Just read a story about how Labour have been sending out mailshots warning of the Tories plans to cut certain guarantees on seeing specialists within two weeks in suspected cases of breast cancer.

I am curious (I didn't know about this policy before now); does the policy only apply to women with suspected breast cancer or does it apply to all people, regardless of gender and regardless of where the primary cancer might be located, for example, men with testicular cancer or a woman with suspected bowel cancer?

Does the time between initial referral and consultation with a specialist matter less for other types of cancer?

Or is this an example of how Labour's susposed drive for a fairer society is just a fairer society for some groups but not all? (OK everything up to that last part was a genuine, non-troll question so please don't get hooked up on me getting all beligerent in the last sentence 😉 )

http://www.guardian.co.uk/politics/2010/apr/11/labour-cancer-postcards-vince-cable

Breast cancer for all! (?)

Here's why you can't trust journalists.
The BBC reports:

Cards saying the Tories would scrap a Labour guarantee for suspected breast cancer patients to see a specialist within two weeks, were sent to 250,000.

The Guardian reports:

The cards said a Labour guarantee that patients would see a cancer specialist within two weeks would be scrapped by the Tories,

So which is it, just breast cancer or all cancer?

More concerning, I think, is the question of how were the addresses obtained. Was it just a "random" selection from an Experian database, or was it more "selected" from NHS records? It's a little concerning.

Also of concern is the person in the photo on these cards;

She believed her photograph had been taken for use in a magazine for the National Health Service, not as part of Labour’s election campaign.

If the picture was taken for the NHS, then WTF are Labour doing using it? If the picture was taken for Labour, how come sh didn't know?

No wonder she

admitted she had “probably been used by Labour”.

Does anyone else think it odd that parties are supposed to have any sort of "policy on cancer", breast, testicle or otherwise?

The next three and half weeks will be full of this sort of non-story, tiny differences between the parties magnified out of all proportion, while no-one talks about the realities (tax increases and cuts in public spending whoever gets in).

Just ignore it all, it's froth.

It sounds like shit stirring to me.
I can't imagine that a party would be stupid enough to adopt such a policy, or that the NHS would decide that it would abandon all forms of data protection.
I can imagine a party or individual seeking political mischief would suggesting such a thing though.

Was it just a "random" selection from an Experian database, or was it more "selected" from NHS records?

Maybe the Labour Party have released an iPhone app to obtain personal details in contravention of the DPA?

Oh, sorry, no, that was the Conservatives.

Maybe the Labour Party have released an iPhone app to obtain personal details in contravention of the DPA?

Oh, sorry, no, that was the Conservatives.

The interesting thing about that is that Cameron is following Obama's playbook…

Yes but what of the breast cancer or otherwise policy. That's not froth, that's pretty important. If the Labour party has a policy that discriminates one form of cancer over another and on the grounds of gender, then that would be something that would stop me voting Labour.

Like I said, this is not a future fair for all, like always it's a future in which some people get along better than others.

So glad I am in the marginal seat of Rothwell and Elmet. I am half tempted to volunteer for door knocking/leaflet dropping. It's going to be an exciting election no matter who gets in.

A colleague of mine received one of those postcards 5 years to the day after she had her mastectomy. She was not pleased!

I received one a couple of days later. It had my name on the photo side!
The expense of that???????

There certainly *is* a 2 week policy re breast cancer, but I don't know if it's across the board – I'm sure someone on the forum will have some reliable information rather than a bunch of idle speculation.

>More concerning

It'd be a bloody sight more concerning if that *is* Tory policy…then again, I'm not sure I'd expect you to admit that….

My partner had a scare a few years ago – turned out there was nothing to worry about – but was seen within about a week, which was just as well 'cos I was crapping myself far more than she was.

All rather different to how long it took my mother to get treatment, 20-odds years ago (wound up with a mastectomy).

Whilst I have no particular allegiance to either the tory or labour parties, an independant report's summarised that the NHS is in a far better state now than it was in 97 (?)..which is interesting given how many times I've heard the old tory story of what an outstanding economy they'd passed over to labour. If it was that outstanding perhaps they should have put some money in the nhs, public tranport, etc (Fragmented rail network, anyone ?)

