Category Archives: Beauty & Care

Stop accusing men of overreacting – ‘man flu’ really does exist, doctor claims

The fight against the ridicule of “man flu” has been taken up by a doctor who says, somewhat tongue-in cheek, that he delved into the issue after growing tired of being accused of overreacting.

In a treatise based on previous studies – some scientific, some notably less so – the Dr Kyle Sue not only puts the case that men might indeed experience worse cold and flu symptoms than women, but also explores why such a difference might have evolved.

“I do think that the research does point towards men having a weaker immune response when it comes to common viral respiratory infections and the flu,” said Sue, a clinical assistant professor in family medicine from the Memorial University of Newfoundland. “This is shown in the fact that they [have] worse symptoms, they last longer, they are more likely to be hospitalised and more likely to die from it.”

But others were not persuaded by Sue’s arguments, pointing out that many different factors can affect how bad a bout of cold or flu is.

The article, published in the British Medical Journal, involved a wry look at previous studies and put forward a number of strands of evidence that suggest men might really experience worse symptoms than women when it comes to viral respiratory illnesses.

Among them, the author points out that mouse studies have suggested that testosterone could dampen immune response to influenza, while certain female sex hormones could boost it. What’s more, some studies on a small group of humans revealed that cells from pre-menopausal women showed different immune responses to the type of virus behind the common cold to those of men of the same age – the difference was not seen when cells from men were compared to those of post-menopausal female peers.

The study also notes that research from the US showed men had higher rates of deaths linked to flu compared to women of the same age, while data from Hong Kong shows men had a higher risk of winding up in hospital with seasonal flu than women. It also pushes back against the idea that men crumble at the first sneeze – pointing to a study which found women were more likely than men to cut down activities when it came to minor respiratory illnesses.

The article also reveals that a survey in a popular magazine found that men took twice as long to recover from such viral illnesses as women.

“Since about half of the world’s population is male, deeming male viral respiratory symptoms as ‘exaggerated’ without rigorous scientific evidence could have important implications for men, including insufficient provision of care,” Sue writes.

Sue admitted the studies didn’t take into account other differences between men and women, such as how much individuals smoked, or that men have been found to be worse at looking after themselves and seeking medical care than women.

“There need to be more studies, higher quality studies that control for other factors between men and women before we can definitely say that this difference in immunity exists,” he told the Guardian. “Is it that women are more resilient, that they are able to juggle more when they are ill, or is it that they don’t have as severe symptoms? That we are not too sure about. But I think everyone should be given the benefit of the doubt when they are ill.”

Sue also explored whether there was an evolutionary explanation for why men might experience worse symptoms than women when it comes to viral respiratory infections.

Among the theories put forward, Sue notes higher testosterone levels might offer upsides when it comes competing against other males that outweigh the possible negative impact on the immune system, or that being more under the weather keeps males bedbound and hence potentially out of the way of predators.

“Perhaps now is the time for male-friendly spaces, equipped with enormous televisions and reclining chairs, to be set up where men can recover from the debilitating effects of man flu in safety and comfort,” Sue suggests.

“I am hopeful that next time men are being criticised as exaggerating their symptoms they can say ‘hey, look at this study, there is some proof that I am not!’” he added.

But not everyone is bowled over by Sue’s arguments, including Peter Barlow, associate professor of immunology and infection at Edinburgh Napier University.

“There are a significant number of factors which can contribute to the severity of an influenza infection,” he said. “As the author of the article alludes, it is currently impossible to say whether there are sex-specific differences in susceptibility to influenza virus, or in the progression of the infection.”

Jeremy Hunt launches opt-out organ donation plans in England and Wales

Health secretary Jeremy Hunt is to launch plans for an opt-out system of organ donation, asking people to overcome their “fatal reluctance” to discuss the issue with family and friends.

Under the plans, everybody in England and Wales would be presumed to be happy to donate their organs on their death, unless they have signed up to a register stating that they do not want that to happen. In practice, however, it is unlikely that organs would be taken against the wishes of the family.

