Many London hospitals give staff vaccine that is ineffective against Japanese flu

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Hospitals across London were today facing questions about whether they had offered frontline staff maximum protection against the worst flu outbreak in seven years.

Major trusts such as Barts Health, Imperial College Healthcare, St George’s, Guy’s and St Thomas and the Royal Free all offered employees the trivalent vaccine, as did London Ambulance Service.

The trivalent vaccine works against “Aussie flu” but is ineffective against the “Japanese flu” strain of the most prevalent Influenza B virus.

Trusts make strenuous efforts each year to encourage staff to receive a vaccine, to protect themselves and prevent them passing the virus between patients.

One frontline medic told the Standard: “I think it leaves a lot of healthcare workers unprotected. Trusts need to answer why they chose the tri – vaccinating staff, with all the associated risks, but only for 75 per cent maximum of the benefit.

“Would the admission rates have been lower, causing less pressure on system, if staff hadn’t been passing it round?”

Guy’s and St Thomas’ NHS Trust said it had ordered the trivalent vaccine 10 months ago after following Government advice. That advice changed last OCtober, and it would now order 15,000 doses of the quadrivalent vaccine in time for next winter.

Barts Health NHS Trust said: “We choose our vaccine months in advance of the colder weather so that it arrives in good time. When making this choice our first consideration is the advice of medical experts, and at that time the quadrivalent vaccine was recommended for use only in children.

“We therefore stocked trivalent, and, having vaccinated over 8,000 of our staff (55 per cent) we are pleased that national experts have confirmed that it remains effective in protecting our patients and our staff.”

Dr Fenella Wrigley, medical director at London Ambulance Service, said: “In line with official guidance from the World Health Organisation and the Joint Committee on Vaccination and Immunisation, we have offered the trivalent flu vaccination to our staff.”

The Royal Free said it continued to encourage staff who haven’t yet got vaccinated to do so “as this is their best chance of avoiding the flu and protecting their patients and their families from also getting the flu”.

Last week in England almost 600 patients were admitted to hospital with flu. Of these, 198 patients were admitted to intensive care units – taking the total to almost 1,000 since the start of winter. There have been 120 deaths.

Trusts such as London North West Healthcare, which runs Northwick Park and Ealing hospitals, and Barking, Havering and Redbridge, which runs Queen’s and King George, did offer staff the quadrivalent vaccine.

This is slightly more expensivet to the NHS – £8 rather than £5 –  and protects against the B Yamagata “Japanese flu” strain in addition to the H3N2 “Aussie flu” strain.

The trivalent vaccine jab is commonly given to adults at GP surgeries, while children are administered a quadrivalent nasal spray.

Public Health England said seasonal flu activity levels continued to increase last week across the UK but the rate of increase was slowing.

Professor Paul Cosford, medical director of Public Health England, said: “In terms of hospital admission, this is the most significant flu season since the winter of 2010/11 and the preceding pandemic year of 2009 although it is not an epidemic.”

The Royal College of GPs said that the number of Londoners attending a doctor’s surgery with flu-like illness rose from 30.3 to 42.1 per 100,000 last week, compared with the first week of January, but remained below the national average of 53.1. The worst affected areas were the Midlands and East England.

Jonathan Ball, professor of molecular virology, University of Nottingham, said: “This is a bad year and some of the components of the trivalent vaccine might not have given the protection that we would have hoped for, but this is nothing more than a bad flu season, not helped by an aging population and an under-funded and creaking NHS.”

  • An edited version of this story appears in tonight’s Evening Standard.
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City Hall denies former cycling tsar’s claims that CS11 cycle superhighway is dead

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CS11 cycle superhighway at Swiss Cottage

A controversial cycle superhighway through Regent’s Park is not “dead”, City Hall insisted today.

Andrew Gilligan, the former cycling commissioner to Boris Johnson, last night claimed that Transport for London was set to publish amended plans that were so watered down as to leave the Swiss Cottage to Oxford Circus CS11 route “effectively dead”.

The original proposals involved closing four of the park’s gates to prevent commuter rat-running. The plans were backed in a public consultation but sparked fierce opposition from a number of residents.

Mayor Sadiq Khan had pledged to find a way to deliver the route when he took office in 2016 but no work has yet started – despite a pledge that construction would start last year.