The NHS ought to be in better shape. There was a quote on Radio 4 today that we spend THREE times more on the NHS now than we did in 1997. THREE times quite a lot considering that compound inflation can only account for 35% of the 300% increase.

Now I am NOT saying we shouldn't have increased spending because I think we should. But I think asking for greater efficiency and productivity would also be a fair request.

Geetee – I think you need to do your sums again!

We do spend more on healthcare than we did. IMO the best way of looking at healthcare spending is as a % of GDP – in 97 it was 7.8 % of gdp – now up to around 9% IIRC. This is still very low – USA 16%, Germany France Holland around 11%.

One of the issues here is efficiency measurement is hard to do. How can you measure improvements in care in terms of efficiency.

One example would be diabetic care. Syringes and other gadgets for injection and testing are far far better than they were – including the choice of near continuous pumps. This costs money – lots of it. Outcomes are roughly similar, numbers of people treated is roughly similar, cost per patient is much higher. Looks like less efficiency but is actually improved care.

I was only quoting what I heard on the radio, but in absolute terms, if the budget was 7.8% of GDP and is now 9% then that would be an increase of about 2.5 times. Take inflation into account and you've got a budgetary increase of about 2.2 times.

I completely agree with how hard it is to measure 'efficiency' gains but that doesn't mean we shouldn't try. The public sector is huge in the UK and one of the biggest challenges with it is that there is no 'in built' efficiency mechanism as there is in the private sector with profit. If you don't have some mechanism by which you instill a need for effeciency then you won't get it.

Mr Wanless said: "If our health services are to meet people's expectations and deliver the high standards over the next 20 years, we need to devote a significantly larger share of our national income to healthcare.

"But money on its own is not enough and provides no guarantee of success – it is essential that resources are efficiently and effectively used.

"Resources and reform must go hand in hand – and both are vital. Neither will deliver without the other."

From 2002

If you don't think there is mechanisms in place to drive down costs int he NHS you are mistaken.

Wanless is a plonker – reform is wasting money.

You still have basic assumptions wrong in your sums.

OK arse wipe:

Wanless was the guy who recommended we should be spending upwards of 12.5% on the NHS at a time when we were spending only 7%. Doesn't seem like much of a plonker to me.
And how the **** can you possibly know what assumptions I've made in my sums? Apart from the fact that I was basing it entirely on your statement of spending as a percentage of GDP?

You sums simply dont add up. its as simple as that. What figures are you taking for GDP now andd in 97? What figures for inflation?

There are some major mistakes in how you work the figures out I believe – lts see some real numbers?

GDP now and in 97

Inflation figures – prices now and then,

One example would be diabetic care. Syringes and other gadgets for injection and testing are far far better than they were – including the choice of near continuous pumps. This costs money – lots of it. Outcomes are roughly similar, numbers of people treated is roughly similar, cost per patient is much higher. Looks like less efficiency but is actually improved care.

if outcomes are roughly similar, and numbers treated are roughly similar, whats the benefit of the new pumps – other than being shiny, costing more, and having internal diameters of BD syringes preprogrammed so you don't have to look them up?

And yes TJ, I've used enough infusion pumps to comment on this one 😉

Edited to add – why is %age GDP the best way to measure it – the UK has a significant proportion of its GDP produced by international financial services that channel through London, meaning that 8% UK GDP is comparative to around 10% of GDP for a similar sized foreign nation

Ease of use. comfort – and I might have been unfair about he outcomes – there will be marginal improvements as control will be better leading to less side effects. That will be marginal

But the main improvement is in quality of life for the people living with diabetes. Pumps for example – you put a cannula in once every couple of days and leave it there – and the pump will give continuous infusions with a bolus when needed – so for one jab with a needle you get the equivalent of many many injections.

click pen injection devices are easier to use – and can be done by touch so blind diabetics can use them independently

Why % of gdp – 'cos we obviously want the best healthcare we can afford and a % of gdp is a good way of seeing how afffordable our healthcare is.

I've never found %GDP a useful measure of spending: it implies that spending should always grow, not because it needs to, but because it can — because fiscal capacity has grown. Indeed, so long as spending growth does not exceed growth in the economy, it is deemed not to have grown at all.

