Category Archives: Cancer

Cross-party MPs request urgent non-partisan debate on future of NHS

Ninety MPs including several senior Tories have urged Theresa May to launch a cross-party convention on the future of the NHS and social care in England.

Sarah Wollaston, chair of the Commons health committee, organised a letter in conjunction with Liberal Democrat former care minister Norman Lamb and Labour former shadow care minister Liz Kendall, that has been sent to the prime minister and the chancellor, Philip Hammond.

The MPs say that the health system has been failing patients and call on Hammond to ensure any moves to lift the public sector pay cap for NHS workers is not funded by raiding existing health budgets.

The signatories, one-third of whom are Conservative MPs, have said only a non-partisan debate can deliver a “sustainable settlement”. They say the failure of normal party politics to secure the future of the system means a non-partisan approach is the only way to ensure action is taken, particularly given that the government does not command a majority.

“The need for action is greater now than ever,” say the MPs, who include about 30 former ministers. “We understand that fixing this is immensely challenging and involves difficult choices.

“We all recognise, though, that patients and those needing care are too often failed by a system under considerable strain. We believe that together we owe a duty of care to the people of this country to confront the serious challenges to the NHS and the social care system.”

The Tory signatories include former education secretary Nicky Morgan, former international development secretary Andrew Mitchell, ex-policy adviser to May, George Freeman, and party grandee Sir Nicholas Soames.

The Labour MPs who have signed include Kendall, Chuka Umunna, Hilary Benn, Frank Field and Caroline Flint. Liberal Democrats signatories include party leader Sir Vince Cable, Ed Davey and Tim Farron.

In a series of tweets Wollaston said:

Sarah Wollaston (@sarahwollaston)

. Govt also needs to focus on the long term, stop planning for health & social care in separate silos as this approach is setting us up for failure. Finance & workforce need urgent attention for the here & now but also for the long term & MPs from all Parties ready to engage

November 18, 2017

Sarah Wollaston (@sarahwollaston)

Current plans to kick social care into the long grass (again) & to separate planning for young and older adults creates even further fragmentation . Essential to think about whole system of NHS & Care

November 18, 2017

In the letter, MPs argued that only a cross-party NHS and social care convention, where there could be a non-partisan debate, would ensure a long-term settlement.

This was echoed by Wollaston in further comments where she said the “simple reality of a hung parliament means that all our constituents will be failed if long-term plans for NHS and [social] care funding do not command cross-party support.”

She added: “It’s better to take a joint approach to planning from the outset and actually deliver.”

Although MPs recognised the immense challenge facing the government involved making difficult choices, they say “patients and those needing care are too often failed by a system under considerable strain”.

Lamb said: “Tribal politics has failed to provide a solution to the existential challenges facing the NHS and social care. We know that the current situation is unsustainable, and these pressures will only get worse as we contend with an ageing population and rising demand for care and treatment.

“This letter shows the strength of cross-party support for a new approach based on cooperation instead of political point-scoring. The fact that so many senior MPs and former cabinet ministers support this initiative is remarkable. Now the government must act on it.”

Kendall said: “Our population is ageing, more people need help and support and our care services desperately need more money to cope, yet any party that comes up with a significant proposal for funding social care risks their political opponents destroying them.

“We could carry on like this for yet another parliament, and yet another election, or we could face up to reality: we will only get lasting change if we secure a cross-party approach.”

The fall per head in NHS funding meant the health service would not be able to meet its routine waiting-time commitments, according to NHS England chief executive Simon Stevens.

Austerity combined with increasing demand for services had created a “mounting toll on patient care”, representatives from the Nuffield Trust, Health Foundation and King’s Fund said earlier this year. They said there was growing evidence that access to some treatments was being rationed and that quality of care in some services was being diluted.

Solving the problem would mean a “steadily increasing share of national income would need to be spent on providing these services, they said.

The UK spends 9.9% of GDP on the health budget – a considerably lower percentage than many other European nations.

Niall Dickson, chief executive of the NHS Confederation, which represents various organisations in the healthcare system, said promises to reform funding were being “kicked down the road”.

He said: “The government promised reform before the election, then said there would be a green paper before Christmas. Now it has been put off until summer next year – and even then we are not being promised firm commitments.”