CS11 announcement

A spokesman for Mr Khan said today: “CS11 was left for dead by Andrew Gilligan and Boris Johnson, with the community bitterly divided by their unnecessarily confrontational approach and all the stakeholders in disagreement about the plans.

“The new Walking and Cycling Commissioner, Will Norman, has been working extremely hard to salvage this scheme and provide a better route to improve walking and cycling through Regent’s Park.

“We’ve had positive consultation results but still need to get full agreement from all the responsible authorities in order for the plans to proceed – this work is ongoing and involves rebuilding the relationships that were severely damaged by Andrew Gilligan.”

Justin McKie, of Regent’s Park Cyclists, who has been closely involved in negotiations on the proposed route, said he feared objections from Westminster council to restricting vehicle access to the park would result in a “very watered down version of CS11”.

He believed the amended plans would not be as poor as Mr Gilligan believed, but added: “Overall, these plans appear to be disappointing. After three years of discussions, we had a workable solution to Regent’s Park. But the Westminster pro-car lobby has been working in overdrive to scupper the plans.

“Westminster really should hang their heads in shame, their policy of fighting against all pro-cycling projects will mean that their roads will remain the most polluted in Europe.”

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

Doctor’s face rebuilt by surgeons after freak horse-riding accident

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Maxillofacial surgeon Nick Hyde and patient Dr Libby Calton. Picture by Alex Lentati

A doctor today told how surgeons rebuilt her face after she was trampled by her own horse in a freak riding accident.

Dr Libby Calton, 38, underwent a 10-hour operation at St George’s hospital after her face was “crushed backwards” into her head – narrowly missing her brain.

Maxillofacial surgeons took pictures supplied by her husband Chris Keating into the operating theatre to help realign her features as they were before the accident.

Her upper jaw was broken in three, her palate was split, both cheekbones were fractured and nine ribs were broken. Eleven plates and 41 screws were used to rebuild her face.

Dr Calton, a paediatric registrar, said the results were “incredible”. She told the Standard: “From those photographs, and the very broken raw material they had in front of them, they have managed to remake my face so you wouldn’t be able to tell.”

The accident happened soon after Dr Calton took her horse Barney for a ride in woods near Esher on a Sunday afternoon last October.

“We were riding really slowly , walking through the woods on a bridal path,” she recalled. “He got frightened by something going on in the woods – there were some children playing. He just ran.

“He veered off the bridleway into the woods. There were trees flashing past us at upwards of 25mph. I couldn’t stop him at all.

“He was just out of control. The safest thing to do in those situations is normally to get off. You get off like a jockey does – you roll to the side, you land on your shoulder and you roll over.

“Unfortunately when I did that, he swerved towards me and ran me over. He wears 550kg and has iron shoes on.”

Dr Calton, who lives in Streatham Hill, was momentarily knocked unconscious. She was found face down and unable to move by two dog-walkers.

They called 999 and the Kent, Surrey and Sussex Air Ambulance was scrambled. She was taken by road ambulance to St George’s, in Tooting, accompanied by the air ambulance medics. Barney was found further along the towpath.

After two operations to clean her wounds and repair her broken ribs, Dr Calton underwent facial reconstruction eight days after the fall, led by maxillofacial surgeons Nick Hyde and Ash Messiha.

 

Pre-op CT scan Dr Libby Calton

Dr Calton’s CT scan before her operation

 

Mr Hyde said: “The tip of the hoof must have landed on the bridge of her nose and just driven in. If the hoof had gone in two inches higher, that could have been potentially life-threatening.

“This is a relatively rare injury, but when they happen they are very challenging to manage. I’m very happy with what we have achieved, considering where we started. It was a big team effort.”

Dr Calton, who did her medical training at St George’s, spent almost three weeks in hospital but was riding again before Christmas. She hopes to be back on Barney next month.

“I’m incredibly grateful,” she said. “It’s amazing to think I went out and had such an awful accident, which genuinely was life-threatening, and from start to finish I’ve had nothing but compassion and kindness and expertise put into getting me back into a position where I can do all the things I love. I can ride, I can work and I feel and look like myself again.”

