John Baron: The change that the NHS needs to help catch cancer early – and save lives

19 Nov

John Baron is MP for Basildon and Billericay.

It is an inconvenient truth that, despite successive governments pointing to improving cancer survival rates, they continue to lag behind international comparisons.

The primary reason for this is that the NHS does not diagnose cancers early enough: catching cancers early overwhelmingly increases the chances of successful treatment thereby leading to better survival rates. My New Clause 19 to the forthcoming Health and Care Bill seeks to put this right by putting improved outcomes (i.e. survival rates) at the heart of the NHS.

As Chairman of the All-Party Parliamentary Group on Cancer (APPGC) for nine years, I have made improving early diagnosis my particular focus. The Government once estimated that if we matched the best survival rates in Europe, 10,000 lives each year would be saved. In 2013, the OECD confirmed that our survival rates rank near the bottom when compared to other major economies, and for some cancer types we only fared worse than Poland and Ireland.

As we have improved our survival rates, so have those of other countries. Unfortunately, there is very little evidence of our closing the gap with international averages, despite the considerable increases in health spending in recent decades. A more fundamental change is required to address this.

Back in 2009, when I first became Chairman, the APPGC conducted a major enquiry which uncovered that the main reason our survival rates lag behind international averages is not because the NHS is worse at treating cancer. The evidence suggested that once a cancer is detected, it largely performs as well as other comparable health services. However, the NHS is not as good at catching cancers in their crucial early stages.

Late diagnosis therefore lies behind our comparatively poor survival rates, and getting the NHS to raise its game in this crucial area would be a major step along the road to improving our cancer performance. Armed with this evidence, the APPGC together with the wider cancer community campaigned over the years, with some success, for a one-year cancer survival rate indicator to be built into the DNA of the NHS, especially at a local level.

The logic was straightforward: as earlier diagnosis makes for better survival rates, holding the local NHS accountable for their one-year rates would encourage it to promote initiatives which boosted earlier diagnosis. A key advantage of focusing on this type of ‘outcome measure’ is that it gives healthcare professionals the freedom and flexibility to design their own solutions – this could include by running wider screening programmes, by establishing greater diagnostic capabilities at primary care or by promoting better awareness campaigns of the signs and symptoms of cancer.

However, from discussions with those involved at the front-line of designing cancer services the APPGC came to appreciate that this one-year survival rate indicator was generally being sidelined by the managements of Clinical Commissioning Groups who are focused on ‘process targets’. These are often linked to funding, with funds being released in accordance with performance against these targets.

In recent decades, the NHS has been beset by numerous process targets, which rather than measuring the success of treatment, measure instead the performance against process benchmarks – A&E waiting times being one high-profile example. These process targets have a role to play in improving the NHS, but all too often are a blunt tool offering information without context and can, in some circumstances, hinder rather than help access to good treatment – especially when funding flows are associated with them, which can serve to skew priorities.

In addition, these process targets tend to be ambitious and therefore have a tendency not to be fully met except in the very best of circumstances. This can lead them very easily to becoming a political football between the parties eager to score short-term points. All sides are guilty of this, but it rarely helps patients.

Research from the House of Commons Library uncovered nine process targets applicable to cancer. These include the ‘two week wait’ to see a specialist after a referral and the ’62-day wait’ from referral to first definitive treatment. Such targets are only part of the journey when trying to improve cancer performance, and yet the NHS cleaves to process targets because often they are the key to unlocking funds. Furthermore, by implication improved outcomes can only be facilitated by improved processes.

In addition, the APPGC learnt process targets are not the best means of improving performance amongst the rarer cancers. These cancers often fall between the cracks of process targets, as data on these cancer types are not used routinely in much of the NHS. Instead, the NHS tends to focus on the ‘low hanging fruit’ of the ‘Big Four’ cancers of breast, prostate, bowel and lung.

However, given rarer cancers account for more than half of cancer cases, serious improvements in cancer survival will be less possible unless performance gets better for these cancer types. Outcome measures have the advantage of encouraging their inclusion when seeking to improve overall survival rates.

