This revelation was linked to an earlier investigation by the Times which referred to the MOD as grossly under-estimating the threat from the Taliban and ignoring warnings that planned troop numbers were inadequate.

Events this week – President Obama’s address to the nation on Iraq gaining sovereignty, and Tony Blair’s “journey” – only serve to focus attention on Afghanistan.  President Karzai has indicated that NATO strategy there needs to be reassessed.  The casualties bring their own imperative.  A further 7 US troops died at the weekend and the bodies of 5 kidnapped aid workers were also recovered.

I do not know if General Freakley’s tactics would have proved to be superior, taking into account the IED threat on mobility, but we do not appear to be any nearer to a solution markedly improved security situation in Afghanistan.

The NICE guidelines state that Gastric surgery should only be offered to the morbidly obese, typically those whose BMI is over 50 or lower if they have some other medical problem like sleep apnea or diabetes.

However, all too often the Primary Care Trusts who have to approve the funding for gastric operations refuse.

Typically, a gastric bypass operation will cost in the region of £8,000 to £10,000. Some PCT’s refuse to spend this relatively small amount of money on the operation preferring to simply offer diet and exercise advice.

In my view, this is an incredibly short-sighted way of viewing a serious problem.

People who meet the NICE criteria for gastric bypass operation are dangerously overweight. These patients have spent years trying to control their weight through diet and exercise but have reached the point where this alone will not work. Gastric surgery is the only option open to them.

Bariatric surgery represents value for money in most cases. If a patient has a BMI of over 50 it is likely that they will go on to suffer from complications of their weight such as sleep apnea, heart disease, high blood pressure and diabetes. All of these complications have to be treated on the NHS often at significantly higher cost than the original gastric operation which the patient requested.

In my view, the case has clearly been made out for PCTs to allow gastric bypass operations in all situations where the NICE guideline state that surgery should be performed.

If you require bariatric surgery but your PTC has rejected funding for the operation we may be able to help you. Contact us now.

It has to be said of course that it is not necessarily due to falling standards. It may be equally due to the fact that patients are finding their voice, and are less willing to accept the consequences of an adverse outcome, without explanation. There is also increased activity in the NHS generally, so potentially more incidents to complain about.

The Complaints Procedure has to be effective however, and whilst it can be said that generally there has been improvement over the past few years in Trusts etc. actually dealing with complaints, I equally come across clients who have consulted a solicitor due to their dissatisfaction with the whole complaints process. Sometimes this can be due to simply not receiving a timely response, or the Trust not adequately addressing the patient’s concerns.

People who are currently taking Avastin will be unaffected by today’s decision.

I have previously acted on behalf of a number of patients whose Consultant had prescribed Avastin but the PCT had refused to fund the drug. In some of those cases I have been successful in persuading the PCT to fund the drug. I now fear that PCTs will be able to use the NICE ruling to prevent seriously ill patients getting this important life prolonging treatment.

In my experience Avastin is only prescribed by doctors in the most serious cases of advanced bowel cancer, which is thankfully considered a ‘rare’ cancer. Although it has been widely reported in the press that Avastin only extends life by six weeks many doctors, patients families and myself have seen much better results when ill patients are prescribed Avastin after other treatments have stopped working.

The NICE decision is subject to appeal and no doubt campaign groups such as Bowel Cancer UK will make a strong challenge to NICE’s decision.

In a joint investigation by the Bureau of Investigative Journalism and Channel 4 News, it was discovered that more than 170 doctors in England and Wales had agreed to “Gagging Orders” at the conclusion of their employment costing the NHS more than £3 million.

The investigation also found that 19 NHS staff decided to take their cases to the Employment Tribunal after “whistle-blowing” about the poor standards in hospitals but their claims were eventually settled before going to hearing.

Whistle-blowers have legal protection from dismissal or victimisation under the Public Interest Disclosure Act 1999. The Act protects whistle-blowers from any retribution by their employer even if they have entered into a contractual Gagging Order.

Patient Safety should always be paramount in the NHS and Trusts should foster an open dialogue with their doctors where staff feel safe to point out bad practice and errors at an early stage.

When they fail to do this problems can occur. The recent scandal at the Bristol Royal Infirmary where 29 babies and children died after heart surgery, fare higher than one would expect from a specialist unit of that type, proved the importance of openness.

1600 tests and examinations have been under review for breast cancer screening, after concerns about the accuracy of the results. 8 women previously told they were not suffering from breast cancer have now been advised that they will need treatment.

Such incidents are thankfully rare, but regretably the consequences of these isolated incidents can be extremely distressing for the individuals and their families concerned. An anxious wait will no doubt follow.

The hospital works on the premise that bigger is better. By carrying out huge volumes of operations the cost of each procedure can be substantially reduced. A complex heart operation at the hospital can be carried out for as little as £1,140 although the hospital is attempting to reduce this to less than £600. The same apportion in the US or the UK may lose up to 20 to 30 times as much

The simple but revolutionary idea means that instead of building small hospitals with only a hundred or so beds, surgery is in fact carried out in super hospitals with over ten times as many beds. Despite carrying out the huge numbers of operations death rates at the Bangalore Hospital are comparable or better than those in the UK or the US.

The hospital, which is a private venture will shortly be opening a similar super hospital in the Cayman Islands where it hopes to attract patients from Florida and other Southern States who do not have access to full healthcare.

On the Prime Ministers recent trip to India Vince Cable, the Business Secretary who was travelling with the Prime Minister called the Cardiac Hospital as well as its two sister hospitals, one specialising in orthopaedics and the other in Cancer treatment “quite inspirational”.

Could this signal a new direction for the NHS?

In addition this bacteria can exist with other bacteria such as e-coli, and then go on to cause urinary tract infections and blood poisoning.

The Health Protection Agency is monitoring information closely, but has stressed the need for hospitals and visitors to be vigilant, and adhere to cleaning and disinfectant procedures

Of course Panorama has already reported that the MOD stopped training new recruits for 18 months in 2002 to cut costs and most of the bomb disposal operators, who have tragically lost their lives, are young men in my view, being in their late 20’s or early 30’s. But one of the pictures in the report gives away the wider problem. “A Royal Marine from 40 Commando searches for IEDs with a metal detector”. We know that the devices are becoming increasingly sophisticated with lower metal content. It is ordinary soldiers who have to search for and locate the devices before calling in the specialists.

The last Inquest I did into an IED death was that of a 19 year old soldier. Health & Safety gets a bad press every day of the week but you have to wonder what the risk assessment of this threat looked like prior to our commitment to deploy and whether it was the risk assessment or those deciding that we would take the risk that got it so wrong.

The College has stated that patients suffering a TIA should have surgery to prevent a larger stroke further down the line, but following research, just a third of 3,000 patients had this procedure in the optimum time specified.

We have all probably seen the recent television campaign about heeding the early signs of a stroke, but it is of course of paramount importance that hospitals and stroke centres around the country have adequate facilities to treat patients and implement these preventative measures, once the signs are noticed.