Patients with suspected cancer forced to wait so NHS targets can be hit
Patients rushed to hospital with suspected cancer are having their treatment delayed so that managers can meet Government targets, an NHS investigation has found. And an appalling case of negligence below. Getting anything seriously wrong with yourself sure is risky in Britain
People arriving at Accident and Emergency departments with symptoms which could indicate the aggressive spread of the disease are waiting weeks for diagnosis and treatment while “routine” cases are prioritised. Hospital managers told researchers that treating desperately sick patients more quickly would “reflect badly” on their performance against Government cancer targets which only cover those referred to specialists by GPs. Doctors, patients groups and politicians were appalled by what one described as a “breathtaking admission” which confirmed their “very worst fears” about how far the NHS target culture has gone in distorting clinical priorities.
Although most people with suspected cancer are referred to hospitals by their GPs, more than 30,000 people diagnosed with the disease each year are first alerted to tumours by violent symptoms, such as seizures, vomiting and jaundice, which cause such alarm that patients go straight to their local A&E departments.
The report by the NHS Institute for Innovation and Improvement, an official health service agency which issues advice to hospital managers, says that many of these emergency patients waited six weeks or longer for basic tests. It said they were “often” not given the same priority as patients who had been referred by GPs, who were covered by two targets, ensuring that they see a specialist within two weeks, and start treatment, following diagnostic tests, within two months. “As a result, they can end up with a very poor experience before finally receiving a diagnosis and the right care,” it warns. The report, due to be published tomorrow added: “Many trusts recognised the need to get some patients in this group onto the same pathway as people on the cancer two week wait [target] but were concerned this would reflect badly on their cancer figures”.
Some A&E departments failed to recognise the risk of cancer in seriously ill patients. In cases where the disease was suspected, patients were sent home to wait six weeks or longer for diagnostic tests. Others waited weeks on wards before seeing a specialist or having scans, the report, which is endorsed by the Government’s cancer tsar, found.
Nigel Beasley, the NHS Institute’s lead for cancer, and head and neck surgeon from Nottingham University Hospitals said: “Targets are very effective, but they do have side-effects. The risk is that these patients are not being prioritised because of the focus on the two-week target for patients referred by GPs.” He said anxious patients admitted as an emergency were often trapped in hospital for weeks waiting for scans, and to see a specialist, and should learn from good hospitals, who carried out investigations quickly, often using outpatients appointments. Mr Beasley said: “Patients can be stuck in hospital for a long time, waiting for scans, and other diagnostic tests. Once they are in hospital, they can end up waiting two, three, or even four weeks before there is a diagnosis and any decision to treat.”
The admission about the effect Government targets were having on emergency cancer patients horrified clinicians and patients groups. Shadow health secretary Andrew Lansley described it as “one of the clearest examples yet of how Labour’s tick-box targets are failing NHS patients”. He said decisions about which patients should be seen first must be taken by doctors, based on the patient’s clinical needs, not by managers following Government diktats.
Katherine Murphy, from the Patients Association, said the report provided “breathtaking” evidence of a confidence trick being played on the public, repeatedly told that waiting times for patients with suspected cancer are falling, while desperate cases were forced to the back of the queue. She said: “This confirms our very worst fears, and exposes the scandal of what pernicious targets are doing to patients. We have seen other targets being used in ways that damage patient care, but of everything we have seen, this really is the cruellest of the cruel”.
Leading cancer specialist Prof Karol Sikora said: “I think it is absolutely horrifying that hospital managers are playing around with targets that can delay treatment for people who may well be at an advanced stage of the disease.” “I know of many cases where people who have been admitted to NHS hospitals as an emergency have languished for weeks before even seeing an oncologist,” added Prof Sikora, Medical Director of independent company CancerPartnersUK.
The British Medical Association said many trusts were bullying doctors into delaying urgent referrals. Dr Jonathan Fielden, chairman of the BMA’s consultants committee, said: “A number of our members have already expressed fears about the two-week cancer target, because it means all the cases referred by GPs are given the same priority, regardless of whether they are expected to be benign or high risk. When this same target is delaying patients who have been admitted as an emergency that is an even greater cause for concern”.
Several oncologists said they supported two-week waiting time targets for cancer patients referred by GPs, but called for the target to be widened to include all patients.
Ian Beaumont, from charity Bowel Cancer UK said it “beggared belief” that anyone would value statistics over efforts to save lives. Dr Jane Maher, chief medial officer at Macmillan Cancer Relief described the revelation in the report as worrying, but said the biggest obstacle to getting the right care for patients admitted to hospitals as an emergency was getting the right diagnosis, as cases were often complex, meaning cancer could be mistaken for other conditions.
Among those who have experienced the problem is Melissa Matthews was 28 when she went to the Accident and Emergency department of her local hospital. For several days, she had been suffering abdominal pain which had left her feeling so uncomfortable that she was unable to eat. She told her family doctor, who advised her not to worry, unless she began vomiting, in which case she should go immediately to A&E.
