Harold Shipman was arrested a quarter of a century ago, but we still have problems with prescribing controlled drugs

Posted on December 15, 2023 by philipcrilly

Catherine Hudson drugged two patients on the stroke ward of Blackpool Victoria Hospital to give herself an easier life. She has been jailed for seven years and two months. Her colleague, Charlotte Wilmot, who conspired with her to drug a third patient, was given a three-year jail term.

The trial highlighted the easy access staff had to controlled drugs. The drug regimen on the stroke ward was described during the trial as “dysfunctional”. But why is this still happening? Wasn’t it all meant to have been sorted following the Shipman Inquiry?

Harold Shipman, a seemingly mild-mannered family doctor, was responsible for the deaths of over 200 of his patients over 23 years. The true horrors of his actions started to slowly unravel in September 1998 when he was arrested for the murder of one of his patients, 81-year-old Kathleen Grundy.

It was the vigilance of Grundy’s daughter, Angela Woodruff, that would set in motion a series of events that would ultimately bring an end to Shipman’s long-running killing spree that began in the 1970s. Until that point, he had been able to kill his patients undetected by being careful to cover up his tracks.

There was a collective denial by the British public that a family doctor could have harmed one of his patients, let alone many of them. Yet, at the conclusion of his murder trial in January 2000, Shipman was found guilty of the murder of 15 of his patients. The true number of his victims, however, is believed to be 215.

Most of the victims were elderly women and Shipman’s weapons of choice were the controlled drugs, diamorphine, morphine and pethidine – strong opioid painkillers.

Controlled drugs are those deemed by governments to pose a high risk to the public due to being addictive or harmful. Shipman administered these drugs to his patients in high doses. At the doses administered, the victims would have quickly lost consciousness and developed breathing difficulties before passing away.

Following Shipman’s conviction, governments around the world sought to ensure that their controlled drugs regulations were sufficient to prevent similar events in the future.

Shipman Inquiry

The Shipman Inquiry was set up by the British government in 2001 to understand how one person could have used controlled drugs so freely to harm their patients and to determine what procedures needed to be put in place to prevent another person doing the same again.

The inquiry recommended not only a cultural change within the medical and pharmaceutical professions, but also the need for new laws to protect the public.

In its fourth report, the Shipman Inquiry focused on the management and regulation of controlled drugs. It recommended better monitoring of them, with running balances being kept for the sale and supply of specific controlled drugs in controlled drug registers.

Harold Shipman mug shot. — Harold Shipman, one of the most prolific serial killer in modern times. Wakefield Prison/Wikimedia Commons

In addition, a team of inspectors was to be appointed to check that controlled drug registers were being kept accurately, to track the prescribing of controlled drugs, and to monitor those who were prescribing them.

The inquiry recommended clamping down on self-prescribing and prescribing of controlled drugs for family members. It also limited the quantity that could be prescribed at any one time to a 28-day supply.

While the Shipman Inquiry only had oversight in the UK, its recommendations were relevant to an audience of global healthcare professionals and governments.

Still a problem

Despite all the changes, 25 years after Shipman’s arrest, controlled drugs are still a global problem.

While many of these medications have an important place in pain management, particularly for those with cancer, they are prone to abuse and misuse. In 2021 alone, the NHS spent over half a billion pounds on controlled drugs, and in the US, the opioid pandemic continues to rage, with people becoming addicted to opioid painkillers, like morphine and fentanyl, after obtaining them from registered prescribers.

The governance and oversight of controlled drug prescribing, in all healthcare settings, is still not as “robust as it should be”, according to the Care Quality Commission (CQC) in the UK.

It has suggested that digital tools, such as ePACT2, will allow authorised users to identify questionable prescribing of controlled drugs so that early interventions can be implemented to ensure safe care of patients.

In the US, prescription drug monitoring programmes are being used in a similar way to give real-time, controlled drug prescribing data to enhance care.