Given the advantages of outcome measures like one-year survival rates, I have tabled the simple amendment New Clause 19 to the Health and Care Bill, which returns to the Commons next Monday. This amendment will ensure that outcome measures are put above process targets by NHS England, better encouraging the NHS to focus on earlier diagnosis and ensuring it bears down on what really matters to patients and their families. It could also save on bureaucracy, as the myriad of process targets need managing.

NC19 has been endorsed by the founding chief executive of Cancer Research UK, Professor Sir Alex Markham, who commented that, ‘comparable health services abroad continue to outperform the NHS in terms of cancer survival. They all remain focused on cancer outcomes and the UK would be foolish not to do likewise’.

At a time of a substantial backlog in NHS care caused by the pandemic, earlier diagnosis of cancers is more important than ever. I urge MPs and the Government to take a large step towards improving our survival rates by supporting New Clause 19.

A big question for libertarians: what would they do about obesity?

17 Jul

In the last few days, there’s been a lot of discussion about the latest instalment of the The National Food Strategy. Commissioned in 2019 by the Government, and put together by Henry Dimbleby, the co-founder of Leon, it contains radical proposals as to how to tackle the nation’s obesity rates.

Some of its most controversial suggestions are that we need salt and sugar taxes, that the NHS should prescribe vegetables and everyone should eat less meat. Hardly anyone likes the last idea, but libertarians have been vexed by the whole strategy – viewing it as the latest example of the nanny state gone mad.

Having combed through Dimbleby’s report (the second of a two-part strategy – intended to shape legislation in England, but also recommended for Wales, Scotland and Northern Ireland), it seems to me that much of the criticism has been unfair.

For starters, the document is 289 pages in length, so it’s a little ungenerous to write it off in one day. The reactions reminded me of when members of the Left immediately dismissed the Commission on Race and Ethnic Disparities report, which is 258 pages, on the basis of a few passages.

Some of the stereotypes about Dimbleby, too – that he’s a rich bloke, like Jamie Oliver, telling us plebs what to do – don’t add up, especially in the context of the report. Far from being bossy, large parts of it are about nature and ecosystems. And where it makes recommendations about food, it acknowledges the challenges for those on low incomes, whom it advises the Government to support more.

On a more serious note, the report has not come about because rich blokes have run out of hobbies. It’s an attempt to tackle a complex but devastating issue: the UK’s rising obesity rates. It points out that one in three people over 45 in England are now deemed clinically obese. You have to wonder sometimes if we have desensitised to these facts and our situation, despite all the warning signs (as the report points out, “[o]ur obesity problem has been a major factor in the UK’s tragically high death rate” from Covid-19).

There are many other things you could say about this report, but for the sake of one article, I have one question: what is the libertarian answer to obesity rates? Because at the moment it appears to be “do nothing” or sneer at the baddies who want to take away our Kellogg’s Cornflakes. Dimbleby and Oliver may not have the perfect answers, but what is our solution exactly?

I count myself as fairly libertarian, incidentally, but obesity is an area that challenges this philosophy. That’s because scientists have increasingly found that weight has a heritable component, meaning people have differing levels of willpower with diets. As the report spells out: “not all appetites are the same… in an environment where calories are easy to come by, some of us need to work much harder than others to maintain a healthy weight. You have to swim against the powerful current of your appetite.”

This corroborates with findings from Robert Plomin, one of the world’s leading experts in behavioural genetics, and author of the book Blueprint: How DNA makes us who we are. He points out that: “Twin studies estimate heritability of weight as 80 per cent, even though all the genetic data together estimate heritability as 70 per cent.”

In short, people are on different starting points when it comes to how easily they can control their weight (and I say that as someone who has to swim hard against the current), hence why telling someone to use willpower doesn’t always work.

