Forum Topic

Government finagry over cancer targets

Allison Pearson in the Telegraph is normally dreadful, but her column today on the government's weasel plan to scrap cancer treatment targets is really good. It's behind their paywall, but this (longish) excerpt summarises it:"This is Health Week on the government’s media grid. With no good news to impart about our calamitous NHS with its 7.5 million (at least) waiting list, Mr Barclay was on the airwaves trying to put the best possible gloss on a decision to scrap two-thirds of cancer waiting-times targets in England. (A move so sublimely cynical it could have come straight out of Yes Minister.) Under the plan, nine targets will be consolidated into three pledges (that weasel word again). Potential cancer patients will no longer have to be routinely referred to a specialist within 28 days which health leaders somehow believe will mean “patients will get better treatment in the longer term”.Honestly, how stupid do they think we are? One in two people gets cancer and Cancer Research UK says this will increase 30 per cent by 2040. Early diagnosis and fast treatment are crucial. The international accepted goal which saves lives is the 62-day treatment target. That is missed in a staggering four out of 10 English patients. (Oncologists around the world regard British waiting times as a sick joke.) Just four weeks’ delay in starting treatment increases the death rate by 8-13 per cent. At least 100,000 people have seen their cancer worsen or been left with fewer treatment options because of appalling NHS delays over the past decade, according to Macmillan Cancer Support. And some 9,000 cancers were missed as a result of breast-screening interruptions during the pandemic.Sorry, I know that’s a lot of statistics to absorb. But those 9,000 women – someone’s wife, someone’s mum, someone’s beloved best friend – are dead or dying now. All the Amys and the Nickys and the Jills buried in the unmarked tomb of excess deaths.It’s mortifying in every sense. But instead of launching a radical new national cancer plan to catch up with superior countries that don’t just allow their citizens to sit on a waiting list until they’ve got Stage 4 (straight to palliative care for you, Sir!), health leaders scratch their heads and exclaim, 'I  know, if we scrap the pesky targets we won’t be accused of failing to hit the targets any more. Simples!'Denial and deceit are their watchwords. The cancer waiting times for April, published on 8 June, were awful, but NHS England continues to insist that everything is tickety-boo. Nothing to see here. Failure in our cancer care has become so normalised that hardly anyone bothers to scream and shout about the obscene number of missed chances to save lives which make the UK such an outlier in the civilised world."https://www.telegraph.co.uk/columnists/2023/08/15/nhs-cancer-crisis-waiting-lists-steve-barclay-rishi-sunak/

Richard Carter ● 902d26 Comments

Mr Hawkes asks if "the problems with cancer carelies with those that run and work in the NHS or the nature of the system itself?"It's neither, but in the shortfall in funding provided in relation to need. the BMA explains it clearly enough:"Healthcare spending has increased nearly every year since the NHS was established. This is necessary to meet increasing demand: the population has grown, and more people are living longer with more complex health issues.However, in the decade preceding the COVID-19 pandemic, UK health funding grew at a slower pace than before, with a growth rate falling below the long-term average. The pandemic triggered additional funding injections, which were much needed but did not make up for historic underspend. Between 2009/10 and 2021/22, the cumulative underspend – the difference between what funding would have been if historical growth rates had been maintained, and what was actually provided – reached £322 billion in real terms."https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/funding/health-funding-data-analysis#:~:text=Although%20NHS%20spending%20has%20increased,and%20some%20estates%20are%20unsafe.However, what this thread is really about us the dishonesty of the government in moving the goalposts. Perhaps you'd like to address that.

Richard Carter ● 899d

For John Hawkes.Please! Treasure the NHS! Insurance companies are no answer. Other countries have it worse with those. Have you not heard of countries where people can't get work because their spouse has health problems? Or people in this country with private health insurance who over a certain age experience sky rocketing health insurance payments?Then there's the situation in France. An example below:https://www.euronews.com/2023/08/19/this-medical-centre-in-france-has-5000-patients-but-no-doctorsJust one of the areas in France. There seem to be quite a few.