A government spokesperson said: “We have announced a cross-government green paper on care and support for older people with input from a group of independent experts. We recognise that there is broad agreement across parliament that reform for social care is a priority and look forward to hearing a range of views.”

It said MPs would be consulted on social care, ahead of the green paper policy statement next year. The government had already provided an additional £2bn to social care over the next three years, the spokesperson said, adding that the government was committed to making the sector sustainable.

Use carrot and stick to tackle obesity crisis | Letters

The UK is the “most obese nation in western Europe” (Report, 11 November), and there is widespread agreement that a range of measures is required to address this problem. One such measure, the government’s proposed sugar tax on soft drinks, should therefore be commended, especially since it introduces the concept of using price policies to promote healthier eating. However, the policy is likely to be more effective if the stick of the sugar tax is balanced by a carrot of subsidies on fruit and vegetables, increased consumption of which protects against numerous disorders – notably heart disease, stroke and bowel cancer – and is likely to limit the rise in obesity. As the WHO pointed out in its 2015 report Using Price Policies to Promote Healthier Diets, “Taxes on sugar-sweetened beverages and targeted subsidies on fruit and vegetables emerge as the policy options with the greatest potential to induce positive changes in [food] consumption”. However, as the WHO says, extra government intervention will likely be required to bring the price of fruit and veg down to a level everyone can afford and provide the maximum benefit to all. This will require more research on price policy strategies of how to spend the tax on sugar-containing drinks – something which was not the remit of the government’s adviser, Public Health England.
Henry Leese
Windermere, Cumbria

Your report says correctly that the government’s childhood obesity strategy was heavily criticised “for its reliance on voluntary action by the food and drink industry and lack of restrictions on the marketing and advertising of junk food”. It was also criticised for making no reference to breastfeeding, or to the current inadequate restrictions on marketing and advertising of breastmilk substitutes that contravene the WHO code. Obesity begins in infancy, and it is no accident that the breastfeeding rate in Britain is among the lowest in Europe.
J Peter Greaves
London

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What’s your reaction to the NHS ‘breakthrough’ breast cancer drug?

Two ‘breakthrough’ breast cancer drugs are to be available on the NHS after the National Institute for Health and Care Excellence (Nice) negotiated prices for the treatments.

The standard price for one cycle of palbociclib is £2,950 for a pack of 21 capsules. The list price for one cycle of ribociclib is also £2,950 but this is for 63 tablets. The company had first offered the drug at a price that was rejected by NICE, but they had later come to a “confidential agreement around the price”.

The Institute of Cancer Research (ICR), London, described the drugs as among the “most important breakthroughs” for women with advanced cancer in the last two decades.

Around 8,000 people in England with previously untreatable breast cancer will now have access to palbociclib and ribociclib which have been shown to slow the progression of advanced cancer by at least 10 months, and can delay the need for chemotherapy.

The latest draft guidance from Nice said that women with oestrogen receptor positive breast cancer that is diagnosed after it has begun to spread will be eligible for palbociclib – also known as Ibrance. If they have gone through the menopause, they will be eligible for ribociclib – also known as Kisqali.

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Long NHS delays can be ‘devastating’ for patients with eating disorders

People with an eating disorder are waiting as long as five years to start treatment on the NHS, putting their recovery in peril, according to a report.

Beat, a charity which helps people suffering from anorexia and bulimia, warns that delays to access vital care can have a “devastating” impact on those with eating disorders.

It stresses that while the five-year wait was a one-off, too many patients are waiting too long to see a specialist, despite recent efforts by the NHS to provide more services and cut waiting times.

Patients wait on average six months after first visiting their GP about their condition before they start treatment, it said. Some have been made to wait as long as that – 26 weeks – just to have the appointment at which they are assessed, after being referred for help by their GP.

And it can then take as much as 13 weeks after the assessment appointment before they see a psychiatrist who specialises in treating eating disorders, Beat said.

Its findings are based on the experiences of 1,478 patients who responded to a survey the charity undertook.

“The impact of having to wait a long time before receiving treatment can be devastating for eating disorders sufferers and their families,” said Andrew Radford, Beat’s chief executive.

“Eating disorders are serious, complex mental illnesses and early intervention is key to recovery. All evidence tells us the sooner someone with an eating disorder gets the treatment they need, the more likely they are to make a full and sustained recovery,” he added.

