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More for less is no solution in the NHS

The audacity of Chancellor Osborne knows no bounds. Having starved the NHS of much needed funding he now says: 'We have a clear plan for improving the NHS. We’ve fully funded it.'

Nothing could be further from the truth.

Britain's National Health Service is in a financial crisis with more Hospital Trusts in deficit and creeping privatisation eating at core provision.  Despite the government giving £3.8 bn funding up front, NHS England is expected to find a further £22 bn in efficiency savings over the next five years on top of the £20 bn already found. As shown in a previous article, this is affecting front line services with increased waiting times and bed shortages.

Mr Osborne wants to avoid last Christmas' headlines of an NHS unable to meet demand.

Last December, NHS England figures show, the numbers of patients waiting on trollies in A&E trebled from just over 13,000 to 38,848.  Now, the government is trying to avert another Christmas crisis by providing extra emergency funding. All well and good, but it is crisis management of a health service brought to its knees through lack of funding.

We are often told that the strains on the NHS are the result of an ageing population.  It is certainly the case that the proportion of older people has increased and will be increasing.  In 1991 15.9% were over the age of 65 -  now it is more than 16.5% (the 2011 figure). But this isn't the real cause of the NHS A&E crisis.  The NHS is under strain from inadequate resources and from efficiency savings that have eaten into the numbers of beds available. The NHS has been striving to do too much with less, for that is what efficiency saving means.

One of Mr Osborne's commitments is for cancer testing within four weeks. This is welcome if it can be achieved.  NHS England unveiled plans for the new cancer strategy back in February, with a view to saving ‘at least 8,000 lives a year’ through the 'early diagnosis drive'.  We can hope this works, but there are warnings that the system is already overloaded.

It should also be an imperative to ensure that the diagnoses are robust and safe.  There are suggestions this would require a doubling of the number of radiologists.

Earlier this year the Royal College of Radiologists reported that radiology departments "are under considerable pressure to minimise the number of unreported studies while facing additional challenges including shortages of consultant radiologists, other resourcing issues and ever increasing demand."

There is a chronic shortage of radiologists in the UK.  Comparison with other european countries is stark. With 48 trained radiologists per million population the UK has half the numbers in Germany (92) , Spain (112) and only a third of the number in France (130) .  The number of scans performed in the UK remains significantly below those in other countries for most tests. 

It is no surprise then that in some trusts there are tens of thousands of X-rays and hundreds of CT and MRI investigations waiting more than 30 days for a report.

Radiology departments are increasingly outsourcing their reporting work to commercial private companies and/or using expensive locum agency staff to minimise any backlog in unreported studies. These are expensive solutions which impact considerably on NHS finances. In the end it is unsustainable. 

Meanwhile, the chances of surviving five of the most commonly occurring types of the cancer in the UK trail at least 10 years behind many comparable European countries. One of the worst examples is lung cancer.  Survival has certainly improved. Where only 7% of patients survived in the 1990s in the UK this improved to 10% a decade later but this was still behind the 14% survival rate achieved in, for example, Austria in the 1990s. Almost 18% of patients diagnosed with lung cancer in Austria survive - twice the rate in the UK. The proportion of people with lung cancer dying within a year of diagnosis in the UK was 70%, compared with 65% in Denmark, 61% in Norway and 56% in Sweden.

In the past decade the survival rates for breast cancer is 81% in the UK – a level exceeded 10 years ago in Sweden, France and Italy.  It is clear that more can and should be done. 

Macmillan Cancer Support say that too many people are diagnosed too late, are shown a lack of compassion during their care and feel abandoned after treatment.  They call for more focus on reducing late diagnosis,  on prioritising the patient experience alongside clinical matters,  and more effort to enable patients to spend their final days in the place of their choosing and with free social care.  

At the beginning of this year NHS England announced that sixteen life-extending cancer drugs would no longer be available to patients in England after the NHS announced it would not pay for them through the Government’s flagship Cancer Drugs Fund. This was a drastic bid to cut costs, saving £80 million from the budget.

Meanwhile Osborne gives with one hand but takes out more with the other. An NHS under pressure to find a further £22 billion in efficiency savings by 2020 is unlikely to be able to meet the ever growing targets placed on it - more for less is not a solution. 

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