham, was used 636 times by the same person.
* One cyclist visited 440 different docking stations.
* Waterloo Station was the most popular docking station with 341,157 trips starting or ending there.
* One cyclist cycled 21km from Lee Valley VeloPark in the Olympic Park to Oxford Road, Putney.

City Hall said there were no further expansions in the pipeline but was “committed to expanding the scheme further”.

‘Facebook boss’ blood cancer: £3,300-per-dose immunotherapy drug backed for NHS patients

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Nicola Mendelsohn

Nicola Mendelsohn: adopting a ‘watch and wait’ approach to follicular lymphoma

A new immunotherapy drug for the blood cancer that Facebook boss Nicola Mendelsohn was diagnosed with a year ago was today recommended for approval for use on the NHS.

Drugs rationing body Nice reversed an earlier decision and backed obinutuzumab, also known by the brand name Gazyvaro, after manufacturer Roche agreed to cut the price of the £3,300-per-dose medication.

The drug has been found in clinical trials to be 34 per cent better than the current treatment, rituximab, at delaying progression of follicular lymphoma, when taken alongside chemotherapy. However there is a higher risk of side effects and its ability to extend life expectancy is not known, according to Nice documents.

Lady Mendelsohn, the head of Facebook in Europe and a mother of four, revealed at the weekend that she had been diagnosed with the slow-growing cancer in November 2016 but had decided not to undergo treatment at present.

Gazyvaro works by recruiting the body’s immune system to attack and destroy the cancer cells. This decision will benefit about 1,200 people with previously untreated advanced follicular lymphoma in England.

Richard Erwin, general manager, Roche UK: “Gazyvaro plus chemotherapy being recommended by NICE for previously untreated advanced follicular lymphoma means more patients will have their disease controlled for longer compared to the existing standard of care, rituximab plus chemotherapy.

“Close collaboration between Roche, NHS England and NICE has resulted in NICE recommending Gazyvaro as a cost effective treatment, even when compared to recently introduced biosimilars of rituximab. This is a positive example of how solutions can be reached when all parties show flexibility.

“We at Roche believe that patients in England should have the best access to medicines in Europe, and this development underlines our commitment to this. We have worked tirelessly with NICE to ensure that those patients who need Gazyvaro can receive it and we are delighted with this outcome.”

Young dad with cancer in crowdfunding bid to raise £100,000 for ‘life-saving’ immunotherapy not available on NHS

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Ryan Cox and family 3

Father-of-two Ryan Cox,  above with his family, was diagnosed with bowel cancer last May at the age of 29.

He is trying to raise at least £100,000 via crowd-funding to pay for an immumotherapy called pembrolizumab, which is available on the NHS – but not for his type of cancer.

Mr Cox, a car mechanic, and partner Lauren Foy have a six-year-old son, Alfie, and a 15-month-old daughter, Grace. He was declared “cancer-free” after chemotherapy and an operation last September at St Mary’s hospital, Paddington. Last November he was told the cancer had in fact spread to his liver and lymph nodes.

“It just doesn’t feel fair,” he said. “They knew I would benefit more from immunotherapy. From day one it seemed weird to me why they put me through chemo when there was something else that I would have done better on.

“They are telling me there are no more trials. If I want it, I will have to win the lottery or pay for it.”

Ryan Cox 2

Mr Cox, from Borehamwood, is determined not to give up. He heard about pembrolizumab, also known by the brand name Keytruda, and went to see oncologist Dr Tobias Arkenau at the private Sarah Cannon Research Institute, which carries out 35 clinical trials a year.

Dr Arkenau told him his unusual genetic make-up – he has a mismatch repair-deficient tumour – made him perfectly suited to pembrolizumab. “These patients respond extremely well to immunotherapy,” Dr Arkenau said.

Pembrolizumab is already approved for use on the NHS for lung cancer and melanoma. With bowel cancer, it is likely to work on only the five per cent of bowel cancer patients with Mr Cox’s unusual biology. Dr Arkenau believes exceptions have to be made for such patients.

“We see so many patients who come in and say ‘I want to have immunotherapy’, compared to chemotherapy or targeted drugs,” he said. “Immunotherapy does make sense but it is not for everyone.

“It’s expensive, but these patients are in their 20s and early 30s. You can’t just see the cost. You need to see the return to society.”

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

London MP: teenagers are falling into ‘zombie-like state’ after taking Xanax

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Xanax has become the “drug of choice” for some young people and has been peddled by a dealer from a McDonald’s restaurant near a school, a London MP has said.

Bambos Charalambous, Labour MP for Enfield Southgate, told how a constituent’s 14-year-old daughter became trapped in a “downward spiral” that resulted in her exclusion from school five moths after starting to take the anti-anxiety medication.

He said the girl and her best friend would mix Xanax with alcohol, falling into a “zombie-like state”. She had been introduced to the drug at house parties across north London last summer.

She would come home with no idea how she was covered in bruises. She became aggressive and attacked her mother, and ended up being temporarily placed in foster care.

In the first parliamentary debate to raise concerns about Xanax, Mr Charalambous said the problem was “going on right under our noses”.