The government’s ambition to change the NHS organ donation programme was announced by Theresa May in her Conservative party conference speech in October. Last year, she said, “500 people died because a suitable organ was not available. And there are 6,500 on the transplant list today.”

NHS Blood and Transplant’s figures show that 1,100 families in the UK decided not to allow organ donation because they were unsure, or did not know whether their relatives would have wanted to donate an organ or not.

“Every day, three people die for want of a transplant, which is why our historic plans to transform the way organ donation works are so important. We want as many people as possible to have their say as we shape the new opt-out process,” said Hunt.

“As well as changing the law, we also need to change the conversation – it can be a difficult subject to broach, but overcoming this fatal reluctance to talk openly about our wishes is key to saving many more lives in the future.”

The consultation will ask three questions: how much say should families have in their deceased relative’s decision to donate their organs? When would exemptions to “opt-out” be needed, and what safeguards will be necessary? How might a new system affect certain groups depending on age, disability, race or faith?

There are particular shortages of organs for people from ethnic minority backgrounds. Only about 6% of donors are black or Asian, although those groups make up about 10% of the population. Orin Lewis, chief executive of the Afro-Caribbean Leukaemia Trust and co-chair of the National BAME Transplant Alliance, said: “As a parent of a young man who sadly passed away from multiple organ failure, I gladly welcome the prime minister’s decision to instigate a much-needed public consultation on the relative positive and negative merits of England having an opt-out donation policy.”

There is still debate over how well an opt-out system works. Spain is often hailed as a success story and has a good supply of organs. However, the opt-out was introduced at the same time as big investments in the transplant programme, and in particular the appointment of transplant coordinators who instigate conversations with the family of a dying patient. If families refuse, their wishes are always respected.

Wales launched an opt-out system in December 2015 and the following June it was announced that it had already been a success. Half the 60 organs transplanted in the six months came from people whose consent had been presumed. But a recent year-on-year comparison showed little difference, with 101 donors under the old system and 104 under presumed consent.

In Wales, 6% of the population have signed the opt-out register. The policy requires that the consent of next-of-kin must always be sought.

Hugh Whittall, director of the Nuffield Council on Bioethics, said there were concerns that the government was asking how an opt-out system should be introduced, rather than whether it should. “The government should not be making this change until there is evidence that it works, and until we are confident that it won’t undermine people’s trust in the system in the long-term,” he said.

“That evidence is simply not there yet, though we do know some things that do work. Key amongst those is raising public awareness, encouraging family discussion, and better support and communication between specialist nurses and bereaved families.

“Even in systems where an opt-out approach has been adopted (such as Spain), it is generally recognised that these are the elements that have made a difference, rather than the legal basis of the donation.”

Keith Rigg, consultant transplant surgeon, said too many people were waiting and he welcomed the opportunity for discussion. “Encouraging people to talk openly with their families about their organ donation wishes is really important. There are strong feelings for and against opting out and there is no convincing evidence from Wales yet that this had made a difference. It is important that any proposed changes are based on evidence, encourage the wishes of individuals to be known and acted on, and support families to make the right decision about their loved ones at the time of their death,” he said.

Have you been rejected by insurers because of mental health problems?

If you have a mental health condition it can be harder to get insurance and in some circumstances you have to pay more.

However, this should only be the case if the insurer can provide evidence that you are at a higher risk of making a claim and if the information they used to access your application was applied in a reasonable way.

Earlier this year travel insurance companies were accused of discriminating against people with mental health problems after a young woman was refused cover when she revealed that she had bipolar disorder.

What are your experiences?

We want to know whether other people feel they have been discriminated in this way. Have you found it harder to get any kind of insurance – travel, health, life – even though there is no evidence you are higher risk? Do you feel you were unfairly treated? Does the current system work for those with mental health problems? Share your views, experiences and stories and we will use a selection in our reporting.

