Pathetic Track and Trace system

My own family are in medical careers, and have been subject to testing because their children have had fevers. The delay in getting the results, and the inconvenience of this delay is a hidden cost of covid. The results of tests are available to professionals on line when they have not yet reached the patient and their families. The central control of rationed tests is being moved to the regions, but the delay is appalling. Planes returning with at risk passengers will have the potential to spread widely unless we get a grip. Public transport the same..

Going on line to find the nearest test centre for your “convenience” can result in being asked to travel hundreds of miles in a round trip.

The latest on line attempt this weekend 30th August gave this  message:

https://test-for-coronavirus.service.gov.uk/register/channels-availability-error

Sorry, there is a problem with the service

No tests are currently available. You’ll be able to use the service later.

If you need any help or advice, call our customer contact number:

• England, Wales or Northern Ireland: call 119 (free from mobiles and landlines)
• Scotland: call 0300 303 2713 (charged at your standard network rate)

 

Heads in the sand, Denial on dementia….

Update 6th May 2022:
1, 2019 BBC News.Tories pledge to double dementia research funding
2. 2022: The Times’ Ben Spencer: Tories drop vow to double dementia funding
3. North East Bylines: Chi Onwurah exposes another Tory lie: on dementia research

There is a systematic denial involving politicians and the media on health, and it is even worse on dementia. The Economist leader highlights our societal inability to face up to the hard truths. Whilst Japan has a mid life tax levy, most countries are simply burying their heads in the sand. All doctors know that dementia care is rationed. Palliative and terminal care is rationed, and hospices are mostly charities. There is no acknowledgement of the cost/price of a human life. (We have to put a Price on Human Life – Matthew Parris) Lets admit it and start the debate..

My mother has finally died, after 5 years as a vedgetable. Her prolonged death, fybded at her own expense, shames us all.

The rising prevalence of dementia is a global emergency – It requires more research, better provision for long-term care and changes in individual behaviour

Of all the troubles facing the world, the rising prevalence of dementia might seem among the less pressing. The reason behind it—longer lifespans—is to be cheered; it does not advance at the speed of a viral infection but with the ponderous inevitability of demographic change; and its full effects will not be felt until far into the future. But the reality is very different. As our special report this week makes clear, dementia is already a global emergency. Even now, more people live with it than can be looked after humanely. No cure is in the offing. And no society has devised a sustainable way to provide and pay for the care that people with it will need.

“Dementia” is an umbrella term for a range of conditions, with a variety of causes, of which the most common is Alzheimer’s disease, accounting for 60-80% of cases. It usually starts with forgetfulness and a mild loss of cognitive functioning. But as it advances, people lose the ability to look after themselves. Many require round-the-clock care long before they die. It does not just affect the elderly, but they are much more likely to have it—and life expectancy globally has climbed from not much more than 30 a century ago to over 70 now, and over 80 in rich countries. By some estimates, 1.7% of 65- to 69-year-olds have dementia and the risk of developing it doubles every five years after that. At present, about 50m people around the world have the condition, a number expected to rise to 82m by 2030 and 150m by 2050. Most of the new cases are in the developing world, where populations are rising and ageing.

The problems these numbers will bring everywhere have already been felt in countries where people are older, and especially acutely during lockdowns—witness the difficulty of looking after people with dementia in their own homes, and the large numbers in overstretched care homes who receive little individual attention. As families shrink, single children and grandchildren will struggle to cope with their old folk. Already, dementia care has had a knock-on effect on general health care. Before the pandemic as many as a quarter of beds in British hospitals were occupied by people with dementia. There was nowhere else for them to go.

Not all the news is bad. Recent research has shown that behaviour such as smoking less, exercising more and losing weight in middle age has reduced the risk of dementia among old people in some Western countries in the past 30 years. And America’s Food and Drug Administration has promised to decide by March 2021 whether to license a drug said to be the first to stem cognitive decline in Alzheimer’s patients. But the risk of dementia still seems to be rising in much of the world and any new therapy in the foreseeable future is likely to benefit only some patients partially.

