NHS pays out millions to patients of surgeon convicted of needless breast operations

The NHS has been forced to pay out almost £10m in compensation to more than 250 patients of a rogue surgeon found guilty of carrying out needless breast operations on patients who were left traumatised and scarred.

Consultant surgeon Ian Stuart Paterson, 59, was convicted on 20 counts of wounding with intent and unlawful wounding against nine women and one man on Friday. But he could have more than 1,000 more victims, among them hundreds of private patients who may never be compensated for botched and needless operations.

Paterson had denied the charges, which related to procedures he carried out between 1997 and 2011. The jury at Nottingham crown court had heard claims that the surgeon – who saw hundreds of patients a year – carried out the operations for “obscure motives”, which may have included a desire to “earn extra money”.

He denied misrepresenting patients’ test results to dupe insurers into paying for surgery, but other former patients have told the Guardian that the surgeon exaggerated or simply invented the risk of cancer and – in some cases – claimed payments for more expensive procedures that those he had carried out.

Paterson was employed by Heart of England NHS trust in 1998 – despite having been previously suspended from the Good Hope hospital in Birmingham – and also practised at privately run Spire Healthcare hospitals in the Midlands over a 13-year period.

The NHS has so far paid out around £9.5m, settling 256 cases, with 25 outstanding, the Guardian has learned. But hundreds of Paterson’s private patients may never see a penny after Paterson’s insurance company – the Medical Defence Union (MDU) – said their cover was “discretionary” and had been withdrawn. Paterson had a limited separate insurance policy of £10m, which solicitors say will not nearly cover the compensation and costs of all private patients.

Spire Healthcare, which runs the Parkway and Little Aston hospitals where Paterson treated private patients, have settled some cases but argue that as Paterson was not technically their employee, they are not responsible for his actions. The company would not divulge any details about compensation.

Sarah Jane Downing, who set up a petition, demanding compensation for Paterson’s private victims, said she had been left “shocked and appalled” at the lack of redress.

Sarah Jane Downing. Photograph: Teri Pengilley for the Guardian

“Many of these people chose private healthcare because they bought into those promises in the glossy brochures. And now we have realised that those promises are not worth the paper they are printed on. It’s utterly devastating.”

At a recent coffee morning for former Paterson patients, many described the consultant’s “brilliant” bedside manner. “He was so lovely, I thought I was so lucky – I thought I was being looked after,” said Elaine Diskin, who had eight operations by Paterson over as many years.

Her husband, Mike, also had a deep respect for the surgeon – so much so that when he had a pain in his chest, he went to him and did not hesitate when the surgeon said he suspected lipoma and that they “had to get it out”.

“Sinister was the word he used,” Diskin said. “I had no reason to doubt him because he was looking after Elaine so well.”

They trusted Paterson so much they also recommended his care to a friend, who went on to have a lump removed. “We used to joke that we’d paid for his skiing holidays,” said Elaine Diskin.

After the Diskins were recalled for a review of their treatment in 2012 they discovered that at least seven of the eight operations Paterson had done on Elaine – along with both performed on her husband and their friend – were unnecessary.

A civil case with seven “test” cases – which will determine to what extent Spire can be held liable for Paterson’s work in their hospitals – is scheduled to be heard in October, but looks likely to be delayed. The outcome will affect all the private patients who have brought civil claims – and who fear they may get nothing.

Solicitors familiar with the case say Spire has made a handful of payments – the largest about £150,000 – to former patients in the private sector which include unnecessary removal of lumps and the received“cleavage-sparing mastectomies”, a controversial operation that left breast tissue behind after the removal of cancerous cells.

Concerns about Paterson were raised as far back as 2003. But despite several internal and external investigations and complaints from patients, GPs and other surgeons he was only suspended by the General Medical Council in 2011. “In every profession you get rogue operators – but there are checks and balances to stop terrible things happening,” said Mike Diskin. “Why were there not in this case, or why were they ignored?”

Timeline

1998: Paterson is hired as a consultant surgeon at the Heart of England NHS trust, despite being previously suspended from the Good Hope hospital, and also sees private patients at Spire Healthcare hospitals Little Aston and Parkway.

2003: Paterson is investigated because of concerns about “cleavage-sparing mastectomies”. Recommendations are not followed through.

2007: Breast surgeon Hemant Ingle is appointed and with others raises concerns. Further investigations are carried out and Paterson is told to stop performing “cleavage-sparing mastectomies”. Mark Goldman, chief executive of the Heart of England NHS trust, informs Spire that the trust is investigating Paterson.

