Category Archives: Cold & Flu

Family doctors working ‘beyond safe levels’, says GPs’ leader

As doctors describe dealing with up to 70 patients a day, college warns of risks to public health

Waiting room of GP practice


Patients face longer waits to see a GP, says the Patients Association. Photograph: Alamy


GPs across Britain are working above safe levels because of relentless and unmanageable workloads, leading doctors have warned.

Prof Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said that family doctors were “regularly working way beyond what could be considered safe for patients”, potentially jeopardising their own health and wellbeing.

Her comments were made in response to a survey by GP magazine Pulse. It heard from 900 GPs across the UK and found that each deals with 41 patients a day. The European Union of General Practitioners (UEMO), a leading forum of European family doctors, has said that seeing around 25 patients is safe.

The Pulse poll found that one in five family doctors (20%) deal with 50 daily patient contacts, which include face-to-face and telephone consultations, home visits and e-consultations. Some GPs told Pulse they have 70 contacts a day.

Prof Stokes-Lampard said: “GPs expect to be busy, and we are making more consultations than ever before as we strive to deliver the best possible care to all our patients who need it. But the workload at the moment is relentless and it’s taking its toll.”

One doctor, who reluctantly left a career carrying out 13- to 14-hour days as a partner for a more manageable workload as a salaried GP and 31 to 40 daily contacts, told Pulse: “I felt I was at a risk of making mistakes and causing potential harm to my patients and my career.”

Another spoke of one exceptional “horrendous” Monday where he had 71 contacts. Since then the practice has since increased the number of on-call doctors on Mondays to three.

Prof Stokes-Lampard said the survey backed up what the college has been saying for years – that many GPs are regularly working way beyond what could be considered safe for patients.

It was not necessarily the number of consultations, but the content of those consultations, she added. “Our patients are increasingly presenting with more complex, chronic conditions, many of which require much longer than the standard 10-minute appointment,” she said.

“Our workload needs to be addressed – it has risen at least 16% over the last seven years,” she added. “Yet the share of the overall NHS budget general practice receives is less than it was a decade ago, and our workforce has not risen at pace with demand.”

Dr Richard Vautrey, British Medical Association general practitioners committee chair, said: “We know that an unmanageable and unsafe workload is the primary reason behind doctors leaving general practice, which is leading to serious issues including practices closing to new patients and other surgeries closing entirely. This workload pressure also means GPs are increasingly suffering from burnout and patients are being put at risk of unsafe care.”

He urged the government to work with the BMA to come up with a longterm solution “to ensure the needs of a growing population with increasingly complex conditions can be met safely on the front line”.

Patients’ groups and MPs also expressed concern at the findings. Liz McAnulty, chair of the Patients Association, said: “We have gone past the point where efficiencies can be found, and firmly into territory where GPs’ workloads are unsustainable and where patients face growing waits to access GPs and greater risks to their safety.”

Shadow health secretary Jonathan Ashworth said the Royal College’s warning should serve as an urgent wake-up call to ministers. “The truth is, since 2010 years of severe underfunding of our NHS has left general practice squeezed with tired, overworked and overstretched GPs. We have lost 1,000 GPs in the past year.”

Family doctors working ‘beyond safe levels’, says GPs’ leader

As doctors describe dealing with up to 70 patients a day, college warns of risks to public health

Waiting room of GP practice


Patients face longer waits to see a GP, says the Patients Association. Photograph: Alamy


GPs across Britain are working above safe levels because of relentless and unmanageable workloads, leading doctors have warned.

Prof Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said that family doctors were “regularly working way beyond what could be considered safe for patients”, potentially jeopardising their own health and wellbeing.

Her comments were made in response to a survey by GP magazine Pulse. It heard from 900 GPs across the UK and found that each deals with 41 patients a day. The European Union of General Practitioners (UEMO), a leading forum of European family doctors, has said that seeing around 25 patients is safe.

The Pulse poll found that one in five family doctors (20%) deal with 50 daily patient contacts, which include face-to-face and telephone consultations, home visits and e-consultations. Some GPs told Pulse they have 70 contacts a day.

