Monday, 31 December 2007

BBC spinning for HMG

This story headlined this morning's news on the BBC. The crux of it comes down to some guidelines on cancer referral by the government's rationing agency NICE that can be seen here and here.

Hardly the straightforward story that the beeb portrays. The NICE guidelines are hardly free of confusion themselves and as the BMA say, the capacity is not there to deal with all these referrals anyway.

Really the issue of capacity should be addressed before laying into GPs who have to do a tricky job. Interestingly capacity is barely mentioned by the BBC, one just wonders how much of a push from government they got to run this story?

In the old days referrals were screened by specialists who would prioritise the referrals as they saw fit, using their years of training and experience to benefit patients. Now referrals are sorted by managers who have no medical knowledge at all, meaning that cases are not prioritised as effectively as before.

The 2 week wait has been shown in the scientific literature to be a complete waste of time as the capacity is not there to see all the urgent cases within two weeks, and the system ends up prioritised the anxious patients over the ones who are more likely to have cancer. For example it has been shown that with breast cancer, the 2 week wait has lengthened the time to diagnosis and has increased the numbers of cancers referred as 'routine' non-urgent cases.

If the BBC actually researched it's stories properly then it would realise that the problem we have is a lack of capacity and the stupidity of the 2 week referral system. We need to increase capacity to deal with referrals and go back to the old system of letting the expert clinicians screen the referrals, thus prioritising the most urgent cases. Experts will also tell you there is currently a crippling shortage of breast radiologists, meaning that it would be impossible to increase the capacity for the quick triple assessment of breast lumps anyway.


Dr Ray said...

Quite right Garth. I had forgotten about the study published this year showing the longer wait for people with breast cancer since the government started to dictate medical priorities. The dermatologists I know were concerned it would occur with skin cancer too but I don't know if anything has been published on this.
Have a good New Year
Xavier Ray

David L. Cox said...

At 8.00pm on Radio 4 on New Year's Day, the BBC might be able to right some of its dreadful reporting on the junior doctor's training fiasco in a programme called "Where's the Femur?". Let us hope they don't spend 40 mins as DoH apologists this time!

Happy New Year, Garth!

Garth Marenghi said...

Happy new year David and Dr Ray!

cheers for reading my depressing rants

Dr Ray, there was a recent piece in the Annals of the RCS on melanoma and the 2 week target.

It showed that melanoma treatment was better with the 2 week target but this was down to a concomitant increase in local capacity to treat, the 2 week wait did result in a lower pick up rate in the referrals, ie it diluted the urgent stuff with more less urgent stuff.

There is loads in the literature on this, and invariably the research concludes that the 2 week wait is pants.

dreamingspire said...

On another topic, the longer than planned Xmas closure of the West Coast Main [railway] Line, the BBC got it spectacularly wrong until, I suspect, Virgin's rail PR man got them by the proverbials. Its widespread incompetence, not conspiracy, that is spoiling the Beeb's news reporting. Reminds me of when I got a young Guardian reporter out of his hole and across the road into the pub, all because of a really sloppy article - he simply told me that he had not been given enough time to research the topic properly.