The inquiry into the Staffordshire hospital scandal over “excessive” patient deaths has left questions as to whether such a case could ever happen again in the NHS.

The first alarm over an excessive death rate among emergency admissions at Mid Staffordshire Hospital was first raised in 2008 when a Healthcare Commission (HC) inquiry was launched.

The report released in 2009 flagged up that NHS managers had failed to act over the poor standards of care and conditions at the hospital – and despite failings in patient care and an excessive death rate at Mid Staffs, managers had gone on to receive promotion.

The number of patients who died as a result of poor care at the hospital has never been logged, but it is estimated between 400 and1,200 more deaths occurred between 2005 and 2009, compared with the average death rate for emergency admissions in NHS hospitals.

Following the HC report, New Labour’s Secretary for Health Andy Burnham launched an independent inquiry into the Mid Staffs hospital trust. The result was a list of recommendations published in February 2010, including setting in motion the trust’s de-authorisation to be overseen by the government’s healthcare regulator Monitor.

Families of loved ones who had been treated at Mid Staffs and those who had been bereaved complained that the inquiry into the trust had been held “in camera” and its remit had been narrow.

The average compensation sum to families for their loss was £11,000, but the then Health Secretary called for a further public inquiry entailing the forensic examination of foundation trusts and their commissioning, supervision and regulation.

The coalition government launched the public inquiry in June 2010 and Robert Francis QC examined more than one million pages of evidence and listened to evidence from more than 160 witnesses. The Francis report which followed called for a fundamental change in the culture of care in NHS hospitals, to place patients first.

The damning conclusions of the Francis report also found that NHS bosses had ignored the concerns of patients – and local MPS and GPs had also failed to “fight their corner” over patient care in the NHS.

The Francis report also found that too much faith had been placed in NHS managers by PCTs (primary care trusts) and local health authorities – and NHS regulators at national level had also failed to challenge attitudes and standards in patient care in the NHS.

The Royal College of Nursing (RCN) also came under fire for failing to support nursing staff who tried to raise the alarm about failings in patient care at their own hospitals.

The Department of Health was also criticised for being too remote in managing the NHS – and engaging in reorganisation of the health service which was deemed counterproductive to patient care.

Examples of failing care for patients which the report highlighted included patients being left so thirsty they drank water out of flower vases, receptionists allowed to make potentially life-changing decisions in A&E, nurses allowed to handle complex equipment without sufficient training, inexperienced junior doctors supervising critical care treatment, pain relief left too late to prevent patients experiencing distress and pain, patients left crying for help on wards and patients left to go hungry and thirsty because food and drink was left out of their reach, with no help with feeding at mealtimes.

The appalling inventory of failings and the fact that some NHS staff had concealed data to cover up the truth about excessive death rates and failings in patient care led to the Francis report calling for a criminal charge regarding the manipulation of data in the NHS to cover up failings – with new laws to ensure doctors were transparent when mistakes were made, a code of conduct for senior managers was introduced and a new emphasis on compassion when recruiting, training and educating nursing staff was introduced.

Chief Executive of Mid Staffs hospital trust at the time of the scandal, Sir David Nicholson, was the main witness at the inquiry and maintained that the hospital did not represent a systemic failure in the health service, as it had been the only hospital found with such failings in care.  Counsel for the inquiry called Sir David’s view “naïve and dangerous”.

Sir David is currently CEO of the NHS but will step down from the post by March 2014.

Families who lost loved ones unnecessarily continue to challenge what happened at the Mid Staffs hospital trust.

Cerebral palsy is the term used to describe a wide range of neurological conditions. There are three main types of cerebral palsy – and within these, a further three main subsections which cover different spasticity conditions.

The main three types of cerebral palsy are:

Athetoid/dyskinetic (ADCP) affects around one-fifth of those with cerebral palsy. ADCP symptoms include abnormal writhing in the limbs, hands, feet and face or mouth. Those with ADCP may also drool or suffer facial contortions if the facial muscles are particularly affected. They may also have problems with speech and communication.

Ataxic affects around one-tenth of people with cerebral palsy and affects balance and walking. Ataxic cerebral palsy can also affect an individual’s perception of space, making it difficult for them to judge their position as they walk. This can cause an unbalanced gait, with feet and legs splayed during walking. There may also be more complex issues regarding movement and mobility with ataxic CP – and this can mean difficulties in carrying out specific motor functions such as holding an object (eg a pen) or reaching for an object. Intricate actions like tying a shoelace can also be problematic for people with ataxic cerebral palsy. They may also suffer from tremors and muscle spasms.

