Category Archives: Heartburn

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.

Many disabled people are genuinely frightened by McVey’s appointment. hen you rely on social security to be able 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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Leave campaign’s £350m claim was too low, says Boris Johnson

Foreign secretary says campaign ‘grossly underestimated’ amount of money UK sends each week to EU

Boris Johnson


Boris Johnson’s decision to push again on the £350m argument could irritate Downing street. Photograph: Teri Pengilley for the Guardian

Boris Johnson has ratcheted-up his defence of Vote Leave’s infamous assertion on the side of their bus that Britain sends £350m a week to the EU, by saying the group could have used a much higher figure.

The foreign secretary said the UK’s weekly gross contribution would rise to £438m by the end of a post-Brexit transition period, and insisted leave campaigners were right to pledge extra cash to the NHS.

“There was an error on the side of the bus. We grossly underestimated the sum over which we would be able to take back control,” said Johnson, in an exclusive interview with the Guardian.

Though he conceded that the leave campaign had used a gross figure, he said around half the total could be ploughed into public services.

“As and when the cash becomes available – and it won’t until we leave – the NHS should be at the very top of the list,” added Johnson, on a day that the Guardian revealed that students were being drafted in to help plug NHS gaps opening up in the winter crisis.

The Vote Leave campaign bus, with the controversial £350m figure on the side.


The Vote Leave campaign bus, with the controversial £350m figure on the side. Photograph: Stefan Rousseau/PA

In the face of rising pressures on doctors, nurses and other health workers, Johnson also said he had sympathy with the call of Theresa May’s former chief of staff, Nick Timothy, in favour of a cross-party royal commission into health and social care funding.

Johnson said NHS funding was a “huge priority for the British people” and something that ought to be looked at.

He also said the British public were not “gagging” for a second referendum, and insisted he was against such a move. But Johnson, who is preparing to deliver a speech on the liberal case for Brexit, insisted that if there was another vote it would deliver another victory to leave. Brexit.

In the interview, the cabinet minister also:

  • Accused Jeremy Corbyn of “insanity” for downplaying the importance of Britain’s relationship with the US.
  • Warned ahead of a Vancouver summit on North Korea that the threat from Kim Jong-un was the kind “the world has not known since the dawn of the atomic age”.
  • Said a key priority for him as foreign secretary would be driving up girls’ education around the world, which he described as a “universal spanner” to tackle population growth and radicalisation.
  • However, his decision to double-down on Vote Leave’s claim of a Brexit windfall could irritate Downing Street and is likely to provoke some remain supporters who consider the use of the £350m figure to be misleading. They believe it suggested that all the money would eventually go to Britain’s hospitals.

  • The shadow Brexit minister Matthew Pennycook said Johnson had no shame. “He spent the entire referendum campaign standing in front of his red bus with a bogus claim on the side, and now he is saying the figure should be higher. The public really do deserve better from the foreign secretary.”

  • But the cabinet minister argued that the UK’s EU contribution was already up to £362m per week for 2017-18, and would rise annually to £410m, £431m, and then to £438m by 2020-21 – “theoretically the last year of the transition period”.

  • Johnson argued that it was reasonable to use the gross figure because the UK government would “take back control” of the full amount. Moreover, he said the net figure was also rising, with around half of the total likely to be available to plough into British priorities in the future.

    Asked about the possibility of another national vote after Nigel Farage raised the spectre of a second referendum, Johnson said he felt it was a bad idea.

    “We’ve just had one, and I think it went pretty well but it was something that caused an awful lot of heartache and soul-searching, and everybody went through the wringer on it,” he said. “I’m not convinced that the public is absolutely gagging for another Brexit referendum.”

    He denied the suggestion that he fears Brexit might not happen, although he admitted that the history of the EU was to try to get countries “back into line” if they tried to vote against integration.

    “I genuinely don’t think that will happen in this case. I think that something very profound has happened in the UK,” he said. “And I think actually were there to be – I don’t think there should be a second referendum – I think the result would be pretty much the same, or the result would be more heavy for leave, I really do.”

    Johnson insisted he was an internationalist, who believed in Britain’s unique global profile. “We can continue to be European, we can continue to be friends and partners with our counterparts across the Channel,” he said, arguing that young people and academics most hurt by Brexit could be persuaded in the long-run.