Katrina Black ● 899d

"Britain is glad of the contribution made by health workers from abroad"How sweet. I expect that Britain is glad of the contribution made by health workers from abroad whose training is most likely to have been paid for by their countries of origin.

David Ainsworth ● 899d

Mr CarterPerhaps if the NHS is diagnosed as being calamitous, instead of administering an additional dose of funding to that of £269 BILLION given in 2020 we should instead look at how health care is managed in other countries and follow their example.You and so many rightly point out that their systems seem more effective in terms of cost and outcomes.Last year the net increase in UK population was 606,000.Also, the population is ageing.Will the system cope ?And who/what is to blame for the cancer treatment statistics you quote ?Is it those that run and work in the NHS or the nature of the system itself ?The Government does not run the NHS.Its function is to provide its revenue which (see above) it seems to be doing.If that is not enough perhaps we should each have a compulsory and individual saving scheme to pay for our health care.

John Hawkes ● 899d

Mr AinsworthI don't know if they are 'health tourists' but when I go to my regular consultations at George's there are many waiting with me who are not speaking English and some require support of friends or family when being treated.With our current immigration process perhaps this is to be expected.However, I have helped pay for the NHS through 45+ years of high rate income tax.I often wonder what their contribution has been !Statistics regarding the origin of NHS staff is a red herring.There is a contract.They want work and we pay them for their skills.

John Hawkes ● 899d

Health tourism is clearly not the biggest problem facing the NHS but it still costs the country up to £300 million per year. This is money that could be spent, for example, on scanners to improve cancer survival rates. So I don't think that it is ignorant or prejudiced to highlight the problem. I don't understand the relevance of the statistics showing the number of Indians and Nigerians and so on employed in the NHS. Britain is glad of the contribution made by health workers from abroad, but that does not mean that people from these countries have the right to avail themselves of free treatment.

Steven Rose ● 900d

David, you're too polite in trying a rational answer to this ignorant, prejudiced rubbish.

Richard Carter ● 900d

"Total UK central government funding for health in the UK in 2022/23 (including spending by central government departments and devolved administrations) is about £180 billion."https://www.myhsn.co.uk/top-tip/how-much-does-the-nhs-cost#:~:text=What%20is%20the%20cost%20of,divided%20by%2067%20million%20population)."EXCLUSIVE: Health tourists from 155 countries have run up £219million of unpaid NHS bills as Brits face huge waiting lists and must battle to see their own GP" (Daily Mail Exclusive)"Unpaid bills run up by 'health tourists' have cost the NHS £219million, a Mail investigation reveals today.""Visitors from Nigeria ran up the biggest debts, owing £6.1million. Indian nationals owe £3.1million, Romanians £2.5million, Jamaicans £2.2million and Americans £2million."https://www.dailymail.co.uk/news/article-11737185/Health-tourists-155-countries-run-219million-unpaid-NHS-bills.htmlNationalities of NHS staff, June 2022 include:-Indians  44,785Nigerians  15,439Romanians  5,519https://commonslibrary.parliament.uk/research-briefings/cbp-7783/#:~:text=Most%20NHS%20staff%20in%20England,staff%20with%20a%20known%20nationality.I'd imagine that their own countries trained them. That costs those countries. It has also, in some cases, created a brain drain.

David Ainsworth ● 900d

Why are we treating so many people who haven't paid for NHS. So many people coming into the Country and being treated. It's only like most things when it affects you, you want something done about it. If you see somebody being treated and not you how does it make you feel. As for Private Hospitals I've heard some stories and I prefer NHS. I had Private with a company I worked for for 10 yrs.

