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Hello, this is Professor Karol Sikora who talks about the long-term plan of the NHS.
It is a 134-page document that was published two weeks ago.
And I will talk specifically about cancer. But just a few general points. The first point is clearly what's wrong with the NHS, it's the silos of community care, primary care and secondary care. And many of them are interested in it, and rightly so, it's something that needs to change. The second feature of the NHS that is really poor is its information technology. And again, that answers that. So, these two points, fantastic.
The third point is much more difficult and much more inexplicable. In disadvantaged areas, men live up to the age of 73, and in affluent neighborhoods, they live up to 83 years. We all know that this is a combination of factors – smoking, diet, exercise, work history, and so on. How to return to normal is a huge challenge.
And then the fourth thing is, he talks about the [budget] settlement of 3.4% per year for the next 5 years, but this is not going to deal with medical inflation. And as we will save 1% on efficiency gains, I have been the clinic director for 15 years in West London. There is more money to save without reducing the quality of service.
So, very difficult.
Constructive criticism
The problem with the report – it's easy to hit it. It's a lot harder to find something constructive.
The things that he does not mention; there is no mention of the private sector. And yet, much of what we do in the NHS is done by the private sector, whether it's cleaning hospitals or clinical services, routine surgeries, for example in private hospitals in the country.
But let's look at cancer. So it's a short section on cancer and it comes largely from the excellent report from Mike Richards that I spoke to about a month ago. And, fundamentally, the long-term plan aims to significantly reduce the number of patients with stage 3 and 4 cancer by 2028, or 10 years. In fact, it is clear that patients with stage 1 and 2 cancer will constitute three quarters of all cancer manifestations. Is it achievable? So, how are we going to do it?
First, we will discuss screening programs – intestinal screening, HPV testing – we will ask Mike Richards to come back and write a report on current cancer screening programs.
In reality, it will not make a huge difference. Screening, no matter how well applied, misses many non-compliant patients who do not show up when they have symptoms. So it's not that simple, and the numbers he's contributing to are relatively small.
Then we will look at lung cancer, especially in disadvantaged areas, and install CT scanners in parking lots. It does not seem very productive to me. There is not a lot of good data suggesting that routine scanning of patients with a history of smoking saves lives. And what's there, is quite controversial. And it's a pretty expensive way to do it.
And again, you have the chosen bias, the people who come for CT are the same people who would turn to their GP if they coughed.
Rapid diagnosis
But the best idea here, and it's really a good idea, is the rapid diagnostic services. The idea of going to a one-stop shop where your symptoms may appear, if you have seen them for a long time, thoroughly examined, examined not by a doctor, but actually made the subject of investigations . You can have an endoscopy, an imaging, an MRI, a scanner or even a scanner. And the idea is that the waiting time to eliminate cancer will be 28 days. That's the only weakness in all of this. In America, you would sue if you had to wait 28 days to determine if your symptoms are due to cancer.
We must speed things up. There is no reason why this should not be done within 1 business day. It's actually cheaper. The patient arrives in one place, brings a book and after three hours he is back on the street, with a report suggesting that he has or not has cancer. So great. The concept is great. What is clear in this report is how you are going to implement it. Are you going to use the facilities of the hospital? The 10 pilots actually use hospital facilities. This means that you have to compete with hospital visitors to get a parking space, that you have to compete with CT emergencies, and so on. It would be better to put them in non-traditional places. No parking, no vans in the car parks. Build it for everyone. Place patients with lung cancer, not in the parking lot, but in the rapid diagnostic center. Get everything simplified.
The real thing he just does not talk about is who will do the referral? How is it going to be done? And it will be deployed in 2019, it is this year. And there is no detail on who will be referring. Can I get in and get a scanner tomorrow if I cough? Who will filter me so as not to waste NHS resources?
We all know the "well worried". When I was clinical director at Hammersmith, we covered very disparate fields. Windsor was the first to report all its problems, then the much less affluent people in Harlesden, at Central Middlebad Hospital, who would stay for months with a cough or other symptom and not disturb the NHS.
We have to work around the diversity of customers we have to do.
So, can we really get a quick diagnostic system? We need criteria, we need to avoid people who have a headache to go back for more and more resource-consuming CT scans. We need a mechanism to make it work and it's very light in that.
OK, give him a chance. That's the plan – fast diagnostic services. Let's do it. The real weakness goes back to the beginning of what I said – the content of the report attempts to break down the barriers of community, primary care and secondary care to try to get a streamlined and streamlined service. If you have a quick diagnostic service, how will the main system and the community system interact with this service? Because it is there that it must come. People can be educated, we can tell people that if you have certain symptoms for more than 2 weeks, you should do something. But now, it may take you a month to get a doctor's appointment. And we all know from reading the newspapers that the number of GPs over 50 years old has never been higher. So we are going to have a crisis in general practice. So we will have to find another mechanism for the gatekeeper function of the rapid diagnostic service.
These are all problems that are not addressed here. But it's a good start. And I think that with the right people behind and the funding, which is absolutely essential for it to work, we can create a diagnostic service. In Europe, France, Germany, Italy, you will not wait more than a week for a cancer diagnosis. You would have your endoscopy, you would have all your imaging done and the biopsy report on the table. Here, it can unfortunately take several months to get there. And it is almost certainly, as the report says, the reason for the low survival rate of cancer here in Britain compared to the rest of Europe.
It's not that we do not have access to expensive drugs, CAR-T cell therapy, proton therapy, that's not at all that. It's just a late diagnosis, stage 3, 4 diagnoses. So this report sets out the problem, it states a solution, but not the mechanism to reach the solution.
I suppose we oncologists will have to help put the plan into action.
If you have comments on what I just said. Please, let me know. I would be very interested to see what you think about the rapid diagnostic services described in the plan.
Thank you.
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