    Johnson, who will take part in cabinet committee discussions this week into what “Brexit end-state” the government is seeking, made clear that a Norway-style option would fail to make the most of the leave vote. He argued that was because it would limit the ability to diverge from the EU in regulation terms, and so restrict the possibility of new trading relationships.

    Don’t knock the flu jab – it’s a modern miracle

    As the flu season begins to ramp up, so too do the annual complaints about the vaccine

    Woman with cold on computer at homeFrome,UK


    Varying rates of flu vaccine effectiveness are to be expected, but shouldn’t stop you getting it Photograph: Cultura RM Exclusive/Colin Hawkins/Getty Images/Cultura Exclusive

    “The flu jab DOESN’T work, officials admit,” scolded a recent headline from the Daily Mail.

    Meanwhile, in the comments under that article, and in shadier regions of the internet, conspiracy theorists are having their usual annual field day: the flu vaccine actually makes people sick; the World Health Organisation is in cahoots with Big Pharma; the vaccine is being deliberately sabotaged by its manufacturers to drum up business for more expensive anti-viral therapies.

    Most sensible people understand that our impressive arsenal of vaccines is a modern miracle that prevents vast numbers of premature deaths. Together with improvements in nutrition, sanitation and modern medicine, routine inoculations have lifted us out of the dark ages.

    The problem with influenza is that, unlike some other bugs, it’s a tricky shape-shifter. Because of this, the vaccine against it is not nearly as effective as others. For example, a complete course of MMR vaccine is 97% effective at preventing measles; two successive doses of the chicken pox vaccine are about 98% effective; and tetanus toxoid is about 100% effective. What’s more, these impressive figures stay relatively constant year on year.

    In contrast, the success of the annual flu vaccine ebbs and flows dramatically, and the healthcare profession is pretty happy when it reaches a modest 40-60% efficacy. Some years it is much worse – as in 2004-05, when its effectiveness was only 10%.

    It’s probably no surprise that people think the flu jab is rubbish – especially when the media is delighted to rub failures into the noses of those who work so hard to make it happen. We have become so accustomed to highly effective vaccines that it can be tempting to criticise those that don’t work perfectly. With such high prevention rates, many vaccinated people will feel disappointed when they succumb to the illness. Just as a man who pulled himself out of starvation to become rich might one day frown upon anything but a grand feast, the developed world – from its privileged, 21st century vantage – is happy to talk down a cheap and serviceable preventive measure that improves global morbidity and mortality and reaps significant economic benefit.

    And the discontent is rife. In 2014-15, the US Centers for Disease Control issued an early press release warning that some circulating strains had drifted and the vaccine might not be as effective. Traditional media outlets tutted, and antivax interest groups went into meltdown, jeering at the august public health body for this admission, as if anything less than perfection was a humiliation.

    In fact, predicting the three or four flu strains that will be included in each year’s vaccination is an astonishing feat of science and surveillance by countless individuals and reference laboratories around the world, on a par with forecasting the precise weather that will occur hour by hour in a month’s time. Every year as the needle slides into my own arm, I give a moment of quiet thanks to these hard-working folk.

    Influenza viruses spread from person to person like lightning and also move through various animal reservoirs. In the process, they discard one coat for another, mixing and matching pieces of their genomes with other viruses in an endless game of cat and mouse with the immune systems of the various species they inhabit. Add overpopulated areas and global travel into the picture and what you have is a stochastic, messy and imprecise brew of many thousands of strains, from which only three or four must be plucked.

    Once you choose you can’t go back. Because influenza will only grow – painfully slowly – in chicken eggs, it takes half a year to create and stockpile each year’s vaccine. When surveillance picks up crucial shifts after the February deadline, as it did in 2004, it’s far too late to do anything about it.

    And let’s unpick the phrase “it didn’t work”. Even the 10% effectiveness rate in 2004-05 wasn’t a complete washout. In the US, as a result of being vaccinated tens of thousands of elderly people did not end up in hospital, and a number of people did not die.

    For the price of a cinema ticket, you had a one in ten chance of dodging the disease had you been exposed to. There are lots of gamblers who would be happy to spin the wheel for those odds. I certainly am, having had the flu before and being painfully aware of how long it can wipe you out. Those one in ten who were protected helped to quell infection in others via herd immunity, and the vaccinated people who did get sick likely received some benefit from cross-reacting immunity elicited against the other strains in the vaccine.

