A political minefield

If there is one place where politics have bungled the ball on near titanic proportions, than it would be healthcare. The UK with the NHS issues, Australia with Medicare, the Netherlands with Gezondsheidszorg and the less we say about Obamacare, the better it is for all of us. They all made massive errors which changed the game for any nation that needs to take care of healthcare.

The UK has had its own issues for some time, yet now we see a new event coming up. Let’s take a look at ‘Cancer diagnosis ‘within four weeks’ under new care plan‘ (at http://www.bbc.com/news/health-33574233). First off, it is a good article by Nick Triggle, he looks at it from a decent viewpoint, but is there an issue?

The first part is “The five-year plan will cost £400m a year but experts say earlier treatment will result in similar savings. They say the plan could help an extra 30,000 patients survive for 10 years“, so basically there is no additional cost, which sounds good, let’s face it, in the increasing pull of funds, breaking even over the next 5 years does sound awesome, the people get to live up to another decade, which is just a bonus.

My initial issue is with the quote “Harpal Kumar, chief executive of Cancer Research UK and chairman of NHS England’s task force, said the changes could help create a “world class” service over the coming years“, the term ‘world class‘ seems a little out of bounds and that also sets the tone, let me go on so that it will all make sense.

The second quote is “We have an opportunity to save many thousands of lives from cancer“, which in light of all this does not make sense, especially when we see “But Mr Kumar believes another 30,000 people a year could end up surviving that long once the changes have been put in place – a third of them simply through diagnosing the disease earlier

I admit that I am splitting hairs, because giving them an additional 10 years is not saving a life, it is prolonging it. Apart from that, is there an objection? You see, healthcare is about keeping people healthy (and saving lives whenever possible) so there is no real objection is there? Giving a person up to 10 years more is a noble goal, especially when 130,000 people die each year, letting them enjoy life a little longer is not wrong at all. So why am I looking at this article?

For that we need to look at the steps. These 7 steps is what brought the light in

  • The creation of a four-week target for diagnosis from GP referral. Currently patients are meant to see a specialist within two weeks of a GP referral but can then face weeks of waiting for tests, meaning a growing number of patients do not get their treatment started within 62 days as they should
  • An 80% increase in the number of tests being carried out, including increasing the ability of GPs to order tests directly – for many they have to go through a hospital specialist
  • Replacing more than 100 radiotherapy machines – half of England’s stock – with new, better models
  • Recruiting extra staff in areas such as specialist nurses and radiologists, with the latter needing to nearly double in number
  • Cancer patients to get online access to all their test results and a specialist nurse or other key worker to co-ordinate their care
  • A call for action on smoking and obesity – four in 10 cancers could be prevented through lifestyle improvements
  • All cancer survivors to be given a recovery package so they get the support they need to recover from their treatment and stay cancer-free

The first premise is shown in dots 3 and 4. Replacing 100 radio therapy machines with newer ones and recruiting extra staff (especially radiologists). The fact that the article implies that there are 200 radiotherapy machines is equally disturbing. You see, 280,000 diagnosed people implies 4 people a day and that is if every machine is properly managed, monitored and staffed. The issue is not complete and facts are missing.

For this we take a look at breast cancer. The site Jezebel had an interesting article linking to all this. ‘Can You Be Diagnosed With Breast Cancer In Just One Day?‘ (at http://jezebel.com/5865123/can-you-be-diagnosed-with-breast-cancer-in-just-one-day), where we read “I wrote to Dr. Karla Kerlikowske, professor of medicine and epidemiology/biostatistics at USCF’s Helen Diller Family Comprehensive Cancer Center. She explained: Mammograms can identify a site likely to be cancer, but it requires taking a sample of breast tissue and looking at it under a microscope to know a person has breast cancer. Rarely, less than 1% of the time a radiologist can look at a mammogram and based on the mammogram know a woman has breast cancer, even then it requires a tissue diagnosis for confirmation“. This seems to be a universal truth. In (as I see it) nearly all forms of cancer, confirmation is needed), which is part of the entire issue.

This does not change one essential truth “simply through diagnosing the disease earlier“, that is again a universal truth, so even for that mere fact this project should go on. The issue is not with the idea, or the plan or what we read, but by what we are not reading here.