Spasticity is the most commonly diagnosed type of cerebral palsy, with around 80% of cerebral palsy patients having this form of the condition. Spasticity causes the muscles in limbs to contract and stiffen, which makes movement very difficult. Botox and other muscle relaxants such as Diazepam (Valium) can be used to help improve muscle function. The classic gait associated with cerebral palsy is a walking style with knees turned inwards and this is a result of spasticity in the leg muscles. The three different types of spasticity in cerebral palsy patients affect different limbs and these are:

·         All four limbs (guadriplegia)

·         Both limbs on one side of the body (hemiplegia)

·         Arms or Legs (diplegia).

Research into cerebral palsy and its recognition among the medical profession has been ongoing since 1860, when English orthopaedic surgeon William Little noticed that some babies with abnormal movements and physical disabilities had been born after a difficult delivery.

The term cerebral palsy was used from 1887 onwards to describe the range of neurological symptoms Little had associated with birth difficulties. It was coined by British medical doctor Sir William Osler. Psychoanalyst Sigmund Freud made the association between premature birth and spastic diplegia in 1897.

Diplegia as a condition is mainly associated with mobility problems in the legs, as with diplegia problems with mobility in the arms are usually less severe. Children with diplegia may have shorter muscles which grow more slowly and this is turn can cause problems with movement and walking. If the tendons become short in the ankles and feet, a child may walk on tiptoe, which happens if the Achilles tendon is shortened.

When children have diplegia, the shortened muscles can also have a knock on effect on other areas of the body, including the hips. Hip dislocations are possible with diplegia and children are usually monitored closely to prevent this happening.

There are also other forms of cerebral palsy including a condition when just one limb is affected (monoplegia), which is rare. In triplegia, three limbs are affected by cerebral palsy and most of the time triplegia involves spasticity of both legs and one arm.

In cases of monoplegia and triplegia, children may be medically treated in exactly the same way as if they had hemiplegia or quadriplegia. This is because monoplegia and triplegia may actually be a form of cerebral palsy in which one limb has very mild symptoms which may be almost unnoticeable, but is still affected.

If a person with cerebral palsy has a set of symptoms which span each category, then this usually referred to as mixed CP unless one set of symptoms is obviously predominant over the other types.

Cerebral palsy (CP) is a condition which is caused by a brain injury before birth or sometimes during delivery, which can happen if a baby is starved of oxygen during birth. The condition can cause varying degrees of disability from mild to severe – and movement is affected, so in severe cases a person may have very limited movement, or any movement may be affected by muscle spasms or limbs may be rigid.

Depending on the area of the brain which has sustained injury, speech, sight, hearing and cognitive skills may also be affected.

Types of cerebral palsy

Cerebral palsy can take the form of three different patterns which affect muscle function and movement:

·         Ataxic cerebral palsy affects balance and walking and perceptions of the space around a person. Patients may be unsteady on their feet or adopt an unusual posture with widely spaced feet and legs when they walk. Ataxic CP can also make reaching for objects difficult and the patient may also suffer from tremors.

·         Athetoid/dyskinetic (ADCP) affects up a one-fifth of cerebral palsy patients and causes limbs, hands, feet and face or mouth to writhe. Patients may also drool, experience unusual facial spasms or have problems with speech if the facial muscles have been affected by a brain injury

·         Spasticity is the most widely known form of cerebral palsy and affects around 80% of cerebral palsy patients. Spasticity causes contraction in muscles, involuntary movement of muscles and shaking or body tremors. Muscle contraction results in the knees being turned inwards when the patient walks. The three types of spastic cerebral palsy are quadriplegia (all four limbs affected), hemiplegia (both limbs affected on just one side of the body) and diplegia (either legs or arms are affected).

Brain injury can mean that the individual has problems communicating – they may know what they want to say but the damaged part of the brain cannot process the thought into actual speech.

But people with cerebral palsy are no less intelligent than their peers and also possess distinctive personalities, just like everyone else. Cerebral palsy does not mean that a child will not develop likes and dislikes, talents, skills and their own unique personality traits, or will be able to play a role within the family.

Children and cerebral palsy

The first signs of cerebral palsy usually appear within the first 12 months of a baby’s life – and parents may at first notice that their baby may not respond to sight or sound, may not be able to grasp toys, or may roll over onto one side instead of being able to develop an upright posture and move normally. How a baby is affected will depend on which area of the brain has suffered damage.

Children with cerebral palsy will benefit from early assessment and medical intervention – and many children adapt to their condition remarkably well and become active and engaged in life in ways which may exceed parents’ initial fears and expectations.

New technology can now predict the sort of aids a child with cerebral palsy may need as they grow, including mobility devices or modifications to the home or aids to help mobility at school or work.

