THE DE-SKILLING OF THE NHS

Closing hospitals and shoving their work onto GPs

Minor surgery such as hernia repairs and varicose vein removal will be carried out in family doctors’ surgeries instead of in hospitals under plans to be announced by Patricia Hewitt, the health secretary, this week. Ministers believe that up to half of the 45m hospital outpatient appointments can be dealt with by GPs and nurses in local health centres. It will save the National Health Service money by freeing up hospital beds which cost about 300 pounds a day. Ministers say surgery in local health centres will make better use of highly trained GPs and be more convenient for patients.

Lord Warner, the minister for NHS reform, said: “The rationale behind providing care closer to home is to make better use of highly specialist skills . . . this will involve (having) GPs who are as skilled with the scalpel as they are with the stethoscope.”

Hewitt will also announce plans to free up hospital beds by discharging patients early with a telephone number for a nurse in case they have a relapse. The health secretary will say patients are likely to make a speedier recovery in the comfort of their own homes. A trial of the dial-a-nurse plan has already been carried out at the Royal Hampshire county hospital in Winchester. Bowel cancer patients have been discharged from hospital early and told to call if their condition deteriorates.

Cancer patients will be given chemotherapy in their own homes as part of the drive to reduce the amount of treatment carried out in hospitals, which are expensive to run. The changes will also reduce the risk of patients catching hospital-acquired infections such as MRSA. Hewitt pledged to move treatment out of hospitals in the government white paper Health Outside Hospitals, published in January. The plans may prove controversial when some hospitals are either downgraded or closed.

David Nicholson, chief executive of the NHS, warned that some hospitals will need to close. Last month he said that there would be up to 60 “reconfigurations” of NHS services, affecting every region in England.

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ANTI-CHRISTIAN DISCRIMINATION IN BRITAIN

(Sad that it takes a Coptic Christian to stand up for the faith. The only thing a member of the Church of England would stand up for is homosexuality)

British Airways has suspended a Christian woman who wears a necklace with a crucifix to work, even though it allows Muslims and Sikhs to wear headscarves and turbans, a newspaper reported overnight. Nadia Eweida, 55, told the Daily Mail that she decided to sue her employer for religious discrimination after having been suspended without pay for three weeks. "I will not hide my belief in the Lord Jesus. British Airways permits Muslims to wear a headscarf, Sikhs to wear a turban and other faiths religious apparel," Ms Eweida said. "Only Christians are forbidden to express their faith." Ms Eweida, a British Airways employee for seven years, works at the BA check-in counter at London's Heathrow Airport.

In a statement, British Airways said: "The case is ongoing, and is still under investigation, and as such it would be inappropriate to discuss it in detail. An appeal is due to be heard next week. "British Airways does recognise that uniformed employees may wish to wear jewellery including religious symbols. Our uniform policy states that these items can be worn underneath the uniform," it said. "There is no ban. The rule applies for all jewellery and religious symbols on chains and is not specific to the Christian cross," it said. "Other religious items such as turbans, hijabs and bangles can be worn as it is not practical for staff to conceal them beneath their uniforms."

The Daily Mail said Ms Eweida, whose father is an Egyptian Coptic Christian and whose mother is English, was ordered last month by a manager at Heathrow to remove her cross or hide it beneath a company cravat. She then asked for permission to wear the chain but was refused. According to the newspaper, BA customer service manager Caroline Girling told Ms Eweida in a letter: "You have been sent home because you have failed to comply with a reasonable request. "You were asked to cover up or remove your cross and chain which you refused to do"

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THE "MEN'S HEALTH" PANIC IN BRITAIN

Yes: The panic is more dangerous than the disease

Michael Baum is in fighting form. The emeritus professor of surgery at University College London, and leading expert on cancer, says he would like to give the `self-appointed custodians of men's health' a `bloody nose'. He's talking about those men's health groups, men's health magazines and men's health officials in the pay of the government, who are constantly advising men - through TV ads, glossy posters in GPs' waiting rooms, information-laden beermats, drop-in advice centres at football grounds or celeb-backed `awareness campaigns' - to get in touch with their bodies and their wellbeing. `You know what they're doing, don't you?' he says. `They are trying to make men into women. They are trying to whip up the same kind of hysteria about health that bugs women amongst men as well.'

