Tag Archives: patients’

Doctors owe it to patients to tell the truth: the NHS is in terminal decline | Rachel Clarke

Like church and state, medicine and politics are traditionally seen as a queasy mix. The last thing you want in your flimsy hospital gown is some zealot with a stethoscope trying to sway your vote. Doctors, at the bedside, should clearly stick to doctoring. But – in a world of ever more outlandishly spun health statistics – where, outside of clinical encounters, do the limits of doctors’ duty to act in our patients’ best interests lie?

I made the sobering discovery, in my first few weeks as a doctor, that serving patients in the modern NHS was at least as much to do with advocacy as medicine. It has to be, in a system that’s stretched beyond breaking point. With resources so scarce, speaking out counts.

Once, I actually stalked a professor, in sheer desperation to provide an inpatient with decent care. He did a double take at the steely-eyed junior doctor, sat perched outside his clinic, fired up to plead her patient’s case. With everyone run ragged, overwhelmed by patients, no one had believed me or cared enough to act when I’d insisted my patient was suffering from a rare diagnosis, adult-onset Stills disease, that had left her heart swamped in fluid, her temperature soaring, her circulation so fragile it might need intensive care. “Please,” I begged. “Just see her for yourself.” As the pre-eminent professor of rheumatology in my hospital, he was the one man I knew who might act. And he did. He confirmed the diagnosis and whisked my patient off to his specialist care, possibly saving her life.

When almost every statistic about today’s NHS depicts a system quietly imploding around us, advocacy writ large has never mattered more. Doctors, like nurses, bear daily witness to the facts behind the spin. Our testimony is a vital corrective to a government hell-bent on airbrushing away the truth about today’s underfunded NHS. We look the patients in the eye as they languish on trolleys in hospital corridors. We apologise, shamefaced, to the families whose loved ones are stranded in hospital, because no social care exists to support their safe discharge home. We turn away the elderly who sob in A&E because the pain in their hip is beyond endurance, yet who haven’t even made it on to a waiting list for surgery. If we turned a blind eye and kept our heads down, would Hippocrates nod his assent?


Having to break bad news to a patient is never easy. But unflinching conversations are a cornerstone of good medicine

The state of the NHS in 2017 demands that doctors speak out about the human cost of underfunding since it clear our political leaders will not. Only this week, Theresa May made an election manifesto commitment of 10,000 more staff in mental health. Unfunded, needless to say, but also – more audaciously – a promise made on the back of the 6,700 mental health staff already culled since the Conservatives came to power in 2010. It’s this kind of political doublespeak that compels doctors to challenge loudly the government line that – despite the most brutal funding squeeze in NHS history – everything is going swimmingly.

In microcosm, we already know what happens when cost-cutting is prioritised above patient care. The scandal of Mid Staffs – a stain upon the history of the NHS, in which patients in their thousands were subjected to inhumane care – arose when one hospital trust strove to slash costs by millions. Yet currently, the government is enforcing £22bn of “efficiency savings” across the NHS, while insisting excellence of care can somehow continue.

Doctors should call out this claptrap for what it is. We are, after all – perhaps more than anyone – trusted to tell unpalatable truths. In this case, the hard medicine is more taxes. A world-class health service requires world-class funding. Either we provide the budget to fit the health care we want, or we cut the NHS to fit the amount we’re willing to spend on health. With a government too cowardly to confront this simple truth out loud, doctors should force an honest debate.

Yet – with a few notable exceptions (Taj Hassan and Neena Modi, for example, the presidents of the Royal Colleges of Emergency Medicine and of Paediatrics and Child Health respectively), the medical establishment is loath to rock the boat. Where is the joint statement from the Royal Colleges, for instance, urging increased taxation to bring our NHS and social care spend to at least the levels of Germany and France? Where are the hospital medical directors brave enough to speak out in public against the ever more fanciful diktats from on high to keep on delivering as their funding dries up?

Having to break bad news to a patient is never easy. But unflinching conversations are a cornerstone of good medicine. Nationally, doctors should be telling it like it is: without more money, our NHS is in relentless, terminal, and wholly avoidable decline.

NHS patients waiting months for vital bowel cancer tests, figures show

Patients with one of the most lethal forms of cancer are having to wait months to have vital diagnostic tests, in a new sign of the relentless pressure on NHS services.