Barbara Stevens ● 900d

Never let a fact stand in the way of a good prejudice. A practising doctor points out that a majority of GPs are working part time. Given that there is a shortage of doctors in this country together with relatively poor cancer survival rates, you would think that this fact might elicit some concern. But so far as Putney Forum is concerned, not at all. Contributors only seem to want to attribute the failings of the NHS to the Tory government led by 'millionaires'. The idea that some NHS professionals might not necessarily be acting in the public interest is immediately discounted. One contributor to this thread said that an internet search showed that the disquieting statistics only referred to 2022. So what? There are probably patients battling against advanced cancer right now because they were unable to obtain an early diagnosis last year. And in any case it is not likely that the working practices of GPs have changed markedly in the last twelve months. This contributor also said that her practice only has two consulting rooms, so the GPs have no room to do more than a three day week. Really? Could not one or more of these GPs join a surgery where there are plenty of consulting rooms but not enough doctors to provide timely diagnoses. Another contributor, if I understand his point correctly, suggests that by working a 12 hour day GPs could do more hours in three days  than they would complete in five days working normally. This is possible, I suppose, but would it be in the best interests of patients? Doctors who work 12 hour days are more likely to make mistakes. And patients may not be able to attend an appointment on the few days where GPs are willing to work. Furthermore none of this addresses the problem of peripatetic GPs and GPs based abroad who can only provide virtual consultations.This thread demonstrates, if further demonstration were needed, that it is virtually impossible in this country to have a sensible discussion about the NHS, which is too often used to score points off political opponents. This extends to the the main political parties. Neither the Conservatives nor Labour are willing to consider fundamental reform for fear of committing 'electoral suicide', as an earlier contributor put it.

Steven Rose ● 900d

I haven't read the article about hours worked but isn't there an issue with hours worked/earnings/ pensions taxed over a certain amount. Isn't that what keeps doctors working restricted hours? For most the hours they work seem - is the term antisocial? Early starts/ late finishing time. Condensed working into 2  or 3 days. They never in my experience worked 9 to 5 so it's unrealistic to expect that now surely.The amount of time each GP is given with a patient has long been a bone of contention and could perhaps be yet another irritant to the working day.

Katrina Black ● 900d

And yet with these semi-utopian conditions, GP numbers are falling, apparently."GP numbers falling while patient numbers rise is making workload ‘unsustainable’, says Royal College of General Practitioners"Publication date: 03 May 2022https://www.rcgp.org.uk/news/gp-numbers-falling#:~:text=General%20practice%20is%20under%20doctored,hear%20about%20difficulties%20accessing%20services.

David Ainsworth ● 901d

The author of the article recommends that GPs should be contracted to a do a minimum of four days per week. The fact that many doctors do three days or less makes it difficult to provide a proper service to the public.

Steven Rose ● 901d

"I have no idea how many hours GPs do per week working three days or less but I presume it is fewer than than they would do working five days."I am surprised that Mr Meirion Thomas has not given the figures. If they do 11-12 hour days in a 3-day week, then I presume that they would do fewer hours per day if they worked a 5-day week. https://www.rcgp.org.uk/News/GP-working-hours-more-complex

David Ainsworth ● 901d

The article is in today's 'Telegraph'. The author is J. Meirion Thomas. I have no idea how many hours GPs do per week working three days or less but I presume it is fewer than than they would do working five days.

Steven Rose ● 901d

I was going to ask the same question, Katrina.But I Googled "poor cancer survival rate is that 57% of GPs work three days a week or less".All the articles that showed up were from 2022.But, my GP has been working for three days a week for some time now.  Mainly, because there is a rota of GPs and there are only 2 consulting rooms.  But, there are GPs throughout the week and appointments are available from 8:30 am to 6:30pm.

Ivonne Holliday ● 901d

"57% of GPs work three days a week or less."How many hours do they work per week?

David Ainsworth ● 901d

Could you give the source of the article please? Which paper?