Around 725,000 people in the UK are estimated to have an eating disorder, and the conditions cost the NHS about £4.6bn a year to treat. Almost 90% of sufferers are young girls or women.

It takes on average three and a half years between symptoms emerging and the sufferer starting treatment, with the gap among adults seeking help double that found in children. People typically take over 18 months to realise they have a problem and then more than a year before they seek help, Beat found.

Under NHS England waiting times targets for eating disorders, under-18s who are classed as an emeregncy should receive treatment within 24 hours, urgent cases should be seen inside a week and non-urgent cases within four weeks.

Barbara Keeley, Labour’s shadow cabinet minister for mental health, said that official waiting times performance figures showed that many young patients were still not receiving timely care.

Between July and September, 29% of urgent cases did not start treatment within a week and 17.6% of patients did not begin routine treatment within four weeks.

“This [Beat] report suggests that Tory ministers need to snap out of their complacent attitude to the treatment of eating disorders. It is yet more proof that warm words from the Tories haven’t been met with firm action to improve services in the community,” Keeley said.

Research by Labour found that a few NHS mental health trusts have reported worryingly long waits for children and young people with eating disorders.

Tees, Esk and Wear Trust reported eight urgent cases who had waited over four weeks, five of whom waited over 12 weeks, and 44 routine cases who had waited longer than 12 weeks.

Avon and Wiltshire Trust had five urgent cases waiting four to 12 weeks and 13 routine cases in which those involved had waited over 12 weeks.

Dr Marc Bush, YoungMinds chief policy adviser, said: “Sadly, these figures chime with what we hear on our helpline, from worried parents who are desperately trying to get support from child and adolescent mental health services.”

Bush added: “Parents of children with eating disorders say that their children have been turned away because their weight isn’t low enough, or that they’re put on long waiting lists, during which time the situation can get worse.

“While services are improving in some areas, these figures suggest that too often NHS targets for the treatment are not being met. It’s also clear that there is still a huge amount of work to do to help young people recognise when they may be developing an eating disorder and seek help earlier on.”

An NHS England spokesperson said: “There are now 70 NHS community eating disorder services for children and young people covering the whole of England, backed £150m of investment. As a result, eight in ten young people now get care within four weeks, and three-quarters receive urgent treatment in a week, so progress is clearly being made.”

Mother killed herself after ‘serious failure’ by mental health unit

A mother who killed herself while suffering from postnatal depression died as a result of a “very serious failure” that allowed her to leave a mental health unit unchaperoned, a coroner has ruled.

Despite having made multiple attempts to kill herself, 32-year-old Polly Ross was allowed to leave the Westlands mental health unit in Hull at about 8.30am on 12 July 2015, telling nurses that she was going to buy cigarettes. She was hit by a train at 11.10am and died instantly.

Speaking at the end of a four-day hearing, coroner Prof Paul Marks said he could not rule that Humber NHS foundation trust had been guilty of clinical neglect, but said the decision to allow her to leave the unit “had a direct causal effect” on her death.

Her mother, Jo Hogg, who was previously employed by the trust as an occupational therapist, thanked the coroner for conducting a “frank and fearless examination” of the circumstances surrounding her daughter’s death.

She said the trust had failed her daughter when she had needed their help the most and that care for women with postnatal depression in the region was “appalling”. She said that mental health services were “not joined up in a way that pays close regard to the complex needs of patients”.

The court heard how Ross, who ran a translation business in Paris before moving back to east Yorkshire in August 2012, had suffered from the extreme form of morning sickness, hyperemesis gravidarum, during both her pregnancies in 2012 and 2014. The condition has received media attention after it was revealed that the Duchess of Cambridge suffered from it during her pregnancies.

The condition caused Ross – who was described as “staggeringly intelligent” – to be hospitalised and put on a drip, which was said to have compounded her mental health issues. The inquest was told that she developed “drug-induced psychosis” after taking cannabis to relieve her symptoms and that when she asked to be admitted to a specialist mother and baby unit in Leeds, she was turned down.

In February 2015, the linguist was sectioned after a breakdown and her children were taken from her care. Over the coming weeks and months she regularly expressed suicidal thoughts and attended A&E on multiple occasions having self harmed or taken an overdose.