  • An edited version of this story appears in tonight’s Evening Standard. View a PDF here: Libby

CS9 cycle superhighway through Chiswick delayed until after local elections as Swiss Cottage CS11 plans remain deadlocked

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CS9 cycle superhighway

Plans for the first cycle superhighway in west London have been delayed after controversy about the route through Chiswick.

It comes amid growing concern that Transport for London is unable to spend all the money promised by Mayor Sadiq Khan for cycling, with next year’s cycling budget slashed by £43 million.

Figures obtained by Green assembly member Caroline Russell show that planned spending for 2018/19 of £154m has been reduced to £111m.

Cycling budget

More than 5,000 people responded to a TfL consultation on the CS9 superhighway, a largely segregated route to link Kensington Olympia and Brentford, with “widespread support” for the proposals.

However Hounslow council this week announced that, following “reservations” from “significant numbers of people”, particularly in relation to Chiswick High Road, no decision will be taken until the summer – after May’s local elections.

Council leader Steve Curran said: “We have listened to the concerns raised over recent weeks and believe changes can be made to mitigate the impact of the scheme on some road users whilst retaining the benefits for cyclists.”

Hounslow Cycling Campaign said it hoped a better scheme would result, but was “disappointed by the lack of a constructive approach from some opponents and attempts to politicise the scheme”.

TfL said it was still analysing the responses to the consultation, and would publish its “next steps” later this year. “We have to make sure that this new infrastructure works for the community,” a spokesman said.

TfL is also analysing responses to the proposed CS4 superhighway linking Tower Bridge and Greenwich and is no further forward on the CS11 route from Swiss Cottage to Oxford Circus via Regent’s Parkdespite Mr Khan pledging work would start last year (announcement below).

CS11 announcement

Ms Russell said: “The Mayor has been slow to continue building and expanding the super cycle highways – even schemes that were shovel ready have hit delays and other issues.

“The London Assembly previously highlighted a persistent issue with TfL underspending the cycling budget.

“Considering the Mayor made healthy streets a priority in his Transport Strategy I am extremely surprised and disappointed that he’s not putting his money where his mouth is.”

TfL said the £154m a year was an average figure and said Mr Khan would spend more than his predecessor, Boris Johnson.

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

Alternative to the Northern line ‘that TfL doesn’t want passengers to know about’

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Transport for London was today accused of failing to inform passengers about a “second Northern line” through central London because it will be operated by a rival firm.

Thameslink services are to expand in May when trains from Cambridge and Peterborough, currently part of its sister Great Northern franchise, will continue south of King’s Cross and across the Thames to Brighton or Horsham via Gatwick airport for the first time.

This is part of a £7 billion taxpayer-funded modernisation of a north-south line said to be as important as Crossrail.

New Thameslink map

It includes a key section – Finsbury Park, St Pancras, Farringdon, City Thameslink and Blackfriars – where services will run at “metro” frequencies of eight trains an hour, creating an alternative to the overcrowded Northern line to and from London Bridge.

This means there will be 24 trains an hour between St Pancras and Blackfriars, once the Bedford/Luton trains are included – equal to Crossrail’s peak frequency.

See here for a map of the expanded Thameslink services:Thameslink future service

Existing Thameslink services, which run between Bedford and Brighton, will also be expanded, including a new route linking Luton and the Medway towns via Greenwich and Abbey Wood. An extra 80 stations will join the Thameslink network.

The Standard has learned that TfL had refused to add the new Thameslink services in central London to its Tube map – despite reprinting it to include its own Crossrail, or Elizabeth line, services, which start in December.

One rail source told the Standard: “It’s a high-frequency service that is meant to complement the Tube but nobody is going to know about it.”

Rail expert Barry Doe said the decision was probably because TfL, which saw Tube passenger numbers drop by 13 million last year, “fears an income loss” if passengers switched to Thameslink.

Writing in RAIL magazine, he called on Mayor Sadiq Khan to “overrule this parochialism, and allow visitors and Londoners alike to see all the benefits of recent public investment”.

New Thameslink train at King's Cross

A new Thameslink train being tested arrives at King’s Cross

The Thameslink expansion has been made possible by a new rail tunnel linking King’s Cross and St Pancras, and Network Rail’s rebuilding of London Bridge station.

