Revealed: why patients continue to flock to A&E, even during a winter crisis


North Middlesex hospital

Patients inundated one of London’s busiest A&Es over winter because it offered “instant access” to healthcare not available from GPs, an investigation has found.

North Middlesex hospital, in Edmonton, saw about 500 patients a day and ran out of general and acute beds on its wards on numerous occasions.

The crisis became so pressing that on one occasion finance director Dave Stacey donated a pair of shoes to a patient to help him get home, enabling the bed to be given to another patient.

An investigation by Healthwatch Enfield found that despite the hospital falling well below the four-hour A&E target – only 82.4 per cent of patients were treated on time – thousands chose it over alternatives, even though most did not have life-threatening or emergency conditions.

Almost 75 per cent of patients turned up at A&E without trying to arrange a GP appointment. They said the hospital offered a “convenient way to see a healthcare professional, even if it meant waiting”.

More than a third were aware of options such as GP out-of-hours hubs, pharmacies or the NHS 111 advice line. However only four per cent sought help elsewhere before heading to the hospital.

Patients also chose A&E over the hospital’s adjacent GP-led urgent care centre because of the 24/7 availability of X-ray, CT and MRI scans and blood tests.

Researchers spent a week in the A&E in January and spoke to 630 patients. The largest proportion, more than 15 per cent, had arrived with a cold, flu or fever. Fewer than one in eight patients were sick enough to require admission to a ward.

One in five patients said they had contacted their GP to be told that no appointment was available. Many others said they did not try after previous failures to get an appointment or because they expected to wait several weeks.

Many said they would be happy to use alternative “walk in” services if they were nearer their home and offered scans and blood tests.

Patricia Mecinska, chief executive of Healthwatch Enfield, said: “Our research clearly demonstrates that there is a mismatch between the current NHS offer and 24/7 demand of local communities.

“From what residents of Enfield and Haringey told us, doing more of the same to address pressures facing A&E at North Mid will not work; people will simply keep coming.”

Maria Kane, chief executive of North Middlesex University Hospital NHS Trust, said: “It’s clear that as a local health system we are not communicating well enough the range of alternatives and how to use them, or how these other options can provide faster treatment and better care for our local communities overall.”

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




MRI scans detect more serious cases of prostate cancer and prevent unnecessary biopsies, UCL-led trial reveals


, ,

More than a quarter of men suspected of having prostate cancer will be able to avoid painful biopsies if MRI scans are used more widely, doctors said today.

An international trial led by University College London found that MRI scans were significantly better than ultrasound at distinguishing between tumours that require investigation and those that are harmless.

Mistaken diagnosis is one of the biggest challenges in treating prostate cancer, which has overtaken breast cancer in being the UK’s third biggest cancer killer, behind lung and bowel cancer, with 11,800 deaths a year.

The Precision study of 500 men with raised PSA blood test results used an MRI on half and ultrasound on half. In the MRI group, 71 men (28 per cent) were able to avoid a biopsy as their tumour was found to be clinically insignificant and not to warrant treatment.

In addition, clinically significant cancer was detected in 95 men (38 per cent) in the MRI group, compared with 64 (26 per cent) in the ultrasound group. This ensures that only men at risk from the cancer receive treatment.

Major London urological centres such as Guy’s hospital and University College Hospital already offer MRI scans but doctors want to see it become standard practice across the NHS.

Biopsies are done under local anaesthetic and involving inserting a hollow needle into the prostate to take about 10-12 samples. The process – dubbed a “stab in the dark” – is painful, costly and carries a small risk of sepsis.

Use of MRI scans, rather than trans-rectal ultrasound, also enables better targeting of the biopsy needle, reducing the number of samples required.

Dr Veeru Kasivisvanathan, from the UCL Surgery & Interventional Science, presented the results at the European Association of Urology Congress in Copenhagen today.

He said: “In men who need to have investigation for prostate cancer for the first time, Precision shows that using an MRI to identify suspected cancer in the prostate, and performing a prostate biopsy targeted to the MRI information, leads to more cancers being diagnosed than the standard way that we have been performing prostate biopsy for the last 25 years.”

Professor Mark Emberton, UCL Division of Surgery & Interventional Science, said: “This study was the first to allow men to avoid a biopsy. If high quality MRI can be achieved across Europe, then over a quarter of the one million men who currently undergo a biopsy could safely avoid it.”

Karen Stalbow, of Prostate Cancer UK, said: “For too long men have had to endure a stab in the dark biopsy technique, which can miss one in four harmful prostate cancers.

“It is now more important than ever that all men with suspected prostate cancer get a multiparametric MRI scan before biopsy.”

Work to transform Highbury Corner to start this summer, says TfL



Highbury Corner 1

Work to transform Highbury Corner from one of London’s most dangerous roundabouts into a safer space for pedestrians and cyclists will start this summer, Transport for London announced today.

The Islington junction has been a building site for the last year while work is completed to strengthen the railway bridge underneath Holloway Road.

This will be followed with changes to the roundabout – blocking off the western arm adjacent to Highbury & Islington Tube station to create a pedestrian area linking with the roundabout’s central grassed area.

Segregated cycle tracks will be built around the three remaining sides of the new “peninsula”. The work is due to finish in 2019. Cyclists account for 22 per cent of morning traffic using the roundabout.

The changes will also improve access to the station, which is frequently overcrowded during Arsenal games, with fans queuing back along Holloway Road to get home after matches.

Highbury Corner 2

Deputy mayor for transport Val Shawcross said: “The changes will make cycling and travelling on foot easier and safer for everyone using this busy area every day.”

Claudia Webbe, Islington council’s executive member for environment and transport, said: “This is an amazing opportunity to transform a busy, polluted and outdated junction into an attractive place for pedestrians, public transport users and cyclists, with safer, segregated cycle lanes.”


‘No crime on the Hipster line’ as Night Overground is extended to Highbury & Islington


, ,

Night services on the “Hipster line” have operated almost without crime despite almost 40,000 passenger journeys since their launch.

Police have recorded only a a single incident – the theft of a bag from a passenger who fell asleep – in the 10 weeks since the Overground began running through the night at weekends last December.

The service, which links New Cross Gate with “hipster” hang-outs such as Shoreditch and Dalston Junction, is being extended north from tonight to Canonbury and Highbury and Islington stations, where passengers will be able to connect with Night Tube services on the Victoria line.

The Night Tube now operates on five lines and has been used by 12 million passengers since being launched in August 2016. Click here for a story about its launch and the belief it would take three years to break even.

Mayor Sadiq Khan said: “This extension will connect the Night Overground to the Night Tube. These night-time services are providing a huge boost to our economy and a safe and reliable way for people to travel across the capital.”

All stations on the Night Overground are staffed while trains are running. Security patrols operate throughout the night, alongside CCTV.

Jonathan Fox, TfL’s director of London Rail, said: “We’ve worked closely with our staff and BTP to keep people safe and secure while travelling, with only one low-level crime reported so far.”

BTP Chief Superintendent Martin Fry said: “We will have police officers deployed each night. We are committed to ensuring that travel on London’s public transport network is a safe and pleasant experience at all times of the day and night.”

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


, ,

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.

Work ‘to start this year’ converting former Royal London hospital into £105m Tower Hamlets town hall


, , ,

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


, , , , , , , , ,

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


, ,

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


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



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.