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."
