Call for lessons to be learned after Ripon mum dies from sepsis at Harrogate hospital

A Ripon family has called for lessons to be learned after a mother died from sepsis at Harrogate District Hospital.

Angela Laybourn was admitted to the hospital on January 17, 2022, after suffering from lack of appetite and dehydration for around a week.

Blood tests showed she had metabolic acidosis – a build-up of acid in the body. However, this was not documented when she was assessed on a ward, an NHS investigation found.

Ms Laybourn was wrongly sent home three days after being admitted. However, she was readmitted to Harrogate hospital on January 22. She was incoherent and disorientated.

Further blood tests indicating metabolic acidosis weren’t acted upon. She died aged 62 in the early hours of January 24.

Following Angela’s death, husband David, instructed medical negligence lawyers at Irwin Mitchell to investigate his wife’s care under Harrogate and District NHS Foundation Trust.

David, aged 64, has now joined his legal team at Irwin Mitchell in calling for lessons to be learned.

Megan Walker, the specialist medical negligence lawyer at Irwin Mitchell representing David, said:

“Angela was a much-loved wife, mum and grandma, whose death has had a profound effect on all her family.

“Sadly, worrying issues in the care she received, and which contributed to her death, have been identified.

“While nothing can make up for what’s happened it’s now vital that the hospital trust learns lessons from the issues in this case to improve patient safety for others.

“We continue to support David and his family at this distressing time.”

Call for lessons to be learned

Ms Laybourn, who was diagnosed with multiple sclerosis in 1999 and was paralysed from the neck down, died in the early hours of 24 January, 2022, after suffering a cardiac arrest.

Her cause of death was sepsis and metabolic acidosis caused by kidney stones. 

She had a history of kidney stones. In December 2021 she underwent surgery to try and remove them. However, doctors were unable to remove all of the stones because of the complexity of the procedure.

Following legal submissions by Irwin Mitchell, the trust admitted that there was a failure to recognise and treat metabolic acidosis following her first admission on January 17. She shouldn’t have been discharged on 20 January, the trust acknowledged.

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An internal investigation report by the hospital trust into Angela’s care identified a total of 18 key findings, root causes and contributory factors into her care.

These included that blood tests that showed metabolic acidosis following her initial hospital admission were not documented when Angela was assessed on a ward.

Mr Laybourn, who was Angela’s carer for 15 years, added: 

“The only way I could describe losing Angela was total devastation. As a family, we couldn’t believe that she was really gone. The grandchildren were knocked for six. Angela’s whole life was based around her grandkids and kids, everything she did was child orientated. She has been taken from all of us.

“The first time that I was aware that Angela had been suffering from metabolic acidosis, was when we received her death certificate. We searched online for the term and were just in complete shock as looking at the symptoms that Angela had they fit the box of metabolic acidosis.

“We just felt let down that no one had picked up on this and that Angela could have been treated for this.

“I miss her all the time. The loss of Angela has created an emptiness in my life which will never be filled. All I can hope for is that by speaking out improvements in care can be made as I wouldn’t want others to go through the pain our family is.”

Trust apologises

Dr Jacqueline Andrews, executive medical director at Harrogate and District NHS Foundation Trust, said:

“We would like to offer our sincere condolences to the family and friends of Mrs Laybourn.

“We failed to deliver the level of care Mrs Laybourn and her family should have been able to expect and for this we would like to sincerely apologise.

“We are committed to learning from what has happened and are implementing new systems and processes to reduce the likelihood of important blood test results being missed to ensure we do all we can to prevent such incidents from occurring in the future.”

Harrogate hospital braced for winter junior doctors strikes

Harrogate District Hospital is braced for two sets of winter strike action as junior doctors stage further walkouts.

Members of the British Medical Association and the Hospital Consultants and Specialists Association announced the industrial action amid a dispute over pay with government.

The latest round of walkouts will take place from 7am on Wednesday, December 20, until 7am on Saturday, December 23 for BMA members.

However, HCSA members will stop strikes a day earlier on 7am Friday, December 22.

Meanwhile, a further walkout from the BMA will take place in the new year on Wednesday, January 3, until 7am on Tuesday, January 9.

