Tom Goodfellow

New cancer target: idiocy in glorious technicolour

When they were young my children’s favourite show was Joseph and the Amazing Technicolor Dreamcoat.

We went up to London twice to see it (with Jason then Phillip), and the tape of the songs was played on every car journey for some years – we all knew the words backwards.

For those unfamiliar with the Biblical story it is a “rags to riches” account of a young man who rises from being an imprisoned slave to become the ruler of ancient Egypt, second only to the Pharaoh himself. For those interested in the history I would recommend Pharaohs and Kings – a Biblical Quest by the Egyptologist David M. Roal (Crown Publications) which was also made into a Channel 4 production some years ago.

Whether you believe it to be fact or fiction the story of Joseph contains many interesting lessons, the chief one being that if you are aware that a crisis is approaching then it is prudent to take well thought out remedial action of some sort to mitigate the effects of the disaster, in this case an approaching seven-year famine affecting the Middle East.

Thoughts of impending disaster brings me to the current state of the NHS. Thankfully the political party conference season is over for another year although we have the looming cloud of the election campaign to face next year. The NHS, we are told, is to be a key campaigning issue and politicians of all parties are almost wetting themselves in their enthusiasm to tell us how much they ‘lurve’ the NHS – the jewel in the crown of the (only just) United Kingdom (wild applause and cheers from the party faithful).

Anyone who dares to suggest otherwise is clearly an unmitigated wretch and heretic.

Indeed last Saturday, Ed Milliband announced the introduction of another wretched target. “The Labour Party is to pledge that by 2020 no-one in England will wait more than a week for cancer tests and results if it wins the next election.” This will be funded by extra tax on the tobacco firms, and will save up to 10,000 lives per year (the evidence for this last statement being somewhat unclear).

However earlier in the month Dr Giles Maskell, the president of the Royal College of Radiologists, sent a letter to the CMO’s in all trusts basically stating that radiology in the UK is at breaking point, and indeed has broken down in some places. The reason is simply that the demand for complex imaging (CT, MRI) has been rising at 10-12% annually for at least a decade, and unfortunately this has not been matched by a similar increase in resources (an understatement if ever there was one).

Specifically there is now a significant lack of consultant radiologists – increasing numbers of posts are unfilled, and we have almost the lowest number of radiologists per 100,000 population in the developed world! Despite modest increases in training numbers this will not address the likely shortfall.

In addition to the reporting backlog there is difficulty in supporting the cancer MDMs which are also increasing in numbers of cases and complexity, and where the radiology input is in frequently crucial to patient management. Due to sudden long term illness, one of my colleagues told me last week that she is facing the prospect of running the radiology of the lung cancer MDT single handed – generally over forty patients per week; many cases referred in from other hospitals. This work load is unsustainable and there is no one else to help her.

But this situation has not just suddenly emerged. Many radiologists and the royal college have been shouting about the impending disaster for some years both at local and national levels, but these warnings have fallen on political deaf ears while they assure us that the NHS is “safe in our hands”.

Exactly the same story is being told by virtually all other specialities in primary and secondary care and also by the allied health professions. A seven day turn around for your “cancer test results” seems a bit pointless if you cannot get a GP appointment for weeks! Many warnings on the impending demographic and funding crisis have been given, but listen to the inanities spouted by the politicians one quickly realises that their heads are firmly inserted ‘where the sun don’t shine’. All they are interested in is political sound bites and winning the election.

The breathlessly enthusiastic shadow health minister, Liz Kendall, burbled on during a Radio4 interview on Saturday morning about their wonderful exciting plans to er…“reorganise” (yes she used that word) how health care is to be delivered by the next Labour Government. Her response to the challenge of the impending £30 billion black hole in NHS finances was disappointingly little more than “care in the community” – do you remember that one?

Now anything we can do to reduce the flood of patients turning up at the front door of the hospital would be welcome, but given that the ‘famine’ has been predicted by so many for so long it is ultimately depressing that so little or indeed nothing has been done to address the problem other than a lot of hot air. There seems to be no sensible joined up thinking at the political level as to how to plan or finance the service and Milliband’ s seven-day cancer target is political posturing at its worst.

No it is worse than that – it is sheer stupidity, and the man takes us for idiots that we cannot see through this.

Not that the other lot have done any better. Recently senior members of the government admitted that the reorganisation of the NHS by the Health & Social Care Act, costing £3 billion, had been their biggest mistake causing “profound and intense damage” to the service. George Osborne has stated that he really did not realise what Lansley was doing otherwise he would have pulled the plug! Oh dear me – why didn’t somebody warn him (irony)!

So we are left with a government who have admitted that they have completely f**ked up the health care system, and an opposition who are so disconnected from the coal face that they cannot distinguish their arse from their elbow. Hardly an encouraging scenario!

The Biblical story says that God gave Pharaoh a dream which only Joseph was able to interpret and so predict the impending famine. However we don’t need dreams to warn us that troubled times are ahead – the omens are all too clear. Perhaps we should all pray for another Joseph to rise up, with or without a dreamcoat, to come and lead us out of this mess.

Dream on!

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