New 100mph German-built trains, costing £1.4bn to lease and dubbed the “Hoover” because of their ability to suck-up 1,750 passengers, are being introduced. The 12-carriage units have 666 seats – fewer than the trains they replace – but more standing room, wider doors and indicators showing which carriages have space. Unlike Crossrail trains, they also have lavatories.

The improvements will add extra capacity to a franchise found by the National Audit Office last week to have suffered the most delays and cancellations in the country for the last three years. This was mainly caused by industrial action on Southern and driver shortages on Great Northern.

TfL said Thameslink services were shown on the London Tube and Rail map, which can be seen at most Tube stations, and on the TfL website and app.

However, copies are not available for passengers at TfL stations to take away – unlike the pocket Tube map.

A TfL spokesman said: “The London Tube and Rail map is produced in partnership with the Rail Delivery Group, who print these maps for distribution at national rail stations.

“We review leaflets available in our station on a regular basis and are happy to consider the possibility of stocking these in central London in the future.”

Flu rates in London doubled over Christmas – while incidence of common cold was highest in country

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Flu rates in London almost doubled in London over Christmas but remain below the national average, GPs revealed today.

However the capital leads the country in the number of people suffering from a common cold, according to the Royal College of General Practitioners.

The figures came after 27 people in the UK died from flu in the first week of January, taking the total since the start of winter to 85.

The RCGP’s weekly survey of communicable and respiratory diseases showed rates of influenza-like illness increased in London from 16.7 to 30.3 per 100,000 people, between the last week in December and the first week in January. The national increase was from 21 to 37.3.

London also had lower rates of acute bronchitis and asthma but the highest rate of common cold, which rose form 119.4 to 158.2. The true rates could be even higher as GP surgeries were only open on four weekdays at the start of the year.

Professor Helen Stokes-Lampard, chair of RCGP, said: “Things are incredibly busy, and demand is increasing – not just with flu but with other common winter illnesses as well.”

Public Health England said the rate of flu hospitalisations was 2.5 times higher than at the same time last year. The highest rates are in the South of England and the lowest in London, Public Health England figures show.

Influenza B is more common in London than Influenza A, but the strains are broadly similar across the country.

In the first week of January, there were 758 hospitalised confirmed cases of flu in England. Of these, 47 were the A(H1N1) “swine flu” strain, 157 were the A(H3N2) strain – the so-called Australian strain that killed dozens last year – another 135 were an unknown subtype of A and 419 were of the B strain.

Campaigners insist the NHS winter meltdown – which yesterday saw emergency doctors tell the Prime Minister that patients were dying prematurely in corridors – was due to a lack of funding and not flu. Overall mortality rates in England are slightly lower this year than in previous years.

Dr Dominic Pimenta, a junior doctor and blogger, tweeted: “There is not a flu crisis. It is flu season amidst a #fundingcrisis.

“The real problem is crippling underfunding relative to demand, catastrophic understaffing, and a health service on its knees.”

‘Pick it, lick it, stick it’: trauma dentist’s advice to West Ham footballer who lost tooth from kick in face

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West Ham medics missed the best chance of saving a tooth lost by one of their players when he was accidentally kicked in the face by an opponent, an expert trauma dentist said today.

Viewers watching yesterday’s televised FA Cup tie between Shrewsbury and the Hammers saw midfielder Josh Cullen spitting blood after the challenge from rival player Abu Ogogo.

Josh Cullen BBC

Josh Cullen: Pic via BBC

A West Ham medic went onto the pitch to retrieve a tooth and it was placed in a cup of milk in the team dug-out.

Serpil Djemal, a consultant in restorative dentistry at King’s College hospital, said West Ham’s medical team acted correctly by putting the tooth in milk, but missed the best opportunity to save it.

Ms Djemal, who is chairwoman of Dental Trauma UK, a charity set up to improve the way trauma to teeth is managed, said: “The best way of saving a tooth is to pick it, lick it and stick it. In other words, immediately pick the tooth up by the crown, lick the tooth clean – the owner only! – and stick it back in position.”

She said putting the tooth in milk could help preserve the cells on the surface of the root, but was not as good as re-implanting.

After the game, West Ham boss David Moyes revealed Cullen, 21, had in fact lost two teeth. He had been sent to A&E to see if they could be saved. Club captain Mark Noble teased his team-mate by tweeting: “Mind the gap.”

