16th September 2015

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New Health Chat

1st December King's Fund 5.30pm

Janet Davies CEO and General Secretary of the Royal College of Nursing.

Discusses the future of nursing, safe staffing, Vanguards and the 5YFV

Tickets... here.

Nearer to the end
News and Comment from Roy Lilley
Cancer. The word leaps off the page. Heart attack, stroke we need to fear them all but there is something about 'Cancer'. It is a word we pay particular attention to.
The word makes us sit up straight... living under the cloud of its discovery? I'm not sure how I'd cope. The thought that something was growing inside me... angry probably.
It can bring out the best in people; discover their hidden strengths, become unbelievably brave. The aura that cancer has, the spectre it creates makes people run marathons, make jam, raffle their stuff, sell greetings cards and pass on unwanted clothing.
Once a word that was only whispered. In hushed tones the reputation of this silent killer was forged from the lives of patients it stole and wrought on misery of those left behind.
Cancer's repute has been on a roll since Hippocrates used 'carcinos' to describe a non-ulcer forming tumour. Earlier, the Egyptians wrote of cancer on papyri, from sources believed to date back to 2500BC.
Of all the conditions Cancer has been the subject of, perhaps, more misunderstanding and mystery than anything else. It wasn't until 1902 that a German zoologist moved us on. Theodor Boveri suggested that mutations of chromosomes could generate cells with unlimited growth.
Cancer has been the back drop to healthcare history and the icons whose life's work have made vivid account; Marie Currie, Janet Lane-Claypon, Richard Doll and Austin Bradford Hill.
Cancer; the disease we 'battle', and 'fight'. Over the years millions of investment, taxpayers money and the public have been poured into the combat. After heart disease comes lung disease, in the top ten causes of death. Cancer occupies half the places on the list.
Politicians pick-up on public fear and 'do something'. There has been a plethora of cancer 'do-somethings'. The latest; 95% of people should be given a cancer diagnosis or the 'all-clear' within 28 days of GP referral.
Amongst all the other pressures and must do's and targets the NHS achieves, this latest one is thought will cost 300m a year and must be achieved by 2020. Beware; it is not a target it's 'simple promise'. I have no doubt the NHS will deliver. It usually does.
This 'promise' supplants its predecessor; seeing a specialist in 2 weeks. Experience would seem to show that it is being achieved but patients then wait ages for test results and may not get their treatment started within the recommended 62 days.
Targets... promises... be careful what you wish for.
Where are we in the international context? Some say we lag behind, other data shows we are among the best. It seems to depend on which cancer.
In a world league table the UK came third in cancer research. That said; in the past ten years, despite the investment, we are still behind France and Germany for 5 year survival rates. We are improving but so are they; apparently the gap is not narrowing.
It seems our problem might be due to late diagnosis. Symptoms can be embarrassing; GPs don't get to see that many cancers a year and may miss some, hence variations in performance across the NHS... pick a reason.
Feeling yer bits, poking yer parts, spooning out the kazi... nothing for the feint hearted.
Is there any good news? Yes. PHE tell us, today, the proportion of cancers diagnosed as a result of emergency presentation at hospital has decreased and the proportion of cancers diagnosed through urgent GP referral with a suspicion of cancer (known as the two week wait) has increased.
In 2006 almost one in four cancers, were diagnosed as an emergency. In 2013 this figure fell to one in five. This is against a rise overall in the numbers of cases of cancer.
For a common cancer like lung, the proportion diagnosed through the GP two week wait referral route increased from 22% in 2006 to 28% in 2013.
A positive trend? Certainly but I am left wondering...
Doctors can't diagnose our symptoms if we don't reveal them. Are we too shy, too stupid? Too busy, too dumb? NHSE has a new 'strategy'; six points (too many) of which only one matters ... earlier diagnosis.
Diagnosis is burden enough and not the end, it is just the beginning.
But... we need to find much better ways to bring the beginning nearer to the end.

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