Mother of anorexic girl killed by train criticises care failings after inquest

The mother of a severely anorexic 15-year-old girl who died after stepping in front of a train has said that failings in her daughter’s care “from beginning to end” resulted in her death.

Pippa “Pip” McManus was granted home leave from the Priory hospital in Altrincham, Greater Manchester, ahead of completion of the formal discharge process, in December 2015.

Five days later, after a family row, she walked to Gatley station in Stockport and was hit by a train. She was pronounced dead at the scene.

A jury at South Manchester coroner’s court concluded on Wednesday that Pip had taken her own life, but said that the lack of support provided to her family and the delay in implementing a care plan when she arrived home could have been contributory factors in her death.

The court was told that Pip’s parents had reservations about their daughter’s release, as they believed she remained in danger of self harming but felt they had no option but to go along with the decision.

Reading a statement outside the court after the verdict, Pip’s mother, Marie McManus, said her daughter’s death had caused a “tear in the thread of our family [that] will never be mended”.

“Anorexia has the highest mortality rate attributed to any psychiatric illness, with as many as 40% of deaths [of those with anorexia] due to suicide,” she said. “Too many of our children are dying from this terrible illness. Effective treatment is needed more quickly and if this had been available to our beautiful daughter, maybe she would still be alive. Maybe we would not have needed this inquest.”

Jim McManus, Pip’s father, said that throughout the three years of his daughter’s illness there were many more failings than that of not creating an adequate plan for her discharge from the clinic. “From start to finish there were many hurdles, which we felt we were failed on,” he said.

The court was told that Pip talked to her mother about suicidal thoughts on many occasions and that once, the family had found goodbye letters written to her family, dog and doctor. One note read: “I do want to grow up and have a life; at the moment I don’t have one. I can’t fight anorexia any more. I have tried so very hard, but it has won me.”

A medical report made a week before the teenager died judged that absconding, suicide and deliberate self-harm were not “current risks” in Pip’s case. Janet Walsh, a consultant adolescent psychiatrist who was in charge of her care at the Priory, told the inquest that 40% of people with the teenager’s condition relapsed.

“She would still have risks with eating habits and exercise, it’s whether they could be managed,” she said. “There are going to be ongoing issues. You don’t get a young person at discharge without significant problems.

“It is about whether you can get a young person to a stage where it is reasonable to do a trial at home. I was concerned she might end up back in hospital, but it is an important learning process. My fears were about long-term hospitalisation. She had been in a long, long time and she was getting frustrated.”

The jury in Stockport decided that the decision to send Pip home had been appropriate, “as this was deemed to be the lowest risk option”. The jury foreman said: “The planning for discharge was not carried out in a timely manner. This resulted in not all necessary support packages being in place at the time of discharge.”

The jury also concluded that Pip’s parents had not been adequately warned of “the statistically increased risk of suicide in the first week following discharge”.

Pip was formally diagnosed with anorexia at 13, before a deterioration in her mental and physical health led her to be detained by the private hospital in Altrincham in September 2014 under section 3 of the Mental Health Act. When she arrived at the facility she weighed 27kg (4st 3lbs), which Dr Walsh said was “probably the most severe case” she had seen.

Responding to the inquest verdict, Paula Stanford, director of the Priory hospital in Altrincham, said: “Our heartfelt sympathies are with Pip’s family and we will now carefully consider the findings of the jury.”

Deborah Coles, director of the charity Inquest, said Pip’s death had exposed serious failings in the mental health system in relation to the discharge of a highly vulnerable child. “Her terrified family knew there was huge risk,” she said.

• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

Mother of anorexic girl killed by train criticises care failings after inquest

AMA head criticises "demonisation" of big pharma by anti-vaxxers

The president of the Australian Medical Association, Dr Michael Gannon, says it has been disappointing to see a growing “demonisation of pharmaceutical companies” by the anti-vaccination movement in an attempt to promote distrust of proven medicines.

Gannon made the comments in response to the NSW health department recommending reforms that, if implemented, would see parents of high-school students compelled to provide details of their child’s vaccination status, and give public health officers the power to exclude unvaccinated children from high schools during disease outbreaks.

This policy already applies to children in childcare and primary school, but may be extended under the Public Health Act to apply to high schools. A bill reflecting the recommended changes will be drafted and considered by the parliament in 2017.

Gannon told Guardian Australia he supported the changes, which would see unvaccinated children banned from childcare and school for up to two weeks if they come into contact with a child suffering a vaccine-preventable disease — even if they aren’t sick themselves.

“I’m reluctant to make the comparison between anti-vaxxers and climate change deniers, but it almost seems if you can shout louder than the careful, temperate advice from medical professionals and scientists you might get support for your non-scientific views,” he said.