  • Your responses are secure as the form is encrypted and only the Guardian has access to your contributions. We will do our best to keep you anonymous.
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Portugal shows the way ahead on drugs policy | Letters

The driving force behind Portugal’s capacity to rescue itself from the throes of an opioid crisis is an emphasis on personalised care that galvanises the community and functions conterminously with the decriminalisation of all substances (The big fix: Portugal’s truce on drugs, 5 December). Crucially, Portugal’s radical policy has gone some way to eradicate the taboo on drug misuse. This cultural shift highlights the very tangible affects of ostracising users from the local community, be it through labelling them with derogatory language – “junkie” or “smackhead” etc – or by deeming them antisocial criminals.

As the UK sinks further into its opioid epidemic, the necessity of radically reforming its legal, political and sociocultural policies on drugs is pushed further to the fore. This means shifting the emphasis from criminalisation to healthcare, increasing public spending on health services, and encouraging communal support for drug users.
Yasmin Batliwala
Chair, WDP drug and alcohol charity

Congratulations on your long read on Portugal’s drugs policy. This should be required reading for policymakers who have refused to base drug and addiction policy on evidence. A young man I know has been to prison 11 times in the last three years. On each occasion the offences have been directly linked to drug and alcohol addiction. The young man is homeless and leaves prison, without meaningful support, to life on the street and a seemingly inevitable return to prison.

At the very least the government should be consulting evidence, and recognising that the justice system is failing addicts and the taxpayer.
Ian McCauley
Reading, Berkshire

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Urgent talks over future of Four Seasons care homes in UK

The care homes operator Four Seasons Health Care is on course for a stay of execution before a crunch debt deadline, after its major creditor offered to drop demands rejected by directors.

Last-ditch talks aimed at staving off the worst care homes collapse since Southern Cross were continuing on Sunday.

Four Seasons’ largest creditor, US investment firm H/2 Capital Partners, is understood to have made concessions amid pressure from the regulator, the Care Quality Commission, to dispel anxiety around the firm’s future.

Loss-making Four Seasons, owned by multimillionaire Guy Hands’ Guernsey-based private equity group Terra Firma, has said it may not be able to honour a £26m debt interest payment due on Friday, raising the prospect of the company falling into administration.

Terra Firma has offered to resolve the crisis by handing over the keys to Four Seasons to H/2, led by former Lehman Brothers banker Spencer Haber, which owns the majority of Four Seasons’ £525m debt.

H/2 has so far rejected Terra Firma’s proposals and instead offered a “standstill” agreement that would defer the debt deadline, but only if conditions are met that sources close to the negotiations said last week were “unsignable”.

One of these was that any detailed discussion of Four Seasons’ finances should be followed by a “cleansing statement”, where confidential information is released.

This would prevent H/2 finding itself in possession of non-public information, a scenario that would narrow its options by legally precluding it from selling its bonds.

H/2 also wanted Four Seasons’ directors replaced by an entirely independent board, but is understood to be ready to withdraw or water down the demand.

Efforts to find a compromise are understood to have been boosted by the intervention of the CQC, which has the power to stop care homes accepting new residents.

A deal under which debt payments are deferred for up to six months could be announced as soon as Monday. However, Terra Firma has been excluded from the talks, leaving the likelihood of a three-way deal, not to mention a more permanent agreement, in some doubt.

One major bone of contention is the ownership of 24 care homes that are profitable, unlike a sizeable chunk of the 343 homes that make up Four Seasons.

These homes, says Terra Firma, were accidentally added to the assets over which H/2 has security due to a slip of the pen by the law firm Allen & Overy.

Postponing the debt deadline will allow time for the matter to be settled in court, removing one element of uncertainty from near-term talks over the company’s future.

An agreement would also stave off the immediate threat that Four Seasons could be placed into administration, either by its creditors or its directors.

