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tv   Boots  BBC News  January 13, 2018 1:30pm-2:01pm GMT

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are pharmacist at the patients say. are pharmacist at the country's biggest chain under too much pressure? wets diane moore has spent the last five years fighting for justice for her father. —— diane five years fighting for justice for herfather. —— diane moore has spent the last five years... in 2012, douglas lamb and died when he was given medication meant for someone else. the 86—year—old raf veteran had a heart condition and was registered as blind. he had trust that they would give him the right tablets. he would never have dreamt that the wrong tablets would have been sent out. suffolk police allowed us to film the tablets douglas was taking before he died. they were delivered by his local boots pharmacy in this pack, a box designed to make it easierfor him to ta ke designed to make it easierfor him to take medicine at the right time.
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0n the outside is douglas's name, but on the inside, the prescriptions are fora mr but on the inside, the prescriptions are for a mr lampard. douglas took more than 30 of mr lampard's ta blets, more than 30 of mr lampard's tablets, including medication to reduce blood sugar levels which he didn't need. to witness him going into heart failure, and then two subsequent cardiac arrests, it's the most devastating and horrible thing to see. this is the pharmacy in felixstowe where the mistake was made, and error so serious that suffolk police consider the charge of corporate manslaughter. staff hadn't followed company of corporate manslaughter. staff had n‘t followed com pa ny safety procedures. i felt angry, that i wa nted procedures. i felt angry, that i wanted to throw a brick through every single boots store that i saw.
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i blame boots for my father's death. in 2011, one manager had been concerned about pressure in boots pharmacies. greg lawton reported to the superintendent pharmacist at boots headquarters. as a clinical governance pharmacist, he thought the company wasn't giving pharmacies enough money for staff. this is the first time he has spoken publicly. when i came into the patient safety role in 2011, i wrote a paper for the superintendent's office which set out those concerns, explained theissues set out those concerns, explained the issues with the staffing model and how that could put patient safety at risk. in 2012, in the same month as douglas's death, police investigated another serious
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dispensing error. the boots uk board ordered an urgent investigation into more than 100 stores with the highest level of incidents. greg lawton was looking at the north region. we spoke to pharmacist, store manager is area managers, and they were saying that poor staffing levels were an issue, there were issues with training that were identified, with premises. the company told us that after the investigation, it implemented a detailed action plan. it then conditioned academic research which it says found that pharmacies with higher levels of dispensing staff we re higher levels of dispensing staff were associated with higher error rates. deaths following dispensing errors are extremely rare, but six months after douglas, arlene devereaux died following a massive morphine overdose. it was her 71st
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birthday. she had osteoporosis. even her hands were painful, you know, so that was why she was on the drug. this time, a boots pharmacy at chesterfield in derbyshire dispensed six times the strength of morphine ta blets six times the strength of morphine tablets prescribed by arlene‘s gp. the coroner concluded that her death was accidental, and there were clear opportunities for the error to be corrected. the pharmacist in charge said he must have been interrupted. we don't know why. it was shocking and it kind of reminded you of the importance of the job that you were doing, and strengthened your resolve to try to make a difference. so, what are the risks? boots told us it dispensed more than 220 million prescription items in a year. there we re prescription items in a year. there were just over
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prescription items in a year. there werejust over 900 prescription items in a year. there were just over 900 reported incidents where patients were harmed in some way, ranging from needing minor treatment to permanent damage. statistically, that kind of incident is very, very rare. and some might not have been the pharmacist‘s fault. boots says that, compared to other chains, it has one of the lowest levels of ha rm, other chains, it has one of the lowest levels of harm, and an industry—leading approach to patient safety. the pharmacist defence association and union is the largest, representing 25,000 members will stop mark worked as a pharmacist for over 20 years. the group is involved in a legal battle to be recognised as a union. pharmacist told us, working for boots, they are finding that increasingly there are less stuff available, which makes theirjob a lot more difficult and more pressurised. they are concerned
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about speaking up about problems in the workplace because they fear the consequences of what will happen to them. boots uk pharmacy director is a qualified pharmacist who has worked for the company for 20 years. he spends one day a week out in its stores. that is not something i recognise. i personally have been able to raise whatever i have needed whenever. we have an open and honest culture. if they speak up, i can guarantee them confidentiality. they have a responsibility as a pharmacist and professional to speak up. the union says that pharmacist it represents at boots are too scared to speak out because they are scared to speak out because they are scared of losing theirjobs. two have spoken out, on condition that we protect their identity. actors speaking there was. some days, you would easily describe the team as
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being at breaking point, simply because the amount of work that has to be done can't physically get done safely, and it can't physically get done without either working longer hours or working after the store has closed. mistakes may not be picked up closed. mistakes may not be picked up on, and that could ultimately lead to someone possibly dying. somebody missing medication, the harm coming to people, small mix—up, really, just one tablet for another tablet. in september 2013, boots told its pharmacists about to make very serious dispensing errors in six days. they were warned not to cut corners with company procedures. two months later, there was another death. to find out what happened, i'm heading to the small highland town of kingussie. margaret forrest