A report from the NSW Child Death Review Team, published on Tuesday, found that in the decade to 2014, 23 child deaths may have been prevented had the children been vaccinated.

Gannon said he believed there was a growing distrust of the medical profession and of big pharma which may be fuelling the anti-vaccination movement.

“Let’s be clear that the pharmaceutical industry is not without sin,” he said.

“But it is disappointing to hear this demonisation of vaccinations as a result of this distrust, and overall the pharmaceutical industry improves and saves tens of millions of lives, without exaggeration, each day.

“The processes by which vaccines get approved and by which the relevant commonwealth government departments decide which medicines to spend tens of millions of taxpayers’ dollars on is very careful, and has to be.

“Vaccines approved have to represent value for money and have to be safe. The idea that big pharma rolls into town and that their latest idea gets approved without scrutiny is ludicrous.”

He said vaccines and their safety were continuously scrutinised and reviewed at a level that “many other things in the community aren’t”.

The director of communicable diseases for NSW Health, Dr Vicky Sheppeard, said that in recent years the incidence of some diseases preventable by vaccine, such as measles, had been higher in high-school-age children than in younger children.

“All recent measles outbreaks in NSW have tended to affect high-school children rather than primary-school children,” she said.

“Since then, catch-up measles vaccination has been offered in all NSW high schools, further reducing the risk of outbreaks occurring in this setting.”

AMA head criticises "demonisation" of big pharma by anti-vaxxers

Coroner criticises care of woman who died after kidney stone operation

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Third inquest into death of Carmel Bloom 14 years ago rules that ‘absences’ in routine aftercare contributed to cardiac arrest

A series of medical “absences” played a part in the death of a woman 14 years ago after a routine kidney stone operation, the third inquest into her death has ruled.

Carmel Bloom, 54, from Ilford, Essex, died on 8 September 2002, after surgery at the private Roding hospital in Ilford, where she worked as a health controller. She was taken to Whipps Cross intensive therapy unit (ITU) but died after her blood pressure fell and she suffered cardiac arrest.

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Coroner criticises care of woman who died after kidney stone operation

GP labelled hypochondriac criticises colleagues after dying from cancer

A GP who died from a rare form of kidney cancer has warned of the difficulties doctors face in getting treatment for themselves, in an emotional blog published posthumously.

Dr Lisa Steen described her anger at colleagues for failing to go the extra mile to help identify the disease and for dismissing her as a hypochondriac, in the essay published on BMJ.com.

The 43-year-old mother-of-two from Cambridge wrote of spending “two years wandering in the wilderness of the medically unexplained” before finally being diagnosed in July 2014, by which time the cancer had spread to her bones. She died in February.

She wrote: “I do not know how long I’ll live. It probably won’t be for many weeks. But right now I am glad to be alive. I am grateful for the expensive drug which is holding back the cancer.

“I am angry at being left in the medically unexplained wilderness and I did not like the way my colleagues looked at me, when they believed me to have health anxiety.”

Steen said hers was a cautionary tale for all health professionals who get ill, and for doctors treating other health professionals.

Affected by myriad symptoms, she eventually attended her GP in August 2012. Various tests failed to lead to a diagnosis and her condition was put down to health anxiety.

Steen, who was a GP for the drug and alcohol service Inclusion, wrote of her frustration at trying to describe her symptoms to doctors, and trying to diagnose herself.

She tried to explain that the symptoms might be connected to a benign carotid body tumour she had had when she was younger.

Her attempts to get investigatory tests and treatment were thwarted, she said, because of a “fear of looking even more ‘anxious’ or suffering from ‘health anxiety’, aka a hypochondriac”.

Eventually, embarrassed by being off work with no diagnosis, she returned to work. “I still knew there was something wrong, but it seemed fruitless going to see specialists. It was so humiliating, feeling like a goldfish with no voice. Watching doctors’ faces glaze over at the multitude of symptoms. Trying to fit it all in with work and looking after my family.”

After two years and prompted by weight loss, a routine ultrasound revealed a mass.

Steen wrote: “If any one of the doctors I saw had gone another mile, they would’ve stumbled upon it.”

But, she said: “they were reluctant to lay their hands on and examine a fellow medic”. And on her part, she said: “I was too embarrassed about my ‘psychiatric’ condition, too confused by not having the whole answer ready.”

She added: “My story is a cautionary tale to all of us health professionals when we get ill. Illness is somehow not the done thing. It upsets our ‘them/us’ belief system, which helps us cope with the horror of what we see.

“Mine is a cautionary tale to those treating health professionals, and those of us who are unwell – doctors do get ill, they don’t always know what is wrong with themselves. Give them a class A service because it is actually harder getting treated as a doctor than a layperson.”