Prof Stokes-Lampard said: “GPs expect to be busy, and we are making more consultations than ever before as we strive to deliver the best possible care to all our patients who need it. But the workload at the moment is relentless and it’s taking its toll.”

One doctor, who reluctantly left a career carrying out 13- to 14-hour days as a partner for a more manageable workload as a salaried GP and 31 to 40 daily contacts, told Pulse: “I felt I was at a risk of making mistakes and causing potential harm to my patients and my career.”

Another spoke of one exceptional “horrendous” Monday where he had 71 contacts. Since then the practice has since increased the number of on-call doctors on Mondays to three.

Prof Stokes-Lampard said the survey backed up what the college has been saying for years – that many GPs are regularly working way beyond what could be considered safe for patients.

It was not necessarily the number of consultations, but the content of those consultations, she added. “Our patients are increasingly presenting with more complex, chronic conditions, many of which require much longer than the standard 10-minute appointment,” she said.

“Our workload needs to be addressed – it has risen at least 16% over the last seven years,” she added. “Yet the share of the overall NHS budget general practice receives is less than it was a decade ago, and our workforce has not risen at pace with demand.”

Dr Richard Vautrey, British Medical Association general practitioners committee chair, said: “We know that an unmanageable and unsafe workload is the primary reason behind doctors leaving general practice, which is leading to serious issues including practices closing to new patients and other surgeries closing entirely. This workload pressure also means GPs are increasingly suffering from burnout and patients are being put at risk of unsafe care.”

He urged the government to work with the BMA to come up with a longterm solution “to ensure the needs of a growing population with increasingly complex conditions can be met safely on the front line”.

Patients’ groups and MPs also expressed concern at the findings. Liz McAnulty, chair of the Patients Association, said: “We have gone past the point where efficiencies can be found, and firmly into territory where GPs’ workloads are unsustainable and where patients face growing waits to access GPs and greater risks to their safety.”

Shadow health secretary Jonathan Ashworth said the Royal College’s warning should serve as an urgent wake-up call to ministers. “The truth is, since 2010 years of severe underfunding of our NHS has left general practice squeezed with tired, overworked and overstretched GPs. We have lost 1,000 GPs in the past year.”

Family doctors working ‘beyond safe levels’, says GPs’ leader

As doctors describe dealing with up to 70 patients a day, college warns of risks to public health

Waiting room of GP practice


Patients face longer waits to see a GP, says the Patients Association. Photograph: Alamy


GPs across Britain are working above safe levels because of relentless and unmanageable workloads, leading doctors have warned.

Prof Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said that family doctors were “regularly working way beyond what could be considered safe for patients”, potentially jeopardising their own health and wellbeing.

Her comments were made in response to a survey by GP magazine Pulse. It heard from 900 GPs across the UK and found that each deals with 41 patients a day. The European Union of General Practitioners (UEMO), a leading forum of European family doctors, has said that seeing around 25 patients is safe.

The Pulse poll found that one in five family doctors (20%) deal with 50 daily patient contacts, which include face-to-face and telephone consultations, home visits and e-consultations. Some GPs told Pulse they have 70 contacts a day.

Prof Stokes-Lampard said: “GPs expect to be busy, and we are making more consultations than ever before as we strive to deliver the best possible care to all our patients who need it. But the workload at the moment is relentless and it’s taking its toll.”

One doctor, who reluctantly left a career carrying out 13- to 14-hour days as a partner for a more manageable workload as a salaried GP and 31 to 40 daily contacts, told Pulse: “I felt I was at a risk of making mistakes and causing potential harm to my patients and my career.”

Another spoke of one exceptional “horrendous” Monday where he had 71 contacts. Since then the practice has since increased the number of on-call doctors on Mondays to three.

Prof Stokes-Lampard said the survey backed up what the college has been saying for years – that many GPs are regularly working way beyond what could be considered safe for patients.

It was not necessarily the number of consultations, but the content of those consultations, she added. “Our patients are increasingly presenting with more complex, chronic conditions, many of which require much longer than the standard 10-minute appointment,” she said.