Sources familiar with the talks have suggested that H/2 would have the least to lose from an administration process. The firm owns the majority of Four Seasons’ £525m high-interest bonds, which it bought at a discount for an estimated £260m and which have already yielded £50m in interest.

If administrators are appointed, they would be obliged to secure the best result for creditors, led by H/2. According to some estimates, H/2 could end up sitting on a profit, either on paper or in cash terms, of more than £200m. As one source familiar with the situation put it: “It’s heads they win, tails they win.”

Some observers have warned that an administration could see loss-making homes closed, causing anxiety and disruption for residents and forcing local authorities to fund their continued care.

Labour’s shadow social care minister, Barbara Keeley, called on the government to explain how this would be possible in a worst-case scenario given tight budgets.

She said: “How will councils be able to meet extra demand when they are already struggling under the weight of Tory funding cuts, which will have led to £6.3bn being taken from social care budgets by March 2018?”

“Tory ministers need to come forward with an immediate funding solution, which was called for by the House of Commons recently, and meet the funding gap both for this year and the rest of this parliament.

Administration now looks a more distant prospect but it remains unclear how Terra Firma and H/2 can agree a mutually acceptable permanent solution for the business.

H/2 said it was “working around the clock” to secure a deal and that Four Seasons’ residents and employees were its main priority.

Concern about Four Seasons could reawaken debate about the role of high finance in social care, with the wounds of the 2012 collapse of Southern Cross still fresh.

Four Seasons, which is responsible for the care of 17,000 elderly and vulnerable people, has passed through the hands of a succession of owners, including the Qatar Investment Authority and RBS, all operating a heavily leveraged model.

While Terra Firma cut the group’s debts, the high interest rate on Four Seasons’ remaining bonds – yielding as much as 12.5% – has become unsustainable.

This is partly because spending on social care by austerity-hit local authorities has fallen in real terms, while costs have risen.

Since the Brexit vote, 96% fewer nurses have arrived in the UK from the European Union, forcing Four Seasons to use agency workers who cost up to three times as much.

Alarm over restraint of NHS mental health patients

Patients in mental health units were physically restrained by staff more than 80,000 times last year in Britain, including 10,000 who were held face down or given injections to subdue them, new NHS figures show.

Girls and young women under the age of 20 were the most likely to be restrained, each being subjected 30 times a year on average to techniques that can involve a group of staff combining to tackle a patient who is being aggressive or violent.

Black people were three times more likely to be restrained than white people, according to the first comprehensive NHS data on the use in England of such techniques, which have provoked controversy for many years.

Mental health campaigners fear that the use of such force can cause patients physical harm or revive painful memories of the trauma that many have suffered in childhood.

The figures, published by the NHS Digital statistical agency, show that the 80,000 uses of restraint in 2016-17 included patients being subjected to “prone” restraint – being held face down – 10,000 times, and patients being controlled by “non-prone” physical force 43,000 times. Chemical restraint was used on another 8,600 occasions.

The findings have prompted fresh concern among mental health experts that too many patients are still being restrained, despite moves by the government and NHS in recent years to reduce the incidence.

“It is troubling to see how prevalent the most severe, and dangerous, kinds of restraint are in the mental health system,” said Brian Dow, director of external affairs at the charity Rethink Mental Illness. Prone restraint, he warned, “can be terrifying and badly damage someone’s recovery”.

NHS Digital’s figures were published in the recent annual mental health bulletin detailing activity and treatment in NHS mental health units in England. They show that:

■ Black people were more than three times more likely to be restrained than white people.

■ Prone restraint, which guidance says should be used only in life-threatening situations, is used on fewer women than men, but is used on the former more often; women are physically subdued multiple times.

■ Mechanical means of restraint were used 1,200 times, seclusion on 7,700 occasions and segregation 700 times.

Katharine Sacks-Jones, the director of Agenda, an alliance of 70 organisations working with women and girls who are at risk, said: “It’s completely unacceptable that so many women and girls are being restrained over and over again.

