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Sunday, January 1, 2012

Complaints against doctors rise by 40 per cent

Complaints against doctors have soared by almost 40 percent in just three years, according to official figures.The number of complaints to the General Medical Council (GMC) – which has the power to strike doctors off the medical register – has hit a record high, with more than 7,100 last year.

Patients’ groups said the figures were a “devastating insight” into a lack of public confidence in the health service, with more and more people feeling so alarmed by the behaviour of those treating them that they had asked regulators to investigate.

The watchdog found that among all groups of doctors, GPs, psychiatrists and surgeons attracted the highest rates of complaints.

The grievances covered allegations of medical failings but also rudeness and sexual misbehaviour.

A second set of figures, from the NHS’s in-house complaints unit, the National Clinical Assessment Authority (NCAA) also showed that the older a doctor was, the more likely they were to be referred to medical authorities because of concerns.

Referrals to regulators were just the tip of the iceberg – for each complaint lodged with the GMC, six more were made to local health services, with more than 43,000 such reports last year.

Katherine Murphy, chief executive of the Patients Association, said: “I think we have got a huge problem with falling public confidence in the health service; these findings are a devastating insight, and they mirror our own experience as a charity, with increasing numbers of people calling us because they do not know where to turn.”

Mrs Murphy said many members of the public felt doctors were still inclined to defend each other, rather than to admit patients had been let down.

The figures show the number struck off the medical register has also risen over three years, but by just 18 per cent.

However, many cases which end up with a doctor being removed from the register take far longer than a year to be investigated, meaning that it is too early to know whether the increase in complaints will mean to record numbers of doctors being struck off.

Last year 92 doctors were erased from the register, while 106 were given a suspension of up to a year.

The dramatic rise in the number of complaints follows a period in which pay for doctors has risen substantially, while workload fell.

GP income rose by more than 50 percent in the three years ending in 2006, with average earnings now around £105,000 per year.

At the same time, nine out of ten family doctors stopped providing care at evenings and weekends – reducing their workload by an average of seven hours a week.

A new contract for hospital consultants increased pay by 27 per cent over the same period, with average earnings now at £118,000, while working hours fell, in an attempt to meet European rules limiting the number of hours worked per week.

Niall Dickson, GMC chief executive said: “I don’t regard these findings as a cause for despair. I don’t think there is evidence that standards are falling, I think in some ways the system is getting better at identifying problems, and doctors are more willing to identify colleagues who are not performing well.”

He said that despite a “rising tide” of complaints from members of the public, surveys on the NHS suggested overall satisfaction remained high.

Some complaints were closed quickly, because regulators felt they were not suitable for investigation, either because they were not felt to be serious enough, or related to matters outside the GMC’s remit.

Of those which went on to full investigation, 60 per cent were complaints about medical care, with allegations about misdiagnosis and substandard treatment.

Another 26 per cent concerned respect and communication with patients, including accusations of verbal abuse, failing to listen to patients and basic rudeness.

Separate figures held by NCAA – an organisation set up a decade ago, in an attempt to resolve concerns about doctors more quickly, by retraining some, while referring others for investigation – show that older doctors were the most likely to attract complaints.

Those above the age of 60 were seven times more likely than those below the age of 40 to be referred to the NCAA.

The rate among those in their 50s was four times that of those below the age of 40.

Male doctors were far more likely than women to be the subject of such a complaint – with almost three times the chance of referral to the organisation, according to the figures, which cover the eight years ending last year.

Crocus offers scientists hope in the battle against cancer

A substance found in a native British flower has been turned into a powerful “smart bomb” drug that can work against a range of cancers.The drug, based on colchicine found in the autumn crocus, cuts off the blood supply to solid tumours, curbing their growth and stopping cancer cells from spreading to other parts of the body.

Tests on laboratory mice have shown that the drug is highly effective at attacking tumours from a range of human diseases such as sarcomas and cancers of the breast, colon, lung and prostate.

The drug is also designed to target solid tumours directly, leaving healthy tissue unaffected, according to Professor Laurance Patterson, director of Bradford University’s Institute for Cancer Therapeutics.