Genes are uncharted territory for libertarians because all of our arguments centre around personal responsibility, free will and individual choice. Of course, these are all important things and many of us reject how much lockdown has taken them away. But there’s a big difference between politicians telling people to wear masks, and how people cope in an environment that encourages overeating, which our society does, especially should they have a predisposition to gain weight. We have to make those distinctions.

Even if we ignore research on genes – some people will say that my argument is fatalistic, wrong and that choice is paramount – it’s here and has already been embedded into public policy. Since 2019, the NHS has sold people genetic tests to spot risk for cancers and dementia. People underestimate how easily these tests can be extended into completely new areas (a test to estimate your risk for obesity), which could then be used to justify preventative measures.

While Dimbleby mentions genes creating differences in eating habits, it’s interesting that the report doesn’t delve much into medicine’s role in addressing obesity rates. Yes, the NHS could prescribe vegetables. But we have also seen drugs developed to help prevent obesity, and even a contraption that stops people’s mouths opening properly.

While I find the latter a rather horrible prospect, I think drugs and other medical solutions (gastric bands, for instance) will become more common and less controversial in years to come – the more we test the “willpower argument”, sugar tax, and move very little on obesity rates.

Ultimately, I don’t think The National Food Plan will make any substantial difference, as – shock, horror – it’s not radical enough. It’s also overly romantic in places, suggesting that school cooking lessons are part of the answer (as someone who did Home Economics for two years, I can’t remember any of the recipes. Boys messing around, however…).

But the report gets it right about environmental triggers and how these correspond with genes. And it has, at least, drawn attention to the urgent situation we are in. A situation to which the libertarian response cannot continue to be – as it seems currently – “let them eat cake”.

Chris Thomas: The Government needs a plan to substantiate its ambitious rhetoric on health reforms

7 Apr

Chris Thomas is a senior research fellow at the Institute for Public Policy Research.

Over the last forty years, there has been a remarkable consistency in health reforms under both Conservative and Labour governments. In different ways, each has reflected a common core triplet: drive quality through competition; maintain financial sustainability through efficiency; and ensure popularity by focusing policy and funding on the NHS.

More recently, Boris Johnson’s government has indicated a willingness to break from this path. February’s health white paper – Integration and Innovation – gestures towards three, potentially seismic changes. First, a shift from competition to collaboration; second, a shift from NHS-centrism to a more holistic vision of health; third, a shift from short-term efficiency to long-term innovation.

Each is a welcome aspiration. But, at the moment, the white paper only constitutes a statement of ambition. It will take far more than some proposed top-down legislation to reflect these ambitions in practice and to deliver lasting change. And indiscriminately throwing money at the NHS won’t help either.

The Government has recognised that business as usual won’t be good enough on health following the pandemic. Achieving pledges like “build back better” will rely on delivering a more collaborative, holistic and long-term approach to health. And that means putting forward a plan to fully substantiate the rhetoric.

From competition to collaboration

Strikingly, the Government’s proposals contain a fundamental ideological shift. Instead of a system fragmented into provider units and forced to compete with each other, it envisions larger integrated providers working together and collaborating to improve the nation’s overall health.

It is the right decision. Competition and the internal market fragmented the health system and made our Covid-19 response noticeably more challenging. But after years of fragmentation, it will take far more than a single, centralised decree to create lasting collaboration.

Bottom-up integration has flourished during the pandemic. When I ask professionals and local health leaders, they almost always put this down to the centre removing artificial barriers – be they financial, regulatory or bureaucratic. Out of Covid-19 necessity, health leaders have been given more freedom, and with that freedom they’ve moved to collaboration by default.

The challenge for the Government is to maintain that new way of working and to replicate the conditions for integrated, local “system working” after the pandemic.

System working means redefining the role of the centre – from commander to enabler. That necessitates a stronger focus on culture change and working with the regulators to align incentives to boost health service integration and population health. It would also mean cultivating a common sense of purpose and mission.

And creating more networks and forums for cross-sector collaboration. Some of these, like the cancer network, were disbanded during the last decade, but forums to meet and discuss are vital for increasing integrated working.

