Category Archives: Patient representatives

Social Care is means tested, so why not health? More funds for cancer care is appropriate, but in Wales it could go on free prescriptions.

Kat Lay in the Times reports 15th June 2018: NHS (England) must use extra funds to fight cancer

Social Care is means tested, so why not health? More funds for cancer care is appropriate, but in Wales it could go on free prescriptions. If the people have a choice they will choose local, ahead of improved outcomes and travelling. As the population ages, and more people survive cancer, we will need more radiotherapy and oncology services. The shortage of Radiologists and Oncologists is so severe that the potential for improvement is threatened.

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The NHS will be expected to improve cancer survival rates and put a greater focus on maternity safety under a multimillion-pound funding package due to be announced within days.

Theresa May appeared poised to set plans to boost the NHS budget by more than 3 per cent after intensive meetings yesterday between No 10, the Treasury and the health team.

At a conference of health service managers in Manchester, Jeremy Hunt, the health secretary, said: “We need to make sure we unite the NHS and British people with a small set of bold ambitions as to how we want to transform our system. To get our cancer survival rate to the best in Europe; to transform our maternity safety so it is as good as Sweden; to truly integrate health and social care; to make sure we have waiting time standards for mental health that are as strong and powerful as the standard for physical health.”

He was still having “difficult” discussions with Mrs May and the Treasury over the precise details of a long-term funding plan, but an announcement is expected soon. NHS leaders say they need funding increases of 4 per cent a year, in line with assessments by think tanks. The Treasury is thought to be reluctant to provide that much.

Brexiteers want rises in health service spending to be funded by the so-called Brexit dividend — money available after Brexit that would have gone to the EU. They worry, however, that Philip Hammond, the chancellor, will suggest funding it through tax rises.

NHS sources fear that a “big picture” announcement could amount to a fudge because it will not spell out the exact funding increases on offer. That would mean health chiefs including Simon Stevens, chief executive of NHS England, waiting until November for the details.

There is also likely to be disappointment at a decision to keep social care funding, which is delivered through councils and is the subject of a forthcoming green paper, separate.

A report from the Institute for Public Policy Research, a left-wing think tank, has called for social care to be free of charge for people with substantial needs as part of a new long-term health funding settlement. Social care is currently means tested. Making it free would bring the care system into line with the NHS, where healthcare is free at the point of need.

Cancer patients given new drugs that won’t help them. GPs needed in oncology clinics…

Advanced directives needed. Choice in death and dying. Lord Darzi warns of “draconian rationing”. GPs need to be involved at the interface of oncology and palliative care.

Rationed – Start of cheaper technique for breast cancer is delayed in UK despite adoption elsewhere. GP commissioners should be demanding intra-operative radiotherapy.

Cancer drugs fund is illogical. More money should be spent on radiology and radiotherapy.

Cancer chief quits amid radiotherapy shortfall

Artifical Intelligence is no threat to doctors, but it’s potential needs to be managed. A shortage of Radiologists is more bad news for the future.

 

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Whay are patients like me denied a new cancer drug? You know the answer – rationing…

Sean O’Neill knows the answer to his question. But he thought, before he was ill, that he never would need to ask this question. After all, politicians deny rationing, and only restriction, priorities, and exclusions. We need not ration at the low volume high cost end (as much) if we charge for the low cost high volume end.

Why are patients like me denied a new cancer drug?

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The cancer cure stories have been coming thick and fast over the past month. We’ve had the “biggest breakthrough since chemotherapy”, a woman cured of breast cancer with an injection of her own cells, a hormone pill that will “liberate thousands of women” from chemotherapy and the notion that artificial intelligence will beat the disease.

After Tessa Jowell’s death from brain cancer last month, Theresa May found a magic money tree to give more patients access to experimental treatments. And Simon Stevens, chief executive of NHS England, was moved to declare that an early diagnosis blood test had placed us “on the cusp of a new era of personalised medicine that will dramatically transform care for cancer”.

Mr Stevens’s lofty words are wedged firmly in my craw, impossible to swallow. I have a cancer, chronic lymphocytic leukaemia, that is already striding into a new era in which doctors feel chemotherapy is largely unnecessary and dangerously counterproductive.

There is a groundbreaking drug available, a once-a-day pill, which stops the growth of cancerous cells without blasting the bone marrow. It’s a drug that allows most patients to get back to a full life — enjoying time with their families, going to work, paying their taxes.

