The NHS Dismantled – In Support of the Original Article

On 7th November we copied an article published in the LRB (London Review of Books) by John Furse which outlined what in his view is the ongoing threat to the NHS posed by privatisation. In a subsequent edition the LRB published two letters criticising the article. The authors of these two letters were Helen Buckingham (a Director of the Nuffield Trust) and Mary Guy (a lecturer at Lancaster University). In the next edition of the LRB the following letter was published by Roy Macgregor (a front-line GP) applauding and supporting John Furse’s original proposition.


As a GP, I sighed with relief reading John Furse’s article on the NHS. No lies on the side of a bus, just home truths. The critical letters the piece received in response do not reflect the changes that have already occurred on the frontline.

Frank Dobson, as Tony Blair’s first health secretary, oversaw the introduction of the National Institute of Clinical Excellence (NICE), intended to help end the ‘postcode lottery’ in the availability of treatments. It has been a partial success but huge variations in availability of treatment remain. What has followed is an ever increasing barrage of guidelines, pathways and directions for clinicians, setting the parameters for what they can and cannot do. Young doctors and nurses, with no memory of any other way of doing things, treat these guidelines as if they were rules while general practice has been transformed into a Kwik-Fit operation that doesn’t give you the freedom to choose even the tyres your patient should have for their onward journey.

An elderly patient with a bad head injury attending casualty is seen by a triage nurse who is obliged to follow specific guidelines. He is treated for a facial cut and broken nose. But severe symptoms persist for four weeks. Only when he returns to see a doctor is a CT scan requested. The scan explains the symptoms. Had he been just a few months older at the time of the accident, he would have been old enough to qualify automatically for a CT scan.

Ankle and knee injuries used to be judged on their severity and other factors specific to the patient. Now the only pathway permitted is to direct the patient to make contact with his local ‘musculoskeletal service’, which is delivered by an outsourced private, profit-driven provider. After telephone consultations, he may, eventually, get to see a physiotherapist; only then might he be referred to an orthopaedic consultant. This may be more than six months after the initial contact. What cost the time off work, the limiting of mobility and exercise, the weight gain, the consequences for the patient’s mental health?

Another patient survives a heart attack because someone in the community performs CPR on her. After being taken to a major hospital, she is given a full cardiological and pulmonary work-up. Two weeks later a request arrives to refer the patient to cardiology for review. When the question is asked what blood tests or other cardiology tests were done when she was admitted the answer is none. New referral, further costs, more anxiety for the patient and her family.

The NHS is being dismantled, and the effects are felt daily by patients and staff alike. Everyone is struggling to practise safe care. So long as sensible thinking and commonsense selection of tests and referrals – specific to each individual – are excessively restricted by guidelines and by fears over costs, we will all suffer; and in the end, no money will have been saved.

Roy Macgregor
Cambridge

How do cancer cells remain dormant for many years?

This pretty little thing is, in fact, a cancer cell!

An interesting question is ‘How do cancer cells remain dormant for many years?’ It’s an unfortunate fact that, despite apparently successful treatment, cancer can sometimes come back many years after diagnosis. And this could be because some cancer cells enter into a hibernation-like state, called ‘dormancy’. “What it means for a cell to be dormant is essentially that it’s not dividing,” says Dr Simon Buczacki, a bowel cancer expert who specialises in dormancy. To learn more about this read this blog from Cancer Research UK …

The NHS Dismantled – How It Happened

(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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C-Side Christmas Lunch 2019

Our Christmas Lunch will be on November 26th at 1.00 p.m. at St. Margaret’s Cottage.
Here is our delicious menu. If you would like to, please feel free to “bring a bottle”.

 

Beating Cancer With Gremlins

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…

 

 

 

Coffee & Cake Morning Fund-Raiser, June 2019

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.

Bowel Cancer Awareness Event- Saturday 6th April, 2019

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.

Advance Directives

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.

Prehabilitation – Improving Cancer Treatment Outcomes

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.

Bowel Cancer Awareness Event in Brighton – April 6th 2019

Many of you reading this, either yourself or someone you know, will have been affected by colorectal cancer. Either directly or indirectly, you will have experience of the presentation of symptoms and the subsequent diagnosis and treatment of a worrying disease. You will know, but many others may not, that despite Bowel Cancer being the second biggest UK’s killer cancer it is eminently treatable and curable, especially when diagnosed at an early stage.

It is vital, then, for the general good that the public become aware of Bowel Cancer symptoms – some of the more common amongst which include:

  • Bleeding from the bottom and blood in poo
  • Persistent and unexplained change in bowel habit
  • Sudden and unexplained weight loss
  • Being easily fatigued with no obvious reason or cause
  • Pain or a lump in the tummy

April has been set aside nationally to educate the public and raise awareness of these symptoms. Bowel Cancer UK have taken the lead in this and have a variety of educational and awareness programmes set up for April, this link shows their strategy.

For its part C-Side (being representative of Bowel Cancer patients in the Brighton area) felt that there might be more that could be done locally. So, in association with Albion in the Community (AITC), Macmillan Horizon Centre and Bowel Cancer Screening & Colorectal Nurse Specialists from the Royal Sussex University Hospitals, we decided to present a Bowel Cancer Awareness Event here in Brighton. The management from ASDA supermarket in Hollinbury have kindly offered the use of their foyer where we (volunteers and clinical experts) will be on hand to answer questions from the general public on matter related to Bowel Cancer, with the particular objective of educating them in identifying the symptoms listed above, should they ever arise. The event, on Saturday 6th April 2019, will take place from about 10.00 a.m. to 5 p.m.