“Our workload needs to be addressed – it has risen at least 16% over the last seven years,” she added. “Yet the share of the overall NHS budget general practice receives is less than it was a decade ago, and our workforce has not risen at pace with demand.”

Dr Richard Vautrey, British Medical Association general practitioners committee chair, said: “We know that an unmanageable and unsafe workload is the primary reason behind doctors leaving general practice, which is leading to serious issues including practices closing to new patients and other surgeries closing entirely. This workload pressure also means GPs are increasingly suffering from burnout and patients are being put at risk of unsafe care.”

He urged the government to work with the BMA to come up with a longterm solution “to ensure the needs of a growing population with increasingly complex conditions can be met safely on the front line”.

Patients’ groups and MPs also expressed concern at the findings. Liz McAnulty, chair of the Patients Association, said: “We have gone past the point where efficiencies can be found, and firmly into territory where GPs’ workloads are unsustainable and where patients face growing waits to access GPs and greater risks to their safety.”

Shadow health secretary Jonathan Ashworth said the Royal College’s warning should serve as an urgent wake-up call to ministers. “The truth is, since 2010 years of severe underfunding of our NHS has left general practice squeezed with tired, overworked and overstretched GPs. We have lost 1,000 GPs in the past year.”

Birth control app reported to Swedish officials after 37 unwanted pregnancies

Users of Natural Cycles, first app certified as contraceptive method in Europe, identified among people seeking abortions at hospital

The Natural Cycles app claims to be 93% effective under typical use.


The Natural Cycles app claims to be 93% effective under typical use. Photograph: Danijela Froki @2016/Natural Cycles

A much-hyped birth control app has been reported to Swedish authorities after a hospital found 37 cases of unwanted pregnancies among women relying on the app for contraception.

Natural Cycles, a smartphone application that marries high-tech algorithms with the old-fashioned rhythm method, last year became the first app to be certified as a contraceptive method in Europe. The app requires women to input their temperature every morning, then calculates the users’ menstrual cycle and informs them when they can have sex without protection.

The Stockholm-based company, founded by Cern physicist Elina Berglund and her husband, Raoul Scherwitzl, claims to be 93% effective with typical use – and without the side effects that many women experience from hormonal birth control.

But the startup is now on the defensive after the Swedish public broadcaster SVT reported that 37 of the 668 women who sought an abortion at one of Stockholm’s largest hospitals from September to December 2017 were relying on Natural Cycles for birth control.

The hospital reported the app to Sweden’s Medical Products Agency, and Natural Cycles said in a statement that it was “responding to each reported case”.

“An unwanted pregnancy is, of course, very unfortunate and we deeply care every time one of our users becomes pregnant unplanned,” the company said. “As our user base increases, so will the number of unplanned pregnancies coming from Natural Cycles users. This is an arithmetic truth applicable to all contraceptive methods.”

A 93% effectiveness rate means that out of every 100 women using the app, seven will experience an unwanted pregnancy. Those figures are about comparable with typical use of oral contraceptives, and better than condoms or other barrier methods, according to the Center for Disease Control.

The traditional rhythm method, which involves tracking one’s cycle without the assistance of a nuclear physicist’s algorithm, has a typical use failure rate of 24%.

Should you give homeless people money? Absolutely | Tamsen Courtenay

Gloucester city council’s poster depicting a faceless homeless person in a hoodie implies they are not worth our compassion. This is a travesty of human decency

The Gloucester council homelessness advert


The Gloucester council advert. ‘No one in their right mind thinks it’s a clever scam to sit on a freezing pavement suffering the humiliation of asking for a few coins.’ Photograph: Gloucester Labour

Have the Tory members of Gloucester city council been busy reading George Orwell’s 1984 in their book club recently?

