(An article by John Furse – LRB, 7th November 2019.)

The Americanisation of the NHS is not something waiting for us in a post-Brexit future. It is already in full swing. Since 2017 Integrated Care Systems (ICSs) have been taking over the purchasing as well as the provision of NHS services in England, deciding who gets which services, which are free and which – as with the dentist and prescriptions – we have to pay for. Known in the US as Accountable Care Organisations (ACOs), ICSs are partnerships between hospitals, clinicians and private sector providers designed – and incentivised – to limit and reduce public healthcare costs, and in particular to lessen the demand on hospitals. Health Maintenance Organisations (HMOs), the forerunners of ACOs, were pioneered by the US health insurance provider Kaiser Permanente in 1953. President Nixon’s adviser John Ehrlichman explained to his boss the basic concept before the passage of the 1973 HMO Act: ‘The less care they give them the more money they make.’ In May 2016 Jeremy Hunt, then health minister, admitted at a Commons Health Committee hearing that Kaiser was a model for his planned NHS reforms. When a trial of ACOs was announced in the UK in 2017, it caused an outcry from campaigners and NHS England quickly rebranded them ICSs. But the Kaiser model isn’t new to healthcare policy in the UK: it has been the inspiration for the long and discreet process of the dismantling and reformation of the NHS since the 1980s. 

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Stand Up To Cancer scientist, Professor Simon Leedham, is supporting research into an entirely new treatment option for people with bowel cancer by investigating a molecule called GREMLIN1. Watch the following animation, which provides the background to the project…

Our Jazz and Coffee morning on Saturday 22nd June was a HUGE success. Members, especially Erika baked a fabulous range of wonderful cakes. We even had a ploughman’s lunch with delicious home baked bread. The weather shone blissfully, so we could sit in the pretty garden at St Margaret’s Cottage and the band “Work in Progress” provided a background of perfect music for a lazy Summer’s day. Here’s a sound clip of the band, recorded on the day; something  to remind those who were there what a great day it turned out to be.

We had an enormous raffle, again thanks to members’ generosity and to Jim Gray who managed to get local stores to contribute several prizes. Our grateful thanks to all those who helped on the day by setting things up, washing up and clearing away. As soon as we know how much was raised by the event, we shall publish it on this website.

Go to our Photo Album for more memories of the day.

AN EVALUATION

This all-day event took place in the foyer of the ASDA stores in Hollingbury, Brighton.  It was funded by Macmillan.  Our aim was to raise awareness of the first signs of bowel cancer amongst the public and to ensure that they knew what to do should the signs be positive.  It was not a fund-raising event.

The event was a multi-agency collaboration with C-Side working with the following organisations:  The Macmillan Horizon Centre; Albion in the Community (the charitable branch of the Brighton and Hove Albion Football Club); the Sussex Bowel Screening Programme; the Colorectal Nurse Specialist team from The Royal Sussex County Hospital and members from C-Side Colorectal Cancer Support Group.

Twenty volunteers from all the participating groups gave up their time over the day, engaging with the public and distributing leaflets and information.  They were well-prepared with shared information and advice on how to approach the public.    When specific questions were asked about Bowel Screening or advice about Bowel cancer was required, volunteers referred people to our clinical specialists: the Colorectal Nurse Specialists or the Clinician representing the Sussex Bowel Screening Programme.  These specialists recorded some of the  “meaningful conversations” to show our sponsors the sort of impact we were having.  We had a large pull up banner, wore t-shirts that showed a unified presence and a table of information in the form of leaflets and posters. We also had tote bags printed by C-Side in which we could put leaflets, and AITC provided us with even more tote bags and pens as freebies.  Furthermore, ASDA were extremely generous and provided several trays of free fruit to support us with our healthy eating message.

While it is difficult to be precise about our impact, we ascertained that we engaged with more than 1000 members of the public between us during the day.  Even people we did not talk to took leaflets and saw what we were about.  Despite being very busy, the clinical specialists recorded 30 “meaningful conversations” – just a sample of the sort of questions we were asked during the day.  People were generally very agreeable and interested in what we were offering and all involved thought it was a very worthwhile event.