That is why governments should act now to lessen the social and economic harm from the growing prevalence of dementia. The first step is to recall the urgency with which many were promising to tackle the problem just a few years ago—in 2013, for example, when David Cameron, then Britain’s prime minister, used the rotating chairmanship of the g8 to convene a “dementia summit”, which promised to fund research with the goal of finding a “disease-modifying treatment” by 2025. Instead, funding for work on dementia has lagged far behind that for cancer or coronary heart disease. And as the pandemic hampers or prevents clinical trials and research, and sucks resources away from other areas, dementia risks again being left behind.

Governments also need to think about long-term care for people with dementia. The question that is most often asked is how to pay for it. Japan’s compulsory long-term-care insurance scheme, requiring everyone aged 40-65 to pay a premium, seems attractive, as it avoids penalising the young. But it is not self-financing. The increasing burden there as elsewhere will fall on individuals and the taxpayer.

And an even more fundamental question than who pays for care is: who will do it? Undertaken with humanity and dignity, it is extremely labour-intensive. Technology can help lighten the load—using remote monitoring to let people stay at home and, perhaps in future, robots to perform some basic tasks (see article). But looking after people with dementia requires people. The job is usually classified as low-skilled and is often poorly paid. In fact it demands huge reserves of patience, empathy and kindness. It should be better rewarded and more highly regarded even though that would add to the bill. In countries such as Japan and Britain, with acute shortages of care-workers, immigration will have to be made easier for those willing and able to do it.

Lastly, evidence suggests that as many at 40% of cases of dementia can be delayed or averted by changing behaviour earlier in life. The trouble is that public-health campaigns have a patchy record and they do nothing for dementia’s most intractable pre-existing condition—old age. No cure, insufficient financing and a tricky public-health message: perhaps that is enough to make you throw up your hands in despair. Instead, however, it only underlines how the solutions to dementia, like the disease itself, will take decades to unfold. It is yet another reason to start working on them right away.

The Canadians shame us with their plans for end of life care..

Live longer with dementia: Mr Hunt pillories the profession. Most doctors will be making “living wills” to avoid over-zealous care and prolonged demented lives…

An advanced directive or living will – It’s important to specify, especially lying flat. Good news if you take action.

The Covid-19 epidemic….. Selected Cartoons reflecting the changes to our way of living,,,

 

 

“Speak the truth”. Politicians…. are “destroying humanity by not speaking out”, in many areas of our lives.

I am a “volunteer” applicant to be on a group discussiong future Health Care Policy for the Liberal Democrats. I will not be selected as I found i disagreed with the starting premise, or the starting conditions for being a member: that the health service remained free. I find that I disagree with this more and more as time goes on. The fact that we pay taxes, not hypothecated, ( unless the Liberals win the next election when 1p or a part will be ) seems to be forgotten. Much of this tax goes towards health and social care. The fact that there are 4 health services all with different outcomes and rationing methodologies. The fact is that we have a two tier health servide by default. Public and Private. The miners of Tredegar dop not get the quality outcomes and choices of the bankers of London.

If social care is means tested, what is the reason we are so squeamish about means testing health care?

With the advance of technology being faster than any government can offord, why should we not ask the richer people to pay more for their health, in the same way as we ask them to pay more tax? The wealth divide is deepening, and the richer people will be able to afford the newest technologies, speedily. States such as the UK will ration by delaying implementation until patents expire, and by waiting lists. We need this truth to be recognised and debated…

Serious problems which affect large numbers, nations such as Melanoma in Australia will still get good care, but where melanomas are rarer the speed of investigation and treatment will be as slow as the gvernement can get away with. Rich people will pay for speed and accuracy, and therefore improv edsurvival.