    There’s been a lot of hype about “Aussie flu” this year, but the offending strain (A H3N2) was around last year and is represented in this year’s vaccine. If the flu season turns out to be as bad in the northern hemisphere as it was in the southern, it won’t be the fault of the vaccine. Instead, we should remember that despite all its imperfections, it’s a remarkable achievement that doesn’t deserve the bad press it perennially suffers. What’s more, one hundred years on from the Spanish flu, which killed 50 million or more people in 1918, it’s comforting to know that we, as a species, have this annual chance to hone our skills of prediction and prevention for when the next pandemic comes.

    When private meets public sector: the history of a tangled relationship

    Interaction between the private and public sectors can be a politically charged process in the UK, not least when the contracts that underpin such a partnership go wrong. Here are some recent examples of cooperation between public bodies and private companies that have caused controversy.

    Scottish schools

    A private finance contract to build a series of Edinburgh schools became a costly embarrassment after the new buildings were found to be faulty and one partly fell down. A report into the deal found that the contractors had used substandard concrete to build the schools, all of which were considered unsafe and in need of substantial repair. But a review by the council found that the financing behind the Edinburgh Schools Partnership (ESP) was not to blame. ESP is a private finance initiative (PFI), a popular form of funding for projects whereby a company pays the upfront construction cost and is then paid back over time by the government, which effectively pays the constructor to lease the property. However, the review did say there were aspects of the way in which the PFI methodology was implemented that “increased the risk of poor quality design and construction”.

    Virgin Health

    Private firms scooped almost 70% of the 386 contracts to run clinical health services put out to tender in England during 2016-17. They included the seven highest-value contracts, worth £2.43bn between them, and 13 of the 20 most lucrative tenders. Last year, Virgin Care, owned by Richard Branson sued six clinical trusts after it lost an £82m bid. It secured an out-of-court settlement. It also went on to win £1bn worth of contracts.

    London Underground PPI

    Bob Kiley, tube boss in the early 2000s


    Bob Kiley, tube boss in the early 2000s, described the PPP financing model for transport improvements in London as ‘fatally flawed’. Photograph: Channel 4

    A series of public-private partnerships (PPPs) were signed by the last Labour government in 2002 and 2003 to upgrade and carry out maintenance on London’s tube network. Described at the time by then tube boss Bob Kiley as “fatally flawed”, by 2010 the process had unravelled. In exchange for carrying out complex work on an ailing network, the businesses behind the contracts would receive a monthly payment that would increase or decrease depending on whether they hit targets for measures such as train cleanliness and reliability of services. The process became mired in endless rows over costs; the biggest contractor, Metronet, eventually went bust and the other, Tube Lines, was bought out.

    East coast rail

    For the second time in a decade, the secretary of state for transport has been forced to bail out a private rail company running the vital east coast mainline. In 2009, the then Labour government took the line under public control after its private operator, National Express, couldn’t pay out the £1.4bn promised under the contract. The previous holder of the franchise, GNER, had already been stripped of the route after its US parent firm was struck by financial troubles. Last year, the government waived the majority of payments due under Stagecoach’s £3.3bn contract to run the London to Edinburgh route. Whenever the merits of rail privatisation are debated, the east coast line is a key argument for those in favour of nationalisation.

    Dentists warn of child tooth decay crisis as extractions hit new high

    NHS surgeons are performing record numbers of operations to pull out rotten teeth in children.

    Hospitals extracted multiple teeth from children and teenagers in England a total of 42,911 times – 170 a day – in 2016-17, according to statistics obtained by the Local Government Association.

    That is almost a fifth (17%) more than the 36,833 of those procedures that surgical teams carried out in 2012-13. Each one involves a child having a general anaesthetic and at least two teeth removed.

    “These statistics are a badge of dishonour for health ministers, who have failed to confront a wholly preventable disease,” said Mick Armstrong, the chair of the British Dental Association, which represents most of the UK’s dentists.

    He condemned “ministerial indifference [to] … the child tooth decay crisis”. Ministers were being “short-sighted” by not taking children’s oral health more seriously. Under-18s in England were receiving “second-class” services to prevent rotten teeth, in contrast to Scotland and Wales, both of which have a dedicated national programme, Armstrong added.

    Tooth decay chart

    The cost to the NHS of removing severely decayed teeth in under-18s has also escalated over those four years, from £27.3m to £36.2m.

    Health campaigners said the “alarming” trend showed children were eating too many sweet foods and should prompt tough action to cut their sugar intake.