People suspected of having bowel cancer are facing waits of three months for tests when they should have them within a maximum of six weeks, the latest NHS waiting time figures show.

In March almost half the patients referred for the disease to Mid Yorkshire Hospitals NHS Trust had to wait more than the six weeks set out in the NHS constitution. In all 144 (49.3%) of the 292 patients that month had to ensure waits of several months, and 39 of them were kept waiting for more than 13 weeks.

Campigners warned that patients could die as a result of the delays in patients undergoing either a colonoscopy or flexible sigmoidoscopy, the two tests used to detect bowel cancer.

Prof Colin Rees, vice-president of the British Society of Gastroenterology, said: “By testing the right people at the right time we can save lives and stop people dying needlessly.”

In March 24% of hospital trusts in England missed the six-week target for colonoscopy, which meant that 1,121 patients were kept waiting. In the same month, 18% of hospitals breached the six-week target for flexi-sigmoidoscopy.

Deborah Alsina, chief executive of Bowel Cancer UK, said the waiting times “present a worrying picture for patients”. She identified a lack of diagnotic staff as a key problem and lamented the latest of several delays in Health Education England publishing a plan, first promised in 2015, to boost the NHS cancer workforce.

About 41,000 people a year in the UK develop bowel cancer and around 16,000 die from it. It is Britain’s fourth most deadly cancer after lung, breast and prostate.

Meanwhile, NHS performance against its key waiting times targets is now the highest it has been for five years, NHS Englnd’s latest statistics show.

During 2015-16, 2.5 million people were not treated within four hours of arriving in A&E, and a total of 362,687 patients did not receive planned care in hospital – usually an operation – within 18 weeks.

Another 26,113 waited longer than 62 days for supposedly urgent cancer treatment after being referred by their GP, while 985,583 people with a life-threatening condition waited more than the maximum eight minutes for an ambulance to respond to an 999 call.

“These figures reveal the dismal human cost of the NHS crisis,” said Norman Lamb, the Liberal Democrat health spokesman. “Millions of patients are waiting in distress and anxiety, but Theresa may doesn’t care.”

Responding to the latest monthly statistics, a Conservative spokesman said: “These figures show A&E performance has improved a great deal since the equivalent time last year. Waiting times for an operation again got shorter in March, and crucially patient outcomes continue to improve. Breast cancer survival is at its highest ever level.”

The figures came as the Health Foundation warned that the care patients receive is under threat because of the NHS’s unprecedented financial squeeze.

In a report, the thinktank says: “It is difficult to see how the intense financial pressures on all NHS and social care services will not threaten the quality of care in the near future if nothing changes.

“As OECD analyses have shown, the UK’s performance on quality is middling when compared with other OECD countries, but then so are our funding levels.”

Healthcare bodies want to scrap the term ‘patients’. As a GP, I have a better idea | Ann Robinson

Many healthcare organisations want to dump the term “patients”, according to participants at a major event in London yesterday called the Future of People Powered Health. “Patient” is widely disliked – with its connotations of having to wait patiently, quietly and uncomplainingly to be the passive recipient of a doctor’s largesse. “Customer” isn’t much better; “client” or “service user” have some takers, and “partner” may be the best of a bad lot. But do we need a term at all?

Halima Khan, executive director of Nesta Health Lab who organised the event in partnership with Guy’s and St Thomas’ Charity , says the debate about whether to ditch the term “patients” has been bubbling up for some time. Many feel that the word, derived from the Latin “patiens” (one who suffers) is now obsolete. There’s support from patient and professional groups to consider changing the language in the hope that some entrenched attitudes will change too. “The Royal College of General Practitioners, for instance is teaching trainee GPs to talk to and about patients in a different way.”

But mental health campaigner Gillian Lamb (not her real name), who has been treated for serious mental health problems, sectioned and admitted to psychiatric units, says she couldn’t care less what she’s called so long as she’s treated with dignity and respect. “I’ve never minded being called a patient because I don’t feel inadequate, secretive or ashamed of having a mental illness. But I know others who are very sensitive about the medicalisation of their condition, and they do object to the term.”

Opponents of ditching the word “patient” say the original meaning of the word doesn’t matter, there’s no suitable alternative, it doesn’t carry connotations of passivity any more, attitudinal change can occur without ditching the name, and changing the name may not lead to meaningful change.