We need professionals to tell people the truth. Hard truths are anathema to politicians.They are “destroying humanity by not speaking out”, not just in health and social care, but the environment, legal services, and in many other areas of our lives.

As an example fo quality care I list the dates and time intervals for treatment of a malignant melanoma in Australia. This speed and thoroughness would be unlikely in the UK.. Whilst one or two steps might function, there would be hold ups particularly in the investigations, and availability of surgery. The interval between diagnosis and excision is critical and this was 10 days.

In another world, 50 years ago, before tests, the patient would have been seen one day and operated on the next working day. Food for thought….

Diagnosis: August 17th  a level three melanoma on the top of the scalp (not stage 3 as the surgeon was quick to point out) on August 19th when I saw him.

August 20th I had an MRI

August 24th PET scan

August 26th lymph node scan and mapping and also told that MRI was clear of cancer ( AND they did manage to find a brain in the skull! )

August 27th was a four hour operation to remove the melanoma from the top of head and do a skin graft.

August 29th: Home after just one night in hospital. Feeling pretty weak and wobbly but otherwise not too bad and not too much pain.

Disastrously risky: Closing Public Health England – An opinion from the Economist

Successive governments have rationed public health for decades, and this we were unprepared for the Covid pandemic. To blame them and scapegoat their staff shows an immature and inexperienced administration.

August 22ns in the Economist: Britain’s government axes Public Health England – A pandemic is not necessarily a great time to scrap the body charged with managing pandemics

“Astrong, capable, co-ordinated, united and efficient public-health agency that rivals any in the world,” was the verdict of a review conducted in 2017 by representatives of some of the world’s top public-health bodies, including the president of Germany’s highly regarded Robert Koch Institute, on Public Health England (phe). Three years later, phe is being scrapped. Its responsibility for dealing with external threats such as infectious diseases and biological weapons will be taken over by a new organisation, the National Institute for Health Protection, which will also incorporate the Joint Biosecurity Centre, provider of expert advice on pandemics. How could this happen to an outfit held in such high regard?

phe was created in 2013 by a merger of 129 organisations, and won those plaudits partly for managing the difficult task of bringing them all together. But the breadth of responsibilities, which included obesity and smoking reduction as well as pandemics and poisoning, cost it something in focus, and its flaws were exacerbated by an instinct to do everything itself. Its failure to outsource testing to private-sector and university labs, which could have helped boost capacity, contributed to a shortage. Its under-resourced contact-tracing system was overwhelmed by early March.

But the government is at least partly responsible for these missteps. Since Britain had plenty of warning of the pandemic, it should have provided the necessary resources for testing, tracking and tracing earlier. By the time it did, the government had lost faith with phe, and created nhs Test and Trace to do the job, with private-sector outsourcing companies such as Serco and Sitel providing the manpower.

The decision to ditch phe has received a mixed response. “You probably need a distinct centre for pandemic preparedness,” says Sir John Bell, regius professor of medicine at Oxford University. “We’ve had nine pandemics or close calls in the past 20 years [sars cov-1 and avian flu twice each, mers, swine flu, Ebola, Zika and sars cov-2 once each]. We’ll have another nine in the next 20 years.”

But some in the public-health business argue that phe has taken the rap for mistakes made by the Department of Health and Social Care and nhs Test and Trace. The failure to provide local authorities promptly with good data, for instance, has made managing local outbreaks unnecessarily difficult. “We have an analyst who does nothing but clean up their data when it finally comes through,” says a local-authority director of public health.

There are also questions about the nature of the change. Britain has been criticised for its centralised approach to the crisis, and Matt Hancock, the health minister, said in announcing the creation of the new agency that Germany was a model for them. But Germany’s public-health system is run by its local authorities, which the Robert Koch Institute supports by providing science and standards. The nihp will be a large, centralised organisation, replacing the large, centralised organisation that has been axed. “This is the result of a gossamer-thin analysis of the German system, and is being done to save Hancock’s skin. What’s needed is proper local infrastructure,” says a director of public health.

