Why A&Es are failing Britain's children: Lylah's mother was told she had a tummy bug. The reality A massive tumour in her stomach
23:30 GMT, 3 September 2012
A large tumour was found growing in Lylah Brabner's stomach (pictured with her mother Simone)
When Tracey and Miguel Moore-Shakes carried their toddler Jayden into Birmingham City Hospital one evening with breathing difficulties, they desperately hoped he would receive urgent medical help.
The two-year-old suffered from asthma, but his wheezing had become so severe that they were worried something was very wrong.
What happened next will haunt them for the rest of their lives.
Jayden received a quick examination by a nurse, and then a doctor.
He was diagnosed with a chest infection and they were sent home with antibiotics at 6pm — just 29 minutes after arriving at A&E.
Back home, the youngster’s symptoms worsened and his parents rushed him back to hospital just before 10pm.
Only then, around five-and-a-half hours after his parents first brought him in, was he seen by a paediatrician. It was a delay that may have cost the little boy his life.
At 11.20pm Jayden suffered a cardiac arrest — his body was unable to fight any more — and he died an hour later.
At the inquest, the coroner was damning.
The toddler had died from neglect, he said, and a ‘gross failure’ by the hospital to take his severe asthma seriously.
He should have been seen by a paediatrician when he first went into A&E and been admitted to hospital.
‘I consider there was a gross failure by staff at the Sandwell and West Birmingham NHS Trust to provide basic medical attention to Jayden on that day,’ said coroner Aidan Cotter.
‘Jayden was only two, he was clearly ill and he deserved much better care than he received.’
So shocked was the coroner that he wrote to hospitals across the Midlands warning of the threat to children’s wellbeing due to lack of specialist doctors in A&E departments.
Experts are warning there is a serious, systemic problem in Britain’s Casualty units when it comes to treating youngsters.
They say that many of them are not fully capable of providing critical care for children, or even of properly diagnosing life-threatening ailments.
The vast majority treat children and adults together, and because of cost-cutting and inadequate training at medical schools, many simply do not have specialist children’s doctors or nurses immediately on hand — even though NHS emergency departments treat more than 3.5 million children every year and one in three children will be admitted to hospital in their first year of life.
More than 1,500 children a year die needlessly from common childhood diseases because of failures across the NHS, and particularly in Casualty units.
Lylah is undergoing an intensive three-month course of chemotherapy at the Royal Marsden Hospital, London. 'She is playing with other children and seems happier in herself,' said Simone
A&E staff too often do not have the knowledge to spot danger signs in children, say experts, because their symptoms can be subtle and very different from those seen in adults.
Children’s health can also deteriorate much more quickly.
Such problems help to put Britain at the bottom of the western European league table, with 52 per 100,000 children dying avoidable deaths, compared with fewer than 40 in the safest country, Sweden.
On top of the human cost, failure or delay in diagnosis has cost the NHS more than 20 million in legal settlements in the past 12 years.
Dr Hilary Cass, president of the Royal College of Paediatrics and Child Health (RCPCH), and an expert in avoidable deaths, has warned: ‘We have limited data on the causes, but we have enough statistical evidence to show we are failing 1,500 children a year.
‘Children are not seeing people with a sufficient depth of experience and knowledge the moment they get through the doors of A&E.’
This was highlighted last week in a tragic case revealed by the health service watchdog, the Care Quality Commission, which savaged a Casualty unit in Essex for delays in treating children that involved the death of one youngster.
It issued a formal warning to Basildon and Thurrock University Hospitals Foundation Trust after unannounced inspections found that the trust’s A&E unit was breaking the requirement for children to be assessed (or ‘triaged’) within 15 minutes of arrival.
The inspections followed the death of an infant who was not assessed within the 15 minutes target time.
The child, who was suffering from blood poisoning but was not medically assessed for 55 minutes, was later rushed to Great Ormond Street Hospital for specialist care.
Sadly, the infant’s condition had deteriorated so far that doctors decided no further treatment was possible.
Inspectors from the CQC subsequently looked at four care records for children at the hospital’s Casualty department and found the 15-minute wait time for triage had been breached in each case.
The trust’s chief executive Alan Whittle, who is due to leave the trust shortly, said that changes had been put in place to ensure the problem did not recur.
The hospital says a subsequent CQC inspection has given the unit a clean bill of health.
However, this is not the first time the trust has fallen foul of such requirements.
In 2009 the CQC’s predecessor, called Monitor, used its legal powers to demand that Basildon and Thurrock tackle ‘inadequate arrangements to treat children in A&E, with few specialist paediatric staff’.
Simone was initially told her daughter had a virus, but persisted the hospital perform blood tests
One reason previously cited by healthcare chiefs for the lack of specialist doctors is the extra cost of employing them.
