A man whose wife died after a drain was accidentally left in her stomach for 21 hours has condemned the increasing use of physician assistants (PAs) within the National Health Service.

Suzanne Pollitt’s inquest concluded that her death at the Royal Oldham Hospital in July 2023 was caused by “neglect leading to an unnecessary medical procedure”.

Roy Pollitt did not know his 77-year-old wife was being treated by a PA – who only needs two years’ medical training – and he believes “if the NHS had used cheap labor Had it not been done, she would have been alive.”

The coroner who investigated Mrs Pollitt’s death highlighted the lack of a national framework covering the training, supervision and competency assessment of PAs.

Associates were introduced into the NHS 21 years ago with the expectation that they would support doctors by providing basic care.

The number of associates has more than doubled to 3,000 in the past two years.

According to the NHS long-term plan, there will be 12,000 physician and anesthetic assistants by 2036.

However, apprehensions have been expressed that some people are operating beyond their core scope.

BBC News has seen evidence that in the month of Mrs Pollitt’s death, the NHS trust that oversees Royal Oldham used PAs to cover about 20% of doctor shifts in elderly care.

A number of organisations, including the British Medical Association (BMA), have expressed concern over the blurring of professional lines between doctors and colleagues in NHS trusts and primary care.

Anesthetists United, a group set up by concerned doctors and consultants, has filed a legal claim against the General Medical Council (GMC) for not, in its view, appropriately defining the roles and responsibilities of associates.

Consultant anesthetist Richard Marks, one of the group’s founders, said that patients were “being put at risk” as a result, something which “pulls at your heartstrings” as a doctor.

BBC News has also learned that PAs have exceeded their limits in a number of NHS trusts, including:

• covering doctors’ shifts
• Prescribing medicines
• ordering an x-ray without supervision

From December, associates will join doctors who are regulated by the GMC.

However, significant concerns remain from some in the medical profession.

Susan Pollitt originally went to the Royal Oldham Hospital with a broken arm after a fall at her home in Failsworth, near Greater Manchester.

Initially treated in the corridor, the great-grandmother was also diagnosed with severe kidney injury.

Due to shortage of gastroenterology beds, he was moved to the respiratory ward.

Her daughter Kate Pollitt said that staffing levels seemed “very low”, adding that on the night her mother died, “it took about four hours to find a doctor in the whole hospital”.

At Mrs Pollitt’s inquest, dozens of issues relating to her care emerged.

Not only did the PA leave the stomach drain – which is used to drain excess fluid from her body – on for 15 hours longer than allowed, but she also told colleagues to take it off, risking infection. The danger increased.

It also emerged that, last year, a liver nurse approved of a colleague’s qualifications in using the equipment simply because she assumed he was a doctor.

Kate Pollitt said: “He thought he was doing the right thing… but he was in a situation where he didn’t get support.

“There was too much confusion and not enough oversight.”

The Northern Care Alliance (NCA) NHS Foundation Trust, which runs Royal Oldham, found that Mrs Pollitt might have survived if the drain had been removed earlier.

Its chief medical officer, Dr Rafiq Bedair, said: “We are saddened that Mrs Pollitt did not receive the standard of care she should have received and we are deeply sorry to her family for this.”

He said the trust had a duty to “learn from what went wrong and make things safer for patients in the future”.

The NCA serves over one million people in Salford, Oldham, Rochdale and Bury, as well as providing more specialist services to patients in Greater Manchester and beyond.

Following Mrs Pollitt’s inquest, North Manchester coroner Joan Kearsley issued a prevention of future deaths notice due to her concerns about the PA.

The GMC agreed that without effective safeguards, patient safety is at risk.

Its chief executive and registrar, Charlie Massey, said the regulatory changes coming next month would be “an important step towards strengthening both patient safety and public trust in these businesses”.

And he stressed that it is up to employers to clearly define roles and, “like all regulated professionals (colleagues), they will be expected to work within their competence”.

But consultant anesthetist Dr Marks warned that the lack of a national scope of practice – with clear boundaries and standards – would still put patients at risk.

He said that lack of oversight for PAs has been a “key feature” in recent high-profile cases, Which also includes the death of a 30-year-old woman from Salford.

“In each of those,” he said, “if a doctor had been more closely involved and seen what was happening, they would have made changes in the care of that patient.”

“What concerns us most is that you have a large increase in the number of PAs who do not have the depth of understanding because of their background, and who will be released to the public without adequate supervision.”

Mr Marks was also concerned that while doctors receive seven years of training, PAs receive two years of training.

“You don’t know what you don’t know,” he said, adding that PAs “don’t have the skills or experience” to diagnose patients with different levels of complexity.

The Academy of the Royal Colleges has also called for an independent review of the use of fellows due to the “increasingly bitter and destructive debate”.

A Department of Health and Social Care spokesperson said: “Our deepest sympathies go to Susan’s family and friends.

“Patient safety is our top priority. We are working urgently with the NHS to ensure that paramedics are supporting doctors, not replacing them.”

NHS England said it has issued “updated guidance on the appropriate deployment of paramedics” and will provide more clarity about their roles.

Polites stressed that he did not want to blame the PA for what happened, saying that he was “the only person who showed Susan – and us – any sympathy”.

Kate Pollitt said she only wished she had more supervision.

“You get angry and upset,” she said. “But we can’t do anything for our mother now, so there’s no point in being angry and carrying that bitterness all our lives.

“We just want change – it doesn’t mean things like this will never happen again, but if we can help reduce the chances it’s worth it.”