2008: Two GPs complain about Paterson’s treatment of a patient, saying he gave misleading information about pathology reports, over-treated patients and disregarded the multidisciplinary team meeting process. Another report is critical.

2009: A Spire Parkway patient makes a formal complaint about Paterson. No action is taken. Heart of England NHS trust recalls 12 patients who have had “cleavage-sparing mastectomies”. West Midlands Cancer Intelligence Unit submits two further reports.

2010: The General Medical Council (GMC) tells Spire Parkway executives about a complaint from an NHS patient. .

2011: Parkway were informed Paterson had carried out a “cleavage-sparing mastectomy” in 2009 after being told to stop in January 2008. A month later the GMC informed Spire about another patient complaint. A total recall of all Paterson’s patients begins.

Paterson is suspended by the NHS in May 2011 but continues to perform breast surgery for Spire until 31 May and general surgery until 8 June 2011. He is paid until November 2012.

NHS pays out millions to patients of surgeon convicted of needless breast operations

"186m needless emails": NHS-wide test message and replies-to-all crash system

Sending an email to everyone in the company is usually a guaranteed way of making yourself unpopular, but the potential for annoyance is even greater if you work in the NHS, employer of 1.2 million people.

On Monday, NHS employees complained on Twitter about a “test email” sent by an IT contractor at Croydon NHS to everyone in the organisation, as well as replies-to-all, leading to claims the entire email system has crashed.

One NHS statistician estimated that at least 186m emails, including replies-to-all asking to be taken off the distribution list, had been sent, clogging up people’s inboxes.

Gavin (@68_gavin)

Another waste of a working day due to some pillick in #nhsmail sending email to entire directory, unable to connect and do my job #epicfail

November 14, 2016

James Andrews (@aptaim)

Hmmmm… wonder if this is why I can’t log in to #NHSmail at the moment ?! https://t.co/wBvuREsB6X

November 14, 2016

Project iHypE (@PIhype)

If you’re trying to get in touch with us today, please be patient, it seems #NHSmail has gone down for the time being. We’ll reply ASAP. A

November 14, 2016

Colin McDonnell (@Malignanthero)

Slow handclap for the individual that sent a test email to the entire NHSMail user base, and bravo to those that “replied to all”… pic.twitter.com/zkg5uG7t2M

November 14, 2016

Graham Hyde (@GrahamHyde)

#nhsmail 1.2 million people have received approx 151 emails in error this morning. That’s 186 million needless emails so far today.

November 14, 2016

A message to NHS mail users described the global email as a “high severity service incident”. It said: “An issue with a distribution list has meant that several test emails have been widely received by users. This has been exacerbated by recipients replying in response and increasing the volume of emails associated with the list.

“The impact of this issue has meant that some users are unable to access OWA [Outlook web access] due to the volume of emails being circulated. The distribution list has been removed and associated emails are being traced and cleared. In the meantime, users will experience slow performance with OWA and email delivery delays from internal and external sources to nhs.net addresses.”

Spare a thought for the NHSmail helpdesk, to which complaints have trebled since the email system was introduced in May.

NHSmail, a secure email service, is approved by the Department of Health for sharing patient identifiable/sensitive information.

"186m needless emails": NHS-wide test message and replies-to-all crash system

"Soft-touch" physicians create 10m needless prescriptions a 12 months, says Wonderful

About a single in 4 prescriptions issued for antibiotics in England each and every 12 months – about 10m in all – are probably to be pointless as individuals deliberately search for “soft-touch” doctors who give in to their demands for the medicines, a foremost well being official has stated.

Mark Baker, director of clinical practice at the National Institute for Health and Care Excellence (Great), has warned that the increasing crisis of antimicrobial resistance, in which profligate use of medicines has permitted bacteria to develop resistance, threatened healthcare and the “whole basis of medicine”. He also explained infections would have to be handled by surgical treatment if drugs no longer worked.

Baker is director of clinical practice at the National Institute for Wellness and Care Excellence (Great), whichNice on Tuesday published advice on the concern for medical professionals, dentists, podiatrists, pharmacists and other experts.

Expectations of getting antibiotics have been now “entrenched”, stated Baker. “There are men and women who are addicted to the concept of possessing antibiotics. If they know there is a soft-touch doctor then they go to them.” If they did not realize success with one medical professional, they would attempt yet another or even search the internet to supply the medicines, he said.

Except if the most recent advice was translated into action, he explained there would have to be a rethink in practice “because we have invested 60 years assuming that most infections will be cured by antibiotic drugs”.

If these no longer worked, explained Baker, “then we will have to rediscover and relearn how to treat infections surgically and I do not feel anyone desires to be in that position”.

