What the papers say – weekly digest (31/05/24)

Your weekly digest of the top healthcare stories, covering news published from 27/05/2024 – 31/05/2024.

The Guardian

Thousands of patients are to be fast-tracked into groundbreaking trials of personalised cancer vaccines in a revolutionary NHS ‘’matchmaking’’ scheme to save lives. The game changing jabs, which aims to provide a permanent cure, are custom-built for each patient in just a few weeks. They are tailored to the individual’s tumours and work by telling their body to hunt and kill any cancer cells and stop the disease returning. Under the scheme, the first of its kind in the world, patients who meet the eligibility criteria and agree to have a blood test and sample of their cancer tissue analysed will gain immediate access to trials for the vaccines that experts say represent a new dawn of treatments for cancer. The head of NHS England, Amanda Pritchard, hailed the development as a ‘’landmark moment’’ for patients. ‘’The NHS is in a unique position to deliver this kind of world-leading research at size and scale,’’ she said. Research into cancer vaccines is at an early stage, but trials have already shown they can be effective at killing off remaining tumour cells after surgery and dramatically cut the risk of cancer returning. NHS England has enrolled dozens of patients on to its scheme, the Cancer Vaccine Launch Pad, with thousands more to be enlisted across England. The first trials are expected to focus on colorectal, skin, lung, bladder, pancreatic and kidney cancer, officials said, but other forms could be added in future. ‘’As more of these trials get up and running at hospitals across the country, our national matchmaking service will ensure as many eligible patients as possible get the opportunity to access them,’’ Pritchard said. Details of the scheme were revealed on the eve of the world’s largest cancer conference, the annual meeting of the American Society of Clinical Oncology (Asco) in Chicago. The German biotech company BioNTEch, one of the companies partnering with the NHS on the trials, will present new preliminary data at the Asco conference tomorrow (Saturday) on how measuring circulating tumour DNA could help increase early detection of colorectal cancer. Iain Foulkes, the executive director of research and innovation at Cancer Research UK, said it was ‘’incredibly exciting’’ that patients were accessing personalised jabs in a development that would be a ‘’gamechanger’’. ‘’Clinical trials like this are vital in helping more people live longer, better lives, free from the fear of cancer,’’ he said. Cancer vaccines are designed to induce an immune response that may prevent cancer from returning after surgery to remove tumours, by stimulating a patient’s immune system to destroy any remaining cancer cells – and stop them coming back. Last month the Guardian reported how doctors had begun trialling the world’s first personalised mRNA cancer vaccine for melanoma, as experts hailed its ‘’gamechanging’’ potential to permanently cure cancer. NHS officials said that if successfully developed, researched and approved, the vaccines could become part of standard care.

Thousands of fed-up family doctors plan to quit the NHS, plunging basic care into chaos. The crisis has seen millions of patients struggle to make routine appointments – but is set to become a national emergency by 2029. Damning figures reveal 37% of fully-qualified GPs are unlikely to still be working in five years. Many blame unmanageable workloads and the stress of life within powder keg surgeries. Professor Kamilla Hawthorne, of The Royal College of General Practitioners, representing more than 50,000 GPs. said: ‘’Our teams have been plagued by workforce and workload crises and our patients feel the impact most. The public are increasingly struggling to access our care and services. They recognise this is out of the control of GPs and our teams, who are trying to do our best in the most difficult of circumstances.’’ Over the past five years demand for doctors has soared, yet the number of fully qualified, full-time GPs has fallen, despite promises to boost the workforce by 6,000. Latest NHS figures show November was the busiest on record for GPs and their teams, who delivered more than 31 million appointments – a 30% increase on the same period in 2019. The average number of patients per GP in England is now 2,290. There are around 27,487 fully-qualified and full-time GPs in England staffing 6,355 practices. Yet half of them say it is financially unsustainable to do so. Just one quarter said running a surgery was financially stable, the lowest figure since 2016. Worryingly one in four GP partners and salaried doctors said they are so stressed they cannot cope at least once a week. Frustrated patients say accessing appointments has become also impossible with many surgeries suspending online booking and advance slots. It now leaves millions at the mercy of a daily 8am phone-line lottery and a slim chance of a same-day consultation. An average doctor will care for a patient who visits, on average, five times a year – meaning they plough through at least 10,000 appointments in 12-months. However, staffing black holes see a handful of GPs looking after tens of thousands of patients. In some cases, doctors deal with more than 60 a day.

