Olaseni Lewis died in part from "disproportionate use of force"

The death of a man after prolonged restraint by police on a mental health ward was caused in part by “disproportionate and unreasonable” use of force, pain compliance techniques and multiple mechanical restraints, an inquest has found.

The narrative conclusion, which came after the coroner ruled out a verdict of unlawful killing, found fault with both police officers and medics involved in the death of Olaseni Lewis at Bethlem Royal hospital in south London in 2010.

Lewis, 23, an IT graduate with no prior history of mental illness, collapsed at the hospital after being taken there by relatives on 31 August 2010. He never regained consciousness and was pronounced dead at Croydon University hospital on 4 September.

A postmortem examination found he had suffered a hypoxic brain injury, which occurs when the brain is starved of oxygen, jurors heard on the second day of the inquest.

Early in the inquest, Lewis’s mother, Ajibola Lewis, recalled how a nurse at the Maudsley hospital in south London, had warned her not to allow him to be transferred to Bethlem, where the incident occurred.

“She said to me, ‘Look, don’t let him go to the Bethlem, don’t let him go there,’” Ajibola Lewis said. However, she took the decision, on the advice of doctors, that her son should attend the mental health hospital as a voluntary patient.

The case only came to inquest after years of investigations into who should be held responsible for Lewis’s death. In 2015, following an investigation by the Independent Police Complaints Commission, the Crown Prosecution Service determined that the officers involved had no criminal case to answer.

Last year, it was decided that no charges of corporate homicide would be brought against the South London and Maudsley NHS foundation trust, which manages Bethlem, after it was investigated by Devon and Cornwall police.

A Health and Safety Executive investigation into Lewis’s death is pending following the conclusion of the inquest.

Olaseni Lewis died in part from "disproportionate use of force"

The government must not force me and other disabled people out of our homes | Tessa Bolt

I have Down’s syndrome and I live in supported housing. Today a parliamentary select committee has put out a report on the government’s planned changes for supported housing that could force people such as me with a learning disability out of our homes.

Last year the government said it wanted to make changes to funding for supported housing that would limit payments to the local housing allowance rate and let local councils have control over the extra money needed to give people supported housing. This would mean people such as me could lose our right to have our housing paid for and that there could be a lot less supported housing available.

Both these changes would obviously be really bad. Thankfully today’s report agrees, which is good to hear as it is what me and other people in supported housing have been saying for a long time. But I’m still very scared the changes could happen.

In March I gave evidence for this report. It was a historic event as I was the first person with Down’s syndrome ever to give evidence to a select committee. I was very proud to be taking such a big step for people with a learning disability, especially as I know these changes could mean that thousands of people like me lose their homes and independence. As a society, we’d be going backwards.

Before supported housing, people with a learning disability had to live with their families or live in institutions. Most care professionals think institutions are not the best place for people with a learning disability; in some cases people end up having to live far away from everyone they know, and sometimes too, without proper support, people can even be in danger of abuse and neglect. I don’t think that’s a life anyone would choose.

I moved into supported housing when I was 30. Before then I had lived with my parents. I love them but I wanted to be independent. Nobody wants to still be living with their parents at 30! After a lot of talking, my parents agreed and I now live in a house run by Golden Lane Housing, with Elizabeth and Katie, two other ladies who have a learning disability. I love living with them – we’re like family.

I couldn’t live on my own without support, but I don’t want full-time care, because I’m not a child. Supported housing means I can be independent but have day-to-day support from Mencap. My support worker Jeanette helps me get out and do the things I love, which include volunteering at Oxfam, my local bookshop and the Cancer Trust. I make my own choices and I get to live the life I want, something everyone has the right to do.

But this will all change if the government’s planned changes happen. A cut could mean that I couldn’t afford to pay my rent any more. I wouldn’t be able to live with Katie and Elizabeth and I might lose my day-to-day support. It makes me scared for my future because I’d have to move away from my home, my friends and my voluntary jobs and go and live with family. It could change my whole life in a way that I don’t want.

But I’m lucky. A lot of people with a learning disability don’t have family who can support them, so they could be forced to live in an institution, where the support and accommodation might not be right for them. They could away from everything they know and they would lose all their independence. This would be a huge step back for everyone with a learning disability.

I make my own choices and I get to live the life I want, something everyone has the right to do

It is a scary thought and I think it’s clear the government isn’t thinking about all the people who use supported housing. So I’m glad that the select committee report has said that these changes could lead to a really bad situation. This is also what a lot of supported housing providers and Mencap have said and it’s what I think as well. But I don’t know if the government will listen to this new report.