This is no pie-in-the-sky experiment: it’s here now. The National Institute for Health and Care Excellence (Nice) says this drug, ibrutinib, is “innovative and effective” and should be “routinely available” for patients (like me) who have relapsed after a previous course of chemotherapy.

But Mr Stevens is denying us ibrutinib. His bureaucrats overruled Nice and issued doctors with a checklist restricting the prescription of the drug. Instead, Mr Stevens thinks I should endure another six months of debilitating chemotherapy, this time including a drug called bendamustine, derived from mustard gas by East German scientists in the 1960s. So much for a new era.

True to form for Whitehall, Mr Stevens’s communications officers refuse to answer questions about who overruled Nice, why or what other drugs are being restricted like this. Jeremy Hunt, the health secretary, should surely intervene. The health department says the NHS “is legally required to fund” Nice-approved treatments.

If Mr Hunt, who has received dozens of letters from MPs about this issue, has not already called in Mr Stevens to ask him why NHS England appears to be breaking the law by secretly curtailing access to approved drugs, now is the moment.

Sean O’Neill is chief reporter

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We need tax and fiscal policies that upset some!..”The role of a leader is to persuade voters of the need for reform, rather than just to follow public opinion.” but we have no leadership, and no honest debate ..

We need tax and fiscal policies that upset some!..”The role of a leader is to persuade voters of the need for reform, rather than just to follow public opinion.” but we have no leadership, and no honest debate .. The media find health too complex, and in a media led society this is part of the collusion of anonymity and denial. Where the author mentions priorities – rad rationing.

June 5th in the Times: Theresa May should stop tinkering and start spending

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To solve the crisis in health and social care, the PM must come up with tax-raising policies that risk upsetting people

Politics is a bit like playing Monopoly. Leaders start the game with a pot of political capital that is gradually eroded by power. As they go around the board dealing with events, they spend more to build up a property empire of popular support. There must be an element of risk-taking and ruthlessness, as well as responsibility. Luck is required, but also the wisdom to know that you must create your own good fortune. The winner is the person with the most capital left when the country goes to the polls, even if everyone is almost bankrupt.

……There is a chance for the prime minister to play a winning hand on the NHS in the year of its 70th anniversary but it will require a courage that she has so far lacked. Jeremy Hunt, who yesterday became Britain’s longest-serving health secretary having fought off No 10’s attempts to move him at the last reshuffle, is pushing hard for more money and he knows reform is also required. Boris Johnson is piling in with demands for a “Brexit dividend” for the NHS, while Sajid Javid wants to overturn the “hostile environment” of immigration and relax visa restrictions on foreign doctors. Philip Hammond understands the need for resources to cope with an ageing population. If the settlement is to be more than a sticking plaster that falls off at the first hint of rain, however, leadership from the prime minister is needed to win some difficult arguments.

The NHS crisis is also a social care crisis in which nearly one in ten hospital beds are taken up by patients who are well enough to go home, a situation that is traumatic for families and damaging to the health service. There needs to be much greater integration between the health and social care systems, with budgets reallocated people in the community. That will mean closing hospitals or reducing the number of wards — a political taboo for many MPs — but if Mrs May is serious about reform it is a row worth having.

It costs about £250 a day to keep somebody in hospital and only £100 for a domiciliary care package, so rebalancing the system would save money and be better for patients. In six areas where the NHS is piloting a scheme to send doctors and nurses into care homes, emergency hospital admissions have fallen. Wakefield reduced ambulance callouts by 9 per cent and the number of days spent in hospital by care home residents by 26 per cent, while in Sutton there was an 18 per cent drop in bed days.

The prime minister also needs to make the case for tax rises, including on the elderly. According to the Institute for Fiscal Studies, spending on healthcare will have to increase by an average of 3.3 per cent a year over the next 15 years, and social care funding by 3.9 per cent, just to maintain current provision. In other words, the NHS needs an extra £2,000 from every household to continue functioning properly. On top of that, the government must introduce a cap on care costs to end the unfairness that some people who have to spend years in residential care end up with crippling bills while others pay nothing. That would cost about £6 billion a year. Such sums cannot be raised by trimming budgets or cutting costs — there needs to be a public debate about priorities.

Mrs May is understandably nervous about engaging in this discussion after the fiasco over the “dementia tax” during the last general election campaign. That policy, however, was fatally flawed because it increased the amount that many people would have to pay for social care without spreading the risk. It therefore created a political problem without solving the policy dilemma.