Associated: Considering of asking your medical professional for antibiotics? Consider once again | Sarah Boseley

The advice calls for prescribers to examine with individuals the very likely nature of their condition, the positive aspects and harms of quick prescribing, and choices this kind of as “watchful waiting” or delayed prescribing, when prescriptions are issued only soon after microbial samples taken from individuals have been examined.

It demands much more rigorous neighborhood policing of prescribing practice, with expert teams monitoring and evaluating information from distinct hospitals, GP practices and other prescribers.

Cases of very high, escalating or reduced volumes of prescribing ought to be examined.

Baker stated an open and transparent culture must permit well being specialists to query colleagues’ prescribing practices when they had been not in line with local or nationwide tips and no causes have been given for those choices.

There was a lot of really great practice, stated Baker, but examples of undesirable practice may, as a final alternative, be referred to skilled regulators this kind of as the Basic Healthcare Council (GMC).

Tim Ballard, vice-chair of the Royal University of GPs, mentioned the guidance “to give the appropriate antibiotic at the proper dose at the appropriate time” was wise.

“But we can come underneath enormous pressure from individuals to prescribe antibiotics, even when we know they are not the correct course of action. People need to realise that this is hazardous for every single and everyone of us, not just ‘other people’.”

He explained it may be counterproductive and unhelpful to involve disciplinary procedures when GPs already faced “very tough and demanding conversations” with individuals.

The college would be searching to regulators to support GPs who refused to prescribe unnecessary antibiotics and then faced complaints from patients.

Separate advice for patients, probably backed up by NHS public education campaigns, is anticipated following yr.

The Division of Health mentioned: “Tackling the overuse of antibiotics is a global issue that has an effect on everybody – government, patients, physicians, dentists and vets treating animals – not just GPs.

“In buy to make certain we have effective antibiotics for generations to come, we are raising worldwide awareness of the dangers of resistance to antibiotics and offering resources for GPs to support prescribing choices.”

Niall Dickson, chief executive of the GMC, said doctors should only prescribe if they had been pleased that this would serve the patient’s requirements.

“Where they take into account that the treatment method would not benefit the patient, they do not have to offer it.”

However, the GMC saw the Wonderful recommendations as “being a lot more about modifying the norms of practice typically than pursuing person doctors”.

Connected: Resistance is not futile – how to tackle drug-resistant superbugs

The dangers of antibiotic resistance initial grew to become a significant situation in the Uk in the late 1990s when they were raised by Sir Liam Donaldson, the then chief health care officer. His successor, Dame Sally Davies, took up the cudgels in 2013, with David Cameron calling for international action the following yr.

Professionals worry the crisis is deepening, with no new class of antibiotics or other major scientific growth in 30 many years.

A total of 41.6m prescriptions have been issued in England in 2013-14, costing the NHS £192m.

Prior Good guidance on the use of antibiotics to deal with respiratory tract infections, issued in 2007, was aimed at cutting prescribing by 22%. After an first dip, it started to increase once more.

A survey final year suggested more than a quarter of physicians prescribed antibiotics even when they have been not certain they were medically required, and nine in 10 felt underneath strain from individuals to prescribe them. Other figures suggest practically all individuals who inquire for antibiotics get them.

"Soft-touch" physicians create 10m needless prescriptions a 12 months, says Wonderful

Diabetic men and women "having needless amputations"

Amputations are twice as probably for grownups with diabetes in the south-west as for people in London. Photograph: Hugo Philpott/PA

People with diabetes are having their legs and feet amputated unnecessarily, according to a group of MPs and peers who have highlighted stark distinctions in treatment of the problem across the NHS in England.

The all-get together parliamentary group on vascular ailment explained amputations are twice as very likely for grownups with diabetes in the south-west compared with London. It calls for reductions in the “stubbornly substantial” numbers of individuals dropping limbs, feet or toes.

NHS commissioners and hospitals need to guarantee a far more constant approach to treating problems this kind of as peripheral arterial ailment, which has an effect on the blood provide to muscles, and “diabetic foot” and make certain they have appropriate multi-disciplinary well being teams, the report stated. Its demands had been backed by a senior surgeon, who warned that needless amputations were being carried out due to the fact of the lack of national standards, and by the charity Diabetes United kingdom which named present variations in treatment “unacceptable”.

It has complained existing greatest practice guidance for the NHS on PAD is often not followed.

Neil Carmichael, Conservative MP for Stroud, who chairs the parliamentary group, mentioned:”As well numerous patients are not obtaining the treatment they want to steer clear of dropping their legs. The figures for parts of the south-west of England are particularly alarming, and this needs to be tackled.”

Decreasing lower limb-loss should be a priority, offered the country’s ageing population, he said.

