My darling Penny died after eight out-of-hours doctors failed to save her: How mother 'fell through widening cracks of the NHS because she fell ill over bank holiday' Penny Campbell died when doctors failed to diagnose her blood poisioning Widower says it happened because of changes to out-of-hours care By Angus Mackinnon Proud young mother: Penny Campbell holding her son Joseph in 1998 Penny's 50th birthday would have meant a great party. She'd have been to buy a new dress and spent days baking the most elaborate cake she could come up with. Her birthday should have been a few weeks ago - Tuesday, May 15, to be exact - although we'd have thrown her party the weekend before. It would have been easier for everyone else - that was Penny's way - and everyone would have wanted to be there. They'd have crowded into our little house in Islington, North London: her family, my family; my friends, her friends; neighbours and her colleagues at Time Magazine, where she had risen to become the associate editor of the European edition only a few years after making the unlikely leap from the world of telecommunications consultancy to journalism. There weren't many people whose lives were not made brighter by knowing Penny. Mine certainly was. We had been together since we were students, nearly 20 years in all. We were both besotted by our lovely little boy, Joseph. I never imagined any life other than the one we had. So it was hard on the morning she should have turned 50 to believe she had been gone for more than eight years. It was hard to think that Joseph, still as blond as his mother and with the same sunny character, is now nearly 15. Hard to think how much she has missed. He learned to ride his bike just weeks after she died. Now, he's got braces and does his homework on an iPad before switching over to Facebook. I know Penny would have loved iPads: there is no limit to the number of recipes you can look up. I think she'd have liked the fact that Facebook reminds you when your friends" birthdays are, but then that was what her little Peter Rabbit birthday book was for. She didn't need a website to remind her to think of others. It's hard, too, to recall how she was taken away from us, so needlessly, six weeks short of her 42nd birthday. According to her post-mortem examination, Penny died of multiple organ failure caused by blood poisoning that was the result of a freakishly rare infection that she contracted after a minor surgical procedure. But the clinical details that emerge from an autopsy never tell the full story of a death. Alone, they can't explain why, on the morning of March 29, 2005, I had to wake a sleeping six-year-old boy, tell him his mother had died and try to make him understand what that meant. Strain: Accident and emergency units are struggling to meet the needs of patients like Penny Campbell The simplest way to describe Penny's death would be to say she fell through the widening cracks in our National Health Service. Specifically, she fell through the gap created by the disastrous 2004 decision to take out-of-hours care out of the hands of GPs. For Penny died because she fell ill over an Easter weekend, on which the doors of our local surgery were bolted shut from Thursday evening until Tuesday morning and the care of its patients left in the hands of a dysfunctional out-of-hours service. The bacteria that killed her, Group A Streptococcus (GAS), are lethal once they get a hold of your system, but this is no superbug. Antibiotics, delivered promptly in response to the early symptoms of blood poisoning - clamminess, fever, steadily-increasing pain - will usually repel it. Penny died because seven of the eight out-of-hours doctors she consulted over the course of that weekend failed to spot the signs, thanks to a scarcely credible combination of individual incompetence and organisational chaos. She had first begun to feel ill - queasy and shivery - on the Thursday afternoon, 24 hours after going to a local hospital clinic for the injection for haemorrhoids that was almost certainly responsible for introducing the GAS bacteria into her bloodstream. Growing up fast: Angus Mackinnon with his teenage son Joseph That night, having got the number for the out-of-hours service from a recorded message on our GP's phone line, she rang Camidoc - the service then responsible for night-time, weekend and holiday cover for our Islington GP and much of North London. The first doctor she spoke to that night said it was probably nothing, but nevertheless suggested a face-to-face meeting. So Penny drove herself the short distance to the Camidoc out-of-hours clinic, where a second doctor confirmed that she was running a fever but, suspecting a viral infection, advised her to wait and see how she felt in the morning. Over the following two days a rash, clamminess and constant, increasing pain in the abdomen and groin were added to the symptoms she explained over the telephone, calmly and precisely despite her growing discomfort, to Camidoc's doctors. At different points she reported a temperature of 41 degrees and that she could hardly walk, each time patiently repeating the history of her symptoms and the injection she'd had. On Easter Sunday another Camidoc doctor did visit her at home, but once again there was no continuity of care. Once again she had to explain her symptoms afresh. Flu, food-poisoning and colic were all put forward as possible explanations and it was not until Penny spoke to an eighth Camidoc doctor that she was referred to hospital, on Easter Monday morning. "She had severe, ongoing pain," that doctor told her inquest in 2006. It was obvious she had to be seen urgently. Obvious but too late. A few hours earlier, another Camidoc doctor had told her, "if you were really sick, you wouldn't be talking to me like this." By the time Penny was placed in an artificial coma at the Royal London Hospital - intended to give her the best chance of responding to the antibiotics being pumped into her - I knew she was going to die. It took just under 24 hours, but it was not until more than two years later that I fully understood why it had happened. In the bleak months that followed the funeral, it was the love of our son Joseph, the imperative of looking after him, that kept me getting out of bed in the morning. But what got me through the days was a determination to get to the bottom of what had gone wrong with Penny's care. Had our positions been reversed, I thought, there was no way she would have let it pass without kicking up an almighty fuss. So with the help and support of a solicitor called Grainne Barton, an expert in clinical negligence issues, I did my best. In October 2006, the shambolic nature of Camidoc's organisation, which meant none of the doctors involved in treating Penny had access to each other's notes, was exposed at the inquest into her death. Out of