It seems someone read the bit at the back where Orwell describes how the political language, Newspeak – with its restricted grammar and limited vocabulary – is designed to distort how people think and control public attitudes. Posters were put up in Gloucester showing someone wearing a hoodie, under the headline of “Are you really helping homeless people?”, suggesting that people sleeping rough are not homeless, but “in accommodation, receiving support and benefits”. This sinister use of Newspeak tells the upstanding citizenry to stop feeling bad about not helping those in need, under the pretence of educating and informing. It even offered a subtle sense of justification that – weirdly – help isn’t really help at all. That’s not Newspeak, it’s doublespeak. Orwell was writing about a totalitarian state. We should be worried.

So that’s the propaganda. What about the fact?

‘Homelessness caused me pain, stress and anger’ – video

During the weeks I spent listening to, and recording, homeless people in London – first-hand accounts of their lives are in my book Four Feet Under – I met a man called Benji who said, “Come on, why are we homeless, for God’s sake? Yeah, I’m going to chuck all my gear away, empty my bank account and give it to somebody and sleep on the street. Sure. Right, I’m going to do that!”

No one in their right mind thinks it’s a clever scam to sit on a freezing pavement suffering the humiliation of asking for a few coins. And, frankly, there are many people out there who are seriously mentally ill and are chaotically struggling to stay alive. And if there are scammers? So what? They would be such an insanely tiny percentage that they are of no interest or relevance to the big picture: why are our streets starting to look like Hogarth sketches?

I never met a single person who likes begging. Most were mortified. Some flat out refused to do it. It is a horrible part of a horrible life, lived out in the open, scrutinised and judged. Hunger, loneliness, physical illness, being beaten up, sometimes raped or set alight are the diet of the homeless. But you can’t see all this under the tatty clothes and worn faces, sat down there somewhere at knee level. You certainly won’t see it in the poster with the faceless, hoodied man – he is meant to radiate menace.

Homelessness is not a lifestyle choice of the criminal classes, despite efforts to convince you otherwise. It is barely a life at all.

People are homeless for lots of reasons – fleeing domestic violence or sexual abuse, loss of a job and a partner often at the same time, leaving the care system with scant resources and being severely mental ill – to name a few.

Lots of people just can’t manage life and when it falls apart, so do they.

Without exception the hugerange of people I had the joy of spending time with were in terrible pain. No one was having fun living like this and all were clinging desperately to the idea that it might, just might, stop and life would get better.

The poster used a crude caricature of a homeless person feeding the notion that a person who is faceless is a non-person. I can’t tell you how many homeless people I met who said the worst thing of all was knowing you were invisible, that you didn’t really exist at all.

Now it’s no longer enough to blame them for their plight – we must criminalise them too. Antisocial behaviour orders and a panoply of other bits of nasty legislation all conspire to make homelessness appear villainous and dishonest.

Should you give them money? Absolutely.

They need it – and assuming you are not the person who will solve homelessness with a click of your fingers – it’s the least you can do. Sleeping bags, hot food and painkillers are also welcome. This idea that homeless people “can’t be trusted” with the money you give is a wicked get-out. They are not children. They are not morons. They are homeless and they are sad. Many need medical and psychiatric help. If all this was available – as that monstrous poster suggests – then there would not be a homelessness problem in the first place. Your money will be spent on food, newspapers, coffees and toiletries. The majority try to beg enough to get a hostel for the night (anywhere up to £20-odd a night.) Some – but by no means all – will spend it on alcohol or drugs.

It’s this that seems to bother some people. Drug use isn’t a sign of moral failure or craven attitudes. The people I met who took Class A drugs had very little choice. Without a daily hit (which costs money) they will, within hours, become extremely ill: vomiting, diarrhoea and excruciating muscle spasms are just some of what they would endure, and having diarrhoea in the middle of Oxford Street isn’t an option for most people. And believe me, after a few cold days sitting out in the cold and damp doing my “research”, I barely made it through the front door in the evening before pouring a very large gin. I did that every night I got home. For people living on the street booze can help dilute the shame and embarrassment of begging.

So let’s put drink and drugs to one side. It’s a diversion, worthy of Orwell’s fictional Oceanian government. If our government really gave a damn they would have provided the services to help the vast numbers who need it and – crucially – would be creating a society that produced fewer people in this state of total despair and ruin. Not one based on greed, selling off social housing stock and cutting benefits and mental health provision. And certainly not one that tells us it is OK not to help the needy.