It seems to me a more meaningful yardstick would measure spending, not against national fiscal output , but against the needs to which it is put: the real cost of services to each of its citizens, which is spending adjusted for inflation allocated on a per capita basis.

%GDP is volatile, it means that %figures shoot up in a recession although absolute sums might remain unaltered, and the opposite effect during economic boom.

Don't work with healthcare tho cos its a bottomless pit and an endless spend – we could easily spend twice as much as we do.

If the demand is virtually unlimited then there spending has to be capped somehow – for me the cap should be what we as a country can afford and theat is best measured by a % of GDP.

Zero waiting lists, free care for all elderly, latest most expensive drugs etc etc.

Its not a finite need – there is always an improvement can be made at a cost.

Diabetes is a very good example. For many people the pumps really are better, but it's not something that you can easily measure. A diabetic having trouble with their control is basically a medical timebomb, diabetic complications can be enormously costly to deal with. The pumps are supposed to be easier to get good results with (I don't know, i don't like the idea and I get on fine with injections)

But if a hospital issues a pump today, what improvement do they see? What target is improved? Absolutely none. There's no NHS target that says "The HbA1C of Patient X was reduced to a more satisfactory level, which will hopefully stop him developing heart disease, glaucoma, or gangrenous extremities"- and no way of knowing exactly what the long-term impact is- but there is a target that says "How much did you spend today".

Seems to me that most practical cost-accounting methods for the NHS will always undervalue preventative medicine, because they can only account for the cost today, as the potential future saving is essentially unknowable.

for me the cap should be what we as a country can afford and theat is best measured by a % of GDP.

But on that basis, you'd be advocating that in time of recession, when GDP drops, we should spend less on healthcare? 😯

Another example, one close to my heart… Well, not my heart, my leg.

When I broke my hip, I got a very modern MIS op to place the bone in traction in-situ (basically, bolts in the leg), whereas 5 years ago I'd almost certainly have got a hip replacement. Now, your hip replacement is a very routine op, that gets patients out the door and on the move again quickly and cheaply, it just happens to have a poor short-term prognosis of loss of strength, mobility, and functionality, and an even worse long-term prognosis of repeat surgery (the lifespan of the replacement is about 10 years in an active person) with diminishing returns each time due to the levels of trauma. (not usually a concern as most people getting hip replacements are older… I was 26)

The alternative meant more highly well trained surgeons, far longer in theatre, some patient-specific tooling, and more initial hospital time. Then, constant follow-up appointments for 5 years, and a vast amount of more intensive physio. The cost of the op and aftercare is, I'm told, roughly 6 times the cost of a half-hip replacement.

But the result is basically a new leg, I'm not 100% but I'm pretty damn close. Put a price on that.

And then, once you're done costing up my life, tell me how you recognise what the NHS did for me- because frankly, all they got out of it so far was longer waiting lists and a hole in the budget. Over the next 50 years or so it'll start to balance out but it'll never be the cheaper option, and there's absolutely nothing on paper or in their results or in Downing Street that says "Andrew Cunningham can ride a bike because of us, he can run because of us, he's been spared a lifetime of traumatic surgery because of us, and if he has kids he'll be able to play football with them and dance at their weddings because of us"

But instead they have people saying "Why is the NHS so expensive"

Nicely put Andrew!

Channel 4's fact check on the labour claims Here

Cancer referrals still require prompt & accurate diagnosis though, which for the "orphan conditions" doesn't really happen as well as the headline conditions.

*** FACT Alert *** – for the OP

All referrals from GPs to hospitals where the GP is 'Suspicious' of cancer, have been seen by the hospital in 14 days (not working) since 2001. Not just breast cancer. Called the 2 Week Wait. This target is now so ingrained in NHS culture, the gov is making it a legal requiremnt to acheive.

Since 2006 2 further cancer targets were imposed, first is a 62 day wait. If you were referred in as a 2week wait by your GP and you are diagnosed with cancer, then you must start your treatment within 62 days of the GP referring you.

The second is that if you have been diagnosed with cancer via any other route, then you must start your first treatment within 31 days.