From NHS-centrism, to the primacy of place

A second key shift indicated by the white paper is the Government’s recognition of the “primacy of place”. Again, this is the correct course – recognising that the places we grow-up, live and work define our health throughout our lives.

It also challenges the widespread assumption that health is synonymous with only the NHS. Reflecting this fact in practice will depend on the cultivation of thriving local partnerships – between the NHS, social care, public health, community services and the voluntary sector. In turn, that means addressing just how bad things have got for many non-NHS health service providers.

The social care system is a case in point. While it struggled during the pandemic, the truth is it needed fundamental reform long before 2020. The political consensus is growing behind free personal social care, free at the point of need and funded through general taxation. The Government should act fast to enact this and end the decades of prevarication.

Similarly, public health is in need of a reboot. Despite covering preventative local services such as stop smoking initiatives, sexual health services and healthy living schemes designed to prevent underlying health conditions, the public health grant has been cut by almost £1 billion since 2014. Those cuts have fallen disproportionately on lower income parts of the country and on the North of England. We need a funded, functional public health system to make the primacy of place a reality.

Simply put, place-based health and care means extending political engagement, resource and reform far beyond the NHS and brick and mortar hospitals, ensuring every community has the local health services needed to lead healthy dignified lives.

From efficiency to innovation

The white paper’s reforms are designed, ultimately, to support innovation. By making all health leaders jointly responsible for the total health of the population, the Government hopes to uncork the power of health innovation. New treatments, medicines and best practice can significantly boost health outcomes and the economy.

Covid-19 demonstrated what’s possible when it comes to the spread of innovation. The shift to digital in general practice for instance has been an aspiration for years, but finally happened at pace during the pandemic. However, if the Government want its reforms to make fast innovation the norm, it will once again need more that legislative changes and top-down diktat.

Much more importantly, it will need to change the fact the NHS is currently run to the top of its capacity – all through the year. In healthcare, austerity suppressed supply, even as health demand rose. This has left the healthcare providers with little headspace, time and bandwidth.

More bluntly, healthcare professionals just do not have the time they need to adopt, adapt and champion innovation. Change will rely on a bold strategy for ending burn-out, driving recruitment and improving retention rates. Evidence indicates an effective, immediate strategy would combine a pay rise, more leave, a right to flexible working, stronger professional development and more extensive action on institutional racism in health.

Innovation is only possible in a system at the top of its game. That is the reason austerity represented short-termism. It is time to invest in health capacity and professionals, to boost productivity and deliver globally leading outcomes.

Meeting an uncertain future

When it comes to health, we face an uncertain future. Analysis by IPPR and the CF health analytics company shows that due to the pandemic we can expect an additional 4,500 extra deaths from cancer this year; 12,000 extra heart attacks and strokes in the next five years; and two million more mental health referrals. On top of that, there is a continuing risk of future health shocks. Pandemics are becoming more likely and resistance to anti-microbials is growing.

A vision for health and care based on a collaborative health system, healthier places and rapid adoption of innovation could help meet those challenges. If the Government gets it right, it could launch a new health consensus and define the agenda for decades. But that will only happen if it combines welcome aspiration with sustained, funded and evidenced health policy.

Mark Brooks: This International Men’s Day, we must do more to promote men and boys’ wellbeing

19 Nov

Mark Brooks was the Conservative parliamentary candidate for Batley and Spen in 2019, and has an OBE for services to male victims of domestic abuse. These are his personal views.

It’s International Men’s Day today, which provides a real opportunity to focus on a whole range of issues that impact on men and boys. It also promotes the charities that support them, and allows for a positive conversation about the contribution they make to their families, society and their country.

There is also a House of Commons debate and I am hoping that our MPs urge the Government to start to hone in and tackle matters specific to men and boys’ wellbeing – which, in turn, affect women and girls, whom we share our lives and society with. If we want to create an inclusive Britain we should ask nothing less of our parliamentarians.

