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Press releases Saturday 14 January 2006

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(1) CANCER PATIENTS PUT AT RISK BY SHORTAGE OF RADIOTHERAPY STAFF

(2) ROBUST MONITORING IS CRUCIAL TO PATIENT CHOICE

(3) NEW SCHEME WILL HELP LONDON’S MOST VULNERABLE PEOPLE

(1) CANCER PATIENTS PUT AT RISK BY SHORTAGE OF RADIOTHERAPY STAFF

(Cancer care: waiting for radiotherapy)
http://bmj.com/cgi/content/full/332/7533/107

Many radiotherapy departments in UK hospitals are heavily overstretched, resulting in long waits for cancer patients which may be jeopardising treatment, says a paper in this week's BMJ.

Radiotherapy treatment can be as successful at tackling some cancers as radical surgery, and often has the advantage of organ preservation. But waiting lists are severe in many radiotherapy departments, and although radiotherapy services in the UK offer high quality treatment, say the authors, they are often less able to cope with the volume of patients needing radiotherapy than other developed countries, and indeed many poorer countries.

For patients with a realistic chance of beating cancer, studies show that delaying treatment hampers doctors’ ability to tackle the disease, report the authors.

With cervical cancer, for instance, a longer waiting time for radiotherapy reduces the chance of the patient’s survival. And for head and neck cancer, patients waiting more than six weeks for post-operative radiotherapy are three times as likely to have the cancer recur. For breast cancer, patients are at a 60% increased risk of the disease returning if the delay between surgery and radiotherapy goes beyond eight weeks.

Despite considerable investment in radiotherapy equipment in recent years, a shortage of specialist staff - radiographers, physicists, and dosimetrists (specialists in radiation dosage) - means that hospitals cannot cope with the rising demand for radiotherapy treatment. More training places are being created, but that does nothing to remedy current staff shortages.

Many hospitals have already done all they can - including adapting staff rotas and skills mix - to optimize staff cover. Where possible patients are also transferred to other hospitals with more capacity to treat them. But removing them from the care of their local team of doctors can bring other problems for patients.

Doctors and radiotherapy managers are faced with the difficult decision to prioritise patients, say the authors, with no clear national guidance or precedent for the unpleasant choices that have to be made.

The time has come to agree a national policy to tackle these issues, say the authors, a strategy not subject to political timetables or funding waves. Avoidance of such a discussion is no longer an option, they conclude.

Contact:

David Dodwell, Consultant in Clinical Oncology, Cookridge Hospital, Leeds, UK
Email: david.dodwell@leedsth.nhs.uk

(2) ROBUST MONITORING IS CRUCIAL TO PATIENT CHOICE

(Letter: Good quality monitoring is crucial for informed choice)
http://bmj.com/cgi/content/full/332/7533/118

The monitoring of care provided under the new patient choice scheme in England is poorly structured and variable, warn two ophthalmologists in this week’s BMJ.

They believe that robust monitoring of standards is urgently needed so that patients can make a truly informed choice.

Under the new patient choice scheme, all primary care trusts in England were obliged from January 2005 to offer patients a choice of providers for cataract surgery including NHS trusts, diagnostic and treatment centres, and independent sector providers from the UK and overseas.

Following concern about variations between different providers of cataract surgery, the authors surveyed the leaders of patient choice for each primary care trust in England asking how they monitored the quality of care from their providers.

Of 125 respondents, more than half relied on non-specific and service level agreements or patient feedback to monitor the quality of cataract surgery.

The public expect that safe cataract care should be commissioned for them, and robust methods of monitoring need to be agreed and implemented so that patients can make a truly informed choice, say the authors.

These decisions need to be made not only for cataract surgery but also for other elective procedures that will increasingly be made available to patients through the patient choice scheme, they conclude.

Contact:

Paul Brogden, Specialist Registrar Ophthalmology, Department of Ophthalmology, St James’s University Hospital, Leeds, UK
Email: paul@paulbrogden.freeserve.co.uk

(3) NEW SCHEME WILL HELP LONDON’S MOST VULNERABLE PEOPLE

(Project: London – supporting vulnerable populations)
http://bmj.com/cgi/content/full/332/7533/115

(Editorial: Primary care for refugees and asylum seekers)
http://bmj.com/cgi/content/full/332/7533/62

This month, the medical humanitarian organisation, Medecins du Monde UK, launches Project: London, an initiative to help vulnerable people to access health care. In this week’s BMJ the founders explain why such a scheme is needed, while an editorial explores what this says about society’s attitude towards marginalised people.

Providing health care to marginalised groups is an integral part of Medecins du Monde’s work in developed and developing countries, write Karen McColl and colleagues.

Some people in the UK, such as homeless people and female sex workers, find it difficult to access health care, while tougher restrictions on entitlement to NHS care are a barrier for migrants.

It is well known that there is a growing health gap between rich and poor within London, leading to reduced quality of life, and early death for many people, particularly those living in the most deprived areas of east London.

As a result, Project: London will help vulnerable people in east London to access the services that they are entitled to. Another key challenge will be to speak out for vulnerable people who are unable to access the medical care they need, say the authors.

This project raises fundamental questions about society’s attitude towards marginalised people, add senior doctors in an accompanying editorial. Denying free basic health care to the most vulnerable groups in society, who are legally prevented from working and unable to pay charges, is ethically unsupportable and a breach of human rights, they write.

“We can only hope that the Secretary of State reviews this policy and ensures that the NHS continues to provide a service to everyone living in the United Kingdom.”

Contacts:

Paper: Michelle Hawkins, Press Officer, Medecins du Monde, London, UK

Editorial: Kambiz Boomla, Senior Clinical Lecturer, Barts and the London, Queen Mary’s School of Medicine and Dentistry, London, UK

or

Sally Hull, Senior Clinical Lecturer, Barts and the London, Queen Mary’s School of Medicine and Dentistry, London, UK
Email: s.a.hull@qmul.ac.uk

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