When she began being sick, her partner took her to the casualty unit of Norfolk and Norwich Hospital. The couple mentioned concerns about bowel cancer, having recently watched a programme about its symptoms, but the doctor reassured her: “You are far too young to have bowel cancer; when the blood tests come back they will show that”. The tests did not indicate a problem; Miss Matthews was sent home to Norwich and told she was probably suffering from irritable bowel syndrome.
But the pain and vomiting continued. A week later, when she was unable to even swallow water, she returned to A&E, and was admitted to a ward for five days, but sent home once more. One week later, after she collapsed in agony at home, she was admitted to hospital again. This time, X-rays revealed a blockage. During an eight-hour operation, surgeons found a tumour so large they were forced to remove her womb and 36 inches of her bowel. The blood tests which Miss Matthews had undergone in A&E, she later found out, were not a clear indicator of bowel cancer, or its absence after all.
Six months of chemotherapy followed Miss Matthews’ operation, after which she was given the all-clear. However, since then the cancer has returned. On Tuesday, Miss Matthews, now 30, will undergo a second operation to remove a tumour. The mother of two girls, aged 11 and 13, says her focus now is on survival. “I don’t feel angry about this any more, my concern is about what happens next, but I did feel very frustrated, and frightened. I thought going to A&E was the safest place to be, but I was just fobbed off”.
A hospital spokesman said patients were encouraged to complain if they were not satisfied with their care, and added that bowel cancer was rare in patients of Miss Matthews’ age.
More than 4,900 people have backed The Sunday Telegraph’s Heal Our Hospitals campaign, which is calling for a review of hospital targets to make sure they work to improve quality of care.
Sir Roy Anderson, Rector of Imperial College London, said the top UK universities, including Oxford and Cambridge, should be freed from state control and allowed to charge students more than the current £3,145 capped fees, and to attract more international students to boost their income.
Why stop there? Before 1919, all UK universities were independent. They should be again. Britain has four universities in the world's top ten, but the league tables are dominated by America's independent universities like Harvard, Yale, CalTech, Chicago, MIT and Columbia. And while we are slipping, America's colleges are rising. They are taking the best brains, and the best students, and are pulling in more cash to fund their teaching and their research. Thirty US universities have endowment funds of over £1bn. Only Oxford and Cambridge come close, but Harvard has five times more cash in the bank than either of them.
But that's how the US system works. The real cost of a university education is not £3,145. It's more like £40,000. And some US universities do indeed charge that amount of money. But they use their endowment funds to make sure that bright students who can't afford fees on that scale are given scholarships so they can get the education anyway. Students are admitted on merit, but supported according to their needs.
As Professor Terence Kealey, head of the (largely) independent Buckingham University, says in an Adam Smith Institute Briefing, that is what should happen in the UK. Instead of subsidizing universities, we should subsidize needy students, so that anyone who is capable of doing well at university has the opportunity to go. I would tell Sir Roy and his colleagues to charge whatever they like – £40,000 if that it what their product actually costs – provided that they make sure no needy student is turned away. Yes, some of the money that is currently doled out to the universities by the Higher Education Funding Councils could be used for those scholarships. Otherwise, the universities will have to go out and raise the money for scholarship funds themselves.
Many pupils 'would be better off learning woodwork than being forced into university'
Half of all teenagers are failed by a school system which forces them to pursue academic studies, a landmark report says today. Hundreds of thousands of youngsters better suited to practical work leave with poor qualifications because their skills go unrecognised. Woodwork, metalwork and home economics have all but disappeared while geography field-work and science experiments are in decline, the six-year investigation concludes.
The Oxford-based Nuffield Review, the most comprehensive study of secondary education in 50 years, found those who are better suited to 'learning by doing' are simply not catered for. Instead, a culture of testing has brought about a narrow focus on written exams at GCSE and A-level. This has consigned a generation of pupils to an 'impoverished' education.
In a damning indictment, the study said school attainment remained 'low' despite unprecedented investment in education. The Government's school diplomas covering 14 industry areas do little to improve matters, because they put greater emphasis on 'learning about the world of work' than on practical learning, the review warns. It says the entire system needs to be overhauled because it has suffered years of tinkering and piecemeal changes. Universities now have so little confidence in A-levels that 45 are setting their own admissions tests to help them distinguish between the most able candidates.
Professor Richard Pring, who led the review team of academics from Oxford, London's Institute of Education and Cardiff University, said concern about the achievement of young people was 'not new'. 'That bottom half is still a cause for concern,' he said. 'So many young people leave school inadequately prepared for further study or training.' He pointed out that around half of 16-year-olds fail to achieve five good GCSEs, including English and maths - the Government's yardstick of secondary school achievement. Around one in ten ended up classified as 'Neets' - not in education, employment or training. 'A lot of those have been told they are failures for about ten years,' Professor Pring said.