There is growing cross-party support among MPs for working pensioners to pay national insurance. At the moment a 64 year old and a 66 year old doing the same job take home different amounts because pensioners are exempt from the deductions, which is illogical and unfair. The levy could be turned into a dedicated health and social care tax, which could be put up or down each year in line with demand. Billions more could be raised by scrapping the planned cut in corporation tax and abandoning the now-annual fuel duty freeze. There may also need to be adjustments to property taxes to ensure those with the greatest assets contribute more. None of this will be popular with everyone but the role of a leader is to persuade voters of the need for reform, rather than just to follow public opinion.

The rumour in Whitehall is that the government is heading towards a promise of a 3 per cent boost for the NHS. Tory MPs have been told it is “not helpful” to ask for more than that. As one senior backbencher puts it: “That would be treated with dismay because it doesn’t even keep the health service at standstill.”

To govern is to choose. If she wants to have a legacy beyond Brexit, Mrs May should approve a proper funding settlement for health and social care, involving radical reform, rather than tinkering around the edges with a package that pleases no one.

One senior Conservative MP says that the prime minister has “to a quite extraordinary extent no leadership in her DNA”. It is time to break with the habit of a lifetime and roll the dice if she wants to get another chance to pass Go on the political Monopoly board and collect £200.

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The real cost of the English taxpayer subsidising NHS Wales – is twice the official figure

In West Wales and the Welsh Valleys we already get over £1000 per head more than English residents. With the overspend on our budget another £600 (minimum) is spent. Realistically this is £1000 and exactly twice the official figure. Joe Public is completely unaware of the relative bankruptcy of our health services. Political parties have a duty to be honest – but will any of them dare to be so?

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Owain Clarke 22nd May 2018: £13.4m claw back over NHS Wales waiting time failures

Jordan Davies 9th May 2018: Ex-counter fraud boss says NHS Wales ‘losing millions’

Paul Pigott 31st May 2018: NHS Wales spends millions on short-term fixes, says BMA

NHSreality posts:

24th May 2018 – Addressing the “black hole” in the health budgets – wait for political denial.

19th November 2015 – Personal Health Budgets – a denial of mutualisation and utilitarianism

1st September 2015 – Politicians: please re-think the philosophy. Media: please force them to do so. Individual Health Budgets are wrong..

February 3rd 2014: GP Recruitment and Spending in Wales: The GP spending share of the health budget has plunged from the highs of 2005-2006

January 13th 2014: Personal Health Budgets – an idea too far without overt rationing

November 23 2013 – Interview with Jon Skone, retired chief of the combined Social Services and Health budget in Pembrokeshire

NHS funding advice: GDP worth debating… Showers of money will not work..

When and who will eventually speak out honestly? 10% now to 20% of GDP by 2061

GDP and GVA differences across the UK – a threat from Scottish Independence

27th May 2018 – Some of the options, all unpleasant, for raising money for the UK Health Services. Tax reform – “fishing for funds” in the Economist

Addressing the “black hole” in the health budgets – wait for political denial.

he NHS at 70: Loved, valued, and too costly (print version) / affordable (on line version) – even the experts don’t know where to stand. The core principles need to be changed..

“An illusory technical excape from spending choice”, “a fourfold revolution is required”, “clumsy and unreliable”…

Jan 6th 2018 – “The NHS is like a tumour on the public finances, expanding so aggressively that it threatens to kill other organs of state …. Better still would be a formal policy if provision is to be limited — but the politics is too sensitive”.

Pragmatic decisions need to be taken to insist on rationing… Are we are gullible enough to believe their lies?

Surveys of the uninformed are less valuable than those of the staff: survey doctors and nurses please Kings Fund

A bigger and bigger deficit in West Wales…… Now at £600 per head……

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Alan Milburn thinks the penny has dropped…. Money alone will solve nothing for the UKs health services.

We cannot expect a former health Secretary to admit we need to ration health care, but this is the nearest we will get. NHSreality does not think the penny has dropped with a majority of the politicians as yet. ….. One of the signs of inefficiency is readmission rates, which are rising fast. There may well not be a bed for YOU when you need one… Rationing is happening but we are all denying it, and as it is covert, Commissioners get away with it where they can.