Since 2009, these targets have been strengthened further, so now if any clinician 'thinks' there may be cancer, the 62 day pathway gets initiated, and secondly, as most cancer patients usally have more than one treatment, all subsequent treatments must aslo happen within 31 days (of agreeing a treatment plan)

The requiremnts I outlined above along with many others since 1997, are all part of the (boo hiss) Targets that are so hated by the media and Tories. (And many staff in the NHS as it makes them work harder, or do something different i.e. CHANGE, which they hate)

They may not be the best way to get improvements in healthcare and to measure the effectiveness of the additional resource spending, but they have been incredibly effective at reducing the ridiculously patchy nature of care that was inherrent before, and in ensuring that people get the right treatment in a timely manner.

The Tories stated position is that they hate targets and want to remove them. They would rather return to the early 90's where previous autonomy in the NHS combined with chronic underfunding caused extended waiting times as it allowed better expenditure control. (If you keep em waiting (2+ yrs), they're either less likely to miss appointments, or will die before treatment)

TinMan – thanks for clarifying that (assuming you're right of course 😉 which I am sure you are).

TJ, serious question to someone who works in the NHS (you do don't you ?)

Based on Tinman's two posts above, and hypothetically of course, which way would you as an NHS employee rather I voted – for Labour who will uphold these targets or the Tories who may well be planning to abolish them?

Northwind – Member
Diabetes is a very good example. For many people the pumps really are better, but it's not something that you can easily measure. A diabetic having trouble with their control is basically a medical timebomb, diabetic complications can be enormously costly to deal with. The pumps are supposed to be easier to get good results with (I don't know, i don't like the idea and I get on fine with injections)

But if a hospital issues a pump today, what improvement do they see? What target is improved? Absolutely none. There's no NHS target that says "The HbA1C of Patient X was reduced to a more satisfactory level, which will hopefully stop him developing heart disease, glaucoma, or gangrenous extremities"- and no way of knowing exactly what the long-term impact is- but there is a target that says "How much did you spend today".

Seems to me that most practical cost-accounting methods for the NHS will always undervalue preventative medicine, because they can only account for the cost today, as the potential future saving is essentially unknowable.

OK, the guidance for which people with diabetes who start pumps are layed out in a NICE technical appraisal, so initially only people who have issues with diabetes control (HbA1c or frequent severe hypoglycaemia requiring assistance) are those who are targeted in this country.

In terms of improvement for people on pump then the obvious measure is a sustained improvement in HbA1c, which can be quite a tight target in adults, sub 6.5% for some, or a reduction in the frequency of severe hypoglycaemia.

In terms of who an insulin pump would suit then out of the Type 1 population it's probably less than 20% of all those with the condition, many people as you state are fine with their current regime and don't want/don't like the idea of pump wearing. In some respects that is why the NICE TA is there, as with initial purchase costs, ongoing consumables etc the cost to the NHS of pump therapy would be extortionate, and considering that diabetes management & the management of associated conditions has been qouted as being as much as 10% of NHS budget then the technological advances do need policing in some way. Once the closed loop or even semi-closed loop pumps start to come through then the whole TA will need reviewing again as the costs will jump yet further.

geetee1972 – Member

TJ, serious question to someone who works in the NHS (you do don't you ?)

Based on Tinman's two posts above, and hypothetically of course, which way would you as an NHS employee rather I voted – for Labour who will uphold these targets or the Tories who may well be planning to abolish them?

Me personally? Tactically on an anti tory line – IE for the party most likely to defeat sitting tory MPS or the candidate most likley to win that is not tory.

Strangely enough tho I have known many Tory supporting nurses over the years – despite the clear detriment to the NHS of Tory governments

Lets face it, neither govt will keep their promises over healthcare, so in some ways it's irrelevant who to vote for.

Remember Labour and the promise to do away with PFI? Who built the hospital wing that GB was stood in launching the manifesto? A PFI, my trust has just been rebuilt under a PFI meaning it's now got a massive 25 year mortgage and the support staff are no longer NHS but privately employed.

There are many employed within healthcare from all roles who don't support Labour, I'm fed up with paper exercises and cheesy dickhead politicians of all sides showing up on sunny days to have photos taken. **** off Burnham, you're a ****!

no wonder most people either vote for personalities or can't be arsed to vote at all

Lets face it, neither govt will keep their promises over healthcare, so in some ways it's irrelevant who to vote for.

Sadly, probably the most accurate statement of the thread 😥