But just as these new tools come into play, more challenges are coming to light. The emergence of non-medical prescribers (paramedics, podiatrists, pharmacists, nurses, radiographers and physiotherapists) adds to the number of people who can prescribe controlled drugs, and, therefore potentially abuse and misuse them.

Winning the war on controlled drugs will continue to be a challenge. New drugs are brought to market every year, with the potential to cause harm and be categorised as controlled drugs. As such, the management of these drugs needs to remain fluid, with healthcare professionals and governments working together to protect the public from harm.

Philip Crilly, Senior Lecturer in Pharmacy Practice and Digital Public Health, Kingston University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Managing your weight

Posted on March 16, 2017 by philipcrilly

The number of people in the United Kingdom who are overweight or obese is starting to spiral out of control. Current statistics suggest that over 50% of British adults are overweight and many of these are at risk of becoming obese.

With a population becoming increasingly overweight the risks of heart disease, diabetes and other long term health complications are reaching scary heights.

Weight loss programmes range from diet based schemes like weight watchers, to self help books such as Dr Atkins diet to those that combine diet and exercise classes like Rosemary Conley’s eat yourself slim diet.

What are the risks associated with being overweight

As mentioned, being overweight can have a serious impact on our health. Some of the risks associated with obesity include

Heart Disease
High Blood Pressure
Cholesterol problems (leading to heart disease)
Stroke
Type 2 Diabetes (the kind you develop rather than are born with)
Cancers (prostate, gallbladder, colorectal, breast, endometrial and kidney)
Sleep Apnea (Snoring and difficulty breathing while sleeping)
Reproductive problems (irregular periods, increased birth defects, especially neural tube defects, and an increased risk of death of the mother and baby).

What diets are out there currently?

Currently, there are a huge abundance of ‘fad’ diets on the market. Very often these diets give us short term results and in the long term, many people actually put on more weight. The reason these fad diets work initially is because they make us dramatically cut the calories we consume so therefore we will naturally lose weight.

The problem with ‘fad’ diets is that they usually aren’t easy to maintain. As soon as you go back to your normal life, the weight generally goes back on.

The key to losing weight and keeping it off is to make the appropriate lifestyle changes and to stick to them. A diet low in fatty, processed foods and high in fruit and vegetables helps us maintain a healthy physique.

What role does exercise have in weight management?

When you exercise you burn calories. The more vigorous exercise you do, the more calories you burn and the more weight you lose. Current recommendations suggest that we should aim to do five thirty minute sessions of exercise per week. Ideally, we should aim to combine cardiovascular exercises like swimming, which help heart health, with weight-baring exercises such as squats or running which help to build strong joints.

Exercise, is not only key to weight management, other benefits include:

It helps you manage your mood – exercise triggers brain chemicals that make you feel good. Regular exercise is encouraged to combat depression.
You’ll feel more energetic
You’ll sleep better
If you do exercise with friends it can even be fun.

Maintaining a healthy weight helps ward off many serious illnesses. Just making a few small lifestyle changes involving diet and exercise can dramatically improve our health in the future.

How much alcohol is too much?

Posted on January 4, 2017 by philipcrilly

Have you ever thought about the effects of alcohol on your health?

For many of us alcohol is a part of our lives. We drink it when we socialise with friends, we consume it when we want to celebrate a special occasion and we drown our sorrows in it during difficult times.

Alcohol in moderation is fine and can actually have some health benefits. Certain varieties of red wine have been shown to contain the anti-oxidants resveratrol and catechins that may help protect artery walls. Alcohol can also boost HDL, the good cholesterol.

In very small amounts alcohol can be used as a relaxant but this isn’t encouraged.

Very often however alcohol is consumed in quantities that will do anything but make us healthy. The long-term effects of alcohol can have a huge impact on our health and wellbeing. Not only are we at increased risk of accidents and injury when we consume alcohol, prolonged consumption of excess alcohol can lead to weight gain, liver disease and a plethora of other serious ailments.