One suggestion is to borrow the language of intentional and therapeutic communities, set up like house-shares in which people are called members and are all expected to muck in and have equal status even if they have different roles. Lamb says that on her ward, “patient meetings” were called “community meetings” – or a “coalition of the unwilling” as an off-message staff member called it.

But the language that organisations use can reflect their philosophy and intended style of delivery. So an upmarket care home wanting to sell itself as being like a hotel may call residents “guests”. The term “service users” has become popular in the NHS though it’s (unintentionally) ironic given that accessing services is often a key problem for people suffering from chronic conditions – “service hopefuls” might be more accurate. “Stakeholders” crops up a lot; I have no idea what it means; don’t we all have a stake in our health and social care?

As a GP and occasional “patient”, I don’t see the need for any term at all. We have 4500 people registered at our surgery. Every person who comes into see me is, just that, a person. When I was in hospital recently for an operation, I didn’t morph into a patient when I entered the ward. I was the same person that I am in the street, but requiring a particular service. After a particularly dehumanising experience with a night nurse, I felt like screaming “I am not a patient, I am a free person”, in a parody of the The Prisoner. Needless to say, I didn’t do that but instead behaved nice and patiently. I say, let’s ditch the term patient altogether and replace it with … person.

Designed by patients: the mental health centre saving the NHS £300,000 a year

Soft, neatly folded blankets hang invitingly over the backs of the modern but comfy armchairs in the Gellinudd Recovery Centre’s communal living room. In the en suite bedrooms, there are white waffle slippers and dressing gowns embroidered with the centre’s tree symbol.

Staff and guests – those who stay are not termed patients – join forces to cook, clean and tend the fruit and veg they then sit down to eat together at Gellinudd, which is the UK’s first inpatient mental health centre to be designed by service users and their carers. “If you’re a psychiatrist you’ll still be expected to be in the kitchen chopping vegetables alongside everyone else,” says the centre’s director, Alison Guyatt.

Over three years, via consultation meetings attended by up to 50 people and annual general meetings attracting as many as 300, service users and carers who are also members of the Welsh charity Hafal, which runs the centre, have influenced everything from the policies and procedures to the decor, facilities and recovery-focused activities on offer.

“They’re the experts,” says Guyatt. “They can say how it feels to be on the receiving end of care, how anxious you would be, what your concerns would be. They have such powerful stories to tell.” The lack of privacy and dignity in hospital settings, together with old and decrepit buildings that provide little access to fresh air, were common themes among those who gave input. “A lot of them feel very clinical, rather than homely and welcoming,” Guyatt says.

Ensuring a different atmosphere at Gellinudd, which opened in April 2017, was therefore critical. Members met the architects in the earliest stages, and Guyatt arranged for furniture makers to bring chairs, tables and beds to consultation events to be tested.

Hafal believes co-produced, recovery-focused services improve outcomes for patients and reduce costs. It has estimated that Gellinudd, which was developed with Big Lottery funding of £1m and £500,000 from the Welsh government’s Invest to Save scheme, will generate year-on-year NHS savings of £300,000 in Wales.

Could the model be copied elsewhere in the UK? Commissioners are increasingly interested in co-production, according to Grazina Berry, director of performance, quality and innovation at the Richmond Fellowship, a voluntary sector mental health support provider that involves its users in shaping services. But the resources to make it happen are not necessarily available.

“We’re seeing many more opportunities coming up which directly ask for co-produced innovations,” Berry says. “But the money to match that isn’t always there because funding is reducing. We as a provider can say we’ll implement a whole range of innovative services. But to prove they work we want to evaluate them, and evaluation costs money.” Berry has no doubt that services designed with users bring better outcomes: “They give power to the people who understand recovery the most.”

At the National Survivor User Network (NSUN), a charity which helps mental health service users shape policy and services, managing director Sarah Yiannoullou believes the extent to which service users are listened to remains patchy. “There are some really good examples where the rhetoric is starting to become the reality, but it’s not consistent,” she says.

“I think we’re still in a system where the medical model is dominant and there’s this culture that the professional still knows best. The problem for the voluntary sector is that quite often what you say works and helps is regarded as anecdotal or dismissed as not credible.”