“The picture for girls and young women is particularly alarming, with those under 20 subjected to restrictive practices nearly 30 times each on average, the majority of these being incidents of physical and face-down restraint.

“More than half of women who have mental health problems have experienced abuse, so not only is restraint frightening and humiliating, it also risks retraumatising them.”

In its annual report in July, the Care Quality Commission, which regulates NHS care in England, said its inspectors had found unwarranted and wide-ranging variation between units in terms of how often staff used restraint. Wards with low rates had staff who had been trained to handle difficult behaviour and de-escalate challenging situations.

But, the CQC added, mental health wards dealing with acutely unwell patients are high-risk environments where patients can regularly be violent towards staff or fellow patients. The number of times restraint techniques are used has risen from 781 per 100,000 bed days in 2013-14 to 954 per 100,000 bed days last year. However, use of face-down restraint has fallen, from 231 incidents per 100,000 bed days in 2014-15 to 199 incidents per 100,000 bed days in 2015-16.

The Department of Health said that its guidance, issued in 2014, stressed that restraint should be used only if other means of dealing with difficult situations were unlikely to succeed.

“Physical restraint should only be used as a last resort and our guidance to the NHS is clear on this – anything less is unacceptable,” a spokeswoman said. “Every patient with mental health issues deserves to be treated and cared for in a safe environment. We are working actively with the CQC to ensure the use of restraint is minimised.”

The bulletin also reveals that almost one in 20 people in England received NHS help last year for mental health problems.

A total of 2,637,916 people – 4.8% of the population – were in contact with secondary mental health, learning disabilities and autism services at some point. Of these, 556,790 were under 18.

In addition, 101,589 (3.9%) of those 2.6 million patients ended up in hospital receiving treatment.

In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

Alarm over restraint of NHS mental health patients

Patients in mental health units were physically restrained by staff more than 80,000 times last year in Britain, including 10,000 who were held face down or given injections to subdue them, new NHS figures show.

Girls and young women under the age of 20 were the most likely to be restrained, each being subjected 30 times a year on average to techniques that can involve a group of staff combining to tackle a patient who is being aggressive or violent.

Black people were three times more likely to be restrained than white people, according to the first comprehensive NHS data on the use in England of such techniques, which have provoked controversy for many years.

Mental health campaigners fear that the use of such force can cause patients physical harm or revive painful memories of the trauma that many have suffered in childhood.

The figures, published by the NHS Digital statistical agency, show that the 80,000 uses of restraint in 2016-17 included patients being subjected to “prone” restraint – being held face down – 10,000 times, and patients being controlled by “non-prone” physical force 43,000 times. Chemical restraint was used on another 8,600 occasions.

The findings have prompted fresh concern among mental health experts that too many patients are still being restrained, despite moves by the government and NHS in recent years to reduce the incidence.

“It is troubling to see how prevalent the most severe, and dangerous, kinds of restraint are in the mental health system,” said Brian Dow, director of external affairs at the charity Rethink Mental Illness. Prone restraint, he warned, “can be terrifying and badly damage someone’s recovery”.

NHS Digital’s figures were published in the recent annual mental health bulletin detailing activity and treatment in NHS mental health units in England. They show that:

■ Black people were more than three times more likely to be restrained than white people.

■ Prone restraint, which guidance says should be used only in life-threatening situations, is used on fewer women than men, but is used on the former more often; women are physically subdued multiple times.

■ Mechanical means of restraint were used 1,200 times, seclusion on 7,700 occasions and segregation 700 times.

Katharine Sacks-Jones, the director of Agenda, an alliance of 70 organisations working with women and girls who are at risk, said: “It’s completely unacceptable that so many women and girls are being restrained over and over again.

“The picture for girls and young women is particularly alarming, with those under 20 subjected to restrictive practices nearly 30 times each on average, the majority of these being incidents of physical and face-down restraint.