Serpil Djemal

Serpil Djemal: footballers should consider wearing mouth guards

Ms Djemal runs a dental trauma clinic at the hospital, in Denmark Hill, and she and colleagues regularly see people with dental injuries from sport – as well as those caused by cycling to work.

She said professional footballers should consider wearing mouth guards. In 2014, Arsenal midfielder Mikel Arteta lost a tooth in a match versus Hull, while in 2016 Man City defender Aleksander Kolarov lost a tooth in the Manchester derby.

“The reality is that prevention is always better than cure,” she said. “If professional footballers and sports people started wearing mouth guards more regularly, people playing amateur sport would soon follow suit.

“They aren’t expensive, particularly compared to how much you might need to pay for expensive and repeated restorative dental work.

“Footballers can afford dental implants, but they are no way near as good as preserving your own, natural teeth – and football clubs can help ensure their medical teams are doing everything possible in the minutes after injury occurs to maximise the chances of an injured tooth surviving.”

A West Ham spokesman today said an update on whether Cullen’s teeth had been saved was awaited from medical staff.

City financiers unite on second Alps adventure to raise £5m in research funds for childhood brain tumours

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Rob Ritchie in the Alps

A HSBC banker and his wife are a leading a squad of City financiers on a return charity expedition to the Alps in a bid to find a cure for their son’s brain tumour.

Rob and Tanya Ritchie aim to top £5 million for pioneering research into childhood brain tumours – an unprecedented amount in an area that receives a fraction of that invested in other cancers.

Their son Toby, 10, was diagnosed at the age of five with a low grade tumour “the size of a golf ball” on his brain stem, which connects the spinal cord with the brain and controls motor skills, coordination and breathing.

See here for previous coverage of Toby in the Evening Standard.

About 500 UK children are diagnosed with a brain tumour each year but treatments have not changed for decades – a “sledgehammer” combination of radiotherapy, chemotherapy and neurosurgery.

Toby Ritchie in sports gear

Toby, above, has undergone chemotherapy and two rounds of life-threatening surgery but the tumour’s location means it cannot be fully removed.
His parents hope the funding will lead to a breakthrough benefiting Toby and countless other children who face uncertain futures and debilitating side-effects.
The first “Everest in the Alps” challenge, led by Mr Ritchie in March 2015, raised £3 million from friends and his then colleagues at Goldman Sachs.

Now a 30-strong team, led by Mrs Ritchie and many of her friends, will return to the Alps next month [February] and again ascend the height of Mt Everest on skis in a bid to raise a further £2 million.

Friends from Barclays, Goldman Sachs, JP Morgan Cazenove, insurer BMS and Smith & Williamson stockbrokers will also take part.

Rob and team in the Alps

Their efforts have already enabled the Brain Tumour Charity to launch a research centre in Germany, drawing on experts at Great Ormond Street Hospital and Queen Mary University of London.

Led by Dr David Jones, The Everest Centre hopes to launch international trials on “re-purposing” adult drugs for melanoma and bowel cancer on children such as Toby within the next one to two years, as one of a series of initiatives.

Sarah Lindsell, chief executive of the Brain Tumour Charity, said: “A cure can’t wait. We are putting a huge amount of pressure on David and his team to do it in a short space of time.”

Toby’s diagnosis in 2013 was followed by 18 months of chemotherapy. That slowed the tumour but it continued to grow. He became confused at school, his balance got worse, and one of his eyes began to close.

Last year, he underwent a seven-hour operation at King’s College hospital to “de-bulk” the tumour.

Mr Ritchie, 44, co-head of HSBC’s global banking business in the UK, based in Canary Wharf, said: “That was a very dramatic operation when they took out just over half of the tumour, next to his brain stem. It’s a very complicated place and he needed to learn to walk again.

“All the things that mattered most have improved, however – his balance may be worse but his eye is open again. His breathing is also better. By and large he has done brilliantly although he gets frustrated when he can’t play sport as his friends can.”

Dr Jones said there was a lack of knowledge about how best to treat the tumours, but said the funding “changes the scope of what we can aim for”.

He said: “We still don’t understand what is the normal course of this disease. It’s often very unpredictable. We don’t know from one scan to the next what we are going to find.”