“What we’ve designed is, effectively, a ‘smart bomb’ that can be targeted directly at any solid tumour to kill it without appearing to harm healthy tissue,” Professor Patterson said.

“What is also new about our approach is that we are effectively targeting the blood supply of the tumour,” he said. “If you can starve the tumour of that blood supply, then you can shut off its ability to grow and, indeed, you also shut off its ability to move around the body.”

The drug is well known as having anti-cancer properties, but is normally toxic to healthy cells and so has had limited potential in medicine.

The trick used by the Bradford scientists is to attach colchicine to another molecule that renders the drug inactive until it comes into contact with a one of a class of enzymes called matrix metalloproteinases (MMPs), which are used uniquely by tumours to burrow into the body’s healthy tissue, said Kevin Adams of the Bradford institute.

“The drug is inactive until triggered by the activity of an enzyme that is always found in the tumour environment but not elsewhere. Triggering releases a potent, anti-cancer agent which destroys the tumour’s blood vessels, effectively starving the tumours to death, a process known as haemorrhagic necrosis,” Dr Adams said. Tests on specially bred mice that have human cancerous tumours have shown that the drug and its delivery system can have a “cure rate” of greater than 70 per cent after a single dose, he said. Four different cancers have been treated and the animals suffered no adverse effects.

The next stage is a phase 1 clinical trial to test its initial safety, which is hoped to be conducted within 18 months at St James’s University Hospital in Leeds.

Daily calorie counting limits changed by nanny state

An advisory committee has concluded that the recommended daily calorie limits to maintain a healthy weight, laid down 20 years ago, have been slightly on the low side.In 1991 the Committee on the Medical Aspects of Food Policy (COMA) set out that the average man should be eating 2,550 calories daily, and the average woman 1,940.

After lengthy consultation, those have now been raised slightly – by a frugal 55 calories for men, but a comparatively generous 139 calories for women.

Which means 2,605 calories a day for men and 2,079 calories a day for women.

Prof Alan Jackman, chair of the Scientific Advisory Committee on Nutrition (SACN), explained that the old figures were based on “limited available evidence”.

They have been updated to take into account advances in science and better understanding of the physical activity people took.

Sadly, that is where the good news ends.

Speaking at a briefing to launch the Government’s new “ambition” to see obesity levels falling by 2020, Prof Jackman; Andrew Lansley, the Health Secretary; and Prof Dame Sally Davies, the Chief Medical Officer for England, emphasised that this was “not a licence to eat more”.

Prof Jackman said “the majority of adults” already ate much more than the new guideline amounts.

“We estimate that on average the population is eating 10 per cent more than they require,” he said.

Thus, as little over a third of the adult population is now not overweight or obese, only that minority is really entitled to an extra guilt-free indulgence.

Mr Lansley decided to unveil the Government’s new anti-obesity ambition the same day, leading to accusations of mixed messages.

The Health Secretary said Britain had to become a nation of calorie counters.

“People should have a pretty good sense of how many calories they are consuming,” he said.

Department of Health policy officers have calculated that England needs to consume five billion fewer calories daily, to ensure average weights fall to healthy levels.

That equates to enough cheeseburgers to cover 20 football pitches, or enough cafe lattes to fill four Olympic swimming pools, said a spokesman.

But Prof Terence Stephenson, president of the Royal College of Paediatrics and Child Health, said it amounted to “peanuts”.

He added: “Sixteen dry roasted peanuts per person, per day to be precise.”

Like others, he attacked the Health Secretary’s reluctance to use stronger measures to tackle obesity, which already costs the NHS one pound in every 20 it spends.

The Prime Minister last week said a ‘fat tax’ on some foods was “something we should look at”, but yesterday Mr Lansley would only say that while taxes might have “a part to play”, they were not a “first resort”.

But Jamie Oliver, the chef and healthy eatign campaigner, dismissed the whole strategy as a “farce” and a “cop-out”, saying it was “worthless, regurgitated, patronising rubbish”.

He said: “Simply telling people what they already know – that they need to eat less and move more – is a complete cop out.  The country’s bill of health is shocking, and it’s not going to get any better over the next 30 years if a clearly defined plan isn’t put into place soon.”