“More than half of women who have mental health problems have experienced abuse, so not only is restraint frightening and humiliating, it also risks retraumatising them.”

In its annual report in July, the Care Quality Commission, which regulates NHS care in England, said its inspectors had found unwarranted and wide-ranging variation between units in terms of how often staff used restraint. Wards with low rates had staff who had been trained to handle difficult behaviour and de-escalate challenging situations.

But, the CQC added, mental health wards dealing with acutely unwell patients are high-risk environments where patients can regularly be violent towards staff or fellow patients. The number of times restraint techniques are used has risen from 781 per 100,000 bed days in 2013-14 to 954 per 100,000 bed days last year. However, use of face-down restraint has fallen, from 231 incidents per 100,000 bed days in 2014-15 to 199 incidents per 100,000 bed days in 2015-16.

The Department of Health said that its guidance, issued in 2014, stressed that restraint should be used only if other means of dealing with difficult situations were unlikely to succeed.

“Physical restraint should only be used as a last resort and our guidance to the NHS is clear on this – anything less is unacceptable,” a spokeswoman said. “Every patient with mental health issues deserves to be treated and cared for in a safe environment. We are working actively with the CQC to ensure the use of restraint is minimised.”

The bulletin also reveals that almost one in 20 people in England received NHS help last year for mental health problems.

A total of 2,637,916 people – 4.8% of the population – were in contact with secondary mental health, learning disabilities and autism services at some point. Of these, 556,790 were under 18.

In addition, 101,589 (3.9%) of those 2.6 million patients ended up in hospital receiving treatment.

In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

Inquiry announced into case of rogue surgeon Ian Paterson

The government will launch an independent national inquiry into the actions of the rogue surgeon Ian Paterson, who was sentenced to 20 years in jail in August after carrying out needless surgery on patients who were left traumatised and scarred.

The inquiry will begin in January and report in the summer of 2019, and will be chaired by the Right Rev Graham James, the bishop of Norwich.

Paterson, a consultant breast surgeon at the Heart of England NHS foundation trust (HEFT) who practised privately at Spire Parkway and Spire Little Aston, was found guilty in April of 17 counts of wounding patients with intent.

The NHS has paid out almost £10m in compensation to more than 250 patients, and Spire healthcare agreed in September to settle a further 750 cases.

The government said the scope of the investigation would include the independent sector, and it would examine whether the Care Quality Commission’s inspection regime needed to be strengthened.

The health minister Philip Dunne said he was determined that lessons would be learned so that similar problems could be avoided in both the NHS and the private sector.

Concerns were raised about Paterson as far back as 2003 but, despite several internal and external investigations and complaints from patients, GPs and other surgeons, the General Medical Council did not suspend him until 2011.

Dunne said: “Ian Paterson’s malpractice sent shockwaves across the health system due to the seriousness and extent of his crimes. I believe an independent, non-statutory inquiry, overseen by Bishop Graham James, is the right way forward to ensure that all aspects of this case are brought to light and lessons learned so we can better protect patients in the future.”

Lawyers for Paterson’s victims said they were disappointed that the inquiry would not be statutory and would not have the power to force people to give evidence under oath or give binding recommendations.

“We have previously expressed doubt in the current government’s political commitment to take on and tackle failings of the private health sector that were so vividly exposed in this terrible case,” said Tom Jones, the head of policy at Thompsons Solicitors, which represented about 500 victims. “Our concerns are reinforced by the potential for this inquiry to kick the can down the road and whose recommendations will not be binding.”

Kashmir Uppal, of Access Legal, said the inquiry was a “positive step” but victims were disappointed and concerned. “The government has said patients’ interests will be put at the heart of this inquiry and so it must take place in public and fully expose the failings that allowed Ian Paterson to continue practising in the private sector long after concerns were raised about him.”

James, the inquiry chair, said serious questions remained unanswered. “It is vital that the inquiry be informed by the concerns of former patients of Ian Paterson and their representatives,” he said. “The interests of all patients, whether they seek treatment in the NHS or the private sector, should be at the heart of this inquiry.”

