Outcomes must matter most if NHS ailments are to be remedied

We will try to get through this week’s column without mentioning the B-word.

Not because our relations with Europe aren’t important but because other things are important, too. Politicians, journalists and party activists may be glued to Sky News and Twitter for the latest chat on meaningful votes and Malthouse compromises but many voters have switched off entirely. Norway isn’t an option for them; they want to be much farther away from all this wearisome wrangling.

Sometimes politics is a matter of life and death but renegotiating our terms of trade with Lithuania is not such an occasion. The story that should have dominated the news agenda last week was the announcement of an independent review into the use of chemotherapy in NHS Tayside.

Letters were sent to 304 women treated for breast cancer between December 2016 and March 2019 informing them that they were given lower-than-usual doses of the drug docetaxel. Oncologists in Tayside prescribed 75mg/m2 rather than the 100mg/m2 that is standard across Scotland.

The inquiry, headed by Scottish Government cancer expert Dr David Dunlop, will probe the cases of 14 women given lower-dose docetaxel who later died. The health board stressed that the risk to patients was very low but confirmed its clinicians would prescribe the standard dosage from now on.

Mid Scotland and Fife MSP Liz Smith raised the matter at First Minister’s Questions on behalf of a constituent who received one of the 304 letters. Nicola Sturgeon confirmed an additional expert group was looking into the clinical decisions and said the Scottish Government took the matter ‘extremely seriously’.

There is no suggestion that events in Tayside are the result of negligence or cost-cutting. Rather, as consultants made clear to Healthcare Improvement Scotland (HIS), they acted on concerns about the toxicity of the drug cocktail and distinctive health problems in the local community. A key worry was the ‘unacceptable rates of neutropenic sepsis’ — a life-threatening infection — they observed after giving patients a full dose.

The consultants were caught between the contradictory approaches of national guidelines and the ‘realistic medicine’ and ‘person-centred care’ the Chief Medical Officer preaches. We will have to wait for the findings of Dr Dunlop’s review to learn if they made the wrong call, with tragic consequences for women and their loved ones, or if they used their professional judgement to treat patients as best fitted their medical needs.

What we do know is that, whatever the clinical merits of their decisions, these specialists did not tell their patients they were receiving a lower dose. In an age when almost everyone consults Dr Google to find out more about their conditions and medications, it is outdated and paternalistic not to provide them with this crucial information. As the HIS report recommends: ‘Where routine practice is different from that supported by the wider oncology community, patients should be informed of this.’

This is brought home hard by the words of Lee Dennis, one of the women who has received a letter. She told the BBC: ‘I actually had to read the letter twice when I first opened it because I was not really sure what I was reading. As it settled into my head, I felt a lot of things — a rush of anxiety, a flurry of questions came to my mind and I incoherently babbled to my husband that he needed to read this letter and explain to me what I was taking in.

‘It instils a massive sense of fear, of distrust, of anxiousness and worry. All these What Ifs? come back again — what’s going to happen? Am I going to be okay?’

There are 303 more women out there experiencing the same anxiety and uncertainty that Mrs Dennis is. As though going through the waking nightmare of breast cancer wasn’t enough, many of these women — even those long since given the all-clear — will struggle to silence a niggling voice in the back of their mind about just how healthy they are now. No matter what conclusions the Dunlop review comes to, some will always hear that whisper of doubt.

Scandals like this shake our confidence in the NHS, a cherished institution most of us trust implicitly. For patients in Tayside, it comes amid a financial crisis that is crippling the health board. This year alone, Tayside is projected to post debts of £22 million, in addition to £45 million it already owes. The chief executive does not expect to climb out of the debt hole before 2022.

Nor is it the only board with troubles. A report published last year revealed a culture of ‘bullying and harassment’ in NHS Lothian, following a 2017 review which found that every acute hospital in the board had under-reported waiting times. In March, it was reported that Greater Glasgow and Clyde’s Queen Elizabeth University Hospital could be facing a £50 million repair bill, just four years after the £800 million super-hospital opened its doors.

The record on waiting times across NHS Scotland ranges from troubling to woeful, not least for conditions like cancer. The 62-Day Standard requires that 95 per cent of patients urgently referred with suspected cancer begin their treatment within 62 days. In fact, just under 83 per cent are being seen on time.

In February, almost one in ten planned operations (around 2,500 procedures) were cancelled. No patients are supposed to wait longer than six weeks for a key diagnostic test; in the last quarter, more than one in five did. No more than five per cent of us should be waiting longer than 12 weeks for a new outpatient appointment — the actual figure is 30 per cent.

On mental health, 90 per cent of patients are meant to begin psychological therapies within 18 weeks of referral. Just one health board in the entire country is meeting the target.

The health service in Scotland is out of shape and the fear among doctors and patients is that those responsible for running it are out of ideas. Initiatives flourish, but meaningful reform long ago stalled. Ministers and NHS executives continue to prefer sticking plasters to effective, if sometimes painful, cures.

This cowardly approach does not benefit the health service or the millions who rely on it. Photo-ops in the wards and warm words for hard-working staff do not balance out inaction and dereliction of duty in the face of mounting crises. There are no end of politicians lining up to tell anyone who’ll listen how much they love the NHS. Rhetoric is the one thing the health service has no shortage of, but to mean anything it must be matched by political and corporate will.

The daunting feat of turning this around falls to Jeane Freeman. Of course, these things involve vast armies of unseen public servants working diligently behind the scenes but the Health Secretary will be the focus of every success and failure. She cannot snap her fingers and change things overnight and yet the clamour for improvement is only going to grow louder.

Freeman is tough. In this game, you need to be tough, especially if you’re a woman, but she must start putting some of that political braun to good use. We know what the challenges are: financial sustainability; staff recruitment and retention; keeping apace of medical and technological advancements; changing lifestyles, mental ill-health, and an ageing population; the social care crisis; and moving from a mindset driven by spending to one governed by outcomes.

Put simply, the NHS must stop being revered like a national religion — blasphemous to criticise, heretical to change — and start treating patients like the paying customers they are.

Our taxes fund the NHS and we should expect and receive fast, flexible, choice-driven, quality healthcare in return. It is Jeane Freeman’s job to make this a reality. As Health Secretary, she will either be remembered as a reformer or damned as a failure.


Originally published in the Scottish Daily Mail. Letters: scotletters@dailymail.co.ukContact Stephen at stephen.daisley@dailymail.co.uk

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