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trusted her local boots to supply the daily medicine she needed. instead, mrs forrest, an active and independent 86—year—old, was given a mrs independent 86—year—old, was given a m rs frost's independent 86—year—old, was given a mrs frost's diabetes tablets. she had total belief in that system. she would have taken medicine given to her in total confidence that that was the right medicine, that she had to ta ke was the right medicine, that she had to take to protect herself, and it didn't. we all know human error and we can all make mistakes. we all do, but unfortunately, some mistakes are very tragic ones, and this was the case with my mother. just like the cases of douglas and arlene, company safety procedures hadn't been followed in kingussie, and the staffing wasn't found to have contributed to any of the deaths. one mistake like this is one mistake too many, and my absolute assurance
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is, despite our record, we will continue to focus on minimising the chances of it happening again. boots told us there have been no further deaths linked to dispensing errors at its pharmacies since mrs forrest died. greg lawton wasn't investigating the deaths, but he had been looking at staffing and budgets in detail, and was concerned that pressure from understaffing in pharmacies could lead to serious mistakes. he told a senior patient safety boss at company headquarters just how worried he was.|j safety boss at company headquarters just how worried he was. i told her i was terrified that something bad might happen to a patient, that a patient might be seriously harmed or mike died because of the inadequate staffing levels and the pressure that was placed on pharmacists and pharmacy teams. greg lawton thought the way the company calculated how many the way the company calculated how ma ny staff the way the company calculated how many staff it needed was fundamentally flawed. a few weeks
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later, he told management he was considering going to the pharmacy regulator. the information that i had, and the things that i knew about the staffing levels, i think that was the biggest risk to patient safety that i had come across within the company. his concerns were immediately escalated to the highest level with a boots board, and he was invited to take part in ongoing work on staffing. so, what is supposed to keep patients safe? as far as enforcing safe staffing goes, the only recourse —— legal requirement is that the farmers that is —— the pharmacist in charge has to be there while the store is open. all companies must set their own safety rules, called standard operating procedures. they are there to protect patient safety and staff should follow them. boots pharmacist have told us that time pressures
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sometimes mean they take short cuts. you don't have the correct amount of time, not even the correct amount of stuff to do things on time. at best, you will barely have enough staff to just cope. we have standard operating procedures in place for all of our operating procedures and are dispensing process in boots. they are recognised as being high quality, industry—leading, and a lot of work has gone in to finding the process that minimises risk to patients. though one should never be ina patients. though one should never be in a position should have to take the choice to take any kind of short cuts. comments on boots's own stuff website also show how concerned some staff are. pharmacists do an excellent job but often staff are. pharmacists do an excellentjob but often in very difficult circumstances, and considering it is the largest pharmacy company in america and europe, it shouldn't be like that. boots told us its own survey suggest
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that four in five pharmacies were either comfortable or neutral about their workload, better than the rest of the nhs. the pharmacy regulator told us it has inspected more than 2000 boots pharmacies since november 2000 boots pharmacies since november 2013. 26 didn't have enough qualified and skilled staff to provide a safe service. it says they are now up provide a safe service. it says they are now up to standard. that means only 1.2% of boots pharmacies failed only 1.2% of boots pharmacies failed on the staffing standard, which co m pa res on the staffing standard, which compares favourably with all other pharmacies. i'm absolutely confident that the resource is there to deliver patient care. i am confident that we have enough staff. community pharmacy is part of the nhs, and its funding is being cut. more prescriptions are being dispensed than ever before, more than 1 billion per year. and as the population gets older, they are
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becoming more complex.|j population gets older, they are becoming more complex. i think my record is 37 medicines that they are run, and you have to check each one for suitability, and you are trying to do that in a busy, hectic environment, and you have all the other tasks to do. accuracy is crucial. boots says pharmacist should only check their own work as a last resort. but the pharmacists spoke to told us that in their experience, when they are busy, that doesn't always happen. often, you have to self check medication. often, you're in a situation with no staff at all mind you have to dispense medication and self check it. everyday, there is an occasion where i have the self check, on all of the shifts i work. all of our prescriptions are checked before they go out. in less than 1%, a pharmacist will check it themselves. if we have pharmacists who think they are in situations where they