But it is crucial service users are listened to: “Meaningful, effective involvement can transform people’s lives, improve the quality and efficiency of services and develop the resilience of communities,” says Yiannoullou. “If commissioners and clinicians really listen to us, respect us and treat us as equals then our experience of services will improve.”

Patients need motivation to recover. The NHS must offer hope | Kate Allatt

Our NHS is under attack from all angles. People are living longer, we don’t eat well or exercise enough. Yet we expect more from the NHS; more people are visiting A&E departments and minor injury units year on year, and costs are rising.

How do we tackle this? What if we focus on marginal gains, the performance strategy that helped British Cycling to success in multiple Olympics?

This is an approach that focuses on “small incremental improvements in any process adding up to a significant improvement when they are all added together”. Could this improve patient outcomes and reduce waste in the health service?

One incremental enhancement we could seek in the NHS might be to improve our understanding of and response to the barriers to patient motivation. For example, could we find a way of encouraging stroke survivors to practise their rehabilitation exercises as frequently and intensively as they are prescribed? Patient adherence to rehabilitation regimes after discharge from hospital is described as “less than ideal”. By addressing these barriers, we will be more able to efficiently allocate therapy time, and thereby reduce GP appointments and hospital readmissions.

You might wonder what makes me an expert on this.


L​owering ​​patients’ expectations of ​recovery​ can be extremely damaging

In February 2010, at the age of 39, I had a huge brainstem stroke and was diagnosed with locked in syndrome. I was on life support and in intensive care for nine weeks, and was then written-off in rehabilitation after a further six weeks. My husband received a phone call telling him that I would never walk or talk again.

Over eight painstaking months in rehabilitation, I obsessively willed my body back to life, practising actions or movements 450 times per week. Slowly I learned how to do basic things like eat again, and at the end of it all I walked out of hospital. I went for a run on the first anniversary of my stroke. I’m now a motivational speaker and go to the gym every day.

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I never gave up pushing my body to improve: to speak, to eat, to run and to hug my kids. I managed to use my bad prognosis to galvanise my recovery, but the risk is that lowering patients’ expectations of recovery can be extremely damaging. Recovery should be measured in terms of improvements, not “getting better” – and that is always possible. My only focus, with three young children at home, was on when I would achieve my goals, not if.

Since embarking on my career in advocacy and stroke activism, I’ve found many reasons why patients lack the motivation to try to help themselves. They may be suffering from post traumatic stress disorder, which is common after a stroke and, just like depression, it affects mood and motivation levels. The side effects of the drug treatments for strokes – sleeping pills and muscle relaxants – can also affect motivation. After a brain injury many patients suffer varying levels of executive dysfunction affecting the set of mental skills that help to get things done, which can be mistaken for apathy or laziness. The overwhelming tiredness felt by those suffering from neurological fatigue can leave patients unable to complete normal daily tasks and therefore non-compliant with their treatment plans. It may be that some patients simply hate exercising or have no family support.

It is futile prescribing a stroke rehabilitation plan if – for any of these reasons – the patient is unmotivated before the therapy session starts or they are left at home trying to manage their own condition. The NHS should be offering hope and encouragement to motivate patients. And to do that, they need to listen to expert patients.

My advice to the King’s Fund Leadership Summit is that we need a better understanding of patient motivation to help rebuild the lives of stroke survivors. If patients adhere to clinical advice about practising their exercises as frequently and intensively as I did, just imagine how much we could improve their outcomes and reduce the waste in the NHS. But to do this we must understand the complex reasons why patients don’t do this already and listen to those who have struggled through similar experiences.

I don’t promise anything when I speak to people now – I just offer possibilities. I talk about how to optimise improvement, but never use the word recovery. After a life-changing event none of us will ever be the same as we were, even if we physically improve really well. We need to embrace that new self and strive to be the best version of ourselves that we can be, both in hospital and back home.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Give overweight patients a year of weight-loss classes, say researchers

Overweight or obese patients should be offered 12 months of weight-loss classes rather than the standard three months, according to research showing that the move could prevent tens of thousands of cases of obesity-related diseases over the next 25 years.

The study found that those given a year-long pass to weight-loss classes lost more weight and were better able to keep it off than those on three-month programmes or those going it alone with self-help guides.