International Men’s Day is not an “establishment” promoted or endorsed event; in fact, to the contrary, it is often met with a wall of indifference as are a number of the issues that men and boys face. It is one that is created and led by the public, charities and organisations large and small across the UK.

It is very much in tune with a grassroots day because without any “establishment” promotion, it will be marked in over 150 ways. Big corporations have sponsored motivational conferences with well-known speakers (Colin Jackson and Nigel Owens) and the Civil Service will be running mental health events for its staff. There will also be the likes of Men’s Sheds Cymru’s Bring a Butty event, to fundraisers for Oxfordshire Mind. Twitter will be alive with the use of #InternationalMensDay.

It shows the public care about:
  • the alarming suicide rate with over 12 men per day taking their own lives;
  • 12,000 men per year are still dying from prostate cancer;
  • the fact that boys are behind girls at every education stage;
  • 60 per cent of the people dying from Covid-19 are men with little explanation of why this is;
  • 85 per cent of those sleeping rough on our streets are men;
  • 700,000 men are victims of domestic abuse per year;
  • 12,000 men are subjected to sexual violence per year; and
  • 75,000 men are in prison.

If the public care about these issues, we need to do too and be proactive about having policies that seek to address these both on broad terms but also look closely at how they affect men. What is it specifically that means more men take their own lives or are behind at school and less likely to go to university? However, because it is not a gender competition we should also be proactively looking at how these areas also affect women.

The Government should consider a range of policies including:
  • Men’s Health Strategy – A number of countries such as Ireland and Australia have a strategy looking at male cancers, mental health and promoting more accessible services. This is also advocated by the World Health Organisation Europe.
  • Male Suicide Prevention Action Plan – To focus in on the causes of male suicide with a plan to greatly reduce the rate.
  • To provide better support for those at risk or suffering from prostate and testicular cancer – As advocated by Prostate Cancer UK, every man with prostate cancer, or at risk of it, should have access to the same high-quality diagnosis, treatment and care, no matter where in the UK they live.
  • To introduce a parallel strategy to the Ending Violence Against Women and Girls (VAWG) titled Ending Intimate Violence Against Men and Boys – In policy terms, men who are victims of domestic abuse, sexual violence and force marriage are victims of “VAWG” crimes, as are sexually abused boys. As well as being factually incorrect, it makes them invisible.
  • To commission an official inquiry into the educational underachievement of boys – There is no agreement on what causes this 30-year problem, let alone how to resolve it. It is time this changed.

We need to do more to resolve men and boys wellbeing issues because to live in a mature and inclusive society, we need to both question why a number of these issues are affecting men and then take action.

More so, we need to act, because the public across the UK want action and are concerned. Why support international Men’s Day otherwise?

Just because it is not fashionable within the Westminster Bubble, in Medialand or in the broader Central London establishment, we still have a moral imperative to act. In fact, as was shown on the Brexit vote and the last year’s General Election win being unfashionable is very fashionable indeed with normal men and women across the UK. They care enough to act, so should we.

Happy International Men’s Day everyone!

David Davis: We are on course to be trapped in never-ending shutdowns with no exit route. Here is an alternative strategy.

1 Nov

David Davis is a former Secretary of State for Exiting the European Union, and is MP for Haltemprice and Howden.

The first question that Boris Johnson will face when he addresses the House of Commons tomorrow about his lockdown plans is: “what will you do on December 2 if the R number is greater than one”?

The probability, of course, is that it will still be greater than one on that date – and that the lockdown, whilst it may have mitigated the infection, will not have stopped it. And in that circumstance, the shutdown will continue.

That is what we, and many other countries, should have learned from the last general lockdown. The disease only really stopped with the onset of summer, and has restarted with the onset of winter.

When the Prime Minister announced the first lockdown on March 23, he was hoping for it all to be done in four weeks, and in practice it turned out to be four months. This time he is announcing a lockdown at the beginning of winter, and we may well be locked down for six months, until next summer.

