Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Not screening the elderly is not ageism
- Neville W Goodman (10 June 2008)
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Geography and equity
- S. Michael Crawford (10 June 2008)
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A quality resource for the NHS
- Vin McLoughlin (12 June 2008)
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Geographical variations in cancer spend
- Alex C.W. May (13 June 2008)
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Re: Geographical variations in cancer spend
- Tony Delamothe (27 June 2008)
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Neville W Goodman, Consultant Anaesthetist, retired Bristol, BS9 3LW, UK
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There may be ways that the NHS is ageist, but failing to screen women over 75 for breast cancer is not one of them. Help the Aged is fond of citing this example, and columnists are fond of repeating it, but the fact is that screening stops at 75 because risk benefit is by then more risk than benefit and thus it is not worth screening older women. In exactly the same way, it is not worth screening teenage girls. Competing interests: None declared |
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S. Michael Crawford, Consultant Medical Oncologist Airedale General Hospital, Skipton Road, Steeton, Keighley, West Yorkshire BD16 4DW
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There is more to geographical variation than just the authority of residence. One of the ways in which the NHS has developed, as is to be expected of a national service, is by centralisation of services where demand is perceived to be too low to justify a locally-provided service, the main examples being thoracic surgery and neurosurgery, and where extensive capital investment is required, as with radiotherapy. Centralisation of these was a enshrined in the 1960s. It has recently been shown[1] that use of thoracic surgery and radiotherapy services diminishes with increasing distance from the patient’s residence. So distance decay adds to the geographical dimension of inequity. All of the facilities that provide these services have issues of capacity; if patients are not gaining access the deficit in capacity must be underestimated. This raises the question of competition between patients for these resources and an explanation for the social gradient of access might be that socially disadvantaged people are simply less competitive in gaining referral to specialist services. Universality of provision is intended to provide equity but if capacity is inadequate, demanding that the well off compete with the deprived for access will compound the inequity 1] Jones AP, Haynes R, Sauerzapf V, Crawford SM, Zhao H, Forman D. Travel time to hospital and treatment for breast, colon, rectum, lung, ovary and prostate cancer. Eur J Cancer. 2008; 44: 992-9. Competing interests: None declared |
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Vin McLoughlin, Deputy Chief Executive, The Health Foundation 90 Long Acre, WC2E 9RA
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This article rightly draws attention to the contribution of Kim Sutherland and Sheila Leatherman to our understanding of quality in the NHS. Much of the evidence in the cited Nuffield Trust report appears in Health Foundation reports by these authors as part of our Quest for Quality and Improved Performance (QQUIP) initiative. QQUIP makes all of the evidence it gathers available free of charge to the public through its website which updates monthly with all of the latest evidence on quality in healthcare in the UK. We hope this can be a further resource for those looking to assess the true level of quality in the NHS. Competing interests: Director responsible for The Health Foundation's Quest for Quality and Improved Performance |
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Alex C.W. May, Fellow University of Manchester (NIBHI), Manchester M13 9PL
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Here you repeat the ‘fact’ that Oxfordshire PCT spent the least on cancer per cancer patient in 2006-07. Your source is: the ‘CIVITAS’ report, “Why the NHS is the sick man of Europe”. Unfortunately, that report was just citing the headline results of an analysis from the Conservatives. Newspapers carried the Tories’ analysis: for example, see [1]. However, Oxfordshire PCT did NOT spend the least on cancer per cancer patient in that year. I discovered an error in the 2006-07 cancer-spend data, supplied by the Department of Health (DH), and used by the Tories for their analysis. I brought the error to the attention of DH and they have acknowledged it [2]. In fact, Dorset is the PCT that spent the least on cancer per cancer patient in 2006-07. (Dorset was shown as second in the ‘least spent’ table of [1].) 1. http://www.telegraph.co.uk/news/uknews/1570535/Figures-reveal- cancer-care-%27postcode-lottery%27.html 2. Personal communication (via e-mail) with Tim Elms, Parliamentary Clerk and Departmental Select Committee Liaison Officer, Department of Health: Tim.Elms@dh.gsi.gov.uk (March 2008). Competing interests: None declared |
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Tony Delamothe, Deputy editor BMA House, London WC1H 9JR
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Thank you for pointing out the error in my article and Civitas's pamphlet. We'll publish a formal correction to my article. Civitas - and my - point still holds. Enormous (? indefensible)geographical variation still exists in resources devoted to various conditions. Dorset now may be in last place on spending on cancer treatment(at £5259 per patient), but this is still less than one third the spending of the top PCT. Could you give us the correct figure for spending by the Oxfordshire PCT? Competing interests: I wrote the article with the error |
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