While offering a year of classes would be more expensive than the typical three months, improvements to quality of life mean the switch would meet measures of cost-effectiveness set by the National Institute for Health and Care Excellence (Nice).

“One of the things we see with weight loss is that the more weight you lose, and the better you keep it off, the bigger the health benefits,” said Amy Ahern, first author of the study from the University of Cambridge.

Published in the Lancet by a team of researchers from institutions across the UK, the study involved 1,267 overweight or obese participants split randomly into three groups. Just over 200 of them were given self-help guides on how to lose weight and a short explanation by research staff. The remaining participants were split equally between those who were offered weight-loss classes for three months, and those offered them for 12 months.

The team followed up on the participants after three months, one year and two years. To reflect a “real world” scenario, participants were also allowed to use weight-loss techniques other than those offered to their group.

The results show that, on average, those offered self-help guides lost 3.26kg after a year, while those offered weight loss classes for three months or 12 months lost 4.75kg and 6.76kg respectively.

Those on the 12-month programme also had a greater drop in waist circumference measurements, fat mass, and markers of risk for diabetes, such as blood glucose levels, compared with both of the other groups.

After two years, participants in all groups had regained some weight, but those who had been offered 12 months of weight-loss classes still fared best, weighing on average 4.29kg less than at the start of the study.

The researchers then used a model to explore how much the different weight-loss classes would cost over a 25-year period.

The upshot was that offering three-months of weight loss classes would save about £2.68 per person over 25 years compared to offering self-help guides, as a result of savings from a drop in cases of weight-related diseases.

However, moving from offering a three-month to a 12-month weight-loss programme has a net cost of £49 per person, over a 25-year period.

But the researchers found that, compared to offering three-months of weight-loss classes, 12-month courses were estimated to result in 1,786 fewer cases of weight-related diseases – including hypertension, diabetes and heart disease – over 25 years per 100,000 individuals.

Despite the 12-month programme being more expensive than either three months of weight-loss classes or the use of self-help guides, researchers say the quality of life gained by individuals means that according to Nice benchmarks it would be considered to be cost effective to move to offering the longer course.

“It isn’t cost saving, but the benefits are considered to be worth the extra cost by Nice standards,” said Ahern.

But the team do not expect 12-month programmes to be rolled out any time soon, pointing out that local authorities are strapped for cash and that currently even provision of three months of dieting classes is patchy.

“Weight management services are typically commissioned by the local authority and you have got to consider that savings in the NHS in 25 years don’t necessarily resonate with the local authority now,” said Ahern.

While the study received co-operation and some funding from Weight Watchers, the authors say the company had no role in the research itself.

Naveed Sattar, a professor of metabolic medicine at the University of Glasgow who was not involved in the study, said the research builds on previous studies showing that commercial weight-loss programmes are more effective than those provided by the NHS.

“What, as a nation, we need to decide is can we fund that more widely and for longer to help people get a grip on their understanding of their diets and help them lose weight – and sustain that weight loss for a longer period of time and therefore retain better health?” he added.

The new study, he says, offers important evidence that “it should be possible and it is cost effective,” he said.

Give overweight patients a year of weight-loss classes, say researchers

Overweight or obese patients should be offered 12 months of weight-loss classes rather than the standard three months, according to research showing that the move could prevent tens of thousands of cases of obesity-related diseases over the next 25 years.

The study found that those given a year-long pass to weight-loss classes lost more weight and were better able to keep it off than those on three-month programmes or those going it alone with self-help guides.

While offering a year of classes would be more expensive than the typical three months, improvements to quality of life mean the switch would meet measures of cost-effectiveness set by the National Institute for Health and Care Excellence (Nice).

“One of the things we see with weight loss is that the more weight you lose, and the better you keep it off, the bigger the health benefits,” said Amy Ahern, first author of the study from the University of Cambridge.

Published in the Lancet by a team of researchers from institutions across the UK, the study involved 1,267 overweight or obese participants split randomly into three groups. Just over 200 of them were given self-help guides on how to lose weight and a short explanation by research staff. The remaining participants were split equally between those who were offered weight-loss classes for three months, and those offered them for 12 months.

The team followed up on the participants after three months, one year and two years. To reflect a “real world” scenario, participants were also allowed to use weight-loss techniques other than those offered to their group.