Dido Harding, the organisation’s boss, who has management experience in food retail and telecoms, is not universally regarded as the right choice. “It’s the culture of amateurism,” says a health-system analyst. “The Germans would never appoint somebody like that to this job.”

The timing is also controversial. “The lesson of health reorganisations is that the cost in short-term disruption outweighs any medium- or long-term benefits,” says the analyst. “It’s an incredibly stupid move,” says a health official. “We’re in the middle of a pandemic. I’ve had four meetings in the past few days in which phe were supposed to participate, and they didn’t turn up.” There are fears that phe staff may be thinking more about their prospects than about covid-19. “All the people who should be focusing on the next wave will be polishing their cvs,” says the analyst. “This is management 101.”■

Editor’s note: Some of our covid-19 coverage is free for readers of The Economist Today, our daily newsletter. For more stories and our pandemic tracker, see our hub

Cumberlege review exposes stubborn and dangerous flaws in healthcare. It is likely to be ignored…

Will Cumberledge be another report that remains unacted on?

BMJ editorial opines: Cumberlege review exposes stubborn and dangerous flaws in healthcare BMJ 2020;370:m3099

“The healthcare system is disjointed, siloed, unresponsive, and defensive”

On 8 July the Conservative peer Julia Cumberlege published her much anticipated Independent Medicines and Medical Devices Safety Review, looking into the response of England’s healthcare system to patients’ reports of harm from drugs and medical devices. Commissioned in 2018, the review was conducted through the lens of three medical treatments: hormone pregnancy tests (mainly the drug Primodos), alleged to cause serious birth defects; the anti-epileptic sodium valproate, which can cause birth defects and developmental delays; and pelvic mesh, a surgical material (technically a medical device) implanted in thousands of women to treat organ prolapse and urinary incontinence. Mesh is now the subject of intense global scrutiny after reports of serious long term effects from material that has twisted, moved, disintegrated, or caused severe allergic reactions.

The Cumberlege review was inspired by longstanding patient campaigns alleging harm from these three interventions, and the panel’s explicitly declared approach was that patients’ and families’ voices, experiences, and views should be “at the heart of the review.” The published report lives up to that promise. The review panel spoke to over 700 affected individuals, held oral hearings, and received evidence from manufacturers, clinicians, and other stakeholders. They documented pervasive shortcomings in the marketing and oversight of the three treatments and in the response to patients who raised concerns. They considered their findings generalisable across healthcare, as the cover letter states: “We have found that the healthcare system—in which I include the NHS, private providers, the regulators and professional bodies, pharmaceutical and device manufacturers, and policymakers—is disjointed, siloed, unresponsive, and defensive. It does not adequately recognise that patients are its raison d’être.”1

Hormone pregnancy tests, sodium valproate, and pelvic mesh have been the subject of regulatory action in the UK and elsewhere. The tests were withdrawn in 1979, 11 years after concerns first emerged.2 Sodium valproate, now also used as a psychiatric medication, is the subject of warnings and voluntary restrictions for women of childbearing age, although, as the report documents, it is surprisingly difficult to get this critical information to either patients or doctors.34 Mesh for pelvic organ prolapse has been the subject of international campaigns and has recently been withdrawn or advised against in most higher income countries. The mesh bladder sling for urinary incontinence, while “paused” in England, remains available in most other countries.

The review found that action in all three cases has been sluggish and inattentive to concerns raised by patients.

Perhaps most striking was the testimony from hundreds of patients reporting lack of informed consent for their initial treatment, followed by years of dismissal by clinicians and regulators who did not want to associate life altering symptoms or injured children with their medical interventions. In a press release Cumberlege said that in years of reviews and inquiries she had never encountered anything like the intensity of suffering of these medically injured families.9 The review panel found that healthcare providers’ dismissive attitude toward patients was underpinned by a reluctance in all parts of the system to collect evidence on potential harms, by a lack of coordination that would allow clinicians and agencies to interpret and act on that information, and by a culture of denial that failed to acknowledge harm and error, impeding learning and safety.