Dr Robert Laurenson and Dr Vivek Trivedi, BMA junior doctors committee co-chairs, said:

“We have been clear from the outset of these talks that we needed to move at pace and if we did not have a credible offer, we would be forced to call strikes. After five weeks of intense talks, the government was unable to present a credible offer on pay by the deadline. 

“Instead, we were offered an additional 3%, unevenly spread across doctors’ grades, which would still amount to pay cuts for many doctors this year. It is clear the government is still not prepared to address the real-terms pay cut doctors have experienced since 2008.”

Harrogate and District NHS Foundation Trust said the industrial action is likely to impact on services and some appointments and elective surgery will be cancelled.

However, hospital officials said patients should continue to attend appointments unless contacted to reschedule.

A statement from the trust said:

“We understand this may cause our patients and their families to worry about how services will be delivered during this period. The safety of our patients is our primary concern and we have developed plans for the proposed action and its impact on our services, patients and staff. We are working hard to prioritise resources to protect emergency treatment, critical care, neonatal care, maternity, and trauma, and ensure we prioritise patients who have waited the longest for elective care and cancer surgery.

“Patients should continue to attend appointments as planned unless contacted to reschedule. We will only reschedule appointments and procedures where necessary and any postponed appointments will be re-arranged as a priority. We appreciate this situation is frustrating for patients affected and apologise for any inconvenience caused.

“Regardless of any strike action taking place, it is important to know that people with life-threatening or severe illnesses or injuries should continue to dial 999 and come forward as normal.”

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Harrogate hospital defends criticism of new parking payment system

Harrogate District Hospital has defended appointing Parkingeye to oversee its car parks after criticism from patients.

The hospital brought in the company to operate its new parking arrangements in September, which includes automatic number plate recognition and a ticketless system.

However, some patients and visitors have criticised the decision after being given fines due to problems paying for parking.

Derek Sendrove and his wife, Zhanna, used the hospital car park in October when both were receiving treatment.

Mr Sendrove said the couple had registered their card with the app, which makes it possible to pay for parking via mobile phone.

Derek Sendrove.

Derek Sendrove.

However, on a visit on October 30, which lasted 44 minutes and would cost £4, the card was not recognised. 

Mr Sendrove said the card has been valid every other time they have used the car park.

The couple were subsequently handed a £70 fine by Parkingeye, which Zhanna appealed but was refused. The pair have since taken the decision to Parking On Private Land Appeals, the industry arbitrator.

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Mr Sendrove told the Stray Ferret he felt the incident raised questions over why the hospital chose the parking company in the first place.

He said:

“It seems that Parkingeye are profiting from their own faulty app, and it is also rather surprising that instead of choosing another app, Appy Parking, which is installed throughout the town; for some inscrutable reason, Harrogate hospital have chosen to partner with a different organisation, Parkingeye.”

The Stray Ferret took Mr Sendrove’s concerns to Harrogate and District NHS Foundation Trust and asked whether it had any response to the question over its choice of provider.

A spokesperson for the trust said:

“Parkingeye has extensive experience of working with NHS organisations and currently manages parking at over 30 NHS trusts and more than 680 healthcare sites. After careful consideration Harrogate and District NHS Foundation Trust chose Parkingeye to provide a car parking management service at Harrogate District Hospital.

“Since the introduction of the new camera controlled barrierless system at Harrogate District Hospital, congestion has significantly decreased on Lancaster Park Road due to the improved access into our car parks ensuring that visitors can get to their appointments on time and visit their loved ones.

“On occasion a parking charge notice may be issued to motorists who do not follow the parking rules which are displayed on the parking signage.

“A motorist has the opportunity to challenge the decision through Parkingeye’s appeal process. Parkingeye will consider the evidence and circumstances and if it is appropriate may cancel a parking ticket.

“Should the motorist still wish to contest the decision, they can contact Parking on Private Land Appeals (POPLA), an independent organisation that allows motorists to contest the decisions of parking operators by visiting https://www.popla.co.uk/. POPLA will look at both sides of the appeal, consider the evidence provided and ultimately decide to uphold or overturn the ruling made by the parking management company.”

A Parkingeye spokesperson said:

“Parkingeye has partnered with Harrogate District Hospital since September this year to significantly improve how its car parks operate.