The results show that, on average, those offered self-help guides lost 3.26kg after a year, while those offered weight loss classes for three months or 12 months lost 4.75kg and 6.76kg respectively.

Those on the 12-month programme also had a greater drop in waist circumference measurements, fat mass, and markers of risk for diabetes, such as blood glucose levels, compared with both of the other groups.

After two years, participants in all groups had regained some weight, but those who had been offered 12 months of weight-loss classes still fared best, weighing on average 4.29kg less than at the start of the study.

The researchers then used a model to explore how much the different weight-loss classes would cost over a 25-year period.

The upshot was that offering three-months of weight loss classes would save about £2.68 per person over 25 years compared to offering self-help guides, as a result of savings from a drop in cases of weight-related diseases.

However, moving from offering a three-month to a 12-month weight-loss programme has a net cost of £49 per person, over a 25-year period.

But the researchers found that, compared to offering three-months of weight-loss classes, 12-month courses were estimated to result in 1,786 fewer cases of weight-related diseases – including hypertension, diabetes and heart disease – over 25 years per 100,000 individuals.

Despite the 12-month programme being more expensive than either three months of weight-loss classes or the use of self-help guides, researchers say the quality of life gained by individuals means that according to Nice benchmarks it would be considered to be cost effective to move to offering the longer course.

“It isn’t cost saving, but the benefits are considered to be worth the extra cost by Nice standards,” said Ahern.

But the team do not expect 12-month programmes to be rolled out any time soon, pointing out that local authorities are strapped for cash and that currently even provision of three months of dieting classes is patchy.

“Weight management services are typically commissioned by the local authority and you have got to consider that savings in the NHS in 25 years don’t necessarily resonate with the local authority now,” said Ahern.

While the study received co-operation and some funding from Weight Watchers, the authors say the company had no role in the research itself.

Naveed Sattar, a professor of metabolic medicine at the University of Glasgow who was not involved in the study, said the research builds on previous studies showing that commercial weight-loss programmes are more effective than those provided by the NHS.

“What, as a nation, we need to decide is can we fund that more widely and for longer to help people get a grip on their understanding of their diets and help them lose weight – and sustain that weight loss for a longer period of time and therefore retain better health?” he added.

The new study, he says, offers important evidence that “it should be possible and it is cost effective,” he said.

Critics slam ‘rip off’ 50p-a-minute charge to call patients’ hospital phones

Relatives who call patients in hospital are still being forced to pay “rip off” charges of 50p a minute despite a promised clampdown on the issue.

The firm Hospedia, which runs bedside TV and phone services in NHS hospitals and made £21.2m in revenue last year, makes people call loved ones via costly 070 numbers. The charges vary from hospital to hospital, but many trust websites say they cost about 50p a minute or more.

Callers are also forced to listen to a lengthy recorded message of about 70 seconds – which racks up charges before they are even connected to their loved one.The message contains information already obvious to the caller, such as the fact the patient is in hospital, and tells callers to be “patient”. Critics say patients are being treated as “cash cows” and described the charges as “extortionate”.

Hospedia currently manages TV and bedside phone services in 150 NHS hospitals, installing services for free in return for keeping the money charged to patients and relatives.

The firm said in 2014 it planned to phase out the use of 070 numbers but it has not happened. Ofcom reviewed the high costs in 2006 following complaints from users and recommended a substantial reduction in incoming call charges.

It urged the Department of Health to review all aspects of the system, and the way these costs appear “to be borne disproportionately by friends and family”.

The department looked at the issue and agreed to consider a skip facility at the start of the recorded message, enabling callers to bypass it and reduce the cost of the call. But this never came into effect and high call charges have remained.

A health department report in 2007 concluded that decisions on phones should remain with local hospitals. MPs on the health select committee also recommended a reduction in phone costs and called for a skip facility on the recorded message.

Hospedia refused to answer several questions posed by the Press Association, including how much money it makes from 070 numbers and why it still uses them.

A spokesman said: “Ofcom granted us use of the 070 number range to enable every bedside unit to have its own unique telephone number so that friends and relatives can call patients directly, alleviating pressure on nursing staff having to field calls.

“The patient’s bedside phone number is unique to each patient’s account and can follow them around the hospital if they are moved bed, a frequent occurrence.”