That Gloucester poster? It heralds the destruction of the innate sense of decency that I believe most of us share. Don’t let that happen.

Tamsen Courtenay is the author of Four Feet Under (Unbound), a collection of 30 stories of homeless people in their own words

‘Haemorrhaging nurses’: one in 10 quit NHS England each year

Data showing 33,000 nurses left in 2016-17 triggers warning of ‘dangerous and downward spiral’

Two NHS nurses


More nurses have left the NHS in England in the past three years than have joined. Photograph: Medic Image/Getty Images/Universal Images Group

One in 10 nurses are leaving the NHS in England each year, according to official figures, raising fresh concerns about staffing shortages in hospitals.

Data published by NHS Digital on Wednesday shows that just under 33,500 nurses left the service in 2016-17 – 3,000 more than joined and 20% higher than the number who quit in 2012-13.

The worrying figures come amid an ongoing winter crisis fuelled by rising demand, coupled with staff and bed shortages.

The data shows more nurses have left the NHS in England than have joined for the past three years, with the deficit highest last year. In each of those three years, the number quitting has been 10% of the total.

Q&A

Why is the NHS winter crisis so bad in 2017-18?

A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied.

NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.

Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine.

The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries.

Read a full Q&A on the NHS winter crisis

Janet Davies, head of the Royal College of Nursing, told the BBC, which initially requested the figures, that they were of great concern. “The government must lift the NHS out of this dangerous and downward spiral,” she said.

“We are haemorrhaging nurses at precisely the time when demand has never been higher. The next generation of British nurses aren’t coming through just as the most experienced nurses are becoming demoralised and leaving.”

Although 6,976 (21%) of the nurses who left in the year to September 2017 were 55 or over (the age at which nurses can start retiring on a full pension), just over half (17,207) were under 40.

The figures suggest Brexit may be having an impact, with more nurses from the EU leaving than joining in recent years. Last year, 3,985 EU (excluding the UK) nurses left, compared with 2,791 who joined. By contrast, in the last full year before the 2016 referendum (2014-15), 2,416 nurses quit the NHS, while 5,977 joined.

Hospital bosses have called for the 62,000 EU workers in the NHS, who represent 5.6% of the total workforce, to be given reassurance about their status post-Brexit.

But it is not just EU nurses who are leaving. Davies said low pay and the pressures of the job must be addressed if retention were to be improved.

Last week, senior doctors wrote to Theresa May, the prime minister, warning that patients were dying in hospital corridors during the winter crisis because the NHS was so underfunded and short-staffed that it could not cope.

The percentage of patients being treated within four hours at hospital-based A&E units in England fell to its lowest-ever level (77.3%) last month.

A Department of Health and Social Care spokesperson said there had been a rise of 11,700 nurses on wards since May 2010, and an additional 5,000 training places would be available from this year.

‘Haemorrhaging nurses’: one in 10 quit NHS England each year

Data showing 33,000 nurses left in 2016-17 triggers warning of ‘dangerous and downward spiral’

Two NHS nurses


More nurses have left the NHS in England in the past three years than have joined. Photograph: Medic Image/Getty Images/Universal Images Group

One in 10 nurses are leaving the NHS in England each year, according to official figures, raising fresh concerns about staffing shortages in hospitals.

Data published by NHS Digital on Wednesday shows that just under 33,500 nurses left the service in 2016-17 – 3,000 more than joined and 20% higher than the number who quit in 2012-13.

The worrying figures come amid an ongoing winter crisis fuelled by rising demand, coupled with staff and bed shortages.

The data shows more nurses have left the NHS in England than have joined for the past three years, with the deficit highest last year. In each of those three years, the number quitting has been 10% of the total.

Q&A

Why is the NHS winter crisis so bad in 2017-18?

A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied.

NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.

Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine.

The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries.