Unfortunately, even the scientists admit that the evidence for the effectiveness of general lockdowns is quite weak. The evidence for the economic damage that they do, however, is so strong that it is obvious.

In truth, there is only one strategy that has worked in the other countries faced with this problem. This was a very early and draconian lockdown that brought the disease under control when it still only affected a small proportion of the population – followed by an extremely focused test, track, and isolate policy. At the moment, no element of this policy is fully operational in the UK.

The complete failure of Public Health England to deliver a functional testing system early in the pandemic crippled Tthe Government’s ability to deliver such an outcome. This is compounded by the worst decision in the whole crisis – on March 12, when we gave up our attempt to test all the suspected cases.

To be fair to Matt Hancock, he has driven the system to deliver a large testing capacity today, but that is too late. It is a little like having ten fire engines outside your house after it had burnt down.

What is needed from the testing system today is immediate availability for everybody with symptoms or exposure, and very rapid response so that action can be taken quickly to suppress the outbreak.

The Government is now talking about a 15 minute test, rather belatedly. Tests that deliver a very accurate result in less than an hour have been available in the United States since March. If there is any doubt at all about delivering the rapid test in the UK, the Government should licence existing foreign technology, and set about creating the capacity to deliver that domestically as soon as possible. The South Koreans achieved more in six weeks at the beginning of the crisis than we have in six months, and we should model our delivery policy on that.

The track and trace system is currently hopeless. It will only ever be useful if it delivers results within a few days of someone testing positive. Otherwise, it is too late to check the infection. It is long past time for the Government to read the riot act to the big companies that are making profits out of failure in this area. If they cannot deliver they should be replaced, ideally by a regional structure, which, as the Germans demonstrated, is much more likely to be effective.

Most important of all, however, is the isolate policy. We currently do not have one. Telling people to stay at home if they are ill simply means that they infect their families, and possibly the supermarket assistant when they do their shopping.

And of course, not everybody who is infected obeys even those rules, and the probability is that even more will flout them after a year of Covid fatigue. So self-isolation at home will be even less effective this winter than last.

Every successful strategy to date has properly isolated the infected, and often their closest contacts as well. In Wuhan, the Chinese government created a number of Nightingale-style hospitals, and used them to immediately isolate those who tested positive, and those closest contacts thought most likely to be infected. It worked, as did similar approaches in other East Asian countries.

We need more Nightingales, and we need to use them as the anterooms to the major hospitals, not as the (empty, unused) overspills. In a Nightingale, patients can be monitored properly, and receive treatment rapidly as they need it.

We should do the same with the private hospitals that we have sequestered. We should also have an explicit strategy to separate the conventional patients from the Covid patients – ideally in different hospitals. We should remember that this is an exercise in saving lives, not in hospital capacity management. Losing track of that aim leads to more excess deaths, rather than fewer. I fear that the slogan “Save our NHS” conflates and confuses those aims. It is said that a number of NHS managers were uneasy for exactly that reason.

During the first round of this crisis, there were four categories of unnecessary excess deaths.

First, there were those who were told to stay at home, unless they were very seriously ill. Many of those turned up in hospital too late to save

Second, there were those, mostly the elderly, that were triaged out of intensive care. The NHS denies this, but the numbers show that many elderly died untreated.

Third, tthere were those who were dispatched to care homes before they had recovered, leading to new rounds of infection amongst the most vulnerable.

Fouth, there were those who were displaced from hospital, leading to excess deaths both now and in the future from untreated non-Covid diseases, most obviously cancer. Much of this was avoidable with more focused management and a little bit of foresight.

Finally, when we do get the virus under control, we should rethink our “local” strategy. The successful countries interpret this at a really micro level, in some cases locking down one street or even one block of flats. It is possible to enforce lockdowns at that micro level.

When you lock down the Greater Manchester region, it is near certain that of its millions of residents, thousands, or even hundreds of thousands of people will break the rules. Such a strategy maximises economic harm and minimises lives saved. So when we return to local lockdowns, we should make them very local indeed.