I think things would be very different if people such as me had more of a voice, more power. I don’t think changes like this would be happening. That’s why it’s important that the government listens to us.

I would say to the government: “Stop and think about what you are doing!” It’s good to save money; I am not against changes. But things have to be fair for everyone, and until you can guarantee that changes won’t take away people’s homes, independence and happiness, then these are changes that the government can’t afford to make.

The government must not force me and other disabled people out of our homes | Tessa Bolt

Record number of GP closures force 265,000 to find new doctors

A record number of GP practices closed last year, forcing thousands of patients to find a new surgery, in spite of government attempts to stop local doctors shutting their doors.

NHS England data showed nearly a hundred practices closed in 2016, a 114% increase in GP closures compared with figures from 2014. Of the 92 practices that shut, 58 did so completely, while 34 merged with other local surgeries in order to pool resources.

The drop in GP numbers meant 265,000 patients – an increase of 150% from 2014 – had to change their practice last year, often travelling further for care. Brighton was particularly badly affected with 9,000 patients displaced when four practices closed. There have been a total of seven closures in the city over the past two years.

The new data, obtained by the GP website Pulse, has renewed fears that family doctors are not coping with increased demand and need an urgent cash injection to survive. Senior doctors also expressed concern that government funding was not being targeted correctly.

patients displaced

gp practices close

It comes despite the NHS announcing its GP forward view plan last year, promising to invest an annual £2.4bn into services by 2020. The government also announced £500m investment as a rescue package, which included £16m to support vulnerable practices.

Dr Chaand Nagpaul, chairman of the British Medical Association’s GP committee, told Pulse: “We know the money, targeted in the right way, for the most severely affected practices, can make a difference.

“The tragedy is clinical commissioning groups have not delivered their part in making the resources available. Many practices that should have received support have had none to date. That’s been a failing of local delivery.”

Prof Helen Stokes-Lampard, chair of the Royal College of GPs, said: “Too many practices are being forced to close because GPs and their teams can no longer cope with ever-growing patient demand without the necessary funding and workforce to deal with it. This has serious consequences for patient safety and the wellbeing of hard-working family doctors and their practice teams.”

The findings are likely to put more pressure on the government to address a growing NHS crisis, with hospitals and family doctors under increasing pressure.

Jonathan Ashworth MP, the shadow health secretary, said: “These are startling revelations and really bring home the extent to which Theresa May’s NHS funding squeeze is impacting on people every day in communities across the country.”

He added: “Given the crisis in hospitals we’ve seen we need to be taking the pressure off hospitals. That means doing much more to protect GP services. With Labour, general practice will be at the heart of making the English NHS more focused on care closer to home.”

Norman Lamb, the Liberal Democrat health spokesman, said: “There is a pressing need for a national, cross-party discussion about how we can afford a modern, efficient, and effective health and care system. I once again urge the prime minister to begin such a process. We must face up to the scale of this challenge, and to the possibility that we might have to pay a little more in tax to ensure that everyone gets the high-quality healthcare they should expect.”

An NHS England spokesperson said: “All NHS patients wanting to register with a GP practice are guaranteed to be able to do so and we have increased investment in general practice by £1bn in two years in order to improve services and boost GP numbers.

“These figures as presented don’t reflect the full picture as they include patients whose records automatically transfer after a merger and therefore don’t have to change practice. As part of our plans to improve general practice services and boost the workforce, many practices are choosing to merge in order to offer patients a much greater range of services.”

Record number of GP closures force 265,000 to find new doctors

Hospital deficits could force NHS to divert money meant for improving care

The NHS expects hospitals to go on racking up such large deficits in the next few years that it will have to divert £5.4bn earmarked for improving patient care to prop them up, experts claim.

NHS trusts in England, which recorded a collective deficit of £2.45bn last year, are meant to reduce their overspending this year to only £580m to help tackle the service’s acute financial problems.

But the Nuffield Trust thinktank has discovered that the £1.8bn trusts will receive this year to help wipe out their deficits will be made available to them again in 2017-18 and 2018-19, despite NHS pledges that they will have got close to balancing their books by the end of March.

However, using that £5.4bn for deficit reduction will threaten the chances of success of the NHS’s plan to ensure its own future, according to Sally Gainsbury, the thinktank’s senior policy analyst who unearthed the planned diversion of funds.