Her husband, Raymond Brown, told the Telegraph: “They didn’t seem to be taking her too seriously, particularly because she had been diagnosed with health anxiety, she was being looked at as a hypochondriac.”

He added: “She just wants doctors to be aware when they are treating doctors to give them really good treatment and they have to be aware they are a patient and they don’t know everything. They need to be treated like a patient, not like a doctor.”

GP labelled hypochondriac criticises colleagues after dying from cancer

NHS boss Simon Stevens criticises lack of diversity in management

The new chief executive of the NHS, Simon Stevens. Photograph: Owen Humphreys/PA

The NHS’s new boss has criticised the lamentable lack of managers from black and ethnic minority backgrounds concerned in working hospitals which, he warned, meant they are not reflecting the communities they serve.

Simon Stevens, who began last month as chief executive of NHS England, explained he is so concerned that he is building a prepare to tackle the service’s inaction over the lack of diversity in its leadership, which he claimed was holding the NHS back.

Regardless of pledging a decade ago to tackle the stark imbalance the NHS’s record was bad and worsening, Stevens stated in a speech at the King’s Fund wellness thinktank on the want for cultural adjust and robust leadership.

“It can not be right that 10 years soon after the launch of the NHS race equality program, although 41% of NHS personnel in London are from black and ethnic minority backgrounds, similar in proportion to the Londoners they serve, only 8% of believe in board directors are, with two-fifths of London trust boards getting no BME directors at all.

“Related patterns apply elsewhere, and have truly been going backwards”, Stevens additional.

The chronic lack of non-white faces in senior positions meant the NHS was missing out, he added. “Yet diversity in leadership is related with much more patient-centred care, greater innovation, higher personnel morale, and entry to a wider talent pool”, he informed an audience of about 250 NHS leaders.

He himself had benefited in his career from getting had three black bosses and a woman as his line manager, even though they have been all when he was operating outdoors of the NHS, stated Stevens. The 47-yr-old worked as an NHS manager before getting to be a particular adviser to Labour overall health secretaries Frank Dobson and Alan Milburn in the early years of Tony Blair’s government and then with Blair in Downing Street. He has spent the last decade considering that quitting Amount 10 for a senior publish with UnitedHealth, the American personal overall health group.

Sir David Nicholson, whom Stevens replaced on one April, lately recognized the lack of black and ethnic minority bosses across the NHS as one particular of the failings of his eight years in the task.

Stevens has asked an equality and diversity group inside NHS England to come up with concepts to tackle the shortage by the time it up coming meets on 29 July.

In the speech Stevens also hinted for the 2nd time in his number of public appearances so far that he opposes the idea, extensively supported by health policymakers, that specialist health-related and surgical providers ought to be heavily centralised, calling into query the viability of smaller hospitals.

“We want to give careful bodyweight to communities’ own values and preferences for access versus specialisation”, he said, in a coded warning that the push to centralise risked alienating local people.

The turnaround in the fortunes of Hinchingbrooke hospital in Cambridgeshire, which for two many years has been run by the personal healthcare company Circle, showed that smaller district standard hospitals could have a sustainable future, he additional.

NHS boss Simon Stevens criticises lack of diversity in management

Chief health care officer criticises media acceptance of currently being overweight

Dame Sally Davies has outlined the value of reducing sugar consumption across the United kingdom. Photograph: Nick Ansell/PA

England’s chief medical officer has criticised outfits companies and the media for assisting to make individuals consider that getting obese is normal.

Dame Sally Davies accepted that the typical man and woman had been overweight and stated the public need to be given a sound knowing of how to alter their diet and steer clear of soft drinks with additional sugar.

“I have extended been concerned about the presentation of underweight as an best fat, particularly in the trend sector,” Davies mentioned in her yearly report.

“Nevertheless I am increasingly concerned that society could be normalising overweight. For illustration: bigger mannequins are being launched into clothes stores “dimension inflation” indicates that garments with the very same size label have turn into bigger in latest decades and news stories about obese often characteristic images of severely obese folks, which are unrepresentative of the vast majority of the overweight population.”

Davies, concerned that two-thirds of adults and 1 third of kids between two and 15 are obese or obese, mentioned that in England the typical man weighed 84kg (13st 3lb) and was 175cm tall (practically 5ft 9in). The common female weighed 70kg (just more than 11st) and was 162cm (practically 5ft 4in) tall. NHS guidance, not cited in her report, suggests a wholesome man of regular height must weigh in between 58kg and 75kg and a girl of regular height must weigh between 49kg and 73kg. She also explained that if meals makers failed to supply on guarantees to minimize added sugar then “we, as a society, may want to consider the public wellness benefits that could be derived from a regulation such as a sugar tax.”