Long term effects of cerebral palsy

In cerebral palsy patients, the brain damage sustained during pregnancy or birth does not get any worse, but other health issues may develop as a result of the disability – for example a high risk for osteoporosis (brittle bones) and/or fractures or hip dislocation if the legs are affected.

People with cerebral palsy also have a normal life expectancy although those with very severe disability may require 24/7 care.

The symptoms of cerebral palsy develop in the early years of life – and the condition can take three different forms:

·         Athetoid/dyskinetic (ADCP) – up to one-fifth of those with cerebral palsy have ADCP, which causes abnormal movement such as writhing in limbs, hands, feet and the face or mouth. The muscles controlling movement in the face may cause patients to drool or exhibit unusual facial expressions, as they are unable to control the facial muscles and may even have difficulty with speech.

·         Ataxic – this form of cerebral palsy affects balance and walking as well as perception of space, which means patients may have an unsteady pattern to their movement or walking or posture, possibly with widely-spaced feet and legs when they walk. Around one-tenth of cerebral palsy patients suffer from the ataxic form of the condition and they may also have problems with more intricate motor actions, requiring precise movements while carrying out a certain function (eg holding a pen and writing or tying a shoelace). Reaching for objects and quick movements can also be difficult and some patients with ataxic cerebral palsy may have spasm or muscle tremors.

·         Spasticity – this is the most widely found form of cerebral palsy and causes muscles in limbs to remain contracted, making movement difficult. A characteristic walking pattern with knees turned towards each other is a sign of spastic cerebral palsy. There are also three types of spasticity cerebral palsy – quadriplegia (all four limbs affected), hemiplegia (both limbs affected on just one side of the body) and diplegia (either both legs or arms are affected). Spasticity cerebral palsy can cause muscle spasms, involuntary movement of muscles and shaking or trembling. Around 80% of those with cerebral palsy have symptoms of the spasticity form of the condition.

Cerebral palsy occurs when brain injury causes an error in transmitting signals from the brain to the spinal cord, affecting movement and senses such as sight or hearing.

It is important to remember that although the outward symptoms of cerebral palsy in a child can be distressing to witness for parents, the condition does not necessarily affect your child’s intellect or inherent personality, although sometimes children with cerebral palsy do have learning difficulties as a result of severe brain injury.

Sometimes cerebral palsy occurs as the result of an adverse event during delivery, including if a newborn is starved of oxygen or suffers any other type of injury during birth (eg forceps injury).

It is also important to remember that the symptoms of cerebral palsy do not usually become worse over time – but existing issues such as impaired hearing or eyesight or severe movement problems may mean adapting to a child’s needs as they grow.

Providing the right type of therapy and social engagement at each stage of their development can mean many children with cerebral palsy develop talents and skills and play an active part in family life.

In an infant, the first signs of cerebral palsy may be slowness in developing motor functions (walking, grasping, holding objects) or even sitting up, smiling or talking. Infants with cerebral palsy may also have noticeably weaker or more poorly developed musculature compared with other babies – or may even appear much stiffer in their movements compared with other babies.

The slow develop of skills may be confined to one side of the body – or one particular skill (eg not able to grasp or hold objects).

Babies naturally follow a pattern of development and doctors use this as a measure to assess whether a baby has cerebral palsy symptoms. Testing reflex actions or assessing whether a baby prefers to use one hand or naturally relies on one side of their body rather than the other can be indicators.

A range of tests can also be carried out such as MRI and CT scans. Sometimes slow development in babies may indicate the presence of another condition rather than cerebral palsy and scans can detect whether a brain tumour might be present, for example – or another condition which could be affecting motor functions and reflexes.

Cerebral palsy can also be accompanied by other conditions, such as epilepsy and sometimes visual or hearing problems. Doctors will also test for these conditions – and weakness or stiffness of movement in a baby, accompanied by a lack of interest in their surroundings or lack of reaction to visual or audio stimuli, should always be investigated as soon as possible.

Babies or young children diagnosed with cerebral palsy will be treated by a multi-disciplinary team, offering a range of daily therapies to help the child achieve their best potential.

It may be that families will need help with adapting their home and support in caring for their baby – a support worker and even a psychologist can help families deal with the challenges, while a medical team consisting of doctors and physiotherapists will work to make sure your baby or young child keeps pace with normal development as much as possible.

The charity Scope also offers information, advice and support to parents and families learning to cope with cerebral palsy.

Author Bio: Leo Wyatt is a freelance writer & journalist who graduated from Birmingham University. Leo has worked for several newspapers in the midlands but now spends most of his time writing articles for companies, websites and businesses on a freelance basis. Leo also has particular interests in cars, bikes, health, safety. sports, law and politics.