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Alan Milburn opines in te Times 1st June 2018: The government can gift the NHS time as well as money

The penny has dropped. The Prime Minister has come to realise that the NHS — indeed the wider care system — needs more money. An announcement, perhaps to coincide with the 70th birthday of the NHS in July, is apparently imminent.

It has become obvious to government that demand and supply are out of kilter. Hospital admissions have risen by one third in a decade but resources have failed to keep pace with NHS funding rising at less than half the rate of the 4 per cent historic average.

The arguments are now raging in Whitehall about how much the NHS needs to be sustainable. History seems like a good guide — 4 per cent is surely the minimum needed.

But here I have a health warning for the government. Increasing the volume of cash is only one leg of the three-legged stool on which a stable NHS needs to sit. The second leg is visibility over-resourcing.

The NHS needs long-term line of sight — 5 to 10 years — over resources so that it can plan with certainty to transform local services so they meet future demographic and disease challenges.

It will take time to change services so that they are less fragmented and more integrated, less dependent on hospital care and more more community-based, less focussed purely on treatment and more on prevention. The government can gift it time as well as money.

Thirdly, reforms must accompany resources. People working in the health service know that the current structures are no longer fit for purpose. Structural reforms since 2010 have led to unprecedented confusion and uncertainty.

The reforms were intended to introduce more competition but the thrust of The Five Year Forward View — the NHS’s reform plan — is about encouraging greater collaboration, not least between health and social care.

Today the NHS is in an organisational no-man’s land. In particular there is a misalignment between the ambition of creating integrated, place-based and outcome-led care and the operation of the current financial system. Money talks in the NHS. Not just the volume of money but how it is used, deployed and how it moves around the system. I know that from my experience as Health Secretary in the Blair government.

When we put record resources into the NHS, at first hospital activity levels stalled and waiting times continued to rise. One of the key things that changed that was the introduction of incentives on hospitals to increase activity and reduce waiting.

The more they did, the more resources they got. That change led to unprecedented reductions in the times patients had to wait for an operation. But today, although reducing wait times remains important, the biggest priority for the NHS is to tackle chronic diseases like diabetes and improve population health outcomes. That needs a different set of financial incentives.

The current financial system is caught in a time warp and needs to catch up. Without reform there is a risk that that the government simply won’t get the most bang for the buck out of the new resources it intends to invest in the NHS. That would mean too many of the extra resources would be wasted.

What is more, if left unreformed, the financial system will be a stumbling block to the service transformation that is so desperately needed. According to a new report drawn up by PwC with the help of the Healthcare Finance Management Association, 76 per cent of NHS finance professionals feel the current funding structures in the NHS are not fit for purpose.

I agree. To make sure that the extra resources are put to the best use, reforms are needed. Health and social care budgets need to be brought together at a local level. How providers get paid should be changed to reward improvements in health outcomes rather than increases in the number of people treated — so helping the drive towards prevention rather than activity.

Channeling NHS resources through local systems rather than single institutions would speed care integration. And banning capital to revenue transfers — which have robbed the NHS of billions of desperately needed infrastructure spending in recent years — would provide more investment in out-of-hospital care. These changes would put extra resources to work for the benefit of patients.

Today the NHS has reached an inflection point. Without change, it will not be sustainable as a universal service providing care according to need regardless of the ability to pay. The promise of more government investment is welcome. but it must be accompanied by reforms.

There is a huge opportunity to better optimise resources, better empower patients and better improve health outcomes. Change is always hard in the NHS but there is a big prize on offer — not just to sustain the system, but to transform it.

Alan Milburn is chairman of the PwC Health Industries Oversight Board and a former health secretary

Chris Smyth reports 1st June: Millions return to hospital after only a month

Is NHS rationing a possibility? – BBC News

Sarah Page reports for West Susses County Times 1st June: Vital eye surgery rationed across the county despite calls for rationing to stop

 

The shortage of diagnostic and filtering skills is costing us dear. GPs retiring especially.

 It is the duty of a government first to protect the realm, then to avoid insurrection and protect the rule of law, then to protect the health of it’s people. Successive UK governments have shown they have no long term view or ability to manpower plan. We need to change the rules of the game that the politicians play, so that they have incentives to plan properly, or we need to take health away from them. The shortage of diagnostic and filtering skills is costing us dear. GPs retiring (or emigrating) especially. Add to this the parlous state of health services finance, and there is going to be trouble ahead… Image result for doctors  emigrate cartoon

Chris Smyth reports May 30th in the Times: Million patients hit by closure of GP surgeries

More than a million patients have been forced to change GP surgery in the past five years, with closures up tenfold as family doctors abandon the NHS.