The government said the inquiry would consider oversight of care in the private sector, the sharing of complaints between private hospitals and the NHS, the role of private health insurers, and arrangements for medical indemnity cover for clinicians in the private sector.

One of Paterson’s former patients, Sarah Jane Downey, said she was pleased the inquiry would report quickly, but she shared the concerns of other victims. “It worries me that the inquiry won’t have the ability to compel witnesses. We know there were people who aided and abetted Paterson and they need to answer questions,” she said. “It is a worry that it could be toothless.”

Spire Healthcare, which runs Parkway and Little Aston hospitals, where Paterson practised, initially argued that as Paterson was not technically its employee, it was not responsible for his actions.

In September, it agreed to settle all claims against it relating to Paterson, paying £27.2m into a £37m fund, with the balance funded by Paterson’s insurers and the Heart of England trust.

Inquiry announced into case of rogue surgeon Ian Paterson

The government will launch an independent national inquiry into the actions of the rogue surgeon Ian Paterson, who was sentenced to 20 years in jail in August after carrying out needless surgery on patients who were left traumatised and scarred.

The inquiry will begin in January and report in the summer of 2019, and will be chaired by the Right Rev Graham James, the bishop of Norwich.

Paterson, a consultant breast surgeon at the Heart of England NHS foundation trust (HEFT) who practised privately at Spire Parkway and Spire Little Aston, was found guilty in April of 17 counts of wounding patients with intent.

The NHS has paid out almost £10m in compensation to more than 250 patients, and Spire healthcare agreed in September to settle a further 750 cases.

The government said the scope of the investigation would include the independent sector, and it would examine whether the Care Quality Commission’s inspection regime needed to be strengthened.

The health minister Philip Dunne said he was determined that lessons would be learned so that similar problems could be avoided in both the NHS and the private sector.

Concerns were raised about Paterson as far back as 2003 but, despite several internal and external investigations and complaints from patients, GPs and other surgeons, the General Medical Council did not suspend him until 2011.

Dunne said: “Ian Paterson’s malpractice sent shockwaves across the health system due to the seriousness and extent of his crimes. I believe an independent, non-statutory inquiry, overseen by Bishop Graham James, is the right way forward to ensure that all aspects of this case are brought to light and lessons learned so we can better protect patients in the future.”

Lawyers for Paterson’s victims said they were disappointed that the inquiry would not be statutory and would not have the power to force people to give evidence under oath or give binding recommendations.

“We have previously expressed doubt in the current government’s political commitment to take on and tackle failings of the private health sector that were so vividly exposed in this terrible case,” said Tom Jones, the head of policy at Thompsons Solicitors, which represented about 500 victims. “Our concerns are reinforced by the potential for this inquiry to kick the can down the road and whose recommendations will not be binding.”

Kashmir Uppal, of Access Legal, said the inquiry was a “positive step” but victims were disappointed and concerned. “The government has said patients’ interests will be put at the heart of this inquiry and so it must take place in public and fully expose the failings that allowed Ian Paterson to continue practising in the private sector long after concerns were raised about him.”

James, the inquiry chair, said serious questions remained unanswered. “It is vital that the inquiry be informed by the concerns of former patients of Ian Paterson and their representatives,” he said. “The interests of all patients, whether they seek treatment in the NHS or the private sector, should be at the heart of this inquiry.”

The government said the inquiry would consider oversight of care in the private sector, the sharing of complaints between private hospitals and the NHS, the role of private health insurers, and arrangements for medical indemnity cover for clinicians in the private sector.

One of Paterson’s former patients, Sarah Jane Downey, said she was pleased the inquiry would report quickly, but she shared the concerns of other victims. “It worries me that the inquiry won’t have the ability to compel witnesses. We know there were people who aided and abetted Paterson and they need to answer questions,” she said. “It is a worry that it could be toothless.”