He said the girl was able to get hold of Xanax easily as it was “being peddaled by a dealer from a booth in a McDonald’s restaurant two minutes away” from her school, Poilice arrested three people on drug-related charges in December, he said.

Xanax is licensed in the UK by the medicines regulator but is not prescribed on the NHS, meaning it can only be bought with a private prescription from a doctor.

It can be illegally obtained for £1 to £2 a tablet due to criminals diverting legitimate production of benzodiazepines, such as Xanax and Valium, onto the black market. About 130 million tablets have been diverted in the UK in the last four years, authorities believe.

It is available on prescription in the US, where it is used by 50 million Americans, It was among a number of substances Whitney Houston is said to have taken before her death. Last November US rapper Lil Peep bragged on camera bout taking six Xanax pills. Hours later he was found dead on his tour bus from an overdose.

In the UK, 20 teenagers were taken in Salisbury and received medical treatment for Xanax. Eight were hospitalised in Sussex over Christmas. Police Scotland issued an alert after 27 Xanax-related deaths last year, some apparently as a result of injecting Xanax.

Harry Shapiro, director of the DrugWise advice website, said there was “no hard data” on the extent of use of Xanax in the UK. He said the drug was likely to be easily obtained from foreign websites. The UK is reportedly responsible for a fifth of all sales of Xanax on the “dark web”.

He said teenagers were probably drawn to it as a cheap way to get “out of it”. He told the Standard: “It’s not that dissimilar to being drunk, in some ways. Whether it’s just a passing phase or something that is going to be more entrenched, we don’t know. But you don’t have to hang around a street corner and meet someone in a big hat to get hold of it.”

The Government’s Talk To Frank website warns: “If you mix it with alcohol you’re at a big risk of overdose caused by heart and breathing problems – and this can lead to death.”

  • An edited version of this story appeared in yesterday’s Evening Standard

Crossrail ‘may miss December opening deadline’ after explosion and as new trains suffer software problems

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Crossrail chiefs have issued a major alert that the £14.8bn line may not open on time and is at risk of blowing its budget.

See the video of the TfL board meeting above. Discussion of Crossrail begins at 2 hours 35 minutes: https://www.london.gov.uk/transport-london-board-2018-01-30

Problems with software on new trains and an electrical explosion in east London, which occurred when engineers tried to switch on the high-voltage power, have caused “real, serious challenges”, Mayor Sadiq Khan was told.

Queen Crossrail

Mr Khan faces the embarrassment of not having the project – renamed the Elizabeth Line – ready for the Queen to open before she heads to Sandringham for Christmas.

Concerns have been raised about the impact on plans to pedestrianise Oxford Street.
Stations such as Bond Street, Paddington, Liverpool Street, Woolwich and Whitechapel – where there have been major construction problems – are behind schedule.

Crossrail chairman Sir Terry Morgan, in a bleak assessment to the Transport for London board yesterday, said there were “a lot of balls in the air” and admitted the line was “very close” to exceeding its budget.

Costs are increasing rapidly as bosses “scramble” to complete the project, which will link Reading and Heathrow with Shenfield and Abbey Wood once fully opened by the end of 2019.

The central section of the line, between Paddington and Abbey Wood via two new tunnels under central London, is due to open in December.

The explosion at Pudding Mill Lane in November caused three months of delays. “It got switched on – and exploded,” a furious Sir Terry said.

“I’m very unhappy with what happened. This is a purpose-built unit. We eventually found out it had been designed incorrectly.”

Engineers last night failed in their third attempt to switch on the power. The first test trains will now not start running on the new tracks until next month at the earliest.

Crossrail chiefs are set to switch to “Plan B” in May, when Heathrow Connect services are incorporated. The Connect trains will have to remain in service as signalling problems are likely to prevent Crossrail trains being driven all the way to the airport.

Sir Terry said he was “very confident” that the line, on which construction began in 2009, would be able to open by the end of December.

He said: “We are very close on the funding envelope, and we’re certainly going to have to continue to work together to make sure we get this railway running this year.

“It’s very difficult, it’s very tough. I don’t know what more we can do. When we’ve had problems we’ve scratched our head and tried to find the best people in the world. We have either got them, or, if we haven’t got them, we have gone and got them.

“It was always going to be a very difficult time but the team is still very confident they can get there.”

Mark Wild, London Underground managing director, who oversees Crossrail, said: “We can still do it, but it’s very, very hard and complex and it brings with it cost pressures as well.”

Mr Khan curtailed discussion of the problems during the public section of the TfL board and ordered that they be held in private.

Mr Khan said: “There are very good reasons to discuss things in private, and it’s not because we have anything to hide but because there are some things you discuss in private for commercial sensitive reasons.”

A spokesman for Crossrail said today: “During the initial energisation of electrical equipment at Pudding Mill Lane sub-station on 11 November 2017, two voltage transformers failed. 

“A full investigation has taken place and the cause is now known. Following correction of the faults in the electrical system by the contractor, powering up of this sub-station will shortly take place.”