Last year 458,000 patients had to find a new practice because their existing surgery shut, up from 38,000 in 2013, according to official data.

Patients are losing personal relationships with a GP and care is suffering, senior doctors warned.

The network of family doctors which props up the NHS is in danger of crumbling as GPs tire of staff shortages in a “serious failure of the system”, professional leaders warn.

Jeremy Hunt, the health secretary, has promised to recruit an extra 5,000 GPs by 2020, saying that hospitals will be overwhelmed if the NHS does not get better at looking after elderly people locally. However, more than 1,000 family doctors have been lost since he made his pledge.

Data gathered under freedom of information law by the GP magazine Pulse shows that at least 202 practices have shut down completely and 243 have closed branch surgeries since 2013. Last year 57 practices closed and a further 77 satellite surgeries were lost. Since 2013 this has displaced almost 1.4 million patients, the data suggests.

Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “A GP practice closing can have serious ramifications for the patient population it served [and] neighbouring surgeries . . . For those living in isolated areas, this can mean having to travel long distances to get to their nearest surgery, and is a particular worry for those who might not drive and have to rely on public transport.”

She said some centralisations into larger hubs could improve care, but warned that when a closure “is because the practice team simply can’t cope with the resource and workforce pressures they are facing, it’s a serious failure of the system.”

GPs are typically independent contractors paid by the NHS for each patient they look after. As older, sicker patients need a doctor more often, this model has become less viable and Mr Hunt has conceded GPs are on a “hamster wheel of ten-minute appointments, 30 to 40 of them every day, unable to give the care they would like to.”

With Britain short of GPs and younger doctors working fewer hours, there are fears of a spiral of decline as the overworked ones who remain become exhausted. Recent taxes on high pension pots also make it less lucrative for GPs to continue to work into their 60s.

Richard Vautrey, head of the British Medical Association’s GP committee, said that family doctors built up long-term relationships of trust with patients “but when practices close this important foundation can be put at risk and patients’ experiences may suffer as a result . . . Without proper investment in primary care, the knock-on effects on the rest of the health service and society as a whole will cost the government dearly in the long run.”

In Plymouth, one of the worst affected areas, a fifth of practices have closed in the past three years, leaving 34,000 patients without a GP. Local doctors say that they get only four hours’ sleep a night as they try to deal with remaining patients and one, Mark Sanford-Wood, said the city’s plight was “a warning of what the rest of the country faces”.

A spokeswoman for NHS England said: “More than 3,000 GP practices have received extra support thanks to a £27 million investment over the past two years and there are plans to help hundreds more this year. NHS England is beginning to reverse historic underinvestment with an extra £2.4 billion going into general practice each year by 2021, a 14 per cent rise in real terms.”

Katherine Sanz in N Ireland reports 10th May 2018: Shortage of GPs as third set to retire

Revealed: 450 GP surgeries have closed in the last five years – Pulse today

 

Radical and simple. Why not expand this suggestion? Fundin the ealt Services..

The Times letters 28th May:

Why do we know that this suggestion will not be acceptable? Because it means that access is not free at the point of delivery. Who on earth made this a sacred cow? We have charges for eyes, dentistry, and prescriptions (in some post codes), so why not an income related co-payment? My only query is why not allow for all means, including capital, as there are many people who would be excluded without. we always want to kick the party tat suggests tax increases…

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NHS FUNDING (The Times letters 28th May 2018)

Sir, There is one way to increase NHS funding without raising the nominal tax or national insurance rates (Comment, May 25, and letters, May 26). Every time a UK citizen uses the NHS the appropriate charge should be logged with HMRC which will then alter the beneficiary’s tax code. This would mean that the beneficiary would pay not the whole amount, but a proportion equivalent to their marginal rate of taxation. Those who do not pay tax would still receive free treatment, while other users would pay a proportion of their benefits.
Christopher Buckmaster

London SW11

 

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Update wit further letters 29th May:

Sir, Paul Johnson (Comment, May 28) excellently highlights the fragmentation and funding crisis of elderly care services. May I offer some considerations for long-term solutions?