Men's health has become big business in recent years. Who are these people? Well, there's the Men's Health Forum (MHF), founded in 1994, which works for the `development of health services that meet men's needs and enable men to change their risk-taking behaviours'. MHF is funded by the UK Department of Health (to the tune of around 200,000 pounds a year) and has also, a bit bizarrely, received money from the Kent Police Service (10,000 for the year 2004/2005), British Telecom (9,375 for 2004/2005), Sport England (10,000 for 2004/2005) and numerous others. Its patrons include the bicycle-riding liberal's favourite newsreader, Jon Snow, TV presenter Lynn Faulds-Wood and celebrity doctor Mark Porter. MHF is currently `devising interventions' in British schools to encourage young boys to think more about their health and enable them to `take control and seek help'

There is Men's Health Week, kickstarted by MHF in 2002 and supported by the DoH, which raises awareness about a different aspect of men's health each year. This year - 12 to 18 June - it was mental health, because apparently men `often find it hard to discuss their feelings and can be reluctant to seek professional help for emotional or mental health problems'. Then there is Everyman, a wing of the Institute of Cancer Research, which seeks to inform the male public about testicular and prostate cancer. It runs numerous advertising campaigns, gimmicks and stunts - most recently the `TacheBack 2006' initiative in September, which encouraged men to sponsor each other to grow moustaches (the `mark of a REAL superhero', apparently) in order to raise money for Everyman (3). It also launched the `Notice your nuts' campaign, with a TV advert featuring men with massive fake testicles hanging out of their flies and the slogan: `Make your balls a bigger part of your life.' Everyman is sponsored by Asda, Virgin, Butlins and Topman, the cheap and cheerful clothes-store for blokes which has produced t-shirts that say `I love my balls' and `Bollocks to cancer' and underwear that come with instructions on how to examine yourself for signs of testicular cancer printed on the inside.

There is Check-Em, an offshoot of Everyman, which as its name suggests is about encouraging young men to check `them' - that is, their testicles. Its website uses cod-ladspeak to encourage young men to practice testicular self-examination (TSE) every month. `Check your nuts!! A hands-on guide as to what to look for.' says a headline, while underneath a cartoon nurse in kinky white boots, suspenders and a tight white leather top (because men don't pay attention to matters related to health unless there's a scantily-clad nurse involved) explains how you should roll each testicle in search of lumps, bumps and other abnormalities (5). There is also the Orchid Cancer Charity, which has sent its self-help video `Know Your Balls: Check `Em Out', featuring celebs like Chris Evans, Jonathan Ross and Steve Davis, to 5,000 schools - and the Prostate Cancer Charity, which during its awareness week in 2005 distributed thousands of beermats to pubs around the country warning men about the dangers of prostate cancer.

Even football stadiums are being colonised by the men's health industry. During last year's Men's Health Week, MHF and government officials launched the `Football and Health' initiative, aimed at `harnessing the mass appeal [of football] to help reinforce and promote healthy living'. Announcing plans to set up drop-in health centres and organise leaflet and advice distribution at football grounds around the country, government minister Caroline Flint declared: `Football is an important part of many people's lives, and with its family-friendly policies including smoke-free grounds, family enclosures and football-in-the-community work carried out by club players, it provides great opportunities to get across key messages about healthy, active lives..'

From schools to pubs, from TV ads to the footie, there seems to be no respite from the `self-appointed custodians of men's health'. Baum is irritated by this burgeoning industry for two reasons: first, it can actually do more harm than good; and second, it takes officialdom's intervention into our private lives to `quite frightening new levels', he says.

Baum says the constant imploring of men to check themselves for testicular cancer, or to submit to prostate specific antigen tests (PSAs) for signs of prostate cancer, really is potentially harmful. `To promote testicular self-examination without evidence.well, it suggests we are not learning from the mistakes of the past', he says. `There are actually no data to support the idea that detecting testicular cancer by self-examination improves on the mortality for testicular cancer; that is just an assumption, but there is no evidence to support that assumption.'

`Testicular cancer is a relatively rare cancer, whereas testicular lumps are quite common', he continues. `So if we encourage young men to check their testes, their chances of finding a benign abnormality are considerably more than their chances of detecting cancer. So what you have is a lot of false alarms, with young men queuing up to see their doctors convinced they have TC when in fact they don't. And the real downside to all this is that if testicular cancer is suspected then the treatment is orchiectomy [the surgical removal of a testicle]. You don't biopsy a testicular cancer, you remove the testicle. And with all this heightened awareness of testicular cancer, with all these young men checking themselves for lumps and convinced that something benign is something really bad, I can see a situation where men will have unnecessary orchiectomies.'