    “These figures show that we have an oral health crisis and highlight the damage that excessive sugar intake is doing to young people’s health,” said Izzi Seccombe, a councillor and the chair of the LGA’s community wellbeing board.

    Children’s poor dental health can limit their ability to eat, play, socialise and speak normally, she added.

    The government’s main policy to prevent tooth decay in children most at risk, called Starting Well, was not given new funding and operates only in parts of just 13 local council areas in England, the BDA said.

    “This short-sightedness means just a few thousand children stand to benefit from policies that need to be reaching millions,” Armstrong said.

    Dr Nigel Carter, chief executive of the Oral Health Foundation charity, said the rise in childhood teeth extractions was “completely unacceptable” and was causing pain and distress for the under-18s undergoing the procedure.

    Dr Sandra White, Public Health England’s director of dental public health, said: “Parents can reduce tooth decay through cutting back on their children’s sugary food and drink, encouraging them to brush their teeth with fluoride toothpaste twice a day, and trips to the dentist as often as advised.”

    Prof Russell Viner, officer for health promotion at the Royal College of Paediatrics and Child Health, said ministers should ban television advertisements for foods high in fat, salt or sugar before the 9pm watershed and stop fast food shops opening near schools and colleges.

    Dentists warn of child tooth decay crisis as extractions hit new high

    NHS surgeons are performing record numbers of operations to pull out rotten teeth in children.

    Hospitals extracted multiple teeth from children and teenagers in England a total of 42,911 times – 170 a day – in 2016-17, according to statistics obtained by the Local Government Association.

    That is almost a fifth (17%) more than the 36,833 of those procedures that surgical teams carried out in 2012-13. Each one involves a child having a general anaesthetic and at least two teeth removed.

    “These statistics are a badge of dishonour for health ministers, who have failed to confront a wholly preventable disease,” said Mick Armstrong, the chair of the British Dental Association, which represents most of the UK’s dentists.

    He condemned “ministerial indifference [to] … the child tooth decay crisis”. Ministers were being “short-sighted” by not taking children’s oral health more seriously. Under-18s in England were receiving “second-class” services to prevent rotten teeth, in contrast to Scotland and Wales, both of which have a dedicated national programme, Armstrong added.

    Tooth decay chart

    The cost to the NHS of removing severely decayed teeth in under-18s has also escalated over those four years, from £27.3m to £36.2m.

    Health campaigners said the “alarming” trend showed children were eating too many sweet foods and should prompt tough action to cut their sugar intake.

    “These figures show that we have an oral health crisis and highlight the damage that excessive sugar intake is doing to young people’s health,” said Izzi Seccombe, a councillor and the chair of the LGA’s community wellbeing board.

    Children’s poor dental health can limit their ability to eat, play, socialise and speak normally, she added.

    The government’s main policy to prevent tooth decay in children most at risk, called Starting Well, was not given new funding and operates only in parts of just 13 local council areas in England, the BDA said.

    “This short-sightedness means just a few thousand children stand to benefit from policies that need to be reaching millions,” Armstrong said.

    Dr Nigel Carter, chief executive of the Oral Health Foundation charity, said the rise in childhood teeth extractions was “completely unacceptable” and was causing pain and distress for the under-18s undergoing the procedure.

    Dr Sandra White, Public Health England’s director of dental public health, said: “Parents can reduce tooth decay through cutting back on their children’s sugary food and drink, encouraging them to brush their teeth with fluoride toothpaste twice a day, and trips to the dentist as often as advised.”

    Prof Russell Viner, officer for health promotion at the Royal College of Paediatrics and Child Health, said ministers should ban television advertisements for foods high in fat, salt or sugar before the 9pm watershed and stop fast food shops opening near schools and colleges.

    Surgeon who burned initials into livers of two patients fined £10,000

    A surgeon who burned his initials on to the livers of two patients during transplant surgery has been given a 12-month community order and fined £10,000.

    Simon Bramhall, 53, used an argon beam – used to stop livers bleeding during operations and to highlight an area to be worked on – to sign “SB” into his patient’s livers. The marks left by argon do not impair the liver’s function and disappear by themselves.

    In December, the liver, spleen and pancreas surgeon admitted two counts of assault by beating. The offences relate to the incidents on 9 February and 21 August 2013. Prosecutors accepted his not guilty pleas to the more serious charges of assault occasioning actual bodily harm.