How many units can I drink?

The recommended daily and weekly intake of alcohol is different for men and women.

Women should not drink more than 2-3 units per day while men should drink no more than 3-4 units per day. It is also important to have alcohol free days to allow your body and liver to rest.

Regular alcohol use at levels greater than this can lead to long-term health risks.

Does alcohol contain any calories?

The answer is YES!

Many of us will diligently follow diet plans and fads in the hope of losing weight but will fail to take into account the amount of alcohol we consume.

A glass of wine is equivalent in calories to a packet of crisps. If you think about the amount of alcohol you consume over the course of a month, this can add a few more inches to your waistline.

Also, one of the short-term effects of alcohol intake is the dreaded hangover.

Hangover cures often involve the consumption of hundreds of calories in the form of high-fat breakfasts, milkshakes, and junk food, all adding to the calorific effect of alcohol consumption.

Tips to avoid drinking too much

In between drinking an alcoholic drink why not have something alcohol free? There are lots of premium soft and sparkling water drinks available that can be a welcome interlude from alcohol. This allows you to reduce the number of units you consume and you’ll appreciate this the next day.
Why not add some tonic water or lemonade to your wine or beer to create a wine spritzer or shandy? This way you will drink half as much as you normally would.
Go for low alcohol content drinks, avoid strong beers and wines as these will make you reach your units limit faster.
How about organising a social event with friends, which doesn’t involve alcohol? That way you will all have a chance to catch up properly and the next day you’ll remember all the funny stories and anecdotes.
If you will be drinking, try having it with a meal or after food. This way the alcohol will take longer to have its effect and you won’t drink as much.

Winter Health

Posted on November 24, 2016 by philipcrilly

As we move into the colder winter months the incidence of the cold and flu will increase. For many this will mean a few days of bed rest but for the elderly and those with other medical conditions it can have much more serious consequences.

So, how do you know if you have a cold or the flu?

The symptoms of a cold are similar to that of the flu, although anyone suffering from the flu will find that these symptoms are more severe. Many people can go about their day-to-day activities if they just have a cold. Those who have the flu will be bedridden and won’t be able to leave the house; such is the impact that the flu has on the body.

What symptoms will you notice with a cold or the flu?

As mentioned, the symptoms of a cold and the flu are similar and include:

Chesty (productive) or dry (tickly) cough
Stuffy, congested nose
Aches and pains
Lethargy

How can you avoid a cold or the flu?

Vitamins and minerals can have some benefit in speeding up your recovery from a cold or the flu. Vitamin C and zinc have been shown to slightly reduce the severity of a cold but will not cure it.

Flu vaccine

The flu vaccine is recommended for anyone over 65 years of age, those with other medical conditions and pregnant women. The reason the flu vaccine is effective is because it introduces a small amount of an inactivated virus into your body, which then allows your body to recognize and fight the flu virus if you become infected again. The flu vaccine doesn’t cause the flu but you may experience a slight increase in temperature and have a few aches after having the vaccine but these are only very short term.

What if you do get a cold?

If you still manage to get a cold there are a number of things you can do to treat the symptoms. Some of these include:

Chesty cough – try an expectorant cough bottle e.g. something containing guaifenesin

Dry cough – a cough suppressant e.g. pholcodine, is usually effective

Stuffy, congested nose – try a decongestant tablet containing pseudoephedrine or a nasal spray containing xylometazoline

Aches and pains – paracetamol is effective for treating aches and pains and reducing temperature. Ibuprofen is good for any inflammatory or muscular pain.

Many of the over-the-counter pharmacy medicines used to treat cold and flu symptoms are not suitable for those people with medical conditions such as diabetes and high blood pressure so always ask your pharmacist for advice if you are taking other medications.

