Tragic death of little Ava could lead to changes in how pharmacists prescribe
PLUS: Hopes that new hospitals in Lancashire could yet be brought forward
Hello and welcome to the midweek edition of The Lancashire Lead.
This week we report exclusively that the government is seriously considering making changes to how doses of vital medicine can be prescribed in instances of shortages after the death of Ava Grace Hodgkinson from Lancashire.
There are issues to overcome before any decision is set in stone and the circumstances would have to be specific to allow it to happen - but ultimately Ava was delayed being given antibiotics that were genuinely available.
It’s a health-focused issue so we also look at the delays to Royal Preston Hospital and Royal Lancaster Infirmary, and the idea that Lancashire should be ready to respond in case there are delays elsewhere.
Thank you for reading as always. Independent journalism takes time, effort and passion and we encourage to take a paid subscription if you are able to. This gives readers access to the paid tiers of all of our titles - including the national edition - and is the best way to support our work.
Pharmacist restrictions could be softened to help save lives after death of Ava Hodgkinson
By Luke Beardsworth
Changes to restrictions regarding what a pharmacist can give out could be introduced in response to the death of a young girl in hospital, The Lancashire Lead can exclusively reveal.
Ava Grace Hodgkinson was two-years-old when she died at Ormskirk District General Hospital after a short illness led to her contracting sepsis.
Her death came after a delay in receiving antibiotics which could have saved her life.
In December 2022, Ava, from Banks in West Lancashire, was suffering from a chesty cough and, due to a nationwide outbreak of Strep A, her parents were concerned she had caught the infection.
A first visit to her GP that morning found no infection but nonetheless antibiotics were prescribed. Locum GP Dr Rizwan’s first choice of phenoxymethylpenicillin was unavailable due to a national shortage and amoxicillin was instead chosen.
However, when Ava’s dad went to the pharmacy to collect the medicine he was told this was also out of stock and he had to wait until the following morning to be able to get any.
That morning, Ava took a first dose but her condition later worsened and she was driven to Ormskirk District General Hospital in the early afternoon. When she got there, she had entered cardiac arrest and despite attempts to resuscitate, the young girl could not be saved.
An inquest concluded that Ava died of Sepsis, resulting from a Strep A infection. At that inquest, concerns were raised that the pharmacist was unable to dispense the prescription in a different domination.
This would only have been allowed if the Department for Health and Social Care (DHSC) had issued a Serious Shortage Protocol (SSP), a mechanism which allows pharmacists to substitute the prescribed order during supply problems. However, no SSP was in place despite the increased prevalence of Strep A causing low stocks of antibiotics.
A letter from the coroner to the DHSC said that while the pharmacist did not have the prescribed dose, they did have a weaker concentration which Ava could have taken a greater amount of to receive the same dose. However, they were not allowed to do this due to restrictions placed on pharmacists.
This led to a delay in Ava receiving antibiotics and the evidence given at an inquest into her death in December led area coroner Chris Long to issue a Prevention of Future Deaths Report. This was addressed to the DHSC and legally requires a response explaining what action will be taken to prevent further tragedy or why the recipient feels no changes are needed.
Ava’s tragic death means that the government is now considering changes to restrictions to enable pharmacists to substitute different doses where it is urgent and safe to do so, The Lancashire Lead understands.
While the coroner's report raises concerns over future tragedies, the body has been keen to stress that the coroner did not find the provision of antibiotics contributed to Ava’s death. However, changes are being considered to allow pharmacists to substitute doses under certain circumstances, with further details still to be shared.
A spokesperson for the Department of Health and Social Care told The Lancashire Lead: “Our deepest sympathies are with Ava’s family and loved ones in this tragic case.
“We are committed to learning lessons to prevent tragedies like this in the future and are considering the recommendations in the coroner’s report closely.”
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Lancashire needs to be poised to capitalise on delays to other UK hospital projects
By Paul Faulkner
More government funding would be needed should the opportunity arise to build new hospitals in Preston and Lancaster sooner than is now expected, local health leaders have said.
It comes after construction work on the schemes was last month pushed back to the mid-late-2030s – around the time the two facilities had previously been due to open. The delay followed a government review of the development of dozens of new hospitals nationwide.
Chorley MP Sir Lindsay Hoyle, who has long championed a state-of-the-art hospital for Central Lancashire on the site recently purchased for that purpose – off Stanifield Lane, in Farington – said in the wake of the hold-up he was hopeful the revised timetable for the national programme would eventually shift in Lancashire’s favour.
He said the county would be well-placed to capitalise on a slowdown amongst any of the other 34 projects due to begin building in phases between now and 2039.
“Inevitably, as we go along, some of those [hospitals scheduled] in the [earlier] rounds won’t come through – and then money can be reallocated and [other] schemes can be brought forward at a faster pace,” Sir Lindsay said last month.
His comments were echoed by South Ribble MP Paul Foster – in whose constituency the proposed new Royal Preston site sits – who said it was important Lancashire was “ready” for such an eventuality.
However, it was later reported the government was planning to withdraw funding for the teams working on any hospital projects that were not due to see construction start until after 2030.
The LDRS asked the Lancashire and South Cumbria New Hospitals Programme how feasible it would be to reheat the Preston and Lancaster schemes quickly if the chance came for them to be moved further up the queue.
A spokesperson said: “As outlined in the recent government review, Royal Lancaster Infirmary and Royal Preston Hospital have been grouped in ‘Wave 3’ of the revised New Hospital Programme, with construction of the replacements for these hospitals expected to start no earlier than 2035 and 2037, respectively.
“While this is disappointing, the NHS in Lancashire and South Cumbria is actively assessing the situation. We would of course welcome any circumstances which allowed either of the new hospitals to be built ahead of the published time. However, this would depend on further funding from the Department of Health and Social Care (DHSC).”
The DHSC was also approached for comment, but had not responded at the time of publication.
A major public engagement exercise over the proposed sites for both new hospitals – Lancaster’s being at Bailrigg East, near Lancaster University – was cancelled last month after the construction delay was announced.
The NHS in Lancashire and South Cumbria said after purchasing the plots in December that it had an “exit strategy” should other more suitable pieces of land become available – or if the outcome of the government review had caused the projects to be cancelled altogether. However, it instead now looks set to be left with the sites lying idle for a decade or more.
A planned March appearance before Lancashire County Council’s health scrutiny committee by health bosses overseeing the Preston and Lancaster hospital projects has been cancelled following news of the delay.
Thank you for reading - we will be back with you at the weekend.
Luke, Jamie, Ed, Sophie and the team.