That is because the money will be swallowed up by cash-strapped hospitals and will not be available to be ploughed into overhauling how care is delivered, which NHS England chief executive Simon Stevens has made clear is vital if the health service is to stem the rising demand for care and ensure it remains sustainable.

The disclosure of a cash shortage in the NHS comes as Stevens and health secretary Jeremy Hunt prepare to face tough questioning from MPs on the Commons health select committee on Tuesday about the state of the service’s finances.

MPs are likely to ask about Theresa May’s decision, revealed by the Guardian last weekend, that the NHS will not get any extra money in next month’s autumn statement, despite fears that it is coming under unsustainable pressures.

If the NHS cannot stop demand for A&E and other care rising from the current 3% increase a year to the 2% increase it hopes to achieve by 2020 – which giving the extra £1.8bn a year bailouts to trusts makes more unlikely – then hospitals will fail to get their finances back on track, Gainsbury added.

“The risk is the NHS starting the next decade with a recurrent overspend of more than £2bn a year, even after the painful cost cuts providers are currently being asked to make to reduce their deficits,” said Gainsbury.

“The fact that there is now less money available for investing in service transformation than originally envisaged matters because the NHS desperately needs to slow the pace at which the demand on its hospitals is growing. If that doesn’t happen through careful investment in alternative services and public health improvement then the risk is it will happen instead through crude rationing and service closures.”

The planning guidance which NHS England issued to the service last month made clear that the sustainability and transformation fund, which Hunt created last year, will “focus on supporting sustainability rather than transformation, aiming not to fund service enhancements but to sustain services”.

NHS England confirmed that all the £1.8bn in the fund this year will help cover hospitals’ deficits; and that of the £2.9bn it has set aside for sustainability and transformation activities in both 2017-18 and 2018-19, of that £1.8bn each year will be used to help ease the financial situation of NHS providers of care and the other £1.1bn to transform how it cares for patients.

Meanwhile, a survey has found that 70% of Britons are prepared to pay an extra one pence in income tax to help fund the NHS, and almost half (48%) would pay an additional two pence.

An extra penny on the basic rate of income tax would raise around £4.5bn, and 70% of those questioned for ITV1’s programme The Agenda said they would be happy to see a tax hike on this scale if it was guaranteed that all the money would go to the NHS.

The same poll found that almost half of Britons (46%) think that the NHS is performing badly, double the number (23%) who think it is performing well.

There is little public support for charges being introduced for NHS services to help ease its financial problems. Just one in four (27%) of those questioned said they would be willing to pay £5 to see their GP, while 66% said they would not. If that cost £10 then only 15% would be happy to pay, while 79% said they would not.

Chris Hopson, chief executive of NHS Providers, which represents hospitals, said: “We know the NHS is under the greatest pressure in a generation. Patients can see this pressure. They’re saying very clearly that they are happy to pay a bit more income tax to get the right quality of care and relieve the pressure on the NHS. We elect governments to make decisions on the NHS budget and we hope the new prime minister and chancellor are listening.

“And an extra penny on income tax would only give the NHS a quarter of the extra £350m a week patients were promised in the Brexit referendum campaign.”

Hospital deficits could force NHS to divert money meant for improving care

Funding change could force rural GP practices to shut, BMA warns

The BMA is ­concerned that extreme cuts in help could depart large places with out a GP practice close by. Photograph: Andres Rodriguez / Alamy/Alamy

About 100 GP practices could be forced to near due to the fact of cuts in national funding, leaving sufferers in rural areas without a GP, doctors’ leaders have warned.

Changes to how practices are paid imply some could no longer be viable, despite the reality that some “offer important providers to 1000′s of rural sufferers”, the British Medical Association (BMA) stated.

It warned that big locations of rural England could be left with no GP practice for residents.

The government has made the decision to phase out a funding arrangement referred to as the Minimum Practice Cash flow Assure (MPIG) in excess of a seven-12 months time period, beginning in April.

MPIG indicates a lot of smaller sized GP practices are guaranteed a minimal level of funding that is not dependent on the quantity of patients on their list.

NHS England has published an anonymised record of 98 “outlier” practices that could drop much more than £3 per patient per year. Some practices on the list will get rid of far more than £100 per patient per yr, although other individuals will get rid of £20 or £30 per patient.

The BMA said that in addition to the 98, there had been a “substantial amount” of other practices that would be severely impacted.