In a statement read to the court, Ross’s aunt Emma May, who acted as her carer after she was first sectioned, said she was certain that the few times her niece had left her home since February “were times she attempted to take her own life”. She said: “I cannot understand how she was allowed to leave the unit to buy her own cigarettes the morning she died.”

Giving evidence to the inquest, Dr Robert Kehoe, a Bradford-based consultant psychiatrist, said that while the overall standard of Ross’s care had been good, there were two serious failures on the part of Humber NHS foundation trust.

“One: there was a failure to clarify and state a plan for what should occur in the situation of a patient requesting to leave the unit,” he said. “Two: the effective decision to end the period of 15-minute observations allowed her to leave the unit at around 8.40am that day.”

Ross’s observations had been increased from once an hour to once every 15 minutes on 10 July after a ligature was found in her room. She was not sectioned at the time of her death, but Kehoe said there was “no logic” in increasing her observations only to allow her to leave the unit unescorted.

In a statement, Humber NHS foundation trust said: “We would like to offer our sincerest condolences to Polly’s mother, aunt, other family members and friends for their tragic loss. The thoughts of everyone associated with the trust continue to be with them at this sad time.

“We would also like to offer an unreserved apology to Polly’s family and friends and acknowledge that there were omissions in her care prior to her death on 12 July 2015. The trust acknowledges Prof Marks’ conclusion regarding the circumstances surrounding Polly’s death and has fully implemented all of the recommended improvements highlighted by our investigations.

“The trust will continue to reflect and learn and seek to continually improve the services we provide to patients.”

In October 2015, Marks ruled that Humber NHS foundation trust was guilty of neglect in the case of Sally Mays, 22, who killed herself after being turned away for inpatient mental health care. The same year, a coroner in Bristol raised concerns about mental healthcare for new mothers after 30-year-old Charlotte Bevan jumped off a cliff clutching her baby girl following a “chain of failures” by medical staff.

In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

One in five European NHS doctors plans to quit UK, survey reveals

Almost one in five of the NHS’s European doctors have made plans to quit Britain, according to research that has raised fresh fears of a Brexit-induced medical brain drain.

And almost half of the health service’s 12,000 medics from the European Economic Area (EEA) are considering moving abroad, the British Medical Association survey of 1,720 of them found.

The findings come amid growing evidence that Brexit may exacerbate problems of understaffing in the NHS by making both retention and recruitment of EU staff more difficult. In September NHS figures showed that more than 10,000 staff from EU countries had quit since the Brexit vote. And the number of EU nurses coming to Britain has dropped by 89% in the last year, Nursing and Midwifery Council figures released this month showed.

In total, 45% of respondents to the BMA survey said they were thinking about leaving Britain following the result of the EU referendum in June 2016 – three percentage points more than when the BMA ran a similar poll in February – while a further 29% were unsure whether they would go.

Among those who were considering going elsewhere 39% – or 18% of the whole sample – have already made plans to leave. The 12,000 doctors from the EEA (the EU plus Iceland, Liechtenstein and Norway) represent 7.7% of the NHS’s medical workforce.

Some of those leaving have been offered jobs abroad, while others are applying for posts overseas. Some have begun the process of seeking citizenship elsewhere, while others are having their qualifications validated so they can work in another country, the BMA said.

Q&A

What was wrong with the claim that the UK sends the EU £350m a week?

The claim that Britain “sends the EU £350m a week” is wrong because:

  • The rebate negotiated by Margaret Thatcher is removed before anything is paid ​​to Brussels. In 2014, this meant Britain actually “sent” £276m a week to Brussels; in 2016, the figure was £252m.
  • Slightly less than half that sum – the money that Britain does send to the EU – either comes back to the UK to be spent mainly on agriculture, regional aid, research and community projects, or gets counted towards ​the country’s international aid target.

Regardless of how much the UK “saves” by leaving the EU, the claim that a future government would be able to spend it on the NHS is highly misleading because:

  • It assumes the government would choose to spend on the NHS the money it currently gets back from the EU (£115m a week in 2014), thus cutting f​unding for​ agriculture, regional development and research by that amount.
  • It assumes​ the UK economy will not be adversely affected by Brexit, which many economists doubt.

“That so many EU doctors are actively planning to leave the UK is a cause for real concern. Many have dedicated years of service to the NHS and medical research in the UK, and without them our health service would not be able to cope,” said Dr Andrew Dearden, the BMA’s treasurer.

