The letter to the Times states ' "business as usual won't do",

How would you change the way the NHS works/provides care to be more effective and efficient?

To get the debate started I can see two areas:

1. Involve the patient & their carers in the care; give them responsibility and means to discharge that responsibility - stop the NHS paternalism its merely serves to generate NHS additional work eg none of this my GP runs my Type 2 diabetes - it's your body you run it.

2. Stop all screening programs; screening being the investigations into the well person by virtue of age alone.

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10 Replies

  • Hi NHSatheist

    That's a very logical suggestion and would probably work with a lot of people. What we need to remember is that there are a remarkable amount of people that are not that sensible. Involving people in their health and treatment should be a given but sometimes relying on people to manage their conditions is a risky business. Clinicians need to make a decision about who can and who can't. I am sure the NHS would be more than happy if everyone with a long term condition could manage.

  • Is there research behind the effectiveness of screening programmes? Some have been carried out for decades. What about smear tests? Aren't they effective at catching early cancer? Wouldn't it be false economy, as well as bad for patient outcomes, to stop effective early diagnosis techniques?

  • Rowantree,

    ' Is there research behind effectiveness of screening progs? ' There is certainly a lot of propaganda, if you take the NHS Breast Screening information leaflet which has recently been revised to provide a more balanced view there are some that say it is still not adequately balanced.

    IMO two useful sources of information on the efficacy of screening are below:


    2. Patient Paradox by Margaret McCartney - there is an overview at

    The only reason I can see for screening is a desperate attempt by DoH management to satisfy the political agenda to bring the UK cancer survival figures in line with the figures from other countries. The BBC article shows why the US prostate cancer survival rates are better than the UK's - its because they measure different metrics!

    Having started the screenings it is going to be difficult to stop because people believe the results are black and white - they are not. The last I heard bowel cancer screening only identified 14% of expected right-side cancers; if this is the case then the screening is worthless yet Joe Public thinks screening must be good - a lot of education is needed here otherwise we will have political opportunists saying that ceasing screening is a NHS cut. It is a cut - one that I would happily take - in fact I and my wife have refused all screenings offered in the last few years.

    Screening generates a lot of unnecessary work and cost for the NHS and psychological stress for the individual. I have no doubt that it does find some cancers before other symptoms become apparent - but on balance is it worth the cost to so many?

  • You're totally right in everything you're saying. Well, in that I have read all that you've just said elsewhere and tended to believe what I was reading and it did make sense, especially in relation to smear/pap testing. It's not so much the screening that is the problem but the mass screening, as you say, because someone is of an age that it is deemed they MAY be of higher risk of developing a disease/cancer, there are often other indicators of risk too and not just age, so perhaps screening should just be limited to those at high risk rather than those at any risk.

    I'll shut up now cos I seem to be rambling a bit - but I know what I mean ;)

  • Rozi,

    ' What we need to remember is that there are a remarkable amount of people that are not that sensible.'

    I agree, but the vast majority are just going to have start taking responsibility for their actions or inactions. There will of course be a small minority who cannot and provision will have to be made; but on balance the majority are more than capable, and just can't be bothered when others will do it for them.

    Recently, sat across the table from person with Type 2 diabetes who had a quad heart bypass. The person continued to eat without reference to the diabetes, with the comment 'my GP runs my diabetes '. The thought went through my mind that the £20,000+ (I assume) cost of the quad heart bypass was a total waste of resources - on this occasion I kept my mouth shut !!

  • I know that I may come across as heartless when I say this, but I think that people must take more responsibility for their well-being, such as quitting smoking, & eating less if theyr`e overweight. another thing that`s costing the nhs too much money is women getting breast augmentation free because they can`t accept being flat chested. I think that cosmetic surgery shouldn`t be on the nhs except for cases of disfigurement. Lottery money should be put into the nhs because it desperately needs more funding.

  • I think there are very few women who receive any kind of cosmetic surgery on the NHS, I think its probably a myth put about by the tabloid press. Yes many women have cosmetic surgery including breast augmentation but they pay for it privately. It's a sad fact that more and more women seem to be able to find the money for such surgery at great sacrifice to themselves, though I think most of it is done as a result of vanity rather than any lack of self confidence.

  • Having seen three people die from: breast, ovarian, and lung cancer, all three were caught at screenings where past ones had been clear, therefore I cannot endorse your removal of testing for these diseases.

    As to Type 2 Diabetes, my husband was diagnosed this at the age of 50 and we managed to contain this by diet alone until 18 months ago, when he was placed on tablets, he is now 70. As his disease is back under control the GP only wants him tested once a year.

    For myself I do know that I am costing the NHS rather a lot of money per month as I have Psoriatic Arthritis with Psoriasis and am on Anti-tnf treatment along with Dmards, and painkillers. Since having this my mobility has greatly reduced and the weight has increased. I have reduced my intake of food yet without the mobility am having a hard time removing the weight.

    I whole heartily agree that each person should take control of their weight loss by exercise, as that is more healthily for you than diet alone. Boot camps are far better than just the plain gym, as these are completed outside in all weathers. This way it's threefold you get exercise, fresh air and extra Vitamin D. They are completed three times a week for twelve weeks.

    For people that have long term diseases, I think we should all be given contacts with others who are in the same situation, so that we can have regular chats with those people and those who are new can see what others have combatted to get to where they are in a good place. As it's the mental side of any conditions that shock your system and you are in denial for several months or years. Once you have reached acceptance, you are then able to turn your life around to fit your situation, you are then able to accept the help and advice which was offered earlier to you.

    These are my views on what I can see from someone who has a chronic medical condition, and living with someone with another.

  • That sounds a logical way forward, and some areas of NHS already do this. We need to care for ourselves to some degree. But as said not everyone would agree and remember those who provide the service are customers too so help to shape the NHS future. Not all persons apply the regs to the rule and too much responsibility seems to be being passed to GP surgeries it should be distributed fairly across the board if that makes sense to you all.

  • Interesting prog Wed 16 July 2014 Inside Health BBC Radio 4 on Brest Screening

    Can be listened to here

    A number of interesting viewpoints

    Edwina Currie - screening was politically motivated, although it could still have been medically justified at the time.

    Seems justification is based upon old research - some say that is important and more research needed others say it is not.

    Switzerland have just taken the decision to run-down breast screening programme.

    The question that wasn't asked was does modern treatment negate the need for early diagnosis thro screening ie can you wait until symptoms occur, when in the past you couldn't.

    I know of four women, all below screening age, who developed symptoms and have been successfully treated.

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