Familiar pattern

These patterns are already familiar to all patients who have been harmed by medical care.1011 What the Cumberlege team has flagged is the stubborn flaw that lies at the heart of the practice of medicine. It is often called “culture.” But this type of embedded attitude seems to go beyond culture, beyond fear of liability, and beyond the profit motive when that exists. It is a patronising and insufficiently curious way of doing business that is often at odds with the realities of helping patients heal and is increasingly out of place in a connected modern world. How to change it is still an unsolved problem. There have been inquiries, reports, and recommendations over the years, but the fundamental issues around power, justice, and compassion are still with us.

The Cumberlege review made nine recommendations (box 1). The first of these, a government apology, has already happened.12 The second, a dedicated patient safety commissioner to help patients navigate the bureaucratic tangle and to troubleshoot problems throughout the system, has generated interest both inside and outside England.13 It is clearly the panel’s centrepiece, characterised as a “golden thread” tying the disjointed system together in the interest of patients. Other recommendations include a Redress Agency to provide remediation to victims of medical harm without forcing them to litigation; schemes and specialist centres to provide care, support, and treatment; reform of the approval and tracking process for drugs and devices; and a public list of doctors’ conflicts of interests, to be run by the General Medical Council.

The Cumberledge report: The Independent Medicines and Medical Devices safety review. *th July 2020. 

BMJ Letters: Deep and Dangerous flaws in healthcare

Summary IMMDS

Reports commissioned by Government and others – but not acted on. A shame on all politicians for their short termism.

GDP and the 4 Health Services (Former NHS) – No prospect of reducing the waiting lists quickly enough to correct mortality and morbidity reductions..

David Smith reports in the Times 26th August 2010: The GDP figures may look extreme but statisticians have done their sums

t is two weeks since the Office for National Statistics published a record-breaking estimate of a 20.4 per cent fall in gross domestic product in the second quarter. At a stroke, the quarterly level of GDP was reduced to its lowest level since mid-2003. If it stayed there, 17 years of economic growth would have been wiped out.

There were other superlatives. This dwarfed the quarterly GDP falls during the financial crisis and was nearly eight times the previous biggest modern-day quarterly decline, of 2.7 per cent, in Edward Heath’s three-day week in early 1974. I remember the three-day week mainly because television shut down at 10.30pm each night and shops were required to turn off their window displays in the evenings. Readers may have memories, perhaps even happy ones, of not being able to go to work for two days a week……

…For most parts of the private sector, employees were furloughed and revenues fell sharply during lockdown. Activity measured in both cash and real terms fell heavily. In the public sector, however, employees were not furloughed and spending — government spending — continued. A large gap opened up between cash, or nominal, spending and real activity.

Thus, while the NHS appeared to be under the most enormous pressure in the second quarter and as we clapped every Thursday evening, non-coronavirus activity was sharply lower. The ONS estimated that what it described as “output of human health and social work activities” fell by 27.2 per cent in the quarter, mainly reflecting cancelled operations and lower attendances at A&E. I think you might include the filling I have needed replacing since February. As for education, the drop in output was even greater, 34.4 per cent, reflecting school closures.

The ONS does not make this stuff up. Over many years it has developed methods for measuring public sector output, which its statisticians regard as the international gold standard. How much difference would it have made if, like some other countries, the ONS had assumed that public sector output had been closer to the level of government spending, adjusted for a bit of inflation? It would have made a difference, but not that much. The decline in health output knocked 1.82 percentage points off growth in the second quarter, while education was responsible for 1.94 percentage points. In normal circumstances, this would represent a massive hit to growth, but in the context of a 20.4 per cent drop, it left most of the fall, 16.6 per cent, in place.

