Budget warning follows latest NICE drug approvals The National Institute for Clinical Excellence has approved the use of orlistat for obesity and pioglitazone for type-2 diabetes by the NHS in England and Wales. Orlistat may be prescribed to clinically obese adults who also have another serious illness such as high blood pressure or diabetes, alongside exercise and a low-fat diet, at an estimated cost to the NHS of £12m in the first year. If it proves successful, treatment can continue for up to a year, and occasionally two years.

NHS Alliance chair Dr Michael Dixon welcomed the prospect of equitable access to treatment but expressed concern about the possible impact on budgets. Pioglitazone therapy for diabetes can be considered for patients for whom treatment with metformin and sulponylurea is unsuccessful.

www. nice. org. uk BMA voices fears over 'risk of accident and error' Doctors are being asked to do more than is reasonable or possible, the British Medical Association claimed, following a meeting of council members last week. Derek Machin, deputy chair of the BMA's consultants'committee said the crunch issue was workload. 'We try to fast-track patients through the system, squeezing extra appointments into outpatient clinics, discharging patients at lightning speed and putting quantity ahead of quality. That increases the risk of accident and error. 'Meanwhile, patients need more time with their GP, said John Chisholm, chair of the GPs'committee.

'Consultation times of eight minutes or less are unfair to patients, 'he said.

NAO seeks better-quality incapacity assessments The standard of medical assessments for people on incapacity and disability benefits needs to be improved, according to the National Audit Office. Medical assessments were outsourced in 1998 to SEMA Group, saving 10-14 per cent on the public sector alternative. But around half of those whose incapacity benefit is withdrawn appeal against the decision and two-fifths of those appeals are upheld. Attention also needs to be paid to improving doctors'awareness of disability and cultural issues, it says. The Commons public accounts committee is due to hear evidence from the Department of Social Security on the subject on 21 March.

The Medical Assessment of Incapacity and Disability Benefits. NAO. Stationery Office. www. nao. gov. uk Ex-CMO defends routine health visiting in Scotland Former chief medical officer Sir Donald Acheson has called for the maintenance of routine health visiting in Scotland, which he insists is quantifiably beneficial to patients. 'We know from randomised trials in America that repeated visits by health visitors during the first two years of life to the homes of mothers has a substantial benefit to the life of the baby up to its third decade. 'A Scottish Executive review of public health nursing calls into question the use of routine health visiting. Sir Donald added: 'You can change the title of what health visitors do to family health nurses or whatever but you must not change what they do. 'David Forbes, secretary of the Scottish Health Visitors'Association, said: 'We have consistently argued for a minimum level of visits and believe there is a benefit in the routine or regular visit. '

Access to breast cancer specialists still improving The number of women with suspected breast cancer seeing a specialist within two weeks of referral is continuing to rise. Figures for October to December 2000 show 19,697 patients seen within two weeks, compared with 18,449 the previous quarter. But the percentage of patients seen within a fortnight has fallen from 97. 7 per cent to 95. 9 per cent over the same period as the volume referred has risen. Public health minister Yvette Cooper said new targets this year will guarantee a maximum one-month wait between diagnosis and beginning of treatment for breast cancer.