“During this time there has been investment in modern consumer-facing systems which has enhanced accessibility and made parking at the hospital easier and safer for staff, patients and visitors. The system is designed to ensure the efficiency and smooth operation of the hospital by ensuring that patients, visitors and staff park in their allocated car parks.

“The car park features over 30 prominent and highly-visible signs providing information on how to use the car park responsibly, including guidance that patients and visitors must pay on exit using one of the user-friendly payment kiosks or through the Evology payment app.

“The motorist received a parking charge after parking in an area that is reserved for patients and visitors and not making a payment. Our systems also show that the Evology app was working effectively and took a normal level of transactions on October 30th.

“Parkingeye operates a BPA (British Parking Association) audited appeals process, which motorists can use to appeal their parking charge.

“The motorist’s appeal was unsuccessful and is now being reviewed by POPLA, the independent appeals service.”

What’s your experience of using the new Parkingeye app at the hospital? Get in touch on contact@thestrayferret.co.uk

 

‘Flatlining’ North Yorkshire stop smoking service blamed on lack of medicines

Efforts to help people stop smoking are being undermined by the unavailability of key medicines, North Yorkshire councillors have heard.

North Yorkshire Council’s executive heard while the authority’s public health team had seen improvements in the numbers of people quitting since taking its stop smoking service in-house, fewer people were using the service due to “no access to Varenicline (Champix) or Bupropion (Zyban)”.

The medicine issue was highlighted by the authority’s scrutiny of health committee chair, Cllr Andrew Lee, referred to performance figures which he said showed the council’s stop smoking results were “flatlining a little bit”.

According to Public Health England statistics in 2021, Harrogate and Scarborough have the highest smoking prevalence across North Yorkshire with 14.4% and 13.6% respectively.

Smoking remains the single largest cause of preventable ill health and premature death in the county and is a key driver of health inequalities.

Nearly 3,000 deaths in North Yorkshire between 2014 and 2016 were estimated to be attributable to smoking.

Analysts say the government’s target for England to become smoke-free by 2030 is being significantly hampered by the unavailability of smoking cessation medicines, and in particular “nicotine receptor partial agonists”.

Medicines such as Varenicline work by stopping nicotine from binding to receptors in the brain and reducing the rewarding effects of smoking.

When asked to explain why the number of people stopping smoking had tailed off, health and adult services director Richard Webb said there had been an improved level of quitting since the council had taken the service back in-house, before he pointed to the lack of medicines.

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An officer’s report to the executive meeting stated quit rates were remaining low compared to previous years.

It stated the reductions in people accessing the service had been “largely driven by the limited access to stop smoking medications over the course of the last 18 months”.

The report stated although e-cigarettes have been an option as a stop smoking tool since July this year, e-cigarettes were only available via the Living Well Smokefree service and not through primary or secondary care, as well as not being available for pregnant smokers.

It added:

“Whilst it is still too early to quantify if this has influenced referral rates into the service and therefore successful quits, it will be interesting to compare to previous years and previous quarters to establish this if this is the case.

“We also expect the return of medications to market that support an individual to stop smoking.”

Strikes cost Harrogate hospital £1.5m this year

Industrial action has cost the trust which runs Harrogate District Hospital £1.5 million in 2023.

The hospital has been hit by numerous strikes in the last 12 months, with consultants and junior doctors staging walkouts in disputes over pay.

Harrogate and District NHS Foundation Trust said the figure was an “unavoidable cost” as a result of the strikes.

The move comes as NHS England has told hospital trusts to reduce targets for routine care in order to pay for the industrial action.

National health officials have estimated that the 40 days worth of strike action has cost NHS trusts £1 billion.

In a letter signed by Julian Kelly, the chief financial officer for NHS England, and Steve Powis, the national medical director for NHS England, local trusts were told that elective surgery targets would be scaled back.

It said:

“For the remainder of the financial year our agreed priorities are to achieve financial balance, protect patient safety and prioritise emergency performance and capacity, while protecting urgent care, high priority elective and cancer care.”

Currently, Harrogate hospital has 822 people waiting more than 65 weeks for surgery. No patients are waiting longer than 78 weeks.

However, a spokesperson for Harrogate and District NHS Trust, told the Stray Ferret that it does not expect NHS England’s target adjustment to affect its plans to tackle waiting lists.

