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You can find the current article at its original source at https://www.theguardian.com/commentisfree/2016/dec/19/aa-gill-death-nhs-broken-private-healthcare-cancer
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| AA Gill’s death doesn’t mean the NHS is broken – or that private healthcare is superior AA Gill’s death doesn’t mean the NHS is broken – or that private healthcare is superior | |
| (about 9 hours later) | |
| The sad death of journalist AA Gill from lung cancer has led to a barrage of criticism of the NHS. In his last piece for the Sunday Times, Gill described how his cancer had spread, despite conventional treatment, and how he was then unable to get a pioneering treatment called immunotherapy on the NHS. | The sad death of journalist AA Gill from lung cancer has led to a barrage of criticism of the NHS. In his last piece for the Sunday Times, Gill described how his cancer had spread, despite conventional treatment, and how he was then unable to get a pioneering treatment called immunotherapy on the NHS. |
| Gill described asking his oncologist, Dr Conrad Lewanski, why the UK is “such a bad place to get cancer”. Lewanski replied: “It’s the nature of the health service. The key to cancer outcomes is the speed of diagnosis and treatment.” In response to the piece there have been letters and articles supporting the perception that you will be doomed if you rely on the NHS. It cannot be acceptable, writes oncologist Dr Mark Saunders, “that in a 21st-century NHS, patients must have to pay privately for a drug that can extend life”. | Gill described asking his oncologist, Dr Conrad Lewanski, why the UK is “such a bad place to get cancer”. Lewanski replied: “It’s the nature of the health service. The key to cancer outcomes is the speed of diagnosis and treatment.” In response to the piece there have been letters and articles supporting the perception that you will be doomed if you rely on the NHS. It cannot be acceptable, writes oncologist Dr Mark Saunders, “that in a 21st-century NHS, patients must have to pay privately for a drug that can extend life”. |
| Gill paid for the drug Nivolumab privately; unfortunately, it wrought no miracles. Nivolumab, marketed as Opdivo, is a so-called checkpoint inhibitor, helping the body’s immune system to attack cancer cells by boosting the impact of our own T-cells. National Institute for Health and Care Excellence (Nice) has approved the use of this drug in advanced melanoma, but ruled that it’s not cost-effective to offer it to all patients who have the specific kind of lung cancer Gill had. Instead, Nice recommends that these patients are tested for a certain biomarker, which predicts whether they are more likely to respond to Nivolumab. Funding could come from the Cancer Drugs Fund for these patients, who make up a third of those with this type of lung cancer. | Gill paid for the drug Nivolumab privately; unfortunately, it wrought no miracles. Nivolumab, marketed as Opdivo, is a so-called checkpoint inhibitor, helping the body’s immune system to attack cancer cells by boosting the impact of our own T-cells. National Institute for Health and Care Excellence (Nice) has approved the use of this drug in advanced melanoma, but ruled that it’s not cost-effective to offer it to all patients who have the specific kind of lung cancer Gill had. Instead, Nice recommends that these patients are tested for a certain biomarker, which predicts whether they are more likely to respond to Nivolumab. Funding could come from the Cancer Drugs Fund for these patients, who make up a third of those with this type of lung cancer. |
| Reaction to Gill’s death has included a wave of letters and comment along the lines of: “God help me if I get cancer and have to rely on the NHS.” Many issues and arguments have been thrown into the pot along the way, including lack of funding for advanced cancer drugs, late diagnosis and poor cancer survival rates in the UK compared to some other countries. Gill himself thought delays in getting a GP appointment, rushed consultations, delayed referral and slow investigations might all play a part, although he visited a private doctor until he started treatment, so wasn’t able to present personal evidence for his view. | Reaction to Gill’s death has included a wave of letters and comment along the lines of: “God help me if I get cancer and have to rely on the NHS.” Many issues and arguments have been thrown into the pot along the way, including lack of funding for advanced cancer drugs, late diagnosis and poor cancer survival rates in the UK compared to some other countries. Gill himself thought delays in getting a GP appointment, rushed consultations, delayed referral and slow investigations might all play a part, although he visited a private doctor until he started treatment, so wasn’t able to present personal evidence for his view. |
| But he may well have been right and there is no doubt that we could do better. The five-year relative survival rate for breast cancer in England in women diagnosed up to 2007 was 79.1%, compared to 86% in Sweden. And the corresponding figures for bowel cancer were 51.3% in England compared to 62.2% in Germany. | But he may well have been right and there is no doubt that we could do better. The five-year relative survival rate for breast cancer in England in women diagnosed up to 2007 was 79.1%, compared to 86% in Sweden. And the corresponding figures for bowel cancer were 51.3% in England compared to 62.2% in Germany. |