The Labour MP Darren Jones, a supporter of the pro-EU Open Britain campaign, said: “The British people were told last year that Brexit would boost the NHS by £350m a week. Now the evidence is piling up that it will break it instead.

“We all depend on the brilliant work done by doctors, nurses and other staff who come from the EU. There is no chance that we could replace their expertise if they continue to leave the UK.”

But the Department of Health said that figures released last week by the General Medical Council, showing a slight year-on-year rise in 2016-17 in the number of EEA doctors joining its medical register, showed the BMA’s findings were inaccurate.

“This survey does not stand up to scrutiny. In fact, there are actually more EU doctors working in the NHS since the EU referendum, more EU graduates joining the UK medical register and 3,193 more EU nationals working in the NHS overall,” a spokesperson said.

It’s true: Conservative governments really do kill people | Zoe Williams

There was a splenetic exchange on BBC Question Time last week, between an audience member and my colleague, Aditya Chakrabortty, who had pointed out that disabled people had died as a result of cuts to social security. You’re like “Donald Trump”, said a guy in the audience: the parallel was, Aditya had made a statement that was stirring, powerful, emotive and trenchant – so I guess, if we leave aside the fact that it was also true, it was pretty Trumpian.

Just as it’s verboten to call someone a liar in parliament, so there is a curious and ancient disapproval around pointing out that a state has been the direct cause of any deaths, whether of its own citizens or abroad. It is taken as hysterical overstatement (something that should only be levelled at an authoritarian regime, which takes its people out and shoots them) and pitiful naivety (a wilful misunderstanding of the business of government, to trace its policies crudely back to the lives of those who are affected by them).

Since “hysterical” and “naive” are two of the deadliest charges in political discourse, one always checks oneself before going full-pelt: we know that 90 people a month die after being declared fit for work, but can we really lay those deaths at the government’s feet? Plainly, they might have died anyway. All we can say about the Conservatives is that they instituted a disability assessment system that makes bad decisions, repeatedly, and causes untold trauma and desperation to people who are on the brink of death.

So let’s refine it: we know of the existence of 49 Department for Work and Pension reports – called peer reviews – that are triggered when someone dies following a cut to their benefits, 40 of which were suicides. They are heavily redacted, and what we can read of them does not amount to a straight causal link between a cut or sanction and a suicide.

The government – which will casually spend hundreds of thousands of pounds fighting a freedom of information request to release these peer reviews, and yet cannot afford to support a terminally ill cancer patient – has upended priorities when it comes to discussing the deaths of its citizens. It ploughs all its energy into denying a link between destitution and desperation, and apparently no energy at all into asking why these suicides occurred.

A much more striking example of that came in 2015, when there were 30,000 “excess deaths” in England and Wales, the greatest rise in mortality for 50 years, according to a study published this year. The researchers – from Oxford University, the London School of Hygiene and Tropical Medicine, and two borough councils – examined possible explanations and, having rejected environmental collapse, natural disaster and war, concluded that “the evidence points to a major failure of the health system, possibly exacerbated by failings in social care”, adding for clarity: “The impact of cuts resulting from the imposition of austerity on the NHS has been profound.”


People die having had their support system ripped from them and the response is a shrugging ‘whatever’

An unnamed Department of Health spokesman rejected the claim, citing “personal bias” of the authors (the truth has a liberal bias, as the saying goes), but strikingly, took no further interest in the matter. You would think that, even if someone vigorously denied responsibility for 30,000 excess deaths, they would at least ask where, then, responsibility lay.

Last year, meanwhile, the suicide rate within prisons in England and Wales reached an all-time high: 119 deaths, or one every three days. The background is a 40% drop in the number of prison officers, which had an obvious practical impact, pinpointed by Prof Pamela Taylor of the Royal College of Psychiatrists: there simply weren’t enough staff to accompany mentally ill patients to clinics and appointments.

But understaffing in prisons has much more profound atmospheric affects: it erodes officers’ capability to observe prisoners closely; to support those suffering a decline; to control bullies and legal highs; and to perform the subtle, invaluable, life-changing business of jail craft. Only a government with no insight at all into the prison estate would think you could shred its staff by nearly half and suffer no catastrophic effects.