One of the strangest things about the incessant campaigning around testicular cancer, which is targeted at young men aged 15 to 24 in particular, is that the disease is rare and very curable. There are around 1,900 cases of TC in Britain each year, which accounts for about one per cent of all cancers - and approximately 95 per cent of these cases of TC are cured. Last year there were 67 deaths from testicular cancer among men of all age groups in England and Wales. Among youthful men aged 15 to 24 - those who tend to be in those schools and colleges bombarded with know-your-balls propaganda - six men died from testicular cancer in 2005. The same number of 15- to 24-year-olds died from liver cancer, while four times that number - 25 - died from cancers of the brain. Strikingly, more men died from breast cancer in 2005 than died from testicular cancer: 82 men in all age groups died from breast cancer, compared to 67 for testicular cancer. Why aren't there campaigns instructing men on how to check their breasts for lumps? Why aren't young men warned about the tell-tale signs of brain cancer? Why the obsessive focus on testicles, with hundreds of thousands of pounds spent on encouraging young men to monitor their balls for a disease that is very rare and often not life-threatening?

Baum says it sums up the men's health brigade: `They are grabbing us by the balls, where it hurts.' When he says that those promoting testicular self-examination have not learned from `the mistakes of the past', he is referring especially to `the constant promotion of breast self-examination'. `As all the experts now know, that was a bad thing', he says. `It did more harm than good.'

As co-author of Breast Cancer and co-editor of History and Advancement of Anastrozole in the Treatment of Breast Cancer, and chair of the Psychosocial Oncology Committee at the National Cancer Research Institute, Baum knows his stuff. `In breast cancer, the mantra has always been "catch it early and you'll save your life" or "Your life in your hands", cliches like that. This hypothesis, that women who regularly practise breast self-examination will have a lower mortality for breast cancer than those who don't, has been tested - and it doesn't hold up. There have been three large-scale trials - one in Shanghai, one in Petersburg, another in the UK - where they compared the outcome of women who had been trained and monitored in breast self-examination with those who had been left alone. And as far as breast cancer mortality was concerned, there was no difference. But there was twice the number of unnecessary surgical interventions among the women who practised breast self-examination, among those who were more "aware", more cautious. `This provoked the publication of the Canadian Medical Association to publish a paper and a leader which argued that as far as public health is concerned, breast self-examination has now been downgraded from Category C - unproven - to Category D: proven to be harmful.'

Now Baum fears that similar harm may come to men who practise testicular self-examination or demand PSAs for prostate cancer. He argues that the endless promotion of awareness about prostate cancer - which is leading more men to ask for PSAs - is `especially worrying'. `There is a potential risk of overdiagnosing a latent pathology which if left alone would not threaten a man's life, yet if detected, and acted upon, might threaten his continence and his performance, if you see what I mean. Promoting PSA in the absence of evidence that PSA testing stops men dying from prostate cancer is foolish and dangerous.' Indeed, numerous studies have confirmed that widespread testing for prostate cancer can be bad news. Earlier this year a US taskforce that investigated the efficacy of PSA testing was only the latest to find that `screening is associated with important harms, including frequent false-positive results and unnecessary anxiety, biopsies and potential complications of treatment of some cancer that may never have affected a patient's health'.

Who'd have thought it - the men's health industry is potentially bad for men's health. However good and noble their intentions might be, male health activists and their funders and supporters in government, business and the media are causing anxiety amongst men of all ages and possibly even giving rise to surgical interventions that are unnecessary, uncomfortable, unhelpful and harmful. `Men are living longer and healthier lives', says Baum. `And there is no evidence that this obsession with health improves length and quality of life - in fact it can actually detract from both. Men should ignore these health zealots.'

Baum argues that the men's health industry is social engineering dressed up as caring awareness. `This is about trying to manipulate behaviour. It is about trying to brainwash people into unnatural ways of behaving, getting men to be more meek and obedient. It is symptomatic of the kind of social engineering we have today. We have a quite extraordinary situation in this country at the moment. On what we might call the left-leaning side of society there is a flight from rational belief towards alternative medicine - and then on the right-leaning side of society there is the transformation of health into a kind of social engineering project. I really think we should tell both sides to get a grip.'

As young men feel up their testicles (after a bath is best, apparently, when the scrotum is soft and shrivelled) and older men have their rectums penetrated by a doctor's digit, could there be a more fitting image of the emasculation of the contemporary male? In the rise of the men's health industry, which treats men as passive victims who must be prodded and studied for signs of distress and disease, we can glimpse the demise of old ideas of manhood - of men as active, strong-willed, ambitious and independent. Nothing better sums it up than the know-your-balls agenda. In Ancient Rome and other societies the testicles were seen as symbols of virility and strength, the source of man's power; today they are seen as symbols of victimhood and sickness, potentially the source of man's downfall. Baum has a message for the testicle-squeezers of the men's health lobby: `Keep you nose out of my anus and keep your hands off my balls - and stop interfering in my life.'

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