Read a full Q&A on the NHS winter crisis

Janet Davies, head of the Royal College of Nursing, told the BBC, which initially requested the figures, that they were of great concern. “The government must lift the NHS out of this dangerous and downward spiral,” she said.

“We are haemorrhaging nurses at precisely the time when demand has never been higher. The next generation of British nurses aren’t coming through just as the most experienced nurses are becoming demoralised and leaving.”

Although 6,976 (21%) of the nurses who left in the year to September 2017 were 55 or over (the age at which nurses can start retiring on a full pension), just over half (17,207) were under 40.

The figures suggest Brexit may be having an impact, with more nurses from the EU leaving than joining in recent years. Last year, 3,985 EU (excluding the UK) nurses left, compared with 2,791 who joined. By contrast, in the last full year before the 2016 referendum (2014-15), 2,416 nurses quit the NHS, while 5,977 joined.

Hospital bosses have called for the 62,000 EU workers in the NHS, who represent 5.6% of the total workforce, to be given reassurance about their status post-Brexit.

But it is not just EU nurses who are leaving. Davies said low pay and the pressures of the job must be addressed if retention were to be improved.

Last week, senior doctors wrote to Theresa May, the prime minister, warning that patients were dying in hospital corridors during the winter crisis because the NHS was so underfunded and short-staffed that it could not cope.

The percentage of patients being treated within four hours at hospital-based A&E units in England fell to its lowest-ever level (77.3%) last month.

A Department of Health and Social Care spokesperson said there had been a rise of 11,700 nurses on wards since May 2010, and an additional 5,000 training places would be available from this year.

Obesity surgery ‘halves risk of death’ compared to lifestyle changes alone

Latest study of long-term impact of bariatric surgery lends support to experts who say more operations should be carried out in UK

Bariatric surgery reduces the size of the patient’s stomach. It is cost-effective and leads to substantial weight-loss as well as helping to tackle type 2 diabetes.


Bariatric surgery reduces the size of the patient’s stomach. It is cost-effective and leads to substantial weight-loss as well as helping to tackle type 2 diabetes. Photograph: Murdo Macleod for the Guardian

Obese patients undergoing stomach-shrinking surgery have half the risk of death in the years that follow compared with those tackling their weight through diet and behaviour alone, new research suggests.

Experts say obesity surgery is cost-effective, leads to substantial weight loss and can help tackle type 2 diabetes. But surgeons say not enough of the stomach-shrinking surgeries are carried out in the UK, with figures currently lagging behind other European countries, including France and Belgium – despite the latter having a smaller population.

“We don’t think this [new study] alone is sufficient to conclude that obese patients should push for bariatric surgery, but this additional information certainly seems to provide additional support,” said Philip Greenland, co-author of the latest study from Northwestern University.

Q&A

Share your experiences of obesity surgery

If you have had stomach-shrinking surgery we would like to hear from you. What was your experience like? Did you find the procedure helpful or not?

You can share your story using our encrypted form here. We will feature some of your contributions in our reporting.

In the new study, one of several on obesity surgery published in the Journal of the American Medical Association, researchers sought to explore whether stomach-shrinking operations, known as bariatric surgery, had a long-term impact on the risk of death among obese individuals, compared with non-surgical approaches to weight loss.

In total, more than 33,500 participants were involved in the study – 8,385 of whom had one of three types of bariatric surgery between 2005 and 2014. The majority of participants had a BMI greater than 35; obesity is defined as a BMI of 30 or higher.

The researchers followed up the participants over the years that followed their surgery until death, or the end of the follow-up period in December 2015, comparing the number of deaths and other metrics with those for obese patients who had not had surgery but were given dietary and behavioural help. Each surgery patient was compared to three who did not have surgery, but had similar characteristics such as age and sex, and were also followed until they too had surgery, died or the study ended.

The results reveal that the death rate during the study was 1.3% for those who had any form of bariatric surgery, while among those who had not had surgery it was 2.3%, although the length of follow-up period varied considerably from patient to patient.

Once other factors including age, sex and related diseases were taken into account, the team found those who did not have stomach-shrinking surgery had just over twice the risk of death compared to those who had, with all three types of surgery linked to lower mortality.