Part 5 is the first real kicker, giving online to test results is a dangerous step, often cancer will hit the elderly, who do not comprehend the need for proper approach to common cyber sense and as such too many medical details will ends up in the open air, a place where medical details should not be allowed. Now, issue number 2 is one that can be handled, there is no reason why not to do this, yet we must acknowledge that specialists are there for a reason, as such, we can accept that GP’s could call for the test yet, here is also the danger that a GP will act under the ‘better be safe than sorry premise‘ which will now give the situation that 80% more tests are being made, yet it will also include the stronger increase of false alarm results, even under an issue of the best intentions. A mere consequence of people doing the best possible for the patient, an anticipated side effect of ‘world class cancer care‘. I do not object to these parts (or fight the approach here), but it calls into question the given budget already from this point on. So what is expected to be £400m a year, could end up being £520m a year. In addition to issue 4 where we see the need for specialist nurses and radiologists, there will also be the need for additional technicians and re-schooling of technicians and upgrading other peripheral devices. It is possible that these parts had been added to the cart of costs, yet the fact that they are not mentioned, the fact that some parts might not have been looked at yet makes the anticipated £400m a year incorrect and dangerous. The Labour party made a 12 billion IT fiasco, let’s not add to that, shall we?

You see, the cancer confirmation part is not always possible on the spot. So when we accept that ‘Most incisional and excisional biopsies are performed by surgeons‘, we see that additional costs and additional resources will be required. This means that there will be additional pressure on surgeons, was that factored in? You see, there is already a massive backlog. The Guardian reported on July 4th 2014 in the article ‘NHS patients waiting longer for routine operations under coalition‘ (at http://www.theguardian.com/society/2014/jul/04/nhs-patients-waiting-longer-for-routine-operations-under-coalition), that delays had been reported of up to 215 days.

So the entire ‘speed need’ in cancer diagnoses is going to take another matter of growth entirely.

So as I give you these facts and the thoughts around this, you might get a first idea what was wrong with the article by Nick Triggle. I am an ample Medici, but I never studied medicine and it took me roughly 17 seconds to get my question marks up, so why did Nick Triggle not voice these concerns?

The quote by Dr Maureen Baker, of the Royal College of GPs, who welcomed the plans was “The system is already overloaded and we must ensure that there is sufficient imaging and specialist capacity to cope with the increased number of referrals before promises are made to patients that cannot be delivered“. Yet her quote is equally incomplete. I would have expected the quote to be “The system is already overloaded and radiology is only one step in determining the path for a cancer patient. We must ensure that there is growth in several ways in several divisions of hospitals to cope with the increased number of referrals before promises are made to patients that cannot be delivered“, which would have been more correct and as lacking as the quote seems to be from my point of view, I personally would acknowledge that the BBC article could have been used to emphasize on how much work the NHS needs and how much more needs to be done.

None of that can be seen in the article.

It seems to be that the response from Lynda Thomas, chief executive at Macmillan Cancer Support is more on point. Even though it is ambitious, she states “This report has to be more than a set of recommendations on paper. It has to inspire action and lead to meaningful improvements for the lives of people with cancer“. I think that she is playing the game carefully as she wants to get whatever she can for people with cancer, yet the though in my mind is (based on the BBC article) that I would have phrased “This report has to be more than just a set of incomplete recommendations on paper“. That will lead to questions and that will lead to proper dimensioning of a massive problem. I agree that this needs to be done, but without the fact that the pressure for surgeons is already beyond believe (not just in the UK), not addressing this part will lead to another fiasco for NHS, which is what we need to avoid at all costs.

So we are facing a political minefield, one that Labour did not survive, I hope that the conservatives and especially the Rt Hon Jeremy Hunt MP takes more than just a few additional looks at it. And even though he might dread sitting down with a collection of ‘funny and entertaining people’ (like hospital administrators), he will do so and get a proper scope of what will be impacted, because spending another 2 billion only to learn that the term ‘similar savings‘ will never be an option is one he must be willing to accept having to deal with.

There is nothing against spending it on treatment and diagnoses of cancer patients, I just want to make certain that they do not end up becoming the group who ends up with the short straw, a draw they never got a choice in voted for.

 

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