    Bramhall was first suspended from his post as a consultant surgeon at Birmingham’s Queen Elizabeth hospital in 2013 after another surgeon spotted the initials during follow-up surgery on one of his patients. A photograph of the 4cm-high branding was taken on a mobile phone.

    Bramhall tendered his resignation the following summer amid an internal disciplinary investigation into his conduct. Speaking to the press at the time, he said marking his initials on to his patients’ livers had been a mistake. He now works for the NHS in Herefordshire.

    Opening the facts of the case against Bramhall, Tony Badenoch QC, prosecuting, said one of the surgeon’s victims had been left feeling violated and suffering psychological harm.

    “This case is about his practice on two occasions, without the consent of the patient and for no clinical reason whatever, to burn his initials on to the surface of a newly transplanted liver,” said Badenoch.

    Badenoch said of the initial transplant operation: “Mr Bramhall had to work exceptionally hard and use all of his skill to complete the operation. At the end of the operation he performed a liver biopsy using the argon beam coagulator, and then used it to burn his initials.”

    The court heard that a nurse had asked what the marks were and Bramhall replied: “I do this.” The surgeon later told police he had “flicked his wrist” and made the mark within a few seconds.

    “He knew that the action could cause no harm to the patient. He also said that in hindsight this was naive and foolhardy – a misjudged attempt to relieve the tension in theatre,” Badenoch said

    The judge, Paul Farrer QC, ordered Bramhall to carry out 120 hours of unpaid work. He told Bramhall: “Both of the operations were long and difficult. I accept that on both occasions you were tired and stressed and I accept that this may have affected your judgment. This was conduct born of professional arrogance of such magnitude that it strayed into criminal behaviour.

    “What you did was an abuse of power and a betrayal of trust that these patients had invested in you. I accept that you didn’t intend or foresee anything but the most trivial of harm would be caused.”

    The Queen Elizabeth hospital said in a statement: “The trust is clear that Mr Bramhall made a mistake in the context of a complex clinical situation and this has been dealt with via the appropriate authorities, including the trust as his then employer. We can reassure his patients that there was no impact whatsoever on the quality of his clinical outcomes.”

    Bramhall was issued with a formal warning by the General Medical Council in February 2017. The body said his conduct had not met the standards required of a doctor.

    “While this failing in itself is not so serious as to require any restriction on Mr Bramhall’s registration, it is necessary in response to issue this formal warning,” it said at the time.

    Surgeon who burned initials into livers of two patients fined £10,000

    A surgeon who burned his initials on to the livers of two patients during transplant surgery has been given a 12-month community order and fined £10,000.

    Simon Bramhall, 53, used an argon beam – used to stop livers bleeding during operations and to highlight an area to be worked on – to sign “SB” into his patient’s livers. The marks left by argon do not impair the liver’s function and disappear by themselves.

    In December, the liver, spleen and pancreas surgeon admitted two counts of assault by beating. The offences relate to the incidents on 9 February and 21 August 2013. Prosecutors accepted his not guilty pleas to the more serious charges of assault occasioning actual bodily harm.

    Bramhall was first suspended from his post as a consultant surgeon at Birmingham’s Queen Elizabeth hospital in 2013 after another surgeon spotted the initials during follow-up surgery on one of his patients. A photograph of the 4cm-high branding was taken on a mobile phone.

    Bramhall tendered his resignation the following summer amid an internal disciplinary investigation into his conduct. Speaking to the press at the time, he said marking his initials on to his patients’ livers had been a mistake. He now works for the NHS in Herefordshire.

    Opening the facts of the case against Bramhall, Tony Badenoch QC, prosecuting, said one of the surgeon’s victims had been left feeling violated and suffering psychological harm.

    “This case is about his practice on two occasions, without the consent of the patient and for no clinical reason whatever, to burn his initials on to the surface of a newly transplanted liver,” said Badenoch.

    Badenoch said of the initial transplant operation: “Mr Bramhall had to work exceptionally hard and use all of his skill to complete the operation. At the end of the operation he performed a liver biopsy using the argon beam coagulator, and then used it to burn his initials.”

    The court heard that a nurse had asked what the marks were and Bramhall replied: “I do this.” The surgeon later told police he had “flicked his wrist” and made the mark within a few seconds.

