Damian Holland, the former district Crown prosecutor for Luton and Bedfordshire, died in his bed at home in Chorley, Lancashire of Covid-19, just over a week ago. He was 56.
His sister, Caroline Heaton, brother, Gregory Holland, and cousin, Chris Hughes, told me about the events leading up to his death. They believe he was let down by the NHS he revered, and in particular the NHS 111 gateway service to hospital.
The story they tell of Damian’s final two weeks is upsetting and troubling. This is what happened:
On 14 April, Damian went into isolation, having displayed Covid-19 symptoms, along with his partner Shirley Harwood, who works at a care home and also had symptoms. Over the course of a week, his condition worsened and on the morning of 21 April, he rang 111 for the first time. He was instructed by 111 to continue his self-isolation, take up to eight paracetamol tablets per day and drink plenty of fluids.
He was warned the debilitating symptoms could last for up to three or four weeks. Only two days later, Damian called 111 again, at around 9 a.m.
He had told his sister Caroline that he was suffering horrific nightmares, that his fever had worsened, he had a terrible cough and acute joint pain. NHS 111 did not ring him back.
The following morning, early again, he was in such distress that he rang 111 again. The 111 adviser asked Damian if he could walk upstairs, which he said he could, and whether he was having difficulty breathing.
He did not.
According to his sister, who talked to Damian about this call shortly afterwards, he was told 'unless you have difficulty breathing or an underlying medical condition the paramedics will not be dispatched'. What is striking about this advice is that it is in contrast to what happened to Prime Minister Boris Johnson, as I pointed out on Sunday.
The Prime Minister was admitted to hospital even though – like Damian – he was not having difficulty breathing (the PM was explicit about this) and having been ill for as long as Damian.
What is also striking is that Damian was on the ACE inhibitor Ramipril for high blood pressure. Caroline is certain Damian would have explained this to 111. There is no medical consensus about whether this would have put him at increased risk of complications from the virus.
Over the course of 24 April, Damian’s partner Shirley became more ill. She is asthmatic and her breathing became shallow. An ambulance was called just after 6 p.m. What is striking is that the paramedics took Shirley to Royal Preston Hospital because the level of oxygen in her blood had fallen.
But although the paramedics were told about Damian’s symptoms, they carried out no tests on him. Shirley told Caroline: 'They did not even look at him.'
The following day, Damian checked his ability to breathe with a peak flow monitor, which he owned. His reading was lower than normal. 'I know Damian had told the NHS 111 this information previously as I had been checking and talking to him every day,' Caroline said.
On 27 April, Shirley came home from hospital to rest and recover. On Gregory's birthday, 28 April, Damian spoke to Caroline in the morning and afternoon and told her: 'I am not better, but I am no worse.'
Then in the evening, he went upstairs to have a brief lie down. Shirley went upstairs to see him. He was completely grey.
He had died.
Caroline was rung by Shirley with the terrible news at 9.38 p.m. Greg was told just as he was about to have a drink to celebrate his birthday.
The big question raised by what happened to Damian is whether NHS 111 is asking the right questions when speaking to those with Covid-19 symptoms and deciding whether an ambulance should be despatched.
There is, as I mentioned when writing about the PM’s illness, a characteristic of this virus that causes oxygen saturation levels of some sufferers to fall to dangerously low levels without them suffering conspicuous difficulties when breathing.
This seeming and sometimes deadly anomaly has been termed silent hypoxia. This, however, is not the end of the story.
Shirley was taken back to hospital on 3 May with breathing difficulties, having passed out.She was admitted to intensive care with a blood clot. She is now back on the ward.
I have spoken to the Department of Health and Social Care about these terrible events. They have said they will investigate. Caroline told me:
“To conclude, he did not ring an ambulance on the day of his death as he was following the advice given to him by NHS111.Damian was a very intelligent, eloquent and conscientious man who would not have wished to take a more deserving patient’s place. He would have spoken clear and concisely, not gasping for air.How can that be the only factor that has been considered as to whether he required an ambulance? We are, as a family, totally shocked and heartbroken. His children Siobhan and Alexander have lost their best friend.The grief is unbearable.