Everybody wants to save lives, and ideally at minimum economic cost. A never-ending lockdown, without an explicit infection reduction strategy, and with it a lockdown exit strategy, offers little more than a winter of misery. The Australian and New Zealand governments initially tried a strategy like our current one, and very rapidly decided that the East Asian disease eradication model was a much better option. We should do the same – or this will be a very long winter indeed.

Pressure rises on Ministers to publish assessments of the impact of lockdowns, restrictions – and Covid itself

20 Oct

Last week, ConservativeHome called for the Government to broaden and deepen the national conversation about Covid-19 – or at least try to as best it can.

It is essential to see the disease in the round by understanding the consequences of lockdowns, restrictions and the virus itself on both lives and livelihoods.

For livelihoods, read what’s usually called the economy, a dry term, but is actually a human story of lost jobs, lower living standards, higher poverty, damaged schooling and vulnerable sectors, including hospitality and retail.

For lives, read healthcare outcomes other than Covid-related ones.  In other words, cancelled operations and fewer treatments, as well as (for example) worse heart disease, cancer, mental health and domestic abuse outcomes.

This is why we urged the Goverment to publish –

  • A regular Treasury report that calculates the economic cost of the lockdown.
  • A rolling Department of Health assessment of the human cost of the shutdown.
  • The creation of an economic counterweight to SAGE.

We also suggested that some think-tanks have the capacity to issue comprehensive reports.

This site originally urged this course during the spring, and is far from alone in having done so.  On which point, congratulations to the Daily Mail, which today publishes a four-page investigation into health outcomes. It finds –

  • 25,000 more people died at home during pandemic, since they didn’t go to hospital as it continued.
  • There is set to be a 20 per cent rise in cancer patient deaths because of treatment backlogs.
  • Organ transplant operations fell by two thirds while waiting list deaths doubled. More than 50,000 operations for children were cancelled.

It’s worth pointing out that some of these outcomes will have been a consequence of Covid-19 itself rather than restrictions – for example, people not going to A & E departments in order to reduce the risk of catching the virus.

The line Matt Hancock took yesterday in the Commons is that suppressing the virus is integral to better health outcomes, because the more NHS resources the virus demands the fewer there will be for other conditions.

But a question that obviously follows is whether or not the Government’s strategy, which is dependent at present on big lockdowns, is the best means of protecting the NHS.

It’s worth noting that a Department of Health analysis has said that “in the long-term, the health impacts of the two month lockdown and lockdown-induced recession are greater than those of the direct Covid-19 deaths”.

The Mail is not alone in trying to get its readers to look at the Coronavirus in a more full context.  Yesterday, the Daily Telegraph reported that the ‘Protect the NHS’ message led to 90 per cent drop in hospital admissions.

The Times last Friday urged the Government to be “more transparent about the economic and health costs – the same day that we took much the same view.

And a wide range of Conservative MPs are increasingly calling for the kind of action we have outlined.  Theresa May has called for more formal economic advice.  Steve Baker, writing on this site yesterday, urged Ministers to publish “serious analysis of the costs of the options they face”.

Downing Street will be reluctant to take this course, and thus indicate that the Government might change its strategy, while it is doubling down on the present one.

In political terms, that’s what our report yesterday about new LAMP and lateral flow tests signified.  Number Ten believes that these can deliver where track and trace has not (though it is not abandoning the latter).

So it is trying to persuade Tory backbenchers not to abandon the testing strategy, and transfer their support either to lockdowns and a permanent suppression plan, or to loosening and a more voluntarist approach.

We shall see whether this push pays off – and if this planned massive scaling-up of new tests works.  ConservativeHome’s understanding is that the Treasury hasn’t ruled out a big report on economic costs.

However, Government sources pointed out that much of the required data is already available (i.e: unemployment figures), and that it would be hard to disentangle the effects of restrictions from those of the virus more widely.