Though she welcomed progress by the foods sector to lessen the quantity of salt in meals, there was far even more to go, she stated. She also referred to as for investigations into anecdotal proof that rapidly-food shops have been opening close to colleges to serve schoolchildren performing lunch hrs and backed Public Well being England’s briefing for regional authorities on how councils could regulate their development.

Davies, the principal healthcare adviser for the Uk government, also condemned the “unacceptably high” relative danger related with walking or cycling, saying the danger of death per kilometres was 17 instances greater for these kinds of energetic travel than going the identical distance by vehicle.

Her report, laden with political challenges, indicates disappointment at ministers’ shelving final summer season of minimum unit pricing for alcohol in England. A strategy for it to be launched by the Scottish government is currently being legally challenged by the drinks business.

Davies, concerned by a possibly massive enhance in deaths from liver ailment, welcomed the government’s move to stop alcohol currently being sold beneath the cost of duty plus VAT from next week, that means an ordinary 440ml can of beer or lager can’t be sold under 50p, although there are “floor rates” for other drinks. But she extra: “I note that modelled information suggests that charging a minimum of 45p per unit of alcohol ought to be far more powerful in lowering premature deaths.”

She said: “Retailers continue to promote alcohol employing techniques which I take into account to be irresponsible. I deplore the methods merchants use to entice buyers to obtain ever higher quantities of alcohol.”

These incorporated multi-purchase offers, offering alcohol at beneath price value and the redefining of “small glasses of wine” by bars and eating places, which had been omitting from menus the 125ml measure they have been legally obliged to provide. The substantial degree of alcohol marketing around football matches broadcast on Television was also especially regarding due to the fact of the variety of youngsters who observe, explained Davies.

Chief health care officer criticises media acceptance of currently being overweight

Chief health-related officer criticises alcohol delivers in supermarkets, outlets and bars

England’s chief medical officer ideas to publish new advice on the optimum quantity of alcohol it is risk-free to eat. Photograph: David Cheskin/PA

England’s chief health care officer has criticised “irresponsible” supermarkets, shops and bars for enticing consumers to purchase “ever greater quantities of alcohol”, and signalled a continuing battle with ministers in excess of the need for minimum unit pricing.

Dame Sally Davies strategies to publish new advice on the optimum amount of alcohol it is safe to consume within the subsequent 12 months. She also repeated warnings that a “sugar tax” could have to be launched if the food business does not ramp up voluntary moves to curb added sugar in merchandise.

Davies, the principal medical adviser for the Uk government, has also condemned the “unacceptably substantial relative” threat associated with strolling or cycling, saying the chance of death per kilometre is 17 instances greater for these forms of “energetic travel” than going the very same distance by vehicle.

Her annual report, laden with political challenges, signifies frustration at ministers’ shelving last summer of minimum unit pricing for alcohol in England. A program for it to be introduced by the Scottish government is currently being legally challenged by the drinks industry.

Davies welcomes the coalition government’s move to avoid alcohol becoming sold below the value of duty plus VAT from subsequent week, which means an ordinary 440ml can of beer or lager are not able to be sold beneath 50p, whilst there are “floor rates” for other drinks. But she adds: “I note that modelled data suggests that charging a minimal of 45p per unit of alcohol need to be a lot more effective in reducing premature deaths.”

Davies says that in spite of clear risks to well being and society, “merchants proceed to sell alcohol using strategies which I take into account to be irresponsible”. She adds: “I deplore the strategies merchants use to entice consumers to acquire ever-higher quantities of alcohol.” These include multi-purchase gives, promoting alcohol at below cost value and the redefining of “modest glasses of wine” by bars and eating places, omitting from menus the 125ml measure which they are legally obliged to provide.”

The higher degree of alcohol advertising all around football matches broadcast on Television is also notably concerning due to the fact of the number of youngsters who view, said Davies.

On combating obesity, Davies stated she had long been concerned that the vogue market presented being underweight as an “perfect” aim.

“Yet I am increasingly concerned that society may be normalising becoming obese,” she added.

“For example: larger mannequins are becoming introduced into clothes shops ‘size inflation’ implies that clothes with the identical dimension label have grow to be more substantial in latest decades and information stories about the overweight typically feature photographs of severely obese individuals, which are unrepresentative of the bulk of the obese population.”

If producers failed to deliver on guarantees to cut added sugar, then “we, as a society, may need to have to take into account the public wellness benefits that could be derived from a regulation such as a ‘sugar tax’”, she mentioned. And though Davies was pleased there had been some progress by the food market to voluntarily reduce the quantity of salt in foods, there was far further to go, she stated.

Chief health-related officer criticises alcohol delivers in supermarkets, outlets and bars