What’s more, the group which had surgery showed a greater reduction in BMI, lower rates of new diabetes diagnoses, improved blood pressure, and a greater proportion of diabetic individuals going into remission.

But the team add that a small proportion of surgery patients required further surgery, while they note the study was observational so cannot prove bariatric surgery itself reduced the risk of death since patients were not randomised, meaning it is possible that those who did not have surgery were in poorer health.

A second, smaller study in the same journal also highlighted benefits of bariatric surgery, comparing diabetes-related markers in obese adults who had lived with a diagnosis of type 2 diabetes for an average of nine years. Participants either received two years of intensive diet, exercise and medical management or, in addition, had bariatric surgery.

The results from 113 participants reveal that complications were more common among those who had had bariatric surgery, but that one year after the study began they had lost more weight on average, with a greater proportion having reached the combined targets for cholesterol, systolic blood pressure and a marker of glucose.

While this proportion fell for both groups after five years – at which point 98 patients were still providing data – those who had had bariatric surgery maintained the edge, with 23% reaching the combined targets, compared to just 4% of those offered lifestyle and medical interventions alone.

Francesco Rubino, professor of metabolic and bariatric surgery at King’s College London, who was not involved in the studies, said misunderstandings and stigma were holding back greater use of such operations in the UK. While Rubino noted that surgery is not for everyone, he added “This is a conversation GPs and doctors should have with patients more often.”

The new work and pensions secretary is an insult to disabled people

As backlashes go, the days following Esther McVey’s appointment as the new work and pensions secretary have seen intense criticism. Between 2012 and 2013, as minister for disabled people and later employment minister, McVey was famed for defending the indefensible, saying it was “right” that people were having to use food banks and claiming that benefit sanctions “teach” jobseekers to take looking for work seriously – going as far as comparing unemployed people to naughty schoolchildren being punished by a teacher – despite the destitution and death that sanctions have since caused. 

Yet this is about more than soundbites. From giving misleading information about the bedroom tax’s impact on disabled people to her decision to close the Independent Living Fund, McVey appeared to relish removing disability support, with campaigners accusing her of distorting the facts to help make that a reality. Worse, she was central in helping the rightwing press stoke up suspicion towards disabled people on benefits – most blatantly as David Cameron’s government began to abolish disability living allowance (DLA) and replace it with personal independence payments (PIP). As the Daily Mail put it at the time, McVey was on a mission to “pursue vast numbers of bogus disabled who carry on claiming the DLA long after they have ‘healed’.” That PIP is now wrongly withdrawing benefits from severely ill and disabled people – with 65% of decisions overturned on appeal – makes this all the more sickening.

The Department for Work and Pensions’ problems do not begin or end with McVey – she is the fifth person to hold the title since 2016 – but for Theresa May to (even reluctantly) promote someone with her track record is emblematic of the Conservatives’ disregard for disabled people.

I’ve spoken to many disabled people who are frightened by McVey’s appointment. That might be hard to understand if you are healthy or on a comfortable wage, but when you rely on social security to eat and pay rent, the DWP minister has power over you. For the families at the sharp end of austerity, McVey represents skipping dinner to pay the bedroom tax or becoming suicidal after losing benefits.

This year, the DWP will continue to oversee major social security changes, including more traumatic transfers from DLA to PIP and the ongoing rollout of the flawed universal credit, which is causing misery and hardship to thousands of families. In her previous ministerial roles, McVey showed herself to be a politician who never cared about the impact of such policies. But DWP decisions affect millions of people’s lives. Largely, for those who are already struggling with poverty and illness. That McVey is now in charge is an insult to them all.