Some specific comments received by participants included:

• It was a well run event
• Volunteers were given a clear direction
• There were more than enough volunteers but the venue (some thought) was restrictive, so that it sometimes felt crowded
• The footfall was high
• The separate, private space considered by the nurses was not possible
• The t-shirts were very effective and immediately identified volunteers
• We had leaflet overkill! Next time (as we hope there will be a repeat) we will be more selective in our choice of leaflets.
• In the future we might do a smaller “pop-up” event in a range of different venues.

C-Side is only a small charity, but we feel it was a very worthwhile event to have run.  While we clearly had an impact on members of the public, perhaps our biggest achievement was to get the different participating groups working together collaboratively to really raise awareness of bowel cancer.

On 30th April one of our members, Don, gave a presentation on Advance Directives. The presentation was as shown below; click into the image then use your keyboard arrow keys or mouse to advance the content. Several links are included showing in yellowish-green text; clicking on them will open the link in a new tab. When you’ve finished with the link’s content, close the tab to return to the presentation.

In addition, here’s two more links to papers related to the subject:-

Advance directives discussion BMJ: Some of the ethical and legal issues

Advance-Decision-Pack-v2.1: Advice on how to go about formulating and establishing these Directives.

Listen to this BBC Inside Health sound clip on Prehabilitation. It’s about 15 minutes in length, but well worth the listening as it describes just how being as fit as possible, before beginning surgery or chemotherapy treatment, increases the favourable outcomes of that treatment.

In thus excellent podcast series Dr Mark Porter demystifies health issues, separating fact from fiction and bringing clarity to conflicting health advice, with the help of regular contributor GP Margaret McCartney. Click on Radio 4 image to see what other health podcasts are available.

To listen to the part of this one, dealing with Prehabilitation, use the play/pause button to play the clip and the volume slider to adjust for listening comfort.

On 29^th March 2013 BBC News on-line broadcast this:-
“All cancer patients should receive a “recovery package” at the end of their treatment offering ongoing support, the Department of Health (DoH) has said. It calls for care targeting patients’ financial, mental and physical needs. Macmillan Cancer Support, which helped develop proposals for a recovery package, estimated that about 200,000 people were not getting a package of support following their treatment.” You can read the entire news report here:  http://www.bbc.co.uk/news/health-21968714

Since then the National Cancer Survivorship Initiative (itself set up in 2008) and Macmillan have developed and refined the Recovery Package; NHS England are encouraging  all CCGs, as a matter of urgency to adopt it. Whilst there is no lack of enthusiasm and support amongst front-line NHS clinical staff, the full implementation of the programme is tardy; during a future meeting we hope to be able to report on the actual progress being made. In preparation for this you are invited to click on the above diagram, you’ll be directed to more details of the Package. In summary it has four main components:-
a) Holistic Needs Assessment & Care Planning.
b) Treatment Summary
c) Cancer Care Review.
d) Health and Wellbeing Events.

For a further description of the Recovery Package and one presented in a slightly more patient friendly fashion click on this; there are one or two faces in it that you may recognise!

The idea of Life Kitchen is simple, but enormously persuasive. As anyone who has undergone chemotherapy will tell you, one of the most frequent and demoralising side-effects is a loss or dramatic change in the sense of taste. Life Kitchen is designed to try to help mitigate that loss, to teach cooking skills and recipes that might restore some pleasure in food, and to do so alongside others facing similar challenges.

Read more about Ryan Riley, who lost his mother to cancer, and his achievements in gaining the interest and attention of well known chefs and TV cooking personalities such as Nigella Lawson, Hugh Fearnley-Whittingstall and Ton Cenci, who features particularly in this recent article in the i newspaper, or this one in the Guardian newspaper.

Presented by Nicola Nye, SSP and Theresa Ayres Lead SSP to Mid Sussex Bowel Cancer Support Group 17th July 2018

The Sussex Bowel Cancer Screening Programme was introduced in 2008 to lower the mortality rate of those people with CRC and bring it in line with the rest of Europe. We serve a screening population of approximately 978,000 people which incorporates two Trusts – Brighton and Sussex University NHS Trust and East Sussex Healthcare NHS Trust. Under the umbrella of Bowel Cancer Screening there are 2 screening Programmes

Bowelscope – once in a life-time Flexible Sigmoidoscopy offered to all those aged 55 years old in our catchment area. This test looks at the left side of the bowel  and can remove polyps which  means you are less likely to get bowel cancer as we know that 70 -80% of bowel cancers start in this area.