However, Dr Cass argues that this is short-termism, and that increasing the numbers of paediatricians would drive down costs in the long-term.
‘If you deliver better quality of care and better decision-making about who you admit and who you don’t admit and you get things right first time, then in the longer term that can be cheaper.’
The College of Emergency Medicine, which represents A&E doctors, has said it is ‘fully aware’ of inadequacies in Britain’s emergency departments.
‘It has warned that medical schools have prepared graduates poorly for paediatric emergency care.
The Royal College of Paediatrics and Child Health has issued tough new stipulations on how A&E units should care for children, including the need to respond rapidly when they come through the door, and to have qualified experts on hand to examine every youngster properly.
This is the first year that the Royal College has issued strict standards rather than just ‘guidelines’, says Dr Stephanie Smith, an emergency paediatrician.
‘People can ignore guidance very easily,’ she says.
Dr Smith says that specialist expertise in paediatrics is vital in Casualty units because illnesses can display very different symptoms in children compared to adults.
‘For example, potentially lethal meningococcal disease (a bacterial form of meningitis) catches people out.
'In children it can present with non-specific symptoms, such as a raised temperature or a child not feeling well or just going quiet.’
New standards require that young children are expertly assessed within 15 minutes of entering a Casualty unit.
This rapid action can be vital, says Dr Smith.
‘Children can deteriorate very quickly,’ she says.
‘Their bodies are so youthfully healthy that they can maintain being well for a longer time than adults. But if they do succumb, they get ill very quickly.
‘With smaller children, they also don’t have the words to explain what they are feeling.’ Lack of political will to improve children’s A&E standards is partly to blame for poor standards, says Dr Smith.
‘The volume of adults going to A&E is much greater than the volume of children, and there is more political will to manage them than children.’
There is no doubt that Casualty units are facing unprecedented burdens. A&E attendances at English hospitals have exploded from 12.9 million in 2001 to 20.7 million in 2010.
Some of this is caused by population growth, but much of it is due to GPs cutting surgery opening hours and out-of-hours visits, leaving patients with nowhere else to turn.
As a result, many parents with sick youngsters now seek care directly from emergency departments.
‘A&E staffing needs to be expanded to meet growing demand,’ says Dr Smith.
‘The big teaching hospitals attract the paediatrically qualified staff, which leaves some communities very short.’
One mother who suffered as a result of such shortages is Simone Brabner, 24.
She rushed her daughter Lylah to A&E last month when the two-year-old was doubled up with stomach pain.
But Simone was told her daughter merely had a virus. Doctors at the North Kent hospital refused to perform blood tests because it was ‘too late in the evening’, and the family was sent home.
But Simone, who lives in Slade Green, Kent, persisted and returned to Casualty the following week demanding proper tests.
The truth then emerged. Lylah was suffering from an advanced neuroblastoma, a childhood cancer.
A large tumour was found growing in her stomach.
‘A trainee doctor was the one who realised Lylah had swollen lymph glands,’ she says.
Lylah was given an ultrasound exam and, later that afternoon, her mother was told the news.
‘Out of the blue, they said they were 99 per cent sure it was cancer.’
Further tests confirmed the diagnosis. The tumour is half the length of her stomach.
A spokesman for Darent Valley Hospital says: ‘The Trust apologises for not making the correct diagnosis at the first A&E attendance. When Lylah attended a few days later, she was admitted and the diagnosis was promptly made.’
Lylah is undergoing an intensive three-month course of chemotherapy at the Royal Marsden Hospital, London.
‘The doctors at the Royal Marsden have been brilliant,’ says Simone.
‘They have got Lylah’s pain under control. She is playing with other children and seems happier in herself.’
Meanwhile, for the parents of Jayden Theo Moore-Shakes — the two-year-old admitted to Birmingham City Hospital — there was no such second chance. They hope that the inquest verdict will spare other families the devastation of losing a child.
In a statement issued through their lawyer, they said: ‘City Hospital was responsible for a series of gross failings amounting to neglect.
‘We are hopeful that the verdict, coupled with the actions of the coroner, will deliver changes that will help to save the lives of children.’
In a statement, the hospital said it had made changes in the wake of the tragedy.
‘We would like to apologise for the distress that this tragic event has caused,’ it says.
‘As a result of Jayden’s death we have made improvements to our service.
‘The trust accepted that Jayden should have received a senior review much earlier than he did.
‘The Trust has reinforced the policy it already had in place, whereby a child who is admitted via the emergency department into a resuscitation area will be reviewed by a specialist clinician regarding their diagnosis and treatment plan.’
One can only hope that such service improvements are properly introduced at Casualty units right across the country.
Lylah’s family and friends are trying to raise money for the Royal Marsden Hospital, the charity cancer Clic Sargent, and for a trip to Disneyland for Lylah. For more information, email [email protected]