I have recently contributed to a thread on the forums re Arimidex , which has lately come out of licence - or whatever the technical term is- so that Anastrole, the generic drug can now be produced at a fraction of the cost of Arimidex. Most GPs are naturally now prescribing this cheaper generic form and a number of forum members have had problems with it- and have had to fight to be allowed to return to Arimidex. I’m fortunate in that there has been no difference in the drug’s side effects for me and I’m really glad if I’m helping to reduce the NHS’s mega drug budget
It has got me thinking about the vast amounts of money that are spent on drugs- plus all the other millions/billions of pounds swallowed up by the NHS. Who decides how money is allocated - the professionals or the politicians? What part do WE have in it all…?
Breast screening costs £100 million a year and is increasingly contentious; is it really best value for money? This week saw a letter in The Times from Professor Michael Baum ,one of the architects of the Screening Programme in London & the S.E. in 1987;
He writes:- “In 2009 I proposed that instead of screening an unselected population we should embark on a risk management programme; we have excellent statistical algorithms these days which would allow us to carry out a triage of breast cancer risk in the general population.
Those at the very highest risks need genetic counselling and genetic testing in the first instance. Those at the lowest risk have more important concerns than breast cancer and are up to 25 times more likely to die of heart attacks, strokes and respiratory disease. This group need screening for risk factors for cardio-vascular disease and some might benefit from life-style advice and more intense anti smoking interventions. The intermediate risk group might have the most favourable benefit/harm ratio from mammographic screening.
I was invited to describe these proposals to the parliamentary scientific committee; I was well received by the Members of both Houses and passed on my proposals to the cancer ‘tzar’ Mike Richards. I still await his reply.
When scientists change their minds as the evidence changes it’s known as scientific integrity;if politicians do the same it’s known as political suicide.”
…and then there’s the question of the huge number of people employed in the NHS- it used to be 4 staff to every patient but I think it’s higher than that now…and they are not all the much maligned ‘over-paid managers’. . I have been lucky and have never had to have much to do with hospitals until BC hit me 3 years ago but over recent years I have not only been to my own appointments but also accompanied my husband etc on other outpatient visits. The hospitals differ but each time I’m staggered by the huge numbers of staff - why are so many nurses required to carry files from A to B and to call out patients’ names? On one visit this week 4 nurses were actually sitting down ‘waiting for work’ (?) whilst 2 receptionists and 2 other nurses were dealing with the patients - there were only 2 consulting rooms in use = so why all those staff?
I do know that in my day the Assistant Matrons would walk the wards and departments and move staff who were not going anything to where they were needed. On the 2 occasions when I have been admitted to hospital as an emergency in the last couple of years I have been appalled at the changes in nursing. Now it is a job and not a vocation. Florence must be turning in her grave.
How would they choose who goes in which band?
There hasn’t been any cancer in my family before me.
There have been loads of heart attacks/strokes in my fam post-60 but they were all smokers and I lead a completely different lifestyle; outdoors strenuous activities (when I’m well), no smoking, fresh food cooked from scratch. I had my cholesterol checked as a precaution but it’s fine.
But I’d be in the cardio-vascular group…and I have BC.
Regards the ‘overpaid managers’ myth:
I work in (not for) the NHS. I know loads of graduates on band 3 (£15,800 - £18,800).
Nurses aren’t on band 3.
My nurse friend is on band 7 (£30,400 - £41,000).
I know that all nurses aren’t on band 7 but newly qualified ones start at band 5.
I think that explains the reason why nursing is now a job choice.
Hi Ninja- I do take your point as to how the screening selection would work but still think Prof Baum talks a lot of sense - and I’m sure HE could produce plenty of evidence to support his arguments.
Mass screening is just too broad-brush - and I’m sure that eventually more people will have the courage to admit it; I think it would have been seriously re- evaluated long ago if it wasn’t such an emotive (ie political) issue: what government would dare to even think of it?
I was picked up on a routine screening, symptom -free etc so I am playing devil’s advocate here to some extent but I really believe that my BC would have been shown itself pretty soon anyway. On the other hand I see so many people over 60 ( I belong to a BC group) who have had mastectomies for screen-detected DCIS who really believe that it was worth it - they have been led to believe that DCIS would have developed into invasive cancer= but who is to say that it would? The jury is still out.