A generation ago, hands-on lessons were 'very much part of the learning experience at school', he said. But the introduction of the national curriculum in 1988 had hastened the 'demise' of practical learning. 'We now have a rather narrow view of success in learning,' he said. 'A great many young people achieve quite a lot in other areas which are equally valid and don't get recognised.' Many might benefit-from practical training in crafts, engineering, hairdressing, mechanics and catering. Apprenticeships should also be promoted more widely as an alternative to university, he added. His review concludes: 'There is not the progress which one might expect from so much effort and investment.
'The review believed that a tradition of learning based on practical engagement has been lost in schools, reflected in the near demise of woodwork, metalwork and home economics, in the decline of field-work in geography, in less experimental approaches to science (caused partly by assessment almost exclusively through written examination), and in the decline of work-based learning and employer-related apprenticeships.
Sixth-formers face extra tests on top of A-levels to get into 45 universities, today's review reveals. These include aptitude tests for medicine and law, and thinking skills tests and SATs. 'The growth of independent entrance tests by universities needs to be curbed,' the review says. It suggests bolstering national qualifications so that universities do not need to resort to other tests to identify the brightest students.
Schools should teach moral values to educate pupils for life as well as work. They should encourage youngsters to take responsibility for themselves, treat others with respect and care for the environment. Academics on the review team had seen youngsters 'transformed' in schools which promote justice and respect.
The review said teachers should also foster intellectual virtues, encouraging children to be open to evidence, argument and criticism.
UK: Government launches “kitchen bin war”
A Government campaign will see the end of confusing 'best before' labels, reduced packaging, and five new plants to convert waste into energy
An ambitious "War on Waste" campaign to tackle Britain's mountains of food-based rubbish with a range of radical new measures is to be launched tomorrow. The programme will scrap "best before" labels on food [Thus creating a health risk], create new food packaging sizes, build more "on-the-go" recycling points and unveil five flagship anaerobic digestion plants, to harness the power of leftover food and pump energy back into the national grid. The government hopes that its plans will reduce the 100 million tons of waste the country produced last year, which included 20 million tons of food waste and 10.7 million tons of packaging waste.
On Tuesday, Hilary Benn, Secretary of State for the Environment, will announce plans to dispense with "best before" labels, in an attempt to reduce the estimated 370,000 tons of food that is thrown away despite being perfectly edible. The latest government research into food labelling showed that the British are very cautious when it comes to eating anything that has passed its "best before" date: 53 per cent of consumers never eat fruit or vegetables that has exceeded the date; 56 per cent would not eat bread or cake; and 21 per cent never even "take a risk" with food close to its date.
"One of the things we found in our research is that confusion over date labelling is one of the major reasons for throwing food away. Often people don't realise the difference between 'best before' and 'use by'," said Richard Swannell, director of retail and organics at Wrap, the Government waste watchdog. It is working with the Food Standards Agency (FSA) and leading retailers to get rid of the "sell until", "display until" and "best before" tags, which confuse customers, causing them to throw away edible food.
"It is an issue that we want to address, but there has to be a balance, as we have to protect consumer safety," said an FSA spokesman. "Not eating out-of-date food is one of the simplest ways of preventing food poisoning."
Ahead of the launch, Mr Benn said: "It's time for a new war on waste. It's not just about recycling more – and we are making progress there – it's about rethinking the way we use resources in the first place. "We need to make better use of everything we produce, from food to packaging, and the plans I'm setting out over the next few days will help us to achieve that. We all have a part to play, from businesses and retailers to consumers."
The minister added: "Too many of us are putting things in the bin simply because we're not sure, we're confused by the label, or we're just playing safe. This means we're throwing away thousands of tons of food every year completely unnecessarily. I want to improve labels so that when we buy a loaf of bread or a packet of cold meat, we know exactly how long it's safe to eat."
On Tuesday, the Government will also unveil plans for dealing with packaging, including increased glass collection from pubs, clubs and restaurants, a huge expansion of "on-the-go" recycling points for aluminium cans, and new packaging sizes for supermarkets.
In addition to tackling food waste and packaging, the Government will reveal plans to use the waste we do produce as fuel. Tomorrow Mr Benn will announce the location of five new anaerobic digestion plants, built with the help of £10m in state funding. The facilities compost waste in the absence of oxygen, producing a biogas that can be used to generate electricity and heat. Mr Benn said: "We need to rethink the way we deal with waste – to see it as a resource, not a problem."
The UK produces 100 tons of organic waste a year. If processed anaerobically this would produce enough energy to power two million homes, or Birmingham five times over. Anaerobic digestion plants are widely used across Europe, and are already being used by high street retailers such as Sainsbury's and Marks & Spencer to tackle their food waste.
Michael Warhurst, senior waste and resources campaigner for Friends of the Earth, said: "This should be happening across the country, instead of councils still putting money into building incinerators. They are the technology of the past – this is the future."