Video report by ITV News Health Editor Emily Morgan
"Harrowing" stories of suffering have been exposed in a report which concludes patients came to "avoidable harm" because the NHS failed to respond to concerns in a serious manner. The inquiry into three NHS scandals set out how patients were "dismissed" and "overlooked". The review looked into concerns over pelvic mesh, the anti-epilepsy drug sodium valproate - which has been linked to physical malformations, autism and developmental delay in newborn children, and hormone pregnancy tests such as Primodos - which are thought to be associated with birth defects and miscarriages.
It is unclear how many women were harmed by the three scandals, the report said.
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More than 700 families across the UK gave evidence as part of the review. The review said: "It has taken this review to shine a light on systemic failings. That the healthcare system itself failed to do so suggests that it has either lost sight of the interests of all those it was set up to serve or does not know how best to do this.
"Patients have been affected adversely by poor or indifferent care, have suffered at the hands of clinicians who do not, or who chose not to listen, and have been abandoned by a system that fails to recognise and then correct its mistakes at the earliest opportunity. "At times patients have been denied their fundamental right to have the information they need to make fully informed choices. These patients should not have to campaign for years or even decades for their voices to be heard."
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Baroness Cumberlege, who chaired the report, said: "I have conducted many reviews and inquiries over the years, but I have never encountered anything like this; the intensity of suffering experienced by so many families, and the fact that they have endured it for decades. "Much of this suffering was entirely avoidable, caused and compounded by failings in the health system itself. "The first duty of any health system is to do no harm to those in its care, but I am sorry to say that, in too many cases concerning Primodos, sodium valproate and pelvic mesh, our system has failed in its responsibilities. "We met with people, more often than not women, whose worlds have been turned upside down, their whole lives, and often their children's lives, shaped by the pain, anguish and guilt they feel as the result of Primodos, sodium valproate or pelvic mesh.
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"It has been a shocking and truly heart-rending experience. We owe it to the victims of these failings, and to thousands of future patients, to do better." Health Minister Nadine Dorries said: "I want to pay tribute to the patients and families whose lives have been turned upside down by mesh, sodium valproate and Primodos, and to thank them for their brave contributions to this report. Their experiences make for harrowing but vital reading and have left me determined to make the changes that are needed to protect women in the future.
"While the NHS is a beacon of brilliant care and safety in the majority of cases, as this report demonstrates, we must do better. Our health system must learn from those it has failed, ensure those who have felt unheard have a voice and, ultimately, that patients are better protected in future. "I want to thank Baroness Cumberlege and the review team for their comprehensive recommendations. We will now give this independent review the full and careful consideration it deserves before setting out our full response."