Re nursing - emmbee and I are in agreement with you here : it’s certainly not a ‘vocation’ for many people these days. I too have family and friends in well-paid nursing jobs- I hope & trust that they have the real qualities needed to be good nurses but if they have, I think that that is almost incidental these days. I trained as a nurse myself many years ago so don’t get me started on that subject…!!
concerning how money is spent in hospitals… well my big bug bear is that a family member who is “management” at our hospital has a work supplied blackberry!, she has her own too and always comment on the fack that she has 2!!! (my mob only cost £30)I’m guessing she is not the only member of management who has been given this perk! what is wrong with being contacted on her own mobile?
there thats me moaned out for now!
I am a nurse. I love being a nurse and I run the biggest student nurse forum in the country and there are very few on there who are doing nursing just for the money. The fact that for the majority they will get £6000 a year for 3 years at university to do a 45 week course and work on wards or placements at least half of that time doing 12 hour shifts, nights and weekends because they love what they do and they want to do it for the love of the job not for the pay packet. The average age of a student nurse is 31 so the majority have given up well paid jobs or have existing commitments to do this. Not many 18 yr olds want to go into nursing or deal with death, dying, blood, guts and vomit and some of the ones that do start reuse they can’t deal with it either.
A newly qualified nurse gets sugnificanky less salary than many other similar service professions and less than many other degree professions within the nhs.
The nhs in turn is reducing the number of staff and replacing qualified nurses with health care assistants and replacing senior nurses with less experienced ones as a cost saving tactic.
Nursing has changed over the years but so has the nhs and so have the patients. In the 1980s only 45% of breast cancer patients survived 5years following treatment. Now 90% survive for over 10 years. That is twice the number of patients for twice the length of time this does cost money. The screening is better the treatments are better but all are more expensive.
In respect of clinics with too many staff I work in a clinic 2 weeks ago I had to see 6 patients only 3 turned up I still had to be there and hang about regardless.
Yes there are some crap nurses and some crap doctors, physios, radiographers, health visitors etc but equally there are some crap policemen, teachers, firemen, accountants, scientists, bus drivers it doesn’t mean they are all bad.
Sorry I just feel really strongly about the fact nurses and the nhs are always top of the heap for slagging off when we are all in such a lucky position to have an excellent health service with excellent staff on the whole. And I’m sure many of our experiences could have been so much worse elsewhere in the world.
I know it’s not perfect… nothing is but like you said at the start if we all do our bit by reducing costs and reducing DNAs and if yhe hospitals and magagers make sure there are enough rooms to run clinics and all the right staff are there when they need to be and arrange to cover other areas it will be even better.
I am in absolute agreement with Lulu on this one … I started training as a nurse in the late 1990s as a mature student after being made redundant from another job. I could not hack it. As a nurse you are 100% responsible from the patients in your care. I could not cope with that degree of responsibility - it terrified me and I left after a year. It also terrifies me that nursing jobs are being replaced with less skilled ones. Yes, nurses are better paid now than they were 20 years ago, and well deserved. If you want people who are highly skilled you have to pay well, otherwise they go elsewhere. Personally, I’d rather be treated by a well-paid, skilled professional.
well said LuLu
if we were in America we would probably have a worse time than in england as not everyone can afford insurance!
the nurses who have cared for me in the different departments have been responsive and caring .They have incredably challenging jobs on the whole and whilst everyone dosent treat it as a vocation I would say the majority of them do.As a matron i have in excesss of 300 nursing staff to manage [.I must say via the sisters]. I am hands on and clinical led with my focus on infection control and the experience of the patient and their families. My job is very stressful at times but so rewarding I will be returning to work very soon. I will have positive and negative things to discusss with my staff but overall I am glad they all helped me.
when people criticise the nurses of today I am also reminded of the poor teaches who get it in the neck when the kids do well at their exams —one thing I have learned is to celebrate all the good and make changes if its bad
sorry for the rant -touched a raw nerve !
That’ll be the “well-paid, skilled professionals” that left me in 1999 as an in-patient with no sheets, no pillow and just one blanket all day (despite requests from me - they told me that they were short of bedding WTF!) until the night staff came on and a Health Care Assistant brought me what I needed for my basic care immediately and also brought me a crossword magazine at midnight (she checked me; I didn’t call her) because I couldn’t sleep due to post-surgical pain after a knee operation.
“A newly qualified nurse gets sugnificanky less salary than many other similar service professions and less than many other degree professions within the nhs”
That only washes if you compare newly-qualified for all. I know what newly-qualified managers get - I work with them. It’s poor.
Speech and Language Therapy is a degree profession but they only get paid on band 5 and at one time, an SLT with a university degree working in a school barely got much more pay than some of the classroom assistants. I used to know a few of them.