They said:

“NHS England’s decision to reduce the elective activity target for 2023/24 is not expected to have a significant impact at HDFT.

“At the start of 2023, we had 2,918 patients awaiting surgical treatment who would have waited 65 weeks or longer by the end of March 2024. This number had reduced to 822 patients by November 2023 and we are currently on track to ensure no patient will be waiting beyond 65 weeks by the end of March 2024.

“We will continue to focus on cancer pathways to ensure we are able to get to a diagnosis within 28 days from referral and provide treatment within 62 days.

“HDFT is committed to providing the best possible healthcare for our patients and to ensure they can be seen at the earliest opportunity.”

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Harrogate hospital postpones 41 operations due to strikes

Harrogate District Hospital postponed 41 operations as a result of last week’s consultants and junior doctors strikes.

Members of the Hospital Consultants and Specialists Association and British Medical Association walked out from 7am on Monday, October 2, until 7am on Thursday, October 5.

Both junior doctors and consultants held the industrial action in a dispute over pay and conditions.

Harrogate and District NHS Foundation Trust confirmed 41 outpatient appointments were cancelled across a range of hospital services due to the walkout last week.

A spokesperson for the trust added:

“These have been re-arranged as a matter of priority. We are in discussions with six patients to confirm new dates for their operations.”

The trust confirmed that internal and bank staff were used to cover the strikes.

Bank staff are temporary workers who agree to work flexible shifts with a hospital trust. Some trusts keep a record of their own bank staff to call upon for shifts.

However, a trust spokesperson added that a total figure for the cost of staffing will not be available until the end of the month.

It comes as Harrogate hospital has been hit by numerous strike action this past year.

Between April 1 and August 31, junior doctors and consultants have staged multiple walkouts with some lasting as long as 48 hours.

The Stray Ferret reported last month that the trust spent £923,000 on staff cover for industrial action in the same time period.

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Council to bid for £1.7m emergency funding for hospital discharges

North Yorkshire Council looks set to bid for up to £1.7 million worth of funding to help ease pressure on hospital emergency departments.

The Department of Health and Social Care has invited local authorities to apply for grants to help with discharges in social care, which in turn will support accident and emergency units.

Ministers have allocated North Yorkshire as one of the authority areas which has the “greatest health and care challenges”.

The government has given the council an indicative funding amount of £1.1 million, but has encouraged it to apply for up to £1.7 million.

A report by Abigail Barron, assistant director for prevention and service development at the council, has proposed a number of measures as part of the council’s bid.

Among them include employing additional agency social workers to speed up discharge allocations, establishing winter grants for the voluntary sector to help with prevention and developing additional support for unpaid carers.

Ms Barron said the measures would help to “avoid hospital admissions and expedite discharge and flow”.

She added:

“The schemes will also assist North Yorkshire Council’s strategic objective of both supporting hospital discharge and reducing reliance on short stay residential beds.”

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The move comes after Harrogate District Hospital managers raised concern that patients were staying in hospital longer than they should because of a lack of private care services.

Last year, Jonathan Coulter, chief executive at Harrogate and District NHS Foundation Trust, said the issue had a knock on effect on emergency departments and was the “biggest issue” that the trust faced.

In September 2022, the trust also outlined plans to launch its own home care service in a bid to free up hospital beds.

At the time, the move was met with some concern by councillors who said it could “distort the market”.

‘No timeline’ for £1.8m care facility at Cardale Park

Council officials have said no timeline has been set on proposals for land at Cardale Park in Harrogate which was purchased to provide care services.

The three-acre site on Beckwith Head Road in Harrogate was previously owned by Tees, Esk and Wear Valleys NHS Foundation Trust, which runs mental health services in the district.

North Yorkshire County Council, which has now been replaced by North Yorkshire Council, completed a £1.8 million purchase of the land last year.

At the time, the authority said it had bought the site in order to progress a “scheme to assist with social care market development in the Harrogate area”.

In February, the council said it was “examining the best options” for the site.

The Stray Ferret asked North Yorkshire Council whether it had any timescales for bringing forward a proposal for the site.

Richard Webb, the council’s director of health and adult services, said:

“We cannot at this stage provide you with a timeline as we are still in the process of examining the best options for meeting the community’s needs and will bring forward a scheme in due course.”