The new treatments being investigated are known as MEK inhibitors, which block alterations or “over-activity” in the cell.

Dr Jones said: “Previously it was not realistic to think you could apply for this sort of money for low-grade brain tumour research. It was something not seen as ‘sexy’ when you have other tumours that children are dying from very quickly.

“But if you think of the longer-term terrible effects that children and their families have to suffer, this is one of the areas that the research can have a massive impact.”

* To sponsor the team, visit: www.everestinthealps.com

Hospital boss: donating my shoes to a patient was typical of the compassion shown by front-line staff every day

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Shoes

A boss at a London hospital badly hit by the NHS winter meltdown donated his shoes to a patient to enable him to be discharged home – freeing-up a desperately needed bed in the process.

Dave Stacey, 33, director of finance at North Middlesex hospital, was praised by colleagues and politicians for his “amazing compassion”.

Rachel Anticoni, the hospital’s chief operating officer, said that staff at a morning bed availability meeting yesterday were told that a “patient was delayed going home as he had no shoes”. She added: “Our director of finance was in the meeting and donated his shoes. This is what it’s all about #actsofkindness.”

MP Jon Ashworth, Labour’s shadow health secretary, tweeted today: “The amazing compassion of our NHS staff – finance director donating own shoes to a patient so can be discharged.”

David Stacey North Middlesex

Dave Stacey: shoe donation “was a really simple gesture to help someone out of the hospital.”

Mr Stacey, above, who lives in south-west London, today played down his contribution, saying similar acts were made every day by his colleagues on the frontline. He told the Standard: “It was a really simple gesture and a small and practicable action to help someone out of the hospital.

“All I know is that he needed a pair of shoes. I happened to have a pair of ‘back-up shoes’ here, because of the inclement weather, and made them available.

“I’m slightly taken aback by the reaction [on social media]. In my mind it was a really minor thing to do. If you think about the 3,000 staff who work at North Middlesex, particularly our doctors and nurses on the front-line, they are doing something like this every day. I don’t hear about it, and Twitter doesn’t hear about it, but it happens.”

North Middlesex, in Edmonton, has consistently been the most under pressure hospital in the capital, with its every one of its general and acute beds filled for virtually every day for the last three weeks. Yesterday it had more than 500 patients in its emergency department, and received 130 ambulances.

Hospital managers such as Mr Stacey, who is married with one child and another on the way, have moved onto the front-line to help. Mr Stacey, who joined the trust last February, was helping to move patients on trolleys on New Year’s Day and on Wednesday night.

“I’m really proud of how we have all pulled together,” he said. “It’s been all hands to the pump to make sure our patients are safe.”

He said the size eight shoes were from Matalan and had cost about £10 four years ago. He rarely wore them because they were a bit too big – but hoped they fitted the patient, who had asked for a size nine.

 

Child patients at under-threat Royal Brompton say it is one of best hospitals in the country

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The London hospital at risk of having heart surgery axed by NHS England was today among only two in the capital to get top marks from child patients.

The Royal Brompton, in Chelsea, was rated as “much better than expected” by children aged eight to 15 in a national survey of more than 11,000 paediatric patients and their parents.

The vast majority of respondents gave the Brompton a 10/10 rating. Moorfields eye hospital was also rated much better than expected by eight to 15-year-olds.

NHS chiefs are due to decide on Thursday on whether to remove child and adult congenital heart surgery from the Brompton as part of a nationwide shake-up of care.

Great Ormond Street hospital were rated “better than expected” by parents of babies and children aged to seven. Homerton, in Hackney, and the Royal Marsden cancer hospital were rated better than expected by the older age group.

Barking, Havering and Redbridge, which runs Queen’s hospital in Romford, Croydon hospital, and North Middlesex hospital were all said to be worse than expected – with North Middlesex, in Edmonton, worse for both young and older children.

Today’s survey, by the Care Quality Commission, found 91 per cent of older children had been looked after “very well” or “quite well” in hospital. A total of 81 per cent of parents rated their child’s experience as 8/10 or above.

Professor Ted Baker, CQC chief inspector of hospitals, said: “Overall, the NHS should be pleased with the results. This is a testimony to the hard work and dedication of hospital staff.”