Katrina Black ● 901d

An article in the paper today, written by a practising consultant surgeon, suggests that one of the reasons for Britain's poor cancer survival rate is that 57% of GPs work three days a week or less. This of course makes getting an appointment more difficult. As a result many patients who could have benefited from an early diagnosis may only be seen when their cancer has reached an advanced stage.Continuity of treatment is also important in helping patients to survive cancer. But this is impaired by the fact that, astonishingly, some NHS GPs are allowed to live abroad, practising by means of virtual consultations. This means that patients who they decide require physical examination need to be referred to a different GP, making continuity of treatment more difficult. It is also increasingly fashionable for GPs not to to be attached to a particular practice. Several thousand GPs are members of the National Association of Sessional GPs. They can be employed on a single session basis. Thereafter they have no further responsibility for the patients seen. The writer concludes his article by asking whether the government will have the courage to reform general practice.

Steven Rose ● 901d

By the way, do you remember this?  

Ivonne Holliday ● 902d

No, it is not nonsense.  Of course, it is not only the current government but the last 4 put together.From 2010 particularly, the NHS has been starved of funds.  Please see:https://www.bmj.com/content/381/bmj.p836.fullYou need to subscribe to it, but it mentions the Kings Fund. It is a 49-page report (link below) but an extract indicates:"Performance has declined since 2010 as a result of much lower funding increases, limited funds for capital investment, and neglect of workforce planning. of the 2010s, deficits in NHS trusts became widespread by 2014 and the NHS failed to hit key waiting time targets in 2014 and the following years.16 Apr 2023"https://www.kingsfund.org.uk/sites/default/files/2023-04/Rise_and_Decline_of_the_NHS_April_2023.pdfI wonder if you could explain why there are still so many vacancies for doctors and nurses?  Also, how come that GP practices in London have been sold to an American healthcare provider?Thank you.

Ivonne Holliday ● 902d

I don't think any party would be dumb enough to sat they're going to dump the NHS. However, some in the Conservative party don't see to be totally sold on the NHS:https://www.independent.co.uk/news/uk/politics/jeremy-hunt-privatise-nhs-tories-privatising-private-insurance-market-replacement-direct-democracy-a6865306.htmlhttps://www.theguardian.com/politics/2009/aug/16/tory-mps-back-nhs-dismantlingSo perhaps death by a thousand cuts is an easier way of killing it off? Underpay doctors so they leave and go into private practice or abroad? Make waiting lists so long that people are forced to use savings for operations such as joint replacements or contribute to BUPA to avoid queues that they'll never get to the end of before they die? (I know a number of people who've had to dip into savings or use private health insurance to avoid a debilitating life of pain.)The NHS has it's inefficiencies and needs to be improved but, interestingly, the US insurance system seems to be worse in some respects - probably because everyone is trying to get their slice of profit out of the insurance companies and the patients' "deductables". Does anyone want a service where the first bit of information needed is your credit card instead of your NHS number?I'm sure some Conservatives such as Justin Greening and Lee Roberts do believe in a free health service at the point of delivery but I think if you believe in what the current millionaires in government say you might just be disappointed?

Michael Ixer ● 902d

What nonsense.  The Government clearly does not want to get rid of the NHS.  It is as close to a religion as we come in this country and getting rid of it would be electoral suicide for any party.The reality is it just doesn’t function at it’s best.  Our population has exploded, we have poured billions in the budget and got poor outcomes.  There is clearly too many staff who are not focused on the patient.  How many of our interactions with it are like Russian roulette whether we get seen or have a satisfactory outcome.We have all paid a fortune into the system and deserve better outcomes.  All previous Governments are responsible and to try and claim it is the current one alone who is responsible is not credible.

Robert Wheeler ● 902d

Hello Barbara,I don't think anybody can answer your question and many people are asking the same question!What is blatantly obvious, sadly, is that the government is trying to do away with the NHS sooner than we know.....

Ivonne Holliday ● 902d

Well who is going to reimburse every person who has worked all their life and paid for NHS. Answer that one then.

Barbara Stevens ● 902d

Well, if you're the party that wants to get rid of the NHS and make people pay for health insurance surely it's the obvious thing to do?

Michael Ixer ● 902d