The land was previously given approval for a 36-bed mental health facility on the site, following the closure of Harrogate District Hospital’s Briary Unit, which helped adults with mental illness.

However, those plans were dropped in 2019 and inpatients on the unit were sent to Foss Park Hospital in York instead.

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Harrogate hospital hoping to learn lessons from Lucy Letby murders

Senior figures at Harrogate District Hospital have said they want to learn lessons from the Lucy Letby murders to prevent similar crimes from happening in Harrogate.

Letby is a former neonatal nurse who murdered seven infants and attempted to murder six others at the Countess of Chester Hospital between 2015 and 2016. She was sentenced to a whole life order last month.

Harrogate and District NHS Foundation Trust’s board met on Wednesday at the Crowne Plaza in Harrogate where the Letby case was top of the agenda.

Emma Nunez, director of nursing and Jacqueline Andrews, executive medical director, gave a presentation that outlined what procedures the hospital has in place to spot patterns of behaviour and how it listens to concerns from staff.

Ms Nunez said:

“It’s difficult to stand here and say we are completely assured that it couldn’t happen here, there’s not an organisation in the country that could say that. However, through our good governance and staff engagement we are in a very good place.”

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She added that the trust has spent time looking at its quality governance, which has included establishing an end-of-life mortality committee to review deaths and prioritising its safeguarding committee. 

Ms Nunez said: 

“Mortality review is something nationally we’ve been asked to look at and how we monitor unexpected deaths.”

Ms Andrews reassured the board that the hospital has the resources to identify anomalies in mortality data which could lead them to investigate potential crimes.

She said: 

“We get a lot of mortality data, we have easily accessible data and we get a monthly alert on any mortality that’s an outlier. We do a deep dive into every one of them.”

Several doctors in Chester who worked alongside Letby said they tried to raise the alarm with hospital managers but were ignored.

Ms Nunez said the trust holds weekly talking sessions with staff where they can speak to managers.

She said she believes the trust fosters a culture where staff are able to voice concerns but she admitted there were still members of staff that were difficult to reach.

She said:

“We have quite a flat structure where it’s not unusual to see staff openly have concerns with executive team. At back of mind, what about the ones who are more difficult to reach? 

“That’s the question we need to ask ourselves, how do we reach those people?”

Harrogate hospital ‘crumbly concrete’ to cost £20m to eradicate

Health officials have estimated it will cost £20 million to eradicate “crumbly concrete” from Harrogate District Hospital.

RAAC, which stands for reinforced autoclaved aerated concrete, is a lightweight material that is less durable than traditional concrete and has a life expectancy of just 30 years before it runs the risk of collapse.

The first section of Harrogate District Hospital was built in 1975 during a period when RAAC was used in the construction of public buildings.

A report about the material at the Lancaster Park Road hospital was discussed at a meeting of Harrogate and District NHS Foundation Trust’s board yesterday at the Crown Plaza hotel.

The report said a full survey of the estate by engineers WSP found 2,500 RAAC panels. It added that remedial works have been completed on 12 “high-risk” panels with some theatres and corridors in the hospital made safe with props.

The report said there will be an annual survey of all RAAC panels and a roof with the concrete will be replaced.  

It said there may also be further propping of panels that are in danger of collapsing.

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To eradicate RAAC from the site, the trust has bid for £20m of funding to NHS England, which includes relocating demolishing and rebuilding a therapy services building.

Whilst there is RAAC present at Harrogate hospital, it is not as prevalent as in other hospitals in Yorkshire such as Airedale in the Bradford district. In May, the government announced it will be completely rebuilt due to RAAC.

Jonathan Coulter, chief executive at Harrogate and District NHS Foundation Trust’s, addressed RAAC in a statement.

He said: 

“There has been a flurry of activity in respect of the management of estate where there is RAAC present. This followed the concerns raised at the end of last month across the education system.

“To be fair, the NHS has been very aware of this issue and risks are being managed, but there is now greater concern and the threshold for risk is being challenged.

“As the board will be aware, we do have some RAAC across the HDH site that we survey regularly, manage, and have a plan for gradual replacement. As part of our capital plans, including our new theatre build, we are reviewing and assessing the potential to tackle this issue more quickly.”