Smartphone project aims to keep cystic fibrosis patients out of hospital

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Brompton CF project 1

Patients with a genetic lung condition that requires them to be segregated during hospital visits will be able to receive care via their smartphone under a pioneering initiative.

The Royal Brompton hospital this week [Thursday] launches a digital healthcare “platform” that could save many of its 600 patients with cystic fibrosis from having to attend clinics.

They will use communicate with their consultant via Skype, undergo lung tests at home and share the results via the internet, send blood tests via the home-testing service Thriva and have prescriptions delivered by Echo, dubbed a medical version of Amazon.

Professor Stuart Elborn, a consultant respiratory physician at the Royal Brompton, in Chelsea, told the Standard: “If we can make it work with CF, we can make it work with asthma, heart failure and congenital heart disease. I trust my money to a smartphone. Why not trust our health care?”

Brompton CF project

The CF Digital project, which will be trialled free of charge by the digital healthcare firm Babylon for six months, would enable many CF patients to avoid attending clinic, which normally happens eight to 10 times a year.

Cystic fibrosis affects about 10,400 people in the UK and causes thick, sticky mucus to develop in the lungs and digestive system. Average life-span is mid-40s, though some Brompton patients are in their 50s and 60s.

Patients have to be isolated from each other as their lungs harbour bugs that could cause serious infection in another person with the condition.

Professor Elborn said the initiative came from the desire to fit hospital services round the lives of patients, rather than the other way round. About 70 per cent of the Brompton’s patients are keen to participate. “The current model really doesn’t meet their needs,” he said.

“Most importantly, it changes the ‘power relationship’. The person with CF has access to the same data as their doctor. We can have an open discussion, sharing blood tests, lung tests, how they are feeling, and come to a decision that is best for the person at that time.

“It allows people to have the same quality of healthcare but not come to hospital. CF patients are mostly young people who do run their lives from their smartphone. This will free them up to live their lives.”

One patient, Alex, 27, who helped establish the new system, said it enabled “real-time” data to be stored – useful for each patient and invaluable for wider medical research.
Eight years ago the Cambridge university graduate missed half of his gap year when his CF deteriorated and he spent months in hospital.

Since then, the ability to monitor his own condition regularly has helped avoid admissions and has taught him which diets and exercises are most beneficial.

“I see the scope of this as massive,” he said. “I think the Brompton don’t even realise the full benefits of this.”

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

London A&E medics tell of UK aid effort to help Rohingya refugees in Bangladesh

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Dr Holly Gettings consultant in emergency medicine and Chrissy Alcock senior sister

Dr Holly Gettings and A&E sister Chrissy Alcock

A London doctor today told how UK aid efforts in Bangladesh had helped to stem the outbreak of diptheria in Rohingya refugee camps.

Dr Holly Gettings, an emergency medicine consultant at St Thomas’s hospital, was deployed just after Christmas with her colleague, A&E sister Chrissy Alcock, to Cox’s Bazar as part of a 30-strong UK Emergency Medical Team.

More than 500,000 Rohingya people have fled their homeland in the northern Rakhine province of Myanmar since last August. A military offensive by the Myanmar military has been described by the United Nations as a “textbook example of ethnic cleansing”.

Dr Gettings, 35, from Streatham, said her team saw about 100 patients a day, with 10-12 a day requiring admission to one of the three new treatment centres. “We had a capacity for 40 patients, and at points we were full,” she said.

None of her patients died but there were more than 2,000 cases and 30 deaths across the camp, where diptheria was able to spread in the cramped and unsanitary conditions. About 75 per cent of patients were children.

Photo taken by Chrissy Alcock (1)

Diptheria is a potentially deadly airborne disease long since eradicated in the West, but which can cause difficulty breathing, heart and kidney failure and paralysis. Victims were administered antibiotics and anti-toxin drugs and a vaccination programme was started.

Dr Holly Gettings (1)

Dr Gettings said: “Seeing the conditions people are living in, and how they are just trying to get by and live their lives, as poor as they are and as limited as they are, I think it makes you feel very fortunate, and how lucky we are to have the healthcare we have and the vaccines we have.

“Nobody in this country thinks about getting diptheria, whereas there you have mothers whose children that could end up dying from this horrible illness.
“The work is something you get a lot out of. I think it’s important people do this. It’s long days and it’s trying but it’s terrible when a child dies from a treatable and preventable illness.

“There was a real concern that the numbers were going up and up and this was going to turn into a massive outbreak. Fortunately it seems like it has been brought under control.”

Ms Alcock, from Camden, said: “Being here has given me just a glimpse of what everyday life is like for these refugees who have fled violence in Myanmar and arrive to these desperate conditions. You cannot see the borders of the camp. It is a massive sea of makeshift tents covering the nearby hills.

“Our aim is that by improving the care for patients with diphtheria we can help in a small way to improve the lives of these people who have suffered so much.”

The team is a collaboration between the NHS, Department for International Development and UK Med, a register of NHS volunteers ready to deploy to global emergencies. It was despatched following a plea for help from the World Health Organisation and the Bangladeshi government.

Guy’s and St Thomas’ NHS Trust ensured their shifts were filled by colleagues to enable its A&E to continue as normal.