Going right back to 2010, this is the enduring picture of Conservative government, which the Liberal Democrats still claim to have cushioned us from the worst of: not the parsimony, the defensiveness, the lack of curiosity when disasters occur, not the callousness or myopia, but the sheer indolence.

Decisions are made as if the consequences belonged to someone else. Judicial process is treated like long-grass. Ernest Ryder, senior president of tribunals, said last week that the DWP habitually provided evidence whose quality was so poor it would be “wholly inadmissible” in any other court. People die having had their support system ripped from them and the response is a shrugging “whatever”, plus maybe a blast of noise about bias and the last Labour government, like ducks flapping pointlessly on a pond. Every tactic is diversionary; the overarching strategy is, break it and see what happens.

Consensus now is that the Tories were governing, sometimes controversially but broadly effectively, when Brexit came along and capsized everything. This is mistaken: the referendum could only have been called, and the leave campaign only fought, by politicians with a fundamental lack of seriousness, a puerile indifference to the outcome of their decisions.

Long before it gambled with our future prosperity and place in the world, the Conservative party was shooting craps with the lives of its own people.

Zoe Williams is a Guardian columnist

Fear of touching women’s chests may be barrier to giving CPR, researchers say

Women are less likely than men to get CPR from a bystander and more likely to die, a new study suggests, and researchers think reluctance to touch a woman’s chest might be one reason.

The study was funded by the Heart Association and the National Institutes of Health and was discussed on Sunday at an American Heart Association conference in Anaheim. It involved nearly 20,000 cases around the country and is the first to examine gender differences in receiving heart help from the public versus professional responders.

Only 39% of women suffering cardiac arrest in a public place were given CPR versus 45% of men, and men were 23% more likely to survive, the study found.

“It can be kind of daunting thinking about pushing hard and fast on the center of a woman’s chest,” said Audrey Blewer, a University of Pennsylvania researcher who led the study.

Rescuers also may worry about moving a woman’s clothing to get better access, or touching breasts to do CPR, said another study leader, Benjamin Abella, who added that doing CPR properly “shouldn’t entail that” as “you put your hands on the sternum, which is the middle of the chest. In theory, you’re touching in between the breasts.”

Cardiac arrest occurs when the heart suddenly stops pumping, usually because of a rhythm problem. More than 350,000 Americans each year experience it in settings other than a hospital. About 90% die, but CPR can double or triple survival odds.

“This is not a time to be squeamish because it’s a life and death situation,” Abella said.

Researchers had no information on rescuers or why they may have been less likely to help women. But no gender difference was seen in CPR rates for people who were stricken at home, where a rescuer is more likely to know the person needing help.

The findings suggest that CPR training may need to be improved. Even that may be subtly biased toward males – practice mannequins are usually male torsos, Blewer said.

“All of us are going to have to take a closer look at this” gender issue, said Roger White of the Mayo Clinic, who co-directs the paramedic program for the city of Rochester, Minnesota. He said he had long worried that large breasts may impede proper placement of defibrillator pads if women need a shock to restore normal heart rhythm.

Men did not have a gender advantage in a second study discussed on Sunday. It found the odds of suffering cardiac arrest during or soon after sex are very low, but higher for men than women.

Previous studies have looked at sex and heart attacks, but those are caused by a clot suddenly restricting blood flow and people usually have time to get to a hospital and be treated, said Sumeet Chugh, a cardiologist at Cedars-Sinai Heart Institute in Los Angeles. He and other researchers wanted to know how sex affected the odds of cardiac arrest, a different problem that is more often fatal.

They studied records on more than 4,500 cardiac arrests over 13 years in the Portland area. Only 34 were during or within an hour of having sex, and 32 of those were in men. Most already were on medicines for heart conditions, so their risk was elevated to start with.

“It’s a very awkward situation and a very horrifying situation to be one of the two people who survives,” but more would survive if CPR rates were higher, Chugh said.

Results of the studies were published in the Journal of the American College of Cardiology.

NHS at centre of storm: Brexit Means … podcast

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In this episode of Brexit Means, we look at a sector of the economy that ought not to be too affected by leaving the EU but that has found itself in the eye of the storm. If anything, healthcare was meant to be a major beneficiary of leaving, at least if you believed the £350m-a-week claim on the side of a bus. But our hospitals and care homes are kept afloat by an army of EU workers, many of whom feel increasingly gloomy about their long-term future in the UK.