hours care: Penny Campbell did not get the help she needed until she spoke to an eighth doctor, but by then it was too late The resulting media coverage belatedly bounced the local Primary Care Trust into a proper independent investigation into what had gone wrong. It concluded, in June 2007, that a major failure of Camidoc's systems had contributed to Penny's death but also highlighted a dangerous national policy confusion over what out-of-hours services were supposed to be doing: handling only urgent cases, in effect acting as a screening service for Accident and Emergency units, or providing the kind of service offered by GPs during regular hours? On the day it was released, the report topped the news bulletins for most of a day. Gordon Brown, then the Prime Minister in waiting, was forced to respond, publicly acknowledging that the NHS had to do much better in its care at nights, weekends and Bank Holidays. Penny would be proud, I remember thinking. A wake-up call had been delivered. Something, surely, will be done. How wrong can you be? Six years on, the Government, Opposition and the medical profession are still embroiled in a futile squabble over who is to blame for an out-of-hours system that continues to be a fiasco, rather than actually addressing how to fix it. It feels as if all those hours that I spent writing letters to Islington Primary Care Trust (PCT), and poring over the service standards that Camidoc never came close to meeting, were in vain. Now, it seems that barely a day goes by without some new out-of-hours tragedy or near-tragedy coming to light somewhere in the country, many of them with echoes of what went wrong in Penny's case. Rushed consultations resulting in confused clinical judgments, the inherent problems involved with trying to assess the gravity of a patient's condition over the phone - it is all painfully familiar. Rushed: Angus MacKinnon feels that there is too little communication between out of hours GPs and too many inaccurate over-the-phone diagnoses In almost every case of avoidable death in the health system, establishing exactly where responsibility lies is a complex process, often hinging on a finely-balanced assessment of whether an individual doctor's mistake amounted to professional misconduct or was forgiveable given the information they had to work with. But surely, by now, we have witnessed enough heartache to recognise that fatal mistakes have been made much more likely because of the fundamental flaws in the out-of-hours system. With too few doctors trying to cope with too many patients, there is too much reliance on diagnosis by telephone and there is zero chance of anyone being seen by someone with an idea of their medical history. The case for a proper review and real reform is unanswerable. The stories of Penny and baby Axel Peanberg King made headlines. But how many more go unreported because the families of those who died just want to be left to grieve in peace, or because they don't know how to voice their rage? Penny's case became news because I had the means to employ a solicitor who helped me ensure I got the most out of the inquest process and because, as a journalist myself, I know how the media works and had the contacts to ensure the case had the best chance of being covered. As the chaotic state of out-of-hours care across huge swathes of the country has become increasingly apparent, it is hardly surprising that more and more people have started by-passing these "dodgy doctor" services and heading straight for the ever more stretched A&E units of their local hospitals. I will spend the rest of my life wishing I'd done that with Penny. Of course I can never be sure, but the surgeon who provided expert testimony at her inquest believed she would probably have survived if she had been delivered into the expert care of the Royal London Hospital even 12 hours before she actually was. Passing the buck: Mr MacKinnon feels that neither Labour's shadow health secretary Andy Burnham, left, nor Health Secretary Jeremy Hunt, right, have any practical solutions to the problem Equally, my gut feeling is that she would also have survived if she had been able to see a doctor in our local GP surgery, someone who knew her medical history, and would immediately have realised that something was going seriously wrong. That's why the debate over what to do about out-of-hours care is so depressing. Instead of actually exploring what can practically be done to solve problems that are costing lives, Health Secretary Jeremy Hunt, Labour's shadow health minister Andy Burnham and BMA chief Laurence Buckman have spent recent days indulging in a game of political buck-passing. Of course, the 2004 reform that allowed GPs to opt out of out-of-hours care is not the only cause of the crisis now engulfing A&E services, and it is opportunistic of Hunt to try to pin all the blame on the previous government. But Burnham is equally wrong not to recognise how badly wrong Labour got it with a reform that was introduced without a single pilot scheme being undertaken and with barely any discussion in Cabinet. Looking back, it is impossible to comprehend what possible rationale there could have been for a government signing off on a new contract which absolved GPs of the requirement to work some anti-social hours while simultaneously awarding them pay rises that mean the average GP surgery partner now takes home a six-figure salary. At risk: Out of hours doctors mean that there is no chance of getting help from anyone with an idea of your family's medical history Equally, it seems disingenuous of the BMA's Buckman to accuse Hunt of "spouting rubbish" for suggesting that GPs will have to take back some of the responsibility for out-of-hours care. Buckman says we can't return to the bad old days of doctors working round the clock to the point that exhaustion was putting patients at risk. But who is advocating that? Plenty of people have to work at night and over the weekend. If our supermarket cashiers and railway maintenance men can do it, why can't we expect the same of doctors who are earning five to ten times as much? Of course, extending the opening hours of GP surgeries will require more bodies. But that's not rocket science, either. If there are not enough doctors to go round, we should just train some more. There's no shortage of people wanting to enter the profession - our medical schools aren't exactly undersubscribed. It needn't even mean increasing the health budget, if only GP salaries were to take a modest cut. In simple terms, the cost of funding 40,000 GPs on £100,000 a year is the same as having 50,000 on £80,000 salaries. It is our health service. We can decide how it is run, and choose to put the people who rely on it first. It won't bring back Penny, or any of the others who have died needlessly, but it might prevent more tragedies.