Spire Healthcare, which runs Parkway and Little Aston hospitals, where Paterson practised, initially argued that as Paterson was not technically its employee, it was not responsible for his actions.

In September, it agreed to settle all claims against it relating to Paterson, paying £27.2m into a £37m fund, with the balance funded by Paterson’s insurers and the Heart of England trust.

Inquiry announced into case of rogue surgeon Ian Paterson

The government will launch an independent national inquiry into the actions of the rogue surgeon Ian Paterson, who was sentenced to 20 years in jail in August after carrying out needless surgery on patients who were left traumatised and scarred.

The inquiry will begin in January and report in the summer of 2019, and will be chaired by the Right Rev Graham James, the bishop of Norwich.

Paterson, a consultant breast surgeon at the Heart of England NHS foundation trust (HEFT) who practised privately at Spire Parkway and Spire Little Aston, was found guilty in April this year of 17 counts of wounding patients with intent.

The NHS has paid out almost £10m in compensation to more than 250 patients, but many private patients have not been compensated. The government said the scope of the investigation would include the independent sector, and it would examine whether the Care Quality Commission’s inspection regime needs to be strengthened.

The health minister Philip Dunne said he was determined that lessons would be learned so that similar problems could be avoided in both the NHS and the private sector.

Concerns were raised about Paterson as far back as 2003 but, despite several internal and external investigations and complaints from patients, GPs and other surgeons, the General Medical Council did not suspend him until 2011.

Dunne said: “Ian Paterson’s malpractice sent shockwaves across the health system due to the seriousness and extent of his crimes. “I believe an independent, non-statutory inquiry, overseen by Bishop Graham James, is the right way forward to ensure that all aspects of this case are brought to light and lessons learned so we can better protect patients in the future.”

Lawyers for Paterson’s victims said they were disappointed that the inquiry would not be statutory and would not have the power to force people to give evidence under oath.

“Obviously this is a positive step forward, but victims were calling for a full public inquiry,” said Kashmir Uppal, of Access Legal, who has worked with Paterson’s former patients since 2010. “The government has said patients’ interests will be put at the heart of this inquiry and so it must take place in public and fully expose the failings that allowed Ian Paterson to continue practising in the private sector long after concerns were raised about him.”

Paterson’s trial at Nottingham crown court heard that he carried out “extensive, life-changing operations for no medically justifiable reason” on 10 patients between 1997 and 2011. But there could be more than 1,000 additional victims, among them hundreds of private Spire Healthcare patients.

The inquiry will look at previous reports on Paterson’s conduct, including a damning report by Sir Ian Kennedy on behalf of the Heart of England trust.

James, the chair of the new inquiry, said serious questions remained unanswered. “It is vital that the inquiry be informed by the concerns of former patients of Ian Paterson and their representatives,” he said. “The interests of all patients, whether they seek treatment in the NHS or the private sector, should be at the heart of this inquiry and I will do my very best in the interest of those affected and the public.”

The government said the inquiry would be shaped by Paterson’s victims and would consider who was responsible for ensuring the quality of care in the private sector; the way concerns were shared between private hospitals and the NHS; the role of private health insurers, including how data they hold about the scope and volume of work carried out by doctors is shared; and arrangements for medical indemnity cover for clinicians in the independent sector.

Paterson’s victims have repeatedly called for “co-conspirators” to be held to account, accusing them of turning a blind eye to the malpractice.

Paterson’s private patients have been frustrated in their attempts to claim compensation after the surgeon’s insurance company, the Medical Defence Union, said its cover was “discretionary” and had been withdrawn.

Spire Healthcare, which runs Parkway and Little Aston hospitals where Paterson practised, has settled some cases but argued that as Paterson was not technically its employee, it was not responsible for his actions. The company would not provide any details about the compensation paid.

After Paterson was jailed, a Spire spokesman said the company was “truly sorry for the distress caused to Paterson’s victims”.