We also detect a concern about the consequences of publishing bad economic news: on the one hand, the Treasury has an interest in alerting voters to the scale of the economic challenge, but none in alarming them.

Karol Sikora: Millions of people are waiting for cancer services. That’s the second wave we should worry about.

3 Aug

Professor Karol Sikora is CMO of Rutherford Cancer Centres and Former Director of the WHO Cancer Programme.

Let me be clear, I have absolutely no interest in getting involved in politics. Despite being labelled a Government stooge on more than one occasion, one glance at my Twitter account will show that I have made my objections to Government policy clear, perhaps too frequently!

Before March I honestly had no idea how Twitter worked, I thought it was the sound birds made in the morning. The whole reason I signed up was to ensure cancer patients weren’t forgotten about in this Coronavirus whirlwind. To be honest, I failed.

We’ve tried everything; writing articles, doing media, lobbying ministers, online petitions. None of it has worked, there are still millions of people waiting for cancer services. Recent estimates put that number at 3,000,000 people, that is staggering. We’ve heard lots of words from Government, but not nearly enough action. Hopefully the message from this article may reach the right people.

Everyone reading this will have been touched by cancer in some way, we all know how relentless and insidious it is. It doesn’t stop for anything, never mind pandemics but we have given it far too much freedom to run riot over the last few months.

A delay of a few weeks in most cases will make no difference, and many cancer patients have had treatment delayed for appropriate clinical reasons, but lots have been delayed for operational reasons.

Sadly at the start of this pandemic I would always talk in hypotheticals about how many people could die from cancer delays. That is no longer the case; people have already lost their lives because the treatment they needed was not available.

We have far too often seen doomsday predictions thrown around by people who don’t fully understand the consequences. It is people of my age who are most petrified by this climate of fear and who are now unwilling to “trouble” the NHS. We’re the ones who need the help the most!

“Stay Home, Protect the NHS” was a brilliant slogan, but it was far too effective. People having heart attacks would refrain from ringing 999 and the numbers of people diagnosed with cancer this year has fallen off a cliff compared to the average. If anyone from the No 10 Behavioural Insights Team is reading this please understand you are playing long term with forces you don’t understand.

Oncologists have spent decades trying to get people to get persistent symptoms checked, so much of that progress has been undone in the last few months. I have neighbours who won’t even open their windows they’re so scared of catching the virus, if they find an unusual lump are they going to go and get a scan? I think not.

So what can we do? I’m acutely aware it’s all too easy to throw stones from the sidelines while offering no solutions. Isn’t that how politics works?

The approach has to be two-fold. First, we have to get cancer care prepared for the inevitable surge, but we also have to encourage that wave to come. If people won’t get checked at an early stage, sooner or later they will need treatment.

We need “COVID-secure” hubs to treat and diagnosis cancer. Weekly staff testing, temperature checks, ultra-caution within the building. We have to make cancer care as safe as possible to give people the confidence to come forward.

Embracing all available capacity seems obvious. My network, the Rutherford Cancer Centres, has increased our collaboration with the NHS during the pandemic and are willing to go further. There are other independent providers who have the capacity to help, it would be wrong to leave those machines empty whilst millions have cancer services delayed.

There is going to be a surge, we need to know exactly when that is coming to get ourselves prepared. I anticipate around September, so oncologists and our dedicated support staff should be getting ready for a very difficult autumn/winter.

What frustrates me the most is the fact that so many other countries have continued cancer treatment with not nearly as much disruption as us. An oncologist friend of mine has a Brazilian partner, even there they are dealing with cancer admirably in the face of a far worse situation than us.

The prospect of a second wave is one we have to take seriously and I have always said we are right to prepare for the worst, but we are already in this cancer crisis. In my mind, the second wave we have to worry about is the millions of neglected cancer, cardiac and other seriously affected patients who have been ignored.

History will not judge us kindly when the full damage of this disaster is visible. It isn’t too late to avert the worst of it, but we desperately need action, not more rhetoric and even worse dithering.