He said Hospedia offers free TV on children’s wards and free channels BBC1, BB2, ITV, Channel 4 and channel 5 from 8am to noon on adult wards. Outbound calls to landlines are also free.

He added: “We believe we offer an excellent service, which would not be provided at all if it weren’t for us taking on the investment and on-going management and support costs.

“Patients can choose to pay for our services, beyond those we offer for free, or not.”

But Liberal Democrat leader Tim Farron said: “These charges are a total rip off. When channels are free at home and people have already paid for their TV licence, it is unfair for them to need to pay it again.

“If someone is to spend four weeks in hospital with a full TV package that is the same price as their yearly fee.

“Hospitals and these businesses are treating the sick as cash cows.

“From hospital parking charges, TV packages to making people call expensive phone services, it seems like they try to eke out every bit of cash they can, it’s frankly unacceptable.”

Liz McAnulty, chair of the Patients Association, said: “Phone contact can be hugely valuable and reassuring to people in hospital and their loved ones at home.

“Any facility to provide this must offer a high quality service at a fair price, but Hospedia’s service appears to fail these tests badly.

“It is unacceptable for people calling someone in hospital to be charged heavily for 70 seconds before they even get through.”

Caroline Abrahams, charity director at Age UK, said: “Since older people typically have longer hospital stays and do not always have access to a mobile phone, they and their families are particularly likely to be impacted.”

Lynda Thomas, chief executive for Macmillan Cancer Support, said the cost of calls was “shocking”.

She added: “When you are having cancer treatment, getting a call from a relative can make a huge difference as you can share your worries, seek reassurance, or just hear their voice.

“But if relatives have to pay extortionate amounts to make these calls they may not call, cut it short, or shoulder the burden of these high charges, at a time when the whole family may be struggling financially.”

A spokeswoman for Ofcom said it was “concerned” about 070 costs and wished to hear from customers as part of its ongoing monitoring.

She said there is no requirement on Hospedia to use 070 numbers, adding: “We are concerned about the cost of making calls to and from hospital patients.

“Following an investigation into this, we referred our findings to the Department of Health, which has since changed its rules on mobile phone use in hospitals.

“We are glad that more patients now have the option of using their mobiles when in hospital, but arrangements for bedside phones are managed by the NHS.

“We want to ensure adequate safeguards for consumers so we are examining the use of 070 number ranges, amid concerns that the cost of calling these numbers can be confusing.

“We welcome evidence of any harm so we can further protect consumers.”

A health department spokeswoman said: “Suppliers should always put patients first in the way they provide services.

“Staying connected to friends and family while in hospital is crucial and we expect local hospitals to tackle anything that prevents this.”

Last year, Hospedia doubled its minimum price for a TV package from £2.50 to £5.

Prices for TV packages vary between hospitals, with the Big Bundle TV and internet package costing £17.50 for two days at Newcastle General, but £15 at Ipswich Hospital. Five days can cost £35.

Sky Sports can cost an extra £10 on top each day. Longer-term packages are less costly.

The surgeon who cruelly betrayed his patients’ trust | Barbara Ellen

Breast surgeon Ian Paterson has been convicted of 17 counts of “wounding with intent” and three counts of “unlawful wounding” and is now bailed, awaiting sentencing.

Many women have come forward to claim compensation, which sounds richly deserved. For years, Paterson performed hundreds of unnecessary or inadequate surgeries, for mainly female patients at the Heart of England NHS Foundation in Birmingham and private clinics run by Spire Healthcare.

As the case unfolded, there was a recurring theme of Paterson’s charming bedside manner, but also of his arrogance-cum-“God complex”, which was allowed to go unchecked, despite many concerns and complaints. Sometimes, Paterson would perform unnecessary disfiguring operations. At other times, his signature “cleavage-sparing mastectomy” procedure left patients in greater danger of developing secondary cancers.

Reading this, one feels sickened for the patients. There’s a nightmarish feel, almost reminiscent of the 1988 David Cronenberg film Dead Ringers, in which an insane surgeon performed gruesome gynaecological operations. Paterson’s patients were at their most vulnerable and in such a specifically female way. For women, breasts are not just another body part but can be bound up in maternal and sexual identity. Paterson’s patients trusted him, not only with their bodies and lives, but also with their identity and he violated them in the cruellest possible way.