    “He knew that the action could cause no harm to the patient. He also said that in hindsight this was naive and foolhardy – a misjudged attempt to relieve the tension in theatre,” Badenoch said

    The judge, Paul Farrer QC, ordered Bramhall to carry out 120 hours of unpaid work. He told Bramhall: “Both of the operations were long and difficult. I accept that on both occasions you were tired and stressed and I accept that this may have affected your judgment. This was conduct born of professional arrogance of such magnitude that it strayed into criminal behaviour.

    “What you did was an abuse of power and a betrayal of trust that these patients had invested in you. I accept that you didn’t intend or foresee anything but the most trivial of harm would be caused.”

    The Queen Elizabeth hospital said in a statement: “The trust is clear that Mr Bramhall made a mistake in the context of a complex clinical situation and this has been dealt with via the appropriate authorities, including the trust as his then employer. We can reassure his patients that there was no impact whatsoever on the quality of his clinical outcomes.”

    Bramhall was issued with a formal warning by the General Medical Council in February 2017. The body said his conduct had not met the standards required of a doctor.

    “While this failing in itself is not so serious as to require any restriction on Mr Bramhall’s registration, it is necessary in response to issue this formal warning,” it said at the time.

    My cancer operation was cancelled and I can’t sleep at night. Jeremy Hunt, how can you? | Carly O’Neill

    Dear Jeremy Hunt,

    I didn’t sleep well last night. I was nervous, anxious about what was going to happen the next day. I’m not great with needles, never mind scalpels. But I also knew that I was in the hands of professionals, who would do absolutely everything they could to make me better.

    I was diagnosed with skin cancer in early October. It’s been a stressful few months, because a cancer diagnosis, even with an excellent prognosis like mine, is terrifying. It was hard to be at the mercy of the NHS waiting lists for different appointments in different hospitals with different specialists.

    But at last, today was the day. I would have surgery, and after that I would be able to focus on recovering and putting all of this behind me. I would be able to get back to my PhD again – I’m due to submit that very soon. I’m getting married later this year, and I look forward to planning the wedding and trying on wedding dresses. Life feels a little like it’s on hold until this cancer is dealt with.

    It’s quite a big operation, and it’ll take a few weeks to recover. Last week, four months since my GP first referred me and three months after being diagnosed, I heard that I would be having surgery soon. I was worried, but mostly really relieved that it would all be over soon. I only heard a few days in advance, so it was quite a dash to get everything sorted. My colleagues have been amazing in organising cover for me at such short notice. My fiance had to take time off work, too. So his colleagues have had to be equally wonderful.

    This morning I got up very early and made my way to the hospital. I saw nurses, and the surgeon, and the anaesthetist. There were boxes to tick and forms to sign. They drew the markings for surgery on me, and I was put in a gown and given wristbands with my name and allergies on them. The most suitable vein for the IV was found. They went through all the possible risks in detail, which is of course a good thing, but it didn’t help me relax.

    Hospitals can be intimidating places and it’s stressful to be at the mercy of others, even when they are the amazing people in the NHS. I can’t emphasise enough how much respect they deserve for working in the circumstances they’re put in, and they remain not only impressively professional, but understanding, calm and kind.

    But at last, all the waiting was over, I was all prepared, the only thing left to do was to actually have the surgery. And after all that, Mr Hunt, after all that: I was sent home, because there wasn’t a bed available.

    The winter pressures on the health system – including flu, which can exacerbate underlying conditions to the point where urgent care is needed – had brought the hospital to a near standstill. Only life-threatening conditions were being treated in the theatres. Even cancer operations, like mine, had to be shelved.

    I’ve been pencilled in for February, but have been warned the same thing could happen again. And I’ve seen the headlines – people with more urgent problems than me are being sent home, sometimes repeatedly. I read yesterday about a young child who had faced five cancellations.

    Mr Hunt, I know you didn’t cancel my operation yourself. And I know that hospitals sometimes have to prioritise. But my local hospital didn’t get into this state simply because of the season.

    You keep telling us how funding for the NHS has increased. What you don’t mention is that, since 2010, the rate of increase has been far below the long-term average increase in health spending, at a time of massively rising demand. Our health system is like an old building: it’s creaking, and shaking in the bad weather because the owners haven’t bothered to keep it in good repair. That is something you are responsible for.

    Long term I’ll be OK, because I’m sure that eventually there will be a bed available. I’ll have a few more sleepless nights, though.

    Congratulations on keeping your job, Mr Hunt. I’m sure you’ll continue to do it ruthlessly. I hope you sleep well.

    Yours,

    Carly

    Carly O’Neill is working on a PhD