In the south-west there had been on typical three.88 amputations per one,000 sufferers with diabetes more than the 3 many years to 2011-12, with the region now covered by the Somerset clinical commissioning group recording a figure of four.seven per one thousand.

The parliamentarians’ report, which based mostly its findings on NHS statistics and answers to freedom of details requests, showed the comparable figure in London was one.94.

Ian Franklin, a council member of the Vascular Society, explained :”To be trustworthy, no person ever desires to complete an amputation … you only ever amputate a limb to save someone’s life.

“In the same way that the regular of breast cancer care is national, the therapy you get in Stockport is the identical as Kent, we want the same factor for limb-threatening issues. We are receiving pointless amputations since in some elements of the country the treatment method is prompt, in some elements of the nation the therapy is sluggish, and it is sluggish without having contravening any recommendations.”

Nikki Joule, policy manager, at Diabetes Uk, mentioned:”Up to 80% of amputations are avoidable with good preventative foot care in the local community and fast access to a specialist multidisciplinary team when necessary.”

Somerset clinical commissioning group (CCG) stated new diabetes foot care companies would start off up coming month. Added clinics with podiatrists would offer a patient review inside 24 hrs in most situations and there would be better functioning with hospitals and accessibility to other professionals.

This new clinical pathway would also see the county complying with the advice recommended by the NHS’s National Institute for Health and Care Excellence. The CCG was assured that amputation rates would fall.

Professor Jonathan Valabhji, national clinical director for diabetes at NHS England, mentioned: “The report highlights an really essential issue, decrease limb amputation, which is one of the most feared complications of diabetes and of peripheral vascular condition.

“The report highlights the issue of geographical variation, which was highlighted previously in analysis in 2012. Given that that time, efforts have been focussed on reproducing very good practice and substantial good quality care across the nation for the management of diabetic foot illness, which has witnessed the proportion of Trusts with multidisciplinary diabetic footcare teams boost from around 60% in 2011 to 72% in 2013.

“Nevertheless, there is nevertheless a lot much more to do, and from July this year we will see the launch of the Nationwide Diabetes Footcare Audit. The audit aims to establish the extent to which nationwide suggestions on the management of diabetic foot condition are being met, and will offer local teams with the proof necessary to tackle any identified differences in practice which will lead in flip to an general improvement in management and outcomes for patients.”

Diabetic men and women "having needless amputations"

Too numerous needless deaths simply because elderly cancer sufferers are "written off"

New study from the charity and the National Cancer Intelligence Network (NCIN) identified that tens of 1000′s of pensioners who have been diagnosed with cancer have survived for at least a decade.

More than 130,000 individuals in the Uk have survived for at least ten years right after getting diagnosed with cancer at the age of 65 or above, the charity stated.

This consists of a lot more than 8,000 individuals who have been diagnosed at the age of 80 and more than.

But the charity explained that the figures would be far higher, if numerous patients in the Uk had been not being denied remedy because they are deemed to be as well old.

Survival prices for practically all widespread cancers are worse in Britain that the European typical, global investigation has discovered.

In December, a examine of more than 29 countries in contrast five year survival for stomach, colon, rectal, lung, melanoma skin, breast, ovarian, prostate, and kidney cancers as well as the blood cancer non-Hodgkin lymphoma.

It found that only for skin cancer was survival in this country better than the EU regular.

For many cancers, survival was on a par with countries in Eastern Europe.

The charity said doctors required to make greater assessments of patients’ physical and wellbeing, with too numerous decisions on whether or not or not to commence treatment method taken on the basis of age alone.

Mr Devane mentioned: “With a suitable evaluation and suitable remedy, our analysis shows that a lot of older cancer sufferers can dwell for a prolonged time and can even be cured.

“Although it really is very good news that so many older men and women are benefitting from treatment method, numerous thousands a lot more could reside longer if our survival rates for above 65s matched people in comparable countries.

NCIN’s clinical lead Dr Mick Peake additional: “It is important that all individuals receive the ideal and most successful therapy based on the nature of their cancer and their fitness for remedy and that chronological age alone is not the choosing factor.

“We know that cancer survival rates in older individuals in a lot of other nations are greater in the United kingdom and guaranteeing optimal therapy at all ages is the way of tackling this concern.”

Dr Mark Porter, chair of council at the British Medical Association, stated: “It is important that all healthcare experts ensure that sufferers are taken care of on the basis of their clinical want.

“With an more and more ageing population, it need to be a key component of health care professionalism to assure that older patients are handled with the care and respect they deserve.”

Too numerous needless deaths simply because elderly cancer sufferers are "written off"