I was a doctor prone to fainting. This is how I got over it

Like 12% of medical students, the graphic sights of the operating theatre caused me to faint. But slowly, after many queasy incidents, I learned how to cope

Surgeon and medical staff working in an operating theatre


‘I did not want to be the one who distracted the surgeon during a delicate phase by fainting’ Photograph: Alamy

Medicine is great, but it involves pain, pus and blood. For some, seeing those things is a problem. When I started medical school, I was worried. Before applying, I had spent a night in the local casualty department as work experience. I watched a junior doctor try to prise a splinter from a young woman’s hand. It was hurting her, and she kept yelping. The doctor got irritated and said the anaesthetic “should be working by now”. He kept digging into her hand with a scalpel tip; she started to cry. I felt lightheaded, my skin went cold, I moved my legs to keep the blood flowing, but seconds later I fainted.

They put me on a trolley, checked my blood glucose, and the same doctor explained that only “an insulinoma” could explain such low sugar readings. I got home, looked it up (a tumour of the pancreas), and for several months assumed there was something growing within me. There wasn’t. But the experience had planted a doubt. Was I really cut out for this?

Fainting is a common problem for medical students. A study in 2009 showed that of 630 students, 77 (12%) said they had fainted or come close to fainting in an operating theatre. Half of these were interested in becoming surgeons, and a significant proportion were put off from pursuing that specialty by their experience. The students reported being adversely affected by ambient heat, the smell of burning flesh, wearing a mask, having to stand for long periods, and menstruation.

For me, the first two years at med school were filled with lectures. Even the dissecting room, where the nasal punch of formalin rises up from the dull brown tissues of dead bodies, failed to sway me. The fascination with internal structures and cotton-thin nerves seemed to banish any queasiness. It was nothing like real, human life.

My first postmortem however, was a different matter. The professor of pathology, wearing long green rubber gloves, lifted up a series of pre-dissected organs. I glanced past him to the cadaver, and glimpsed the sawn head; I watched green juices drip off the liver, and … down I went. Apparently, when the professor heard the thump he looked into the audience and called out, “Will someone check to see if she’s alright?” I’m a man.

Then the day arrived for us to practise blood tests on each other. My trembling partner inserted a needle into one side of my elbow vein and out the other, causing a swelling the size of a large marble. As I watched it grow I began to sweat, the edges of my visual field closed in and I sat on the floor with my head between my knees until the blood rushed into my head and I recovered. A close one.

Entering the hospital wards for the first time, I didn’t do as well. We met the house officer and were told that it was our job to do the blood rounds each morning. She assembled a needle and blood tube set, and asked me to roll my sleeve up. Pretending to take blood, showing us how to handle the tube, she held the needle just a few millimetres from my skin. The sweat came on, and I fainted.

Repeated exposure to the causes of fainting is recommended. Of the 77 students in the study who fainted in the operating theatre, 10% benefited from making themselves go back. Others made sure they ate and drank well beforehand, requested frequent breaks from assisting the surgeon, and moved their legs.

surgeons


‘The blood poured over the side of the table, down the surgeon’s gown and into the top of his white rubber boots. Yet I remained standing.’ Photograph: Valery Sharifulin/TASS

The Doceatdoc website, written for students considering a career as a doctor, contains similar advice about keeping your blood sugar levels up, avoiding dehydration, and ensuring there is blood flow to the brain. Here though, they recommend avoiding specific situations that you know will cause a problem (patients screaming in pain, infected leg ulcers and bad feet, for me).

So how did it go for me in the operating theatre? I told nobody about my fears, but I walked in for the first time with trepidation. I did not want to be the one who distracted the surgeon during a delicate phase by fainting.

The patient was an emergency case. His abdominal aorta (the largest blood vessel in the body) had ruptured. I moved my toes and flexed my ankles to keep the blood flowing to my brain. He opened the abdomen and the patient’s blood welled up. It poured over the side of the table, down the surgeon’s gown and into the top of his white rubber boots. I heard him curse as he nicked the spleen with his scalpel and was forced to remove it. Blood. Negative emotion. Potential calamity. The unholy trinity of faint-inducing factors. Yet I remained standing.

I have since found myself in many faint-prone situations, but I am glad to report that it is no longer a problem. The connection between eyes and brain has been modified by experience, seniority, confidence … who knows what? Rest assured, if you are a fainter, it tends to get better.

If you would like to contribute to our Blood, sweat and tears series about experiences in healthcare, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

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