Dr Chaand Nagpaul, chair of the BMA’s GP committee, mentioned: “The government has significantly misjudged the prospective effect of its funding modifications, especially on rural GP companies.

“It is most likely that a few hundred practices will get rid of obvious levels of funding, with 98 practices identified by NHS England as currently being at serious danger from extreme cuts in their fiscal help that could threaten their capacity to remain open.

“This comes at a time when GP practices are already below stress from growing workload and declines in overall levels of funding.

“The government has not confirmed exactly where these practices are or the extent of their fiscal problems, nevertheless some will be smaller sized GP practices in rural communities with comparatively modest numbers of individuals registered with them.

“These GPs provide important companies to individuals in locations where accessing healthcare is previously not easy simply because of the big distances sufferers have to travel to get to their local NHS providers. If these practices were to shut it could depart large geographical areas with no a nearby GP practice.

“The predicament has not been assisted by NHS England’s decision to devolve accountability for this problem to nearby NHS managers with no a framework on how these GP practices ought to be supported. We are with no a nationwide plan of how to tackle this issue and safeguard GP services.

“Ministers have to get a grip on this issue urgently, given these funding reductions are just weeks away from currently being implemented. We want to guarantee no practice closes and that there is a co-ordinated method to deal with this situation.”

Dr Katharina Frey, who runs a rural practice in Cumbria, stated: “My practice is a very modest one particular that cares for just below 1,000 sufferers in a rural south Cumbrian area.

“We have for a lot of years provided a genuine household-orientated support for sufferers and I feel we are a genuinely important service for our regional local community.

“We are under actual financial strain already and can’t, simply because of the current funding climate, afford to utilize a practice nurse.

“We are also possessing to feel quite carefully about how we substitute senior staff. This situation will grow to be even much more pressurised when we lose the MPIG support that at the moment accounts for close to a third of our existing core funding.

“We are previously working at complete capacity with declining sources – I just do not know how we will cope with this further monetary blow.”

An NHS England spokesman mentioned: “NHS England is committed to producing sure patients have access to large-high quality GP providers wherever they dwell and the GPs are effectively funded to provide these providers.

“MPIG is not an equitable way of funding practices, which is why we are supporting its phased withdrawal. We think it is fairer to allocate funds based on the numbers of individuals practices serve and the overall health needs of those individuals.

“We have looked very cautiously at how the changes to MPIG, together with other changes to the general health-related providers contract, will impact on practices and we estimate that the vast majority will acquire added funding as a outcome.

“We also know that some practices will shed funding and we have asked our spot teams to function with them to see how they can be supported. It might be that an option arrangement might be appropriate.

“This choice will be made by region teams right after a complete assessment of all the nearby situations.”

Funding change could force rural GP practices to shut, BMA warns

Government could force manufacturers to include folic acid to bread

Study dating back to the early 1990s has proven that taking folic acid tablets in early pregnancy final results in a 72 per cent reduction in neural tube defects in unborn infants.

A amount of charities and health bodies, such as The British Health care Association, have prolonged campaigned to force makers to include folic acid, the synthetic type of Vitamin B9, to bread flour.

The move is also supported by Baroness Tanni Grey-Thompson, who is wheelchair bound as a consequence of her spina bifida.

A Division of Well being spokesperson mentioned they are “currently contemplating the situation of mandatory fortification of flour with folic acid and will attain a determination in the light of new data from the National Diet regime and Nutrition Survey.”

The BMA estimate that neural tube defects affects up to 900 pregnancies in the Uk each and every year, and their board of science chair Averil Mansfield has urged the Government to “save lives with our daily bread”.

Women are suggested to consider folic acid dietary supplements by their doctors and midwives once they know they are pregnant, but authorities say anomalies take place when a foetus is 28 days outdated, before numerous are mindful they are expecting.

However, critics warn that extra folic acid could hide other problems, such as a deficiency of vitamin B12 in the elderly, which could lead to anaemia.

Professor Bayston stated that the debate had been raging for many years and had been stymied by “scare stories” associating folic acid with well being problems which includes cancer.

“All the discussions of chance that have being going to and fro have come to absolutely nothing and we have to accept that the so referred to as dangers of folic acid are not borne out by the proof.”

He mentioned necessary fortification would be a “major step forward”, incorporating that folic acid has been shown to have a range of health positive aspects, and has been found to affect on certain types of cancer and cardio vascular ailment.

The move is supported by the sector, he stated, who are waiting for the official ruling.

Government could force manufacturers to include folic acid to bread