We should not accept official statistics uncritically, but people can be too sceptical. Some insist that the productivity stagnation of the past decade is a statistical aberration that will be revised away. It isn’t and it won’t be. Others say that all official statistics are produced for the convenience of the government and to help it out. They aren’t.

During the financial crisis, an old Treasury hand told me the advice that he always gave to ministers. The context was the economy’s emergence in 2009 from what was then the biggest postwar recession and the UK was slower out of the blocks than others. Don’t criticise the ONS for this, he told them, or you will never be able to use official statistics when they are in your favour. He was right.

NHS HIDDEN WAITING LIST – The Times letters 29th August 2020

Sir, Claims that the NHS has a “hidden waiting list” of 15 million patients (report, Aug 27) reinforce what the medical profession has been saying for a long time: we urgently need extra capacity to tackle the backlog of non-Covid-19 cases. The entire health service has been forced to focus on the initial influx of Covid-19 patients, which has led to treatment being delayed for patients with other conditions. The task now is to ensure that these people receive treatment while we prepare for seasonal flu and a possible second wave of Covid-19. That challenge is immense: 60 per cent of doctors are not confident in their local health economy’s capacity to manage demand as normal NHS services resume. We need a long-term plan to rebuild an exhausted and depleted NHS workforce, clearer public information and more effective track and trace. Everyone must take Covid-19 seriously by wearing face coverings, observing physical distancing and practising good hygiene.

Dr Helena McKeown

Chairwoman of the British Medical Association’s representative body

NHS workforce plans don’t add up? An epidemic of dementia will likely follow the covid -19 pandemic..

With the coming dementia pandemic, you would have thought a responsible governement would have a meaningful plan for providing the staffing levels needed…. but no. The First Past the Post political system ensures no planning beyond 4 years.

David Oliver:  NHS workforce plans don’t add up? BMJ 20th August 2020.

Workforce recruitment, retention, and morale are the biggest threats to the viability, quality, and scope of health and care services in the UK. We need credible solutions, quickly.

July saw the publication of the We are the NHS: People Plan for 20/21 for England and a “further details” Home Office document on implementing the new UK-wide, points based immigration system.12345

In 2018 a joint report by the King’s Fund, Nuffield Trust, and Health Foundation found that around one in 11 clinical posts throughout the NHS was vacant, including one in eight nursing vacancies, and vacancy rates are higher in some areas of geography or practice.6 The Health Foundation has reported a dramatic drop in nurses coming from overseas during the pandemic.7 And the Royal College of Nursing reported that 31% of nurses were considering leaving the profession, citing workload and staffing gaps.8

You’d hope for government policy to tackle this, but will it?…..

…There are also nods to broadening entry routes into clinical professions and increasing training places and numbers, with some limited financial support for nurses to study and some new apprenticeships. But you’ll have to look very hard for concrete numbers not previously announced elsewhere, let alone logistics, operational plans, and timelines.

In the face of the existential threat posed by the existing workforce crisis in health and social care, government policy veers between too little too late, ambition over action, and—in the case of immigration policy—an act of self-harm.

MENTAL ILLNESS ‘ON THE RISE’ 26th August 2020 in the Times
Sir, Professor Karol Sikora highlights how treatment for cancer will be playing catch-up (“Cancer care backlog may cost 30,000 lives, PM told”, Aug 22) because of the NHS’s focus on Covid-19. The detrimental effect on treatment for mental ill-health is also extremely concerning. I lead a residential service at the Bethlem Royal Hospital treating the most severe forms of obsessive compulsive disorder. The unit was closed at the start of the lockdown, having been classed as “inessential”.

We still have no date for reopening our vital service, despite the fact that each patient is housed in a separate room and people with OCD are generally far more compliant with measures to combat the risk of transmission than the population at large. Sufferers have been particularly badly affected by the virus as it seems to confirm many of their worst fears about contamination and responsibility. The NHS shutdown has made it far worse.

