A cancer patient’s appeal for resistance

POLITICIANS, IT seems, feel obliged to genuflect before the altar of cancer, so it's not surprising that the government has made strenuous efforts to cast itself as a defender of cancer patients. Some of its measures are genuinely beneficial. Innovative bowel-screening procedures will save thousands of lives, and extra money for new, expensive life-extending cancer drugs will benefit thousands more (including me).

But the Conservative-Liberal Democratic government's headline cancer pledges are minute compensation for its spending program's detrimental impact on cancer patients in general.

Far from being "ring-fenced"--a term used by leaders of Britain's new government to claim that Britain's National Health Service (NHS) will be protected from the massive spending cuts it is proposing--the NHS will be forced to make (and already is making) substantial cuts in services.

The 0.1 percent per annum real terms increase in funding is nowhere near enough to keep pace with demand (a significant part of which comes from the increasing numbers of people diagnosed with cancer). What's more, this paper-thin increase is qualified by the previously announced demand for more than $30 billion in NHS "efficiency savings." A government health insider admitted to the Guardian that in the coming years, "a fifth of everything the NHS does today will stop."

LIKE ALL those with serious long-term illnesses, cancer patients are bound to suffer disproportionately. Longer waits (the government has already abandoned the one-week target for cancer test results) will add to the 10,000 lives lost every year as a result of late diagnosis and treatment. Closures of wards, departments and hospitals will mean more exhausting and costly travel.

As health workers try to treat increasing numbers with ever more restricted resources, quality of care is bound to diminish. A small example from my own experience: one of the less pleasant features of having a hemotological cancer is the need for periodic bone marrow tests, which involve the insertion of a needle into the pelvic bone. I've learned that the longer the doctor takes in applying the anesthetic, the less the pain--and an extra 15 minutes makes the difference between the excruciating and the just about bearable. Under increasing financial pressure, that extra 15 minutes will become a luxury. The cuts mean, quite brutally, more avoidable pain for more people.

Cuts in disability benefits, local government services and science funding will all have a serious negative impact on cancer patients. But most frightening of all is the government's proposed reorganization of the health service (costing around $5 billion, five times the amount promised for new cancer drugs).

Once cancer symptoms are detected, patients are referred to hospitals for long-term treatment. For three-and-half years since my GP referral, overall responsibility for my health has been taken by Bart's. Its staff have dealt with all manner of unpredictable symptoms, aches and pains related--and sometimes unrelated--to my underlying disease.

Under the government's proposals for GP commissioning, self-financing hospitals will have to refer back each case as it evolves to GP consortia for renewed commissioning--or risk not being paid for the services they deliver. Operating within budgetary constraints, the GPs will then have to decide whether treatments are necessary, affordable and the cheapest available. So basic decisions about my care will be made by a doctor who is not involved in treating me.

Cancer patents need multidisciplinary care involving diverse specialists often scattered across different sites. The proposed fragmentation of the NHS can only obstruct the timely delivery of integrated care, and in the end make it more costly.

Fragmentation will also spell the end of national bargaining, conditions and career structure. Cancer patients are profoundly aware how much their welfare depends on the commitment and diligence of NHS workers. In the long run, a poorly rewarded, insecure, overworked and in many cases casualized staff can only provide a lower standard of treatment.

So here is an appeal from one very grateful patient to NHS workers: The government takes advantage of your sense of commitment to your patients, but by letting them do so, you are doing no favors for those patients. Reluctance to take any action that might disrupt patient care is understandable, but by not taking action you may be doing harm to your patients' long-term prospects.

You may feel you have little power, but collectively you have much greater power than individual patients. We need you to take action on our behalf, action that is a necessary extension of the sense of dedication that guides you in your daily work.

First published by the Guardian. A longer version of this article will appear in the December issue of Red Pepper.