“We simply can’t afford the financial or health costs of doing nothing. This Government might be able to navigate us slowly out of a recession, but it has no clue about how to make sustainable change in the short or long term, or how to inspire, enforce or empower public health.”

Dr David Haslam, a GP and chair of the National Obesity Forum, said issuing the new calorie guidelines alongside the updated anti-obesity drive was “really unhelpful”.

“It gives out entirely the wrong message,” he said. “People are going to think that they can eat that little bit more. If anything, that will add to the obesity problem.”

Death sentence as NHS killer quango rejects skin cancer drug

The first new skin cancer treatment since the 1970s has been rejected by the NHS’s rationing body, in a decision branded a “death sentence” for patients.Clinical trials had shown that half of those who were given the drug were still alive a year later, twice as many as those given an alternative treatment.

The drug, called ipilimumab, works by teaching the immune system how to tackle melanomas and was widely seen as an important advance on “old-fashioned” chemotherapy.

But in draft guidance NICE- the National Institute for Curbing Expenditure has recommended that NHS trusts do not prescribe the treatment, because it costs about £80,000 per patient and because it had doubts over the research data.

It means that unless the manufacturer cuts the price, the only way that the growing number of advanced melanoma sufferers can access the drug is by applying to the Government’s Cancer Drugs Fund.

The decision comes after a provocative academic report claimed that some expensive cancer drugs are “futile” as they cost a lot and cause toxic side-effects yet only give dying patients a few more weeks to live.

In a joint statement, the support group Factor 50 and charity SKCIN said: “The breakthrough that patients and clinicians throughout the UK have been waiting for has arrived in the form of this drug.”

“Standard treatments that have been available since the 1970s are ineffective and to deny this drug to patients, many of whom are young and with very young families, has undoubtedly handed them down a death sentence.”

“To have come so close to a breakthrough and to be told no at this stage is truly devastating.”

Dr Pippa Corrie, Consultant Medical Oncologist at Cambridge University Hospitals NHS Foundation Trust, added: “Licensing of this drug for use in the UK marked a step change in melanoma patient care, and whilst the Nice decision is predictable, it is disappointing.

“It is essential that we all work to avoid any negative impact on facilitating patient access to this drug. Our patients have waited too long already.”

Rates of skin cancer are rising faster than any other type of the disease in Britain and it affects teenagers and young adults more than any other group.

Almost 12,000 people now develop the most serious kind, malignant melanoma, every year and about 2,000 will die after it spreads across the body.

For the past 30 years the only treatment has been a type of chemotherapy called dacarbazine which is not seen as particularly effective and leaves patients tired and at greater risk of infection.

The new treatment, marketed by Bristol-Myers Squibb as Yervoy, is taken in just four injections, one every three weeks and is said to have fewer side-effects.

In a trial on patients who had undergone prior therapy for skin cancer, 46 per cent who took the new drug were still alive after a year compared with 25 per cent who had not taken it.

In addition, 24 per cent were still alive at two years compared with 14 per cent of those who did not take the drug, and the median survival was 10.1 months compared with 6.4 months among those who did not take it.

But Nice, which assesses whether or not new treatments should be widely available on the NHS in England and Wales, has recommended against its use.

Sir Andrew Dillon, its chief executive, said: “We need to be sure that new treatments provide sufficient benefits to patients to justify the significant cost the NHS is being asked to pay.”

He said the evidence showed that ipilimumab was only effective for a “small percentage” of patients, it was not clear how long its effects last, and that it was linked to “a number of adverse reactions”.

“The Committee considered all these factors and concluded that, on the basis of the evidence provided so far, ipilimumab could not be considered a cost-effective use of NHS resources.”

But he added that the decision is open to public consultation while the manufacturer can offer to cut the cost.

Amadou Diarra, European Vice President and General Manager at Bristol-Myers Squibb UK, said: “We are fully committed to demonstrating that Yervoy represents real value for money to the NHS, and we will be submitting further evidence the hope that Nice will reconsider this decision so that all patients with metastatic melanoma can access this potentially life-extending treatment.”

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