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Reports reveal threats to NHS patients' safety

· Women raped in psychiatric wards

· Poor medical training causing drug deaths

Wednesday July 19, 2006

The safety of patients within the NHS came under fresh

scrutiny yesterday after evidence emerged of women

raped in psychiatric wards, and patients dying because

of prescribing errors by badly trained junior doctors.

The revelations came as Sir Ian Kennedy, author of the

blueprint for NHS reform written after the Bristol

babies scandal, warned that patients' safety was still

not the priority it should be.

The National Patient Safety Agency said there were at

least 19 rapes of mental health patients in England,

and more than 100 other improper sexual incidents in

psychiatric units over the last two years.

Eleven of the rapes were alleged to have been by NHS

staff, but the agency did not disclose whether staff

were also involved in 20 cases of consensual sex,

three unwanted pregnancies, and allegations of

exposure, sexual advances and touching. Louis Appleby,

the government's mental health tsar, ordered a review

of the most serious incidents, and asked every mental

health trust to put in place measures to ensure the

sexual safety of inpatients.

But Mind, the mental health charity, said the

initiative came too late to protect women who

continued to be abused on mixed-sex wards. It accused

the government of reneging on a promise to abolish

mixed-sex accommodation, and of doing nothing to stop

" multiple incidents of abuse " this year since

ministers became aware of the problem.

The evidence that mistakes by junior doctors in

issuing prescriptions kill hundreds of patients each

year came from four pharmacologists, including Sir

Michael Rawlins, chairman of the National Institute

for Clinical Excellence.

They blamed the problem on changes to training.

Students are no longer examined on how drugs interact

with the body, and which drugs to prescribe. Many

receive minimal teaching, and at least a quarter of

medical schools have closed their pharmacology

departments. As a result, junior doctors leave medical

schools with less knowledge of how to use drugs than

nurses, and at risk of harming patients. The exact

numbers of deaths they cause is unknown, but at least

10,000 people a year die from adverse drug reactions,

three-quarters of which are avoidable.

David Webb, professor of clinical pharmacology in

Edinburgh and chair of the Scottish Medicines

Consortium, said: " There's no doubt that patients are

becoming ill and some are dying as a result of poor

prescribing. " Prof Rawlins added that young doctors

were " taught about drugs to treat a particular

condition but not about the underpinning principle for

how it works and the balance between the benefits and

harms of the drug " . He insisted students should have

to pass exams in clinical pharmacology and basic

pharmacology before qualifying as doctors, as they did

before reforms 12 years ago.

In a speech tonight Sir Ian Kennedy will say reforms

have failed to secure a safe health service. For all

the talk of the choice agenda, needs and interests of

patients are still not at the heart of the way the NHS

operates and doctors and managers think, he will say.

" Government reforms might edge towards that but they

are not radical enough to achieve that goal, " he said

yesterday. After the Bristol report, hailed as a

blueprint for NHS reform, the government set up the

National Patient Safety Agency to collect information

on mistakes by staff. Yet the National Audit Office

recently detailed the deaths and damage still

occurring: nearly 1m incidents and near-misses were

reported in a year, of which 30% were avoidable. There

were between 800 and 34,000 deaths but the NHS had no

idea of the exact figure.

Replying to the assertions about prescription deaths,

a Department of Health spokesman said that junior

doctor training had been reformed last August: " All

now have to prove they are skilled in prescribing

before they are able to move up to the next level of

training. Skills junior doctors must demonstrate

include being able to take accurate patient drug

histories, recognise the sources of medication error

and ways to minimise it, and prescribe drugs

appropriately. "