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have to do that when they shouldn't, they must, they have a professional responsibility to, raise that.“ the pharmacist in charge thinks the pharmacy is unsafe, one option is to temporarily close. in a union survey of more than 400 boots pharmacist, 31 said they had closed pharmacies because they had been concerned about patient safety. more worryingly, 160 out of 212 who had considered it, said they didn't close because they didn't believe their decision would be supported. you end up staying open in these unsafe situations, and out of your own goodwill, trying to catch up on back logs or reorganise things. 160 isa very back logs or reorganise things. 160 is a very small sample but an important one. if we have people who genuinely feel like that, it does concern me, so please genuinely feel like that, it does concern me, so please do come and speak to me and give me the chance
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to sort it out. this is a very extreme circumstance, and we will always support the shop with what they need. there is no regulation to say that if you dispense this many prescriptions, you have to have this many staff. to calculate the workload, boots uses a complex model which includes the time it takes to dispense various prescriptions. in july dispense various prescriptions. in july 2014, greg lawton was asked to be part of a team which recalculated those times. the work that we did on time standards was regarded as very robust. it was done alongside external co nsulta nts, robust. it was done alongside external consultants, and they called it world leading. the team reported back that boots needed to spend tens of millions more on its pharmacies. we calculated the amount of investment from the time standards and from other operational
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considerations, and to meet the expectations the company had pharmacy staff. it was in excess of £100 million of additional investment every year to fund that. boots says that only greg lawton held the view that in excess of £100 million a year was required. the company told us it did make significant additional investment in pharmacies following the time standards review, but says the specific figure is commercially sensitive. greg, his opinions and concerns, left the business over two yea rs concerns, left the business over two years ago and aren't relevant to boots today. we continue to invest in more people, more pharmacists, than ever before, and it helps to make things more safe. as the uk's biggest pharmacy chain, boots is providing a crucial nhs service. we asked the company to explain exactly how it works out how many staff to
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put in almost 2400 pharmacies. it refused. the company told us the time standards which are part of the calculation are a trade secret which could be copied by its competitors. lloyds, the uk's second largest pharmacy chain, has provided its time standards and how they are used to work out staffing levels. boots says you can't compare one company with another, and it shares the principles of how it works out staffing budgets with line managers. j°y staffing budgets with line managers. joy wingfield is a pharmacy law and ethics expert who has trained the last two boots superintendents, the pharmacists in charge of safety. last two boots superintendents, the pharmacists in charge of safetylj don't really accept that they are trade secrets. so, if they are confident that their staffing calculations do maintain patient safety, i don't see why they should be unhappy to share them. in may
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2016, in scotland, stephen forrest represented his family at the fatal accident enquiry into his mother's death. he wanted to know what happened before the prescription was handed over. the pharmacist in charge exercised her right not to appear. instead, her witness statement was read out. the mere fa ct statement was read out. the mere fact that that didn't, we didn't have the opportunity to talk to the pharmacist about that, to find out her views on that, it is very alarming to us. that was a key witness. but stephen did cross examine other members of staff. the fatal accident enquiry heard that short cuts were taken if they were too busy or tired. in the court, evidence was presented by staff to say that they were understaffed. at least two of the staff weren't there. one was on honeymoon and one was sick. the sheriff concluded the
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pharmacy was quiet at the time and understaffing didn't play our part. a member of staff hadn't followed company procedures. the name and address had not been checked when the tablets were handed over. there was no defect in the actual system of working. margaret forrest's death was caused by human error.“ was caused by human error. it is all very well saying, we have standard operating procedures, but if they are not being followed and you are not addressing why they are not being followed, these incidents will continue to happen. staff at kingussie were given additional training. ina kingussie were given additional training. in a personal injury claim by the family, boots uk admitted vicarious liability for the carelessness of one of its staff. last march, the inquest into douglas lamond's death was held in suffolk. staff told the coroner that on the day the prescription went out, they had been busy and under pressure. they said they kept telling their
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area manager they didn't have enough space to do theirjob. the police report said that meant they were following the compa ny‘s report said that meant they were following the company's standard operating procedures. the coroner said they were operating in a difficult situation. boots told us it found no record of staff raising concerns with the manager. the pharmacist in felixstowe was eventually given a police caution foran eventually given a police caution for an offence under the medicines act. when detectives in suffolk investigated douglas's death, they wa nted investigated douglas's death, they wanted to see boots' own internal investigation report. the company was entitled to refuse under legal privilege. while the detective in charge acknowledges that, he feels the company had a moral responsibility. do i feel that boots gave us full co—operation? no, i don't. i think that particularly big corporate companies such as boots have a significant responsibility to
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public safety and a moral duty to comply with any investigation. they also have a responsibility to the family. boots... is it said it wanted to apologise to the families of the three patients who died following dispensing errors. we wa nted following dispensing errors. we wanted to find out how many mistakes there are in community pharmacy, but it hasn't been easy. we know that in one year, more than 17,000 incidents involving medication were reported to the nhs across the industry, but that reporting is voluntary, so the realfigure could be higher. a new law has gone before parliament. it is hoped it will encourage pharmacists to report more errors so that lessons can be learned. in