Beveridge designed the National Health Service as a “make-you-better” service, offering acute interventions that cure patients who can resume normal life. It was never intended as a “look-after-you-for-ever” service for increasing numbers. The major policy failure arises because no government has allocated pre-funding for care needs. Rising demand and costs have resulted in ever-stricter rationing of care provision, which inevitably increases NHS costs.

Reforms of health and care services in recent decades have focused on highlighting problems rather than implementing solutions as costly reorganisations addressed parts of the system, rather than the whole.

Care funding should be a core element of 21st-century retirement planning. Kick-starting care funding through baby-boomers’ pensions or long-term savings could be facilitated by allowing tax-free pension withdrawals for care funding, or an inheritance-tax-free care Isa allowance.

In addition, national insurance (or tax) must encompass elderly care, not just pensions, for future generations.
Baroness Altmann

House of Lords, SW1

Sir, There is no doubt that the NHS would be helped by a tax hike or an increase in national insurance but would that solve the problem (Comment, May 25, and letters, May 26 & 28)? A modest charge on a GP appointment has been suggested and that would deter unnecessary users. What the NHS does now is far more than what was envisaged at its inception 70 years ago. Putting aside contentious matters such as gender changes and homeopathy, heroic attempts to extend life can sometimes be as costly as they are cruel. Assisted dying is to be avoided at all costs but resuscitation of the terminally ill or operating on them to extend life by a few weeks is cruel, costly and puts a load on often-elderly relatives.

Throwing taxpayers’ money at the problem is not the solution; caring about care may be.
Dr Robert J Leeming

Coventry

Sir, Christopher Buckmaster makes a good point on NHS funding (letter, May 28). When I lived in France 30 years ago a similar system existed. When visiting the doctor you handed over FF100 (about £10) and were given a receipt: the local tax office would refund the amount against the docket. If the state offered you a life-saving procedure, you were given the option of paying for it or attending a month’s residential course on improving your lifestyle.
Denis Harvey-Kelly
Sherborne, Dorset

Update 31st May Times letters

INCREASED FUNDING FOR THE NHS
Sir, As we approach the 70th birthday of the National Health Service it is welcome that we are now having a national debate on its financial sustainability. Medical royal colleges have consistently called for increased funding for the NHS, public health and social care and last week’s report from the Institute for Fiscal Studies and the Health Foundation Securing the future: funding health and social care to the 2030s makes clear that increases of about 4 per cent a year will be needed if the government wishes to improve NHS services, including meeting waiting-times targets and addressing under-provision in mental health.

We urgently need a settlement for the NHS and social care that goes beyond managing short-term crises, acknowledges the financial deficits and recognises the need to invest in transformation and recruitment.

As leaders of medical professionals, we recognise that alongside increased funding there need to be substantial changes in how health and care services operate if we are to
provide first-class, integrated care
for patients.

Professor Carrie MacEwen, chairwoman, Academy of Medical Royal Colleges on behalf of Professor Derek Alderson, president, Royal College of Surgeons of England, Professor Derek Bell, president, Royal College of Physicians of Edinburgh; Professor Alan Boyd, president, Faculty of Pharmaceutical Medicine; Dr Liam Brennan, president, Royal College of Anaesthetists; Mr Mike Burdon, president, Royal College of Ophthalmologists; Professor Wendy Burn, Royal College of Psychiatrists; Professor Jane Dacre, president, Royal College of Physicians of London; Dr Anna de Bono, president, Faculty of Occupational Medicine; Professor Michael Escudier, dean, Faculty of Dental Surgery; Professor David Galloway, president, Royal College of Physicians and Surgeons of Glasgow; Dr Tajek Hassan, president, Royal College of Emergency Medicine; Dr Paul Jackson, president, Faculty of Sports and Exercise Medicine; Dr Asha Kasilwal, president, Faculty of Sexual and Reproductive Health; Mr Mike Lavelle-Jones, president, Royal cOllege of Surgeons of Edinburgh; Professor Jo Martin, president, Royal College of Pathologists; Professor John Middleton, president, Faculty of Public Health; Professor Lesley Regan, president, Royal College of Obstetricians and Gynaecologists; Professor Helen Stokes-Lampard, chairwoman, Royal College of General Practitioners; Professor Russell Viner, president, Royal College of Paediatrics and Child; Professor Carol Seymour, president, Faculty of Forensic and Legal Medicine; Dr Nicola Strickland, president, Royal College of Radiologists; Dr Carl Waldman, dean, Faculty of Intensive Care Medicine