The NHS’s provision for the mentally ill was already struggling before the virus struck. In addition to patients left untreated during lockdown, the incidence and severity of anxiety disorders has increased. Yet the NHS appears to lack any sense of urgency over the disaster threatening to overwhelm the nation’s mental health. It is time it allowed specialist services to reopen so that we can get on with tackling these problems.
Professor David Veale
Anxiety Disorders Residential Unit, Bethlem Royal Hospital, Beckenham

Closure of many more surgeries…. And there’s an epidemic of dementia coming…. August 2019

Disasters: wars, tsunamis, earthquakes, hurricanes and epidemics – are all regressive. April 2020

 

With 15m on the waiting list, life has suddenly become less valuable. Continuity of care brings trust. Wisdom and compassion from a traditional GP may only become available privately…

You could argue that a low threshold for suspicion of cnacer protects patients in that they will worry for a shorter perios (Until death) if they remain ignorant of the severity of their condition. Kat Lay is reporting in the Times 27th August: Coronavirus: NHS data shows 15m on ‘hidden waiting list’ – The new frightening total highlights struggle for vital treatment. This shortfall, on top of the pre-existing undercapacity before Covid -19, means that life is less valued, rationing is more intense and covert, and that medical charities and volunteering community groups are even more important. The open market solution may become evident as private General Practice, in certain post codes, becomes in demand again…

Kat Lay reports 25th August in the Times: GP intuition effective at spotting cancer, study shows

People are more likely to be diagnosed with cancer if it was their GP’s instinct that they had the disease, researchers have found.

The chances of a cancer diagnosis were four times higher when gut feelings were recorded, and the chances of those suspicions being correct rose as doctors became more experienced or when they knew the patient better.

The study, published today in the British Journal of General Practice, drew together existing studies that had looked at the role of family doctors’ intuition in cancer diagnosis. Brian Nicholson, one of the authors of the study at Oxford University’s Nuffield Department of Primary Care Health Sciences, said: “We found research that suggests that gut feelings are more effective at identifying people with cancer than the symptoms and signs used in guidelines.

“We wanted to understand what leads to a GP having a gut feeling in case the guidelines could be improved.”

Jonathan Leach, joint honorary secretary of the Royal College of GPs, said: “GPs consider a huge variety of factors when making a patient diagnosis. As well as more obvious physical symptoms, non-verbal cues can often indicate that something is wrong — not necessarily what the patient has made an appointment to speak about.

“This ‘gut feeling’ or intuition is something that GPs develop by having close, trusting relationships with patients that are often built over time.

“As this paper suggests, a GP’s ‘gut feeling’ can be useful in identifying potential serious health conditions, such as cancer, even when patients don’t meet the official criteria for referral to specialist care. This is one reason why GPs need some flexibility in being able to refer patients where they are concerned, as well as better access to investigations in the community . . . so they can pursue their intuition, and take the results into account when making an informed decision to refer a patient.”

The study found that some specialists “questioned” the value of a GP’s gut feeling and so GPs sometimes omitted it from referral letters or chose investigations not needing specialist approval.

“GPs reported varying success of integrating gut feelings into clinical practice: some were able to refer patients based on gut feeling, but others recounted instances when referrals made because of a gut feeling had been rejected by specialist colleagues due to a perceived lack of clinical evidence,” the authors siad.

“These patients were later diagnosed with cancer, suggesting that earlier diagnosis may have been possible.”

Dr Leach added that the research also posed questions for the continuation of remote consultations after the coronavirus pandemic.

GP’s INSTINCTS 26th August 2020 in the Times
Sir, To an experienced GP it will come as no surprise that non-verbal cues aid the diagnosis of cancer and many other serious diseases (“GPs who follow instincts good at spotting cancer”, Aug 25). As your article notes, accurate diagnosis depends on knowing the patient and is based on a good and trusting relationship. Sadly GPs these days rarely know their patients well as continuity of care by one dedicated doctor is fast becoming a thing of the past. Video and phone consultations are now being promoted by many GPs in a mass rush to work from home. In this way yet another barrier is being introduced to the highly nuanced art of diagnosis.
Dr Christine Dewbury
Ret’d GP, Shawford, Hants

Sunday 23rd August: Letters to the Editor: Cancer patients are being left to die

I have been treating cancer patients for nearly 50 years and I can honestly say I have never been as worried about cancer care in this country as I am now.