8 ways to eat better

Posted on October 25, 2016 by philipcrilly

Knowing what foods to eat to support your health is an essential part of living a long and happy life. We live in a world of convenience, filled with fast food restaurants and junk food. It often seems like the easiest option is to reach for the high-fat snacks, but have you thought about what this could be doing to your wellbeing? What we eat can affect how we look and feel – and many junk foods have been linked to serious illnesses. Being conscious of what we are eating can make a massive difference to our long-term health. So, how can you get the most from your food?

1. Go organic – To avoid harmful chemicals and hormones, you should choose organic varieties of foods. Organic food supports your health. As it becomes more popular, it is also becoming more affordable.

2. Organise a meal plan – Planning ahead is planning to succeed. Just take a little time each week to plan your meals. This way you only buy the food you need and can plan healthy meals in advance.

3. Choose fish – Fish is a great low-fat, high-protein food choice. You should aim to eat fish three or four times per week if possible. Fish oils have also been linked to increased brain function, a healthy heart and supple joints.

4. Choose wholegrain – Wholegrain varieties of popular food items, including breads and pastas, can help put off hunger for longer as they help to keep us feeling full. They also ensure we don’t have the sugar spikes that can result from the refined alternative.

5. Cut out the salt – Salt is packed into so many foods nowadays that it’s easy to exceed the recommended daily amount. This can have a huge impact on our blood pressure, possibly leading to heart disease.

6. Get your five-a-day – Eating your five-a-day of fruit and vegetables will ensure you get all the essential vitamins and minerals your body needs to function at its best. Try to vary the fruit and veg that you eat so that you get a wide range of different vitamins.

7. Explore supplements – Sometimes it isn’t always possible to get all the vitamins you need through diet alone. Vitamin supplements can also support a healthy lifestyle. Consult a diet expert to find out what vitamins you are lacking and what support you may need.

8.Eat your breakfast – Evidence suggests that people who eat a balanced breakfast are less likely to over- eat throughout the rest of the day. So start the day with a healthy breakfast like porridge with honey, or scrambled egg on whole-grain toast. Be prepared – One of the best ways to avoid snacking is to keep a selection of fruit and nuts in your bag for whenever hunger strikes.

How much sugar is too much?

Posted on October 8, 2016 by philipcrilly

Anyone who knows me will know that I have a massive sweet tooth!

I’m a particular fan of mints and chocolate but have a soft spot for those really tangy, sour jelly sweets too! As much as I love these sweet treats I am fully aware that they can’t be good for me in the long run. Too much sugar has been linked to the growing obesity epidemic as well as many health conditions like diabetes and dental decay.

And I’m not the only one to worry about my sugar habit.

On the 5th March 2014, the World Health Organisation (WHO) launched a public consultation so that it could review its guidelines on sugar intake.

Sugar is also a “hidden ingredient” in lots of foods and drinks so we may be consuming even more than we think.

Did you know that 1 tablespoon of tomato ketchup contains 4-grams of sugar? Or that many of the fruit juices we might assume are healthy are also packed full of sugar?

In 2002, the WHO recommended that, “sugars should make up less than 10% of total energy intake per day.” In this latest consultation they are suggesting that reducing our sugar intake to less than 5% of total energy intake per day “would have additional benefits.”

It is hoped that these new guidelines will encourage food manufacturers to reduce the amount of sugar they use in their products and will also mean that nutritional labels will have to be clearer about the amount of sugar present.

Here are my 5 tips to help you start reducing your sugar intake today:

1. Make sure you have breakfast

Eating a healthy breakfast everyday will help to prevent sugar cravings later in the day. Opt for porridge or whole meal toast with poached egg to satisfy your hunger.

2. Avoid having sugary snacks at home

When it comes to sweets if they are in sight then I will eat them! I have found that the best way to reduce my sugar intake is to avoid keeping sweet treats at home. It makes it easier to avoid temptation.

3. Eat foods with a low glycemic index

Low GI foods release energy over a longer period of time so you won’t experience those sugar highs and lows. Nuts and raisins, apples and pears all have a low GI so are a good choice for snacking on.