I see all the time the white-washing that gets done in the media - they compare a new-qualified rate for one job and compare it to top-of-payscale rates for another. Oh, poor firemen/nurses/whatever.
I agree that some of the top managers get stupid amounts of money - but that goes for top management in every walk of life.
“We pay your wages” is the cry - but if you shop at (say) Tesco, you are paying the obscene wages of their CEO as well.
Everyone is going to stick up for their own job/workmates!
BTW - that was me being devil’s advocate, as I said above - I have spent nearly all my working life receiving the government’s shilling and getting all the “we pay your wages” “you work for me” cr@p.
Sorry Emmbee- it was an oversight- I’d drafted my comment and wanted to refer to your post and I didn’t realise I’d added your name again at the bottom of the page.
Please accept my apologies
Mary
I agree that screening everyone is not a good idea.
They could concentrate on people in the most risky groups e.g. people with a family history of breast cancer, people who have children late or no children and older people.
At the moment they stop the breast screening programme at 70 or so except on demand when the most likely people to get breast cancer are older women.
Also 80% of tumours are found by woment themselves yet the breast screeening programme gives the impression that they will detect tumours earlier than women themselves. This may happen for a lucky few but some may be lulled into a false sense of security.
Breast density makes a difference to detection, younger women’s breasts are denser which is why it breast screening isn’t that good for younger women. Speaking as someone with very dense breast tissue, I’ve opted not to have breast screening despite being diagnosed with breast cancer. I found my tumour, if I get another I expect to find it myself sooner than screening.
the pick up rate for screen detected cancers is actually 45%, there are many ongoing advances in screening such as two views, digital machines and improved training for readers… but these things all cos money as well as the treatment and aftercare.
for all the women on here who had screen detected cancers many im sure are thankful of the screening programme we are lucky enough to have.
i think compromising the screening programme could set us back eons… the majority of the 45% of cancers detected at screening are at early or pre invasive stage… the majority of women have no idea they have breast cancer they have no lump and no other symptoms… we can detect tumours as small as 7mm in screening.
im sure there other areas that are very expensive where they could be more cost effective… although there probably are health professionals from their fields saying yes gender reassignment surgery is necessary or giving liver transplants to drinkers and lung transplants to smokers or paying for methadone programmes for drug addicts… im not saying the funding for these should be withdrawn just they are more controversial areas of health.
im wondering if your 80% figure refers to young women as most of those under 50 will have found their cancer themselves, with only a few being screen detected.
“we can detect tumours as small as 7mm in screening”
Screening works for some people but shouldn’t be relied on as a Gold Standard of detection as the regular screening programme told me that I was safe and cancer-free.
I have multiple primaries that arose simultaneously; all much smaller than 7mm, undetectable by mammo and CT. Had I not noticed the change in my lymph nodes very quickly, the cancer cells that had already spread rapaciously to my nodes within weeks would have travelled throughout my body.
the 2009/10 report of the breast screening service says they diagnosed 14,229 cancers in women aged 45 plus. Altogether 45,000 people get diagnosed with breast cancer in the UK each year. 20% of those are aged under 50, so I’d say the numbers diagnosed through breast screening form a small proportion of those diagnosed overall.
Unless I’ve completely misunderstood how things work…
Hi mole on my phone but will try find link to stats when I get home.
Topsymo that’s a really difficult one cos we just dont know which DCIS will turn invasive and which won’t. There is a new research trial starting which is going to monitor patients with low grade DCIS to see if they turn into cancer or not. Thing to remember too is that all ductal cancers were DCIS at one point. And low grade DCIS looks pretty much the same as high grade DCIS on mammo. So could be quite difficult to decide who to biopsy.
There is a lot controversy surrounding that issue though and some people may feel over treated whereas those who go on to get secondaries or even invasive cancer may have wished it could have been diagnosed at an earlier stage.
My IBC was found through the screening programme. It was deep and the Consultant couldn’t feel it. I asked why I had been screened at 48 thinking it maybe due to my Mum having breast cancer in her early 40’s, but apparently we go onto the database at 47 as it is a 3 year cycle so we get seen by the time we are 50. Had I waited 2 more years I would almost certainly have found the lump, but may have had to have an Mx rather than a lumpectomy, possibly chemo too , so that would have ended up costing a lot more I imagine. There again I am just one person. But very glad for the screening. Whichever way they go with screening it will be good for some, but not for all i feel…
Jude