Faecal Occult Blood test (FOBt)  – 60-74 year olds

Presently participants complete a home sampling kit called a Faecal Occult Blood test, sending off a sample of faeces to the Screening Hub laboratory in Guildford. The kits are sent out every 2 years and If the sample is positive for a pigment found in blood the participant is offered a clinic appointment with a Specialist Screening Practitioner for review. They are then assessed for suitability for a colonoscopy. In some instances a CT scan of the Colon may be discussed instead.  

Colonoscopy is the gold standard procedure offered because it allows us to diagnose and treat certain abnormalities. A colonoscopy will identify 98% of abnormalities whereas a CT scan of the colon is comparable but could mean a colonoscopy is still required to remove any polyps or take tissue samples.

 The stool test kits are sent out from a central booking hub in Guildford. At a national level there are plans for the FOBt test to be changed to a more sensitive and specific test namely, the Faecal Immunochemical test (FIT). . The age group offered FIT may be extended to include younger patients possibly from 55 years; this is not confirmed at present.

Due to the more accurate outcomes of FIT and the fact that the home test will be easier to undertake the suggested impact on screening will be an increase in uptake. This will result in more referrals for   colonoscopy and increasing support services, in particular the pathology service.   The new test will be easier to undertake at home so it is expected that uptake will increase resulting in more of the Sussex population taking up screening with the benefits of early detection of any abnormality.

At present after the age of 74, people can choose to opt in to Bowel Cancer screening by phoning the Guildford programme hub on 0800 7076060 and requesting to be sent out a test kit.

Those diagnosed with bowel cancer within the screening programme who remain within the age range are offered an FOB test 2 years after diagnosis. At this time, they may still be under the care of the cancer services and may choose not to participate in screening at that time; those overage can also request a test kit by phoning the Hub.

We promote awareness of symptomatic changes in health. Sometimes there are no symptoms of bowel cancer in the early stages. We encourage people to report any rectal bleeding, change in the frequency of their bowel habit and any abdominal pain to their GP rather than waiting for the next round of bowel cancer screening. We encourage people to be aware of life style changes that can influence their health and reduce the risk of bowel cancer; Such as stopping smoking, reducing alcohol intake, increasing physical activity and increasing intake of fruit and vegetables.

The Specialist Screening Practitioners have completed extra training to undergo this role, they are qualified senior nurses who also offer support when a patient is first identified with a suspected cancer and who coordinate the progress of the patient from presenting the patient at the Multi-Disciplinary Meeting (MDM), liaising with the Cancer Nurse Specialists, and organising any further investigations or informing the patient of our suspicions.

Some facts and figures from the FOBt programme

In 2017 in the Sussex programme the uptake was 59.55% (uptake is the number of eligible participants who return the FOBt kit)

The positivity in 2017 was 1.18% (positivity is the number of kits testing positive, from all those returned)

In 2017 the Sussex programme undertook the following investigations:-

663 colonoscopies

44 CT colonogram

20 limited colonoscopies /flexible sigmoidoscopies

Cancers detected since the start of the programme in Nov 2008 to date = 558

The BCSP nationally, since inception in 2006 has detected 29,134 cancers to date.

In Sussex since 2008, left sided cancers detected = 453

In Sussex since 2008, right sided cancers detected = 103

Treatment

Surgical 389

Endoscopic 79 – removal of polyp cancers

Non-invasive 49 – includes chemo/radiotherapy

If you have any questions or would like further information please email BCSP@bsuh.nhs.uk

St Bernard Support (SBS) provides assistance to people affected by life limiting illnesses such as cancer, heart disease etc. The people they help include people diagnosed with life limiting illnesses, their families and their carers. They also provide assistance and training to medical professionals and other organisations (charities, support groups etc) to enhance their ability to support people.

On 14th June and 25th June 2018, SBS will be hosting Webinars covering the following topics at the stated times:-

• 11 am – Pensions
• 12 pm – Wills, Trusts & Lasting Powers of Attorney
• 2 pm – Welfare Benefits

Please contact admin@s-b-s.org.uk or call 0800 7720723 to participate in the webinar. Click on the logo to connect to their website and find out more.