You report that thousands of lives may be lost to cancer because the pandemic has “derailed” treatment services (News, last week). This is not hypothetical: people will die because they did not receive prompt cancer treatment. The whole country and its healthcare came to a halt to fight Covid-19 — but where is the outrage for cancer patients?

Cancer will continue to kill relentlessly unless we get our diagnostic processes back into full swing. I am not one for apocalyptic predictions, but this will get a lot worse before it gets better.

Cancer patients deserve better than this. Restoring full services has been recognised as an urgent priority at the top of the NHS — but I am concerned that the implementation of an effective solution will come too late for our patients this year.
Professor Karol Sikora, medical director, Rutherford Cancer Centres

The consequences of poor manpower planning.

Its not news to the 4 health services’ staff. NHSreality confirms that you have a nearly 50% chance of being seen, assessed and treated by an overseas trained doctor if you are suddenly ill. If you are in a peripheral District General hospital where there is less technology and poorer recruitment due to infrastructure and schooling, the chances are higher still. We have trained too few for too long. With 5 times as many applicants as places, sustained for 30 years. why has this happenned? The blame goes back to Mr Major, and Mr Blair, and all subsequent administrations. First Past the Post systems do not help longer term planning.

Lucy Ficher reports 24th August 2020 in the Times: NHS pays millions in fees for overseas staff

The NHS has been forced to pay more than £15 million in immigration fees for hiring overseas specialists to staff its hospitals during the past three years, according to new data.

The sum spent by healthcare trusts on the government’s immigration skills charge was revealed in a freedom of information request submitted by Labour. At least 52 trusts have had to pay the levy to hire foreign specialists, which Labour said was due to a domestic skills gap caused by a failure in government policy.

Portsmouth Hospitals NHS Trust has been the worst hit, paying £2,007,000 since 2017. Three other trusts have also spent more than £1 million on the fee in this period: Barts Health NHS Trust in London, Royal Free London NHS Foundation Trust and University Hospital Southampton NHS Foundation Trust.

Holly Lynch, the shadow immigration minister, called the levy a “stealth tax on our NHS”. It was “an outrage”, she said. “Local NHS trusts require specialists from overseas, yet the Tories are punishing hospital budgets for their own failure to train enough skilled staff.

“The irrationality of the immigration skills charge for NHS trusts has been underlined by the coronavirus pandemic. The Conservative government should be doing all they can to support the NHS. Instead, they are presenting trusts with an unenviable choice: either leave life-saving specialist roles unfilled, or fork out expensive fees for overseas staff.”

The immigration skills charge costs £364 for a small or charitable organisation, and £1,000 for a medium or large sponsor, for an overseas worker’s first 12 months. Each additional six months, up to a threshold of five years, costs an employer between £182 and £500.

In April Andrew Goddard, president of the Royal College of Physicians, urged the government to rethink an array of charges levied on overseas workers wanting to join Britain’s health and social care sectors. Professor Goddard said: “Once the UK ends freedom of movement, EU citizens coming to work in the UK next year and their employers will suddenly be faced with a barrage of costs.”

A government spokesman said: “Right across the immigration system we are supporting frontline healthcare staff through initiatives such as visa extensions and the creation of the bereavement scheme . . . We’ve already taken steps to support the NHS during the pandemic by removing the skills charge for employers when automatically renewing visas. Our new points-based immigration system, for introduction from January 2021, will go even further to make sure the NHS and wider health and care sector can continue to access the best and brightest talent from across the world.”

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