4. Cook from scratch avoiding processed foods

If you cook using fresh ingredients then you know exactly how much sugar is in the food you are eating. Processed foods and ready meals are packed full of hidden sugar so are best avoided.

5. Cut out the fizzy drinks

Lots of fizzy drinks are loaded with sugar. Try replacing fizzy drinks with sparkling water and a slice of lemon.

The 8 quickest way to get into the exercise habit

Posted on September 24, 2016 by philipcrilly

As well as being a great way to stay fit and healthy, exercise also has many other benefits, both mental and physical. Burning off those excess calories by going for a run or a dance or heading to the gym can help you to look and feel better. You may find it easier to relax and you may sleep better at night.

With so many positive benefits it seems strange that we all find it so hard to keep motivated with our fitness goals. We often have many excuses for not exercising and it is often the easier choice to sit in and watch TV than to go out and release those feel good endorphins.

So how can you get into the exercise habit?

1. Exercise with friends – not only is this a great way to get fit, it’s also a great opportunity to catch up with your friends and hear all their news. Keeping fit with a friend also means that you’re not just accountable to yourself. If you don’t exercise you’re not only letting down yourself, you’re letting down your friend too.

2. Vary the exercises that you do – In order to maintain a regular exercise routine you need to make it fun and enjoyable. One way to do this is to vary the types of exercises that you do. You could go to a dance class on a Monday, a spinning class on a Tuesday, a run with a friend on a Wednesday and swimming on a Thursday. Keep things fresh and do what you enjoy most.

3. Make exercise an important part of your life – Try telling yourself that doing exercise is part of your job or part of your day-to-day routine. This way you won’t avoid doing it and will keep a commitment to yourself. If ‘better offers’ come up, remember what your priorities are.

4. Develop a fitness plan – With the help of a personal trainer or health and fitness expert, develop an exercise plan for yourself that helps you achieve your health goals. Having a plan is also a great way to keep on track of your progress.

5. Set yourself fitness goals – Setting yourself a fitness challenge, such as competing in a 10k running race or doing a triathlon, can help to give you focus when you exercise. Knowing that you have a deadline to be fit is a great motivator and one that keeps many people on track with their fitness regimes.

6. Tell people about your fitness goals – By telling others about your fitness goals you are putting pressure on yourself to continue to train hard. Knowing that other people will now have an expectation of you will help to motivate you!

7. Exercise at a time that suits you best – there’s no point deciding to exercise first thing in the morning before work if you know you are a night owl. For some exercising before work keeps them focused all day, for others an after work gym session helps them forget about the stresses of the day.

8. Focus on your achievements and successes – when you do achieve something you are proud of, it’s important to make it a big deal and to realize how far you’ve come. Use it as a further motivator for your next fitness challenge.

Try some of these tips to get yourself fit again and soon you will be enjoying the benefits of being active like looking good and feeling great.

Changes to alcohol unit guidelines in the UK – January 2016

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Changes to alcohol unit guidelines in the UK
January 2016

You may have heard the news recently that the UK government has made changes to the advice it gives on drinking alcohol.

Whereas before men were advised that they could drink more alcohol than women (21 units for men, 14 units for women), this has now changed. Men and women are now advised that they should each drink a maximum of 14 units of alcohol per week.

In addition, the guidelines suggest that these units should be spread across at least 3 or more days per week and that you should include regular alcohol-free days

Binge drinking is also not advised; it has been associated with a greater risk of short term health problems, like the dreaded hangover, as well as the longer term risks of causing certain cancers.

For pregnant women the advice is not to drink alcohol at all.

Some tips on keeping on top of your alcohol:

• When drinking, try to do so with a meal
• Have a glass of water or a soft drink in between alcoholic drinks
• Try some alcohol-free alternatives

Dr Philip Crilly

Senior Lecturer in Pharmacy Practice and Digital Public Health

Tag Archives: Health