The problem of non-attenders. There has to be a penalty… the denial of equal access to tertiary specialist care could be addressed by combining rural trusts, such as Hywel Dda, and Swansea.

Today in the Times 2 Letters: The good Samaritan approach that has led to a non functioning and disrespected system is the one below. The “hard cop” approach is first, and I have reversed the order that the editor chose! There has to be a penalty. In other countries there are much more financially affordable systems, and their life expectancy is little different. Putting state money into the expensive medical treatments (both in the developed & developing world) is of little benefit in extending life expectancy of the population, because we are at the top of the “gapminder” graph (real time today). Now look how the picture has changed in the last decade, since 2006. What makes populations healthy is wealth. We have enough money to afford an Irish or a Swedish style system, where there are co-payments for those earning enough, and punishments for abuse. The “hard truth” is that, without encouraging autonomy and discouraging paternalism, the health service is impossible to maintain. 

In the last two weeks the local Western Telegraph Newspaper has had two reports. One is with myself (Dr Rger Burns Illogical not tto have a hospital in Pembrokeshire, and Dr Robertson Steel, who mostly agrees with me. He wants reorganisation, but fails to address the issues around rationing and money. Dr Robertson Steel exit interview. The report is in fact a form of exit interview, and one wonders if he would have said it when employed, and kept his job. His article is titled “NHS challenges need to be faced by government”, but does not suggest how to combine a means tested social care with a free medical care, and make it work.

We already know that rural areas are being cheated when compared with cities, and now we know that life expectancy (In Scotland) is 5 years lower in the rural parts. Some of this is due to access, some to stoic people, and some to poorer education. But the denial of equal access to tertiary specialist care could be addressed by combining rural trusts, such as Hywel Dda, and Swansea. 

Notice the change in the slope of the graph (its nearly flat now(, and the lowest life expectancy (50 in the Central African republic) compared to 40 a decade earlier.


Sir, In Sweden, if you fail to attend or fail to cancel an appointment with a healthcare assistant at least 24 hours beforehand, you can expect to be charged 100 SEK — or about £9. If you fail to cancel an appointment with a doctor, it’s 300 SEK. It concentrates the mind.
Michael Storey
Wokingham, Surrey

Sir, Some 25 years ago I analysed the “Did not attends” (letters, Dec 10 & 11) in my hospital outpatient clinics and a minority could be blamed on patient apathy. Many had serious other commitments but more had never received the appointment in the first place. Booking systems should write in an overbooking of 10 per cent. It’s good enough for airlines.
Dr Andrew Bamji
Rye, E Sussex

[PDF] Cancer Incidence and Cancer Mortality by Urban and Rural areas (2007) Wales

Daily Mail 12th December 2018: Living in the countryside gives you a ‘survival disadvantage’

The Times December 13th: Rural cancer patients less likely to live



People living in rural areas are less likely to survive cancer than those in cities, according to a global review.

Researchers examining 39 studies found that 30 of them reported a “clear survival disadvantage” for rural inhabitants compared with those living in urban areas. Those living in the countryside were found to be 5 per cent less likely to survive cancer than their metropolitan counterparts.

The research by the University of Aberdeen suggested a number of reasons for the discrepancy, including transport infrastructure and distance from health facilities. As most services in developed countries are based in urban areas, it can be more time- consuming and expensive for rural people to travel for treatment, which may put them off seeking help in the first place or missing appointments.

Professor Peter Murchie, a GP and primary care cancer expert from the University of Aberdeen and the lead investigator, said: “A previous study showed the inequality faced by rural cancer dwellers in northeast Scotland and we wanted to see if this was replicated in other parts of the world.

“We found that it is indeed the case and we think the [5 per cent] statistic . . . is quite stark. The task now is to analyse why this is the case and what can be done to close this inequality gap.”

The university said that theirs was the first systematic review to consider this information on a global scale.

The team had previously found that those in the northeast of Scotland who lived more than an hour away from a treatment centre were more likely to die within the first year after a cancer diagnosis than those who lived closer.

Image result for mind the health gap cartoon

This entry was posted in A Personal View, Rationing, Stories in the Media, Trust Board Directors on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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