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september 2014, at boots uk headquarters, greg lawton was on the verge of going to the regulator. he wa nted verge of going to the regulator. he wanted senior management to go with him. he had a crucial meeting with the then superintendent pharmacist, who was the head of patient safety, and the director of stores for boots uk at the time. that was the most difficult point in my career, i would say. every difficult. it is like a weight that you would carry with you all the time. it would never leave you, even outside of work. and... sorry, if we could just pause for a minute. the superintendent told me that he felt that nobody is out there would welcome the conversation. knowing that all that i had done was try to
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protect patients, that was very difficult. boots says the superintendent pharmacist never attempted to dissuade mr lawton or any member of staff from whistle—blowing, and he was supported throughout. it took another six months, but greg lawton did become a whistle—blower. he met the gbh hc to discuss his concerns. i felt relief because it felt like finally someone would be able to do something about it. we were aware that the company would be investigated. shortly afterwards, greg lawton resigned. he eventually presented the regulator with a 55 page witness statement, and dozens of supporting documents. he shared his detailed evidence with the
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pharmacist defence association union, whom he has been working for. since september 2015, boots says it has increased the number of pharmacists by 430. pharmacy technicians have gone up by more than 360. staff with pharmacy capability has risen by more than 2400. those last two groups include staff in training. the company agrees there has been an increase in the workload of pharmacists, but says it has been fully funded. in december 2016, the department of health began cutting nhs funding for community pharmacy. by march, budgets will have fallen by more than £200 million. the owners of lloyds pharmacy announce that as a result they are closing almost 200 stores. also in december 2016, the
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general pharmaceutical council responded to greg lawton's evidence. it recognised the very difficult position he was in and said his information was invaluable. but for greg lawton, the response was a huge disappointment. they told me they we re disappointment. they told me they were going to review their inspection model as a result. they didn't interview a single person, and they concluded that there wasn't any problem at all. the gp hc told us any problem at all. the gp hc told us it conducted a thorough investigation, both looking into mr lawton's concerns, and evidence from boots senior management. it concluded there wasn't sufficient evidence to suggest that mr patient safety across the organisation, and understaffing was not systemic. however, it told us the information provided by mr lawton assists them when inspecting boots pharmacies. the regulation around pharmacy is inadequate. we need regulatory
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standards to specify what staffing levels must be in pharmacies.|j agree with that, the idea that staffing levels are too difficult to set and don't allow flexibility. i don't think anybody could have envisaged that the employment of a pharmacist would devolve on such an enormous international company. the regulator told us that pharmacy owners are best placed to set staffing levels. it is also providing new patient safety guidance this year which will stress that owners must provide enough qualified staff. our pharmacies are busy places, but they are safe places. we have an industry—leading patient safety record, we continue to invest and improve our processes,
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systems and operations in order to get safer into the future.|j systems and operations in order to get safer into the future. i do not wa nt get safer into the future. i do not want this to happen again to someone else's mother, grandmother or sister. as long as the public, the patients who are ultimo the ones at risk and the ones we are ultimately meant to be serving, as long as they don't know, then nothing will ever change. i would like to think that this could be a catalyst to force an industry change. hello. the grey and cloudy theme that has been with us for several days now is sticking around through the weekend. there will be glimpses of brightness around here and there. this was sent in from the isle of wight, shoving the extent of the cloud there. we will keep with cloudy conditions, some rain around, in the north west in particular, later today. the radar shows that rain working into western parts of the country. the east has been dry and will likely stay dry for much of the day. the reason for the east— west split is because high pressure holds on across scandinavia, keeping things largely dry, and this front is bumping into that area of high pressure from the west. it is not making progress further east.
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there will be western areas through the afternoon, whereas further east, you are likely to stay dry still cloudy grey, and it is breezy wherever you are. this is bbc news. the headlines at 2pm. ministers are urged not to bail out the troubled construction company, carillion, as the bbc understands high level government meetings are to take place this weekend. it can't possiblyjust bail out the company because then you have a position where the private sector is allowed to privatise profits by then the government nationalises the losses, a problem we had with the banks —— but then the government. the african union demands an apology from president trump — for derogatory remarks he reportedly made about the continent. warnings of a tooth decay crisis amongst children in england. a record 43,000 operations to remove rotting teeth were carried out last year. also in the next hour.
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tributes are paid to bella emberg, who has died at the age of 80.
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