Both Theresa May and her Brexit secretary, David Davis, have said they want to keep existing EU nationals working here and then have a system for allowing skilled workers to arrive from Europe. But the first desire depends on the divorce agreement with the rest of the EU and the second is in direct contradiction with continued promises to slash immigration rates.

Then there are the numbers. According to Health and Social Care Information Centre, 55,000 of the NHS’s 1.3 million workers and 80,000 of adult social care’s 1.3 million workers come from the rest of Europe.

Joining Dan Roberts to discuss what Brexit means for the NHS, and for healthcare more generally, are Janet Davies, the chief executive and general secretary of the Royal College of Nursing, and Sarah Johnson, a Guardian journalist who writes and commissions for our Healthcare Professionals Network.

Thousands with advanced cancer are surviving two years or more, data shows

Thousands of people in England with the most advanced stage of cancer are surviving for several years after diagnosis thanks to improved treatment and care, research shows.

Macmillan Cancer Support and Public Health England’s (PHE) National Cancer Registration and Analysis Service found that at least 17,000 people have survived for two years or more after being diagnosed with stage 4 cancer, when the disease has already spread to at least one other part of their body.

The figure, which has not previously been available, includes at least 1,600 women diagnosed with stage 4 breast cancer and 6,400 men diagnosed with stage 4 prostate cancer. It also includes at least 1,200 people diagnosed with stage 4 lung cancer and at least 2,300 people diagnosed with stage 4 bowel cancer.

Adrienne Betteley, Macmillan’s specialist adviser for end of life care, said: “Advances in treatment and care mean that a growing number of people have cancer that cannot be cured, but can be managed by treatments that alleviate the symptoms and may also prolong their life.

“This is really positive news, but living with advanced cancer can be a difficult situation to be in. As well as dealing with the physical symptoms of cancer and having multiple hospital appointments, scans and treatment options to contend with, there’s also the emotional and psychological impact of having an uncertain future.”

The research, revealed on Wednesday at the 2017 National Cancer Research Institute Conference in Liverpool, is based on data from England’s national cancer registry.

It captures people who were diagnosed with one of 10 common types of cancer between 2012 and 2013 and were still alive at the end of 2015.

The 17,000 is certain to be an underestimate, as there were a further 43,000 patients alive in 2015 who were diagnosed two to four years previously, but whose stage at diagnosis was not recorded in the registry. Many of those patients are also likely to have had stage 4 of the disease, also known as secondary or metastatic cancer.

Macmillan said the figures highlight the changing nature of the disease and expressed the hope that patients whose options were previously limited could see their cancer become more “treatable” and manageable, like other chronic illnesses.

Carol Fenton, 55, from London, was diagnosed with stage 4 breast cancer in 2015 and said her life since has been a “rollercoaster” of periods when her symptoms are settled and others when changes in scan results necessitate changes in treatment. She said: “It is hard to plan family activities a long way into the future, so we plan our life around my three-monthly scans. I’m concentrating on what I can do, rather than what I can’t, and I’m hoping that I will stay as well as possible for as long as possible, yet being realistic about preparing for when my condition progresses, not knowing if this will be in a few months, a year, or within five years or more.”

Several studies have suggested that cancer survival rates in the UK lag behind those of other European countries. For instance, survival rates for breast cancer are a decade behind countries including France and Sweden, according to one piece of research. Another found that the average adult five-year survival rates for patients diagnosed with eight common types of cancer between 2000 and 2007, were lower in the UK than the European average. Experts have flagged the need for earlier diagnosis and improved access to treatments.

Dr Jem Rashbass, cancer lead at PHE, said it was imperative people got diagnosed earlier, which was why the agency was running the Be Clear on Cancer campaigns to educate the public on the signs and symptoms of the disease.

Rashbass described the cancer registry data as “an invaluable resource in helping us to track improvements in cancer outcomes and gain more understanding of the implications for those living with and beyond a cancer diagnosis”.

The 10 types of cancer in the Macmillan and PHE study were: bladder; female breast; colorectal; kidney, renal pelvis and ureter; lung, trachea and bronchus; melanoma of skin; non-Hodgkin’s lymphoma; ovary; prostate and uterine cancer.