| So for those of us who live in the UK and rely on NHS care, just how bad is it to get seriously ill here? The Organisation for Economic Co-operation and Development (OECD) produced a pithy summary of the state of UK healthcare last year. It said access to care is good, while quality of care is “uneven” and “continues to lag behind that in many other OECD countries”. We’re good at keeping people with diabetes out of hospital, but less good when it comes to asthma and respiratory diseases. UK health spending per person is slightly below the OECD average. And the main factor the summary highlights is the fact that we smoke, drink and overeat more than the OECD average. “To reduce premature mortality, more attention to tackling health risk factors – smoking, alcohol consumption and obesity” are needed, according to the report. Public Health bodies are trying, but the alcohol, sugar and tobacco lobbies are powerful brakes on change. | So for those of us who live in the UK and rely on NHS care, just how bad is it to get seriously ill here? The Organisation for Economic Co-operation and Development (OECD) produced a pithy summary of the state of UK healthcare last year. It said access to care is good, while quality of care is “uneven” and “continues to lag behind that in many other OECD countries”. We’re good at keeping people with diabetes out of hospital, but less good when it comes to asthma and respiratory diseases. UK health spending per person is slightly below the OECD average. And the main factor the summary highlights is the fact that we smoke, drink and overeat more than the OECD average. “To reduce premature mortality, more attention to tackling health risk factors – smoking, alcohol consumption and obesity” are needed, according to the report. Public Health bodies are trying, but the alcohol, sugar and tobacco lobbies are powerful brakes on change. |
| And what about if you get cancer? Should you board a plane as soon as you’re diagnosed? In truth, survival following diagnosis for cancer has improved in the UK over the past 10 years but we are still in the bottom third of OECD countries in five-year relative survival for colorectal, breast and cervical cancer. On the plus side, writes the OECD, “survival rates are improving at least as fast as the OECD average”. | And what about if you get cancer? Should you board a plane as soon as you’re diagnosed? In truth, survival following diagnosis for cancer has improved in the UK over the past 10 years but we are still in the bottom third of OECD countries in five-year relative survival for colorectal, breast and cervical cancer. On the plus side, writes the OECD, “survival rates are improving at least as fast as the OECD average”. |
| Perhaps the solution lies in taking out private health insurance? But buyer beware: read the small print. Insurance companies pay for some treatments, not others. Say you find you have a genetic mutation that gives you at least a one in two chance of getting breast or ovarian cancer. You may want to opt for risk-reducing surgery as Angelina Jolie and Sharon Osbourne did. But you may be surprised to learn that most health insurance policies won’t cover you for any form of preventive treatment; you have to wait until you get the cancer to be treated. If you want it done, you will be able to get it on the NHS if eligible. | Perhaps the solution lies in taking out private health insurance? But buyer beware: read the small print. Insurance companies pay for some treatments, not others. Say you find you have a genetic mutation that gives you at least a one in two chance of getting breast or ovarian cancer. You may want to opt for risk-reducing surgery as Angelina Jolie and Sharon Osbourne did. But you may be surprised to learn that most health insurance policies won’t cover you for any form of preventive treatment; you have to wait until you get the cancer to be treated. If you want it done, you will be able to get it on the NHS if eligible. |
| But why have any system at all? Why not just stow away some cash and use it to buy whatever healthcare you need directly? That would work if you have unlimited wealth, never get sick and are determined not to access modern medicine even if one of your kids gets seriously ill. | But why have any system at all? Why not just stow away some cash and use it to buy whatever healthcare you need directly? That would work if you have unlimited wealth, never get sick and are determined not to access modern medicine even if one of your kids gets seriously ill. |
| Most would agree that we do need some sort of system in place for our healthcare. And there is no system on Earth that offers the full range of treatment options as soon as they come to market. Each system in operation has pros and cons; it is tempting but daft to attribute headline figures about cancer survival rates in different countries entirely to the way they deliver healthcare. | Most would agree that we do need some sort of system in place for our healthcare. And there is no system on Earth that offers the full range of treatment options as soon as they come to market. Each system in operation has pros and cons; it is tempting but daft to attribute headline figures about cancer survival rates in different countries entirely to the way they deliver healthcare. |
| The NHS is not the monolithic, static system some would have us believe; there is scope to deliver the evolutionary changes that we certainly need. This means adapting to the new opportunities offered by science and technology; expect to see rapid innovations in coming years in the field of genomics and artificial intelligence. And there will be more emphasis on promoting wellbeing and preventing ill-health rather than just treating disease. This can only happen if the NHS engages better with patients, carers and citizens. That’s the vision, and we’re all a part of it. | The NHS is not the monolithic, static system some would have us believe; there is scope to deliver the evolutionary changes that we certainly need. This means adapting to the new opportunities offered by science and technology; expect to see rapid innovations in coming years in the field of genomics and artificial intelligence. And there will be more emphasis on promoting wellbeing and preventing ill-health rather than just treating disease. This can only happen if the NHS engages better with patients, carers and citizens. That’s the vision, and we’re all a part of it. |