Paterson has also undermined general trust in surgeons, not least with this recurring theme of arrogance and “God complex”. These are all too familiar complaints when it comes to surgeons. However, is it always a case of the surgeon being arrogant or could it sometimes be about the solid confidence that you need to do the job? My partner is a surgeon and, from what I’ve gleaned from him and other surgeons, a high level of confidence, in their decisions, in their ability, is crucial. They’re cutting people’s bodies open; they need to be in charge, to make the tough calls. The last thing anyone wants is an unconfident, self-doubting surgeon.

This doesn’t mean that surgeons think they know it all. Far from it. Good surgeons not only welcome second opinions, they continue to train, learn new techniques, question and push themselves, like the driven type-A personalities so many of them seem to be. It sounds as though Paterson had stopped all that, if he ever started, instead letting himself slide into a state of self–serving toxicity and, from the sounds of it, lucrative complacency.

In someone like Paterson, the “God complex” would emanate not from innate belief, but the self-conviction that, ultimately, their wrongful behaviour is justified. Certain details spring out: the endless operating, the fact that Paterson kept himself apart from colleagues. Not only is performing unnecessary operations simply not done, able surgeons are much more likely to confer over diagnoses, to want to share knowledge and expertise. When someone shies away from doing this, it suggests not so much arrogance as a fear of exposure or a mask for incompetence.

None of this excuses how Paterson was allowed to continue mutilating patients or placing them in danger, unhindered, for so long. The culture of secrecy and protection around high-ranking medical professionals must be stamped out. Moreover, I’m sure that some surgeons are just arrogant sods who bully patients. No one is defending that, however good they may be at their jobs.

However, this case shouldn’t lead to people automatically distrusting or fearing confident surgeons. While Paterson’s actions are the stuff of nightmares, they also feed straight into a paranoid, 1950s-style narrative of haughty surgeons badgering patients into doing as they’re told. In truth, whatever Paterson was (incompetent? greedy? psychotic?), his crimes clearly demonstrate that he wasn’t on the normal surgeon spectrum, not even at the arrogant end. What Paterson did was criminal and pathological.

Hundreds of private patients seek compensation from rogue surgeon

Hundreds of private patients of a surgeon convicted of carrying out needless breast operations are seeking compensation after nearly £18m worth of claims were made against the NHS.

Ian Paterson, 59, was convicted on Friday of 17 counts of wounding with intent and three counts of unlawful wounding against 10 patients, upon whom he conducted “extensive, life-changing operations for no medically justifiable reason”.

More than 250 NHS patients have received payouts after being treated by the surgeon and it has now emerged that around 350 patients who underwent treatment privately at clinics owned by Spire Healthcare in the West Midlands are also taking civil action against Paterson and the firm.

Paterson, described in court by one victim as being “like God”, lied to patients and exaggerated or invented the risk of cancer to convince them to go under his knife.

Thompsons Solicitors, a firm representing the private patients, said the Spire Healthcare’s treatment of those who complained was “shabby”.

“We are determined to secure appropriate compensation for every single one of our clients, some of whom found the courage to come forward only as recently as four weeks ago,” said Linda Millband, lead national lawyer at the firm.

“Spire needs to face up to its responsibilities, because they let him operate well after he was suspended by the NHS.”

A freedom of information request revealed the NHS has resolved 256 cases, paying out £9.5m in compensation and £8.2m in costs, while a further 25 cases are still to be heard.

Paterson, who was suspended by the General Medical Council in 2012, lied to patients and exaggerated or invented the risk of cancer in order to convince them to go under the knife.

He sobbed as the jury returned the guilty verdicts on Friday at Nottingham crown court. The surgeon was released on conditional bail ahead of sentencing in May, when he faces a custodial sentence.

One patient who gave evidence in the trial had 27 biopsy cores taken from her healthy right breast and had “absolutely not” received medical best practice.

A Spire Healthcare spokesman said: “What Mr Paterson did in our hospitals, in other private hospitals and in the NHS, absolutely should not have happened and today justice has been done.

“We would like to reiterate how truly sorry we are for the distress experienced by any patients affected by this case. We can say unequivocally that we have learned the lessons from these events.

“We commissioned a thorough independent investigation and have fully implemented all of the recommendations.”