A test that can detect oesophageal cancer at an earlier stage than current methods should be made more widely available to prevent deaths, charities have said. The capsule sponge test, previously known as Cytosponge, involves a patient swallowing a dissolvable pill on a string. The pill then releases a sponge which collects cells from the oesophagus as it is retrieved. The test can detect abnormalities that form part of a condition known as Barrett’s oesophagus, which makes a person more likely to develop oesophagus cancer. About 9,300 people are diagnosed with oesophageal cancer a year across the UK, according to Cancer Research. The disease is difficult to detect because the symptoms of the cancer are not easily recognisable – and can be mistaken for indigestion – until it is at an advanced stage. The disease had a 10 year survival rate of 12%, a rate that rises to 55% if the cancer is detected early, at stage one. The capsule sponge test can detect the cancer at an earlier stage than current methods used to diagnose oesophageal cancer, such as an endoscopy. However, it is only currently available to higher-risk patients as an alternative to endoscopy as part of NHS pilot schemes. Cancer Research UK is working with the National Institute for Health and Care Research on a trial aiming to recruit 120,000 people to see if the capsule sponge test can reduce deaths. If successful, the test could be rolled out more widely. Mimi McCord, the founder of Heartburn Cancer UK, is calling for the wider adoption of the capsule sponge test in order for patients to be diagnosed earlier and given a better chance of survival.

The Telegraph

More than 140 hospitals have pledged to bring in Martha’s Rule, ensuring that doctors must respond to parents’ concerns about how their children are faring under NHS care. The new rule gives patients and their families the right to a second medical opinion if their own or a loved one’s condition deteriorates. Doctors will be told that they must make formal notes of changes in behaviour or condition seen by those who know the patient best. Martha’s Rule is being brought in following the avoidable death of a teenage girl from sepsis, a life-threatening reaction in which the immune system attacks the body’s tissues and organs. Merope Mills began campaigning for NHS rules to be changed after her 13-year-old daughter Martha died at King’s College Hospital, London, in 2021. Doctors missed signs of sepsis and did not take heed of warnings from Martha’s parents that her condition was rapidly deteriorating. The NHS described the introduction of the rule as ‘’the next step in a major patient safety initiative’’. Prof Sir Stephen Powis, the NHS national medical director, said: ‘’Rolling out Martha’s Rule to over 143 NHS sites in this first phase will represent one of the most important changes to patient care in recent years. We are pleased to have seen such interest from hospitals right across the country, all thanks to the moving and dedicated campaigning by Martha’s parents, Merope and Paul.’’ About 50,000 people a year die from sepsis, however, many are older and suffering from other illnesses.

Holland & Barrett have been accused of ‘’insulting’’ women by selling chocolate bars covered with ‘’menopause almonds’’. The UK’s largest health food chain claims the £3.79 dark chocolate snack soothes menopause symptoms and ‘’contributes to the regulation of hormonal activity’’. Instructions on the packaging state that the 75g bar contains vitamin B6, which is naturally present in almonds. Yet Kate Muir, a menopause campaigner, branded the bars a ‘’ridiculous money-making product’’. She said: ‘’I feel very strongly that this is exploiting a vulnerable group of women who deserve much better than they’d get from a chocolate bar. Hopefully (women) won’t be distracted by ridiculous money-making products like this.’’ Despite describing the products as ‘’nuts’’, Ms Muir stressed that ‘’joking aside’’, hormone deficiency is a ‘’very serious’’ problem. ‘’There is a peak in suicide among women in perimenopause. Women need to know they can go to the NHS and get proper help, rather than relying on chocolate bars.’’ Holland & Barrett states on its website that the bars contain a tiny amount of saffron extract, branded as ‘’affron’’. But this was tested in one small 2021 trial, which was sponsored by its makers, and no effect on physical menopause symptoms was identified. The packaging advises that each bar contains 462 calories and 20g of fat, a quarter and a full daily allowance for women respectively. A Holland & Barrett spokesman said the retailer champions ‘’greater awareness and education on menopause and menstrual health’’. Our Almonds in Dark Chocolate with Benefits Bar is delicious dark chocolate with affron, a clinically studied extract, which helps to support moods during menopause and contains vitamin B6 to help the regulation of hormonal activity. It is recommended to be consumed as part of a balanced and varied diet.’’

Men could cut their risk of prostate cancer by more than a third if they improve their fitness levels by just 3 per cent a year, a study has suggested. Experts have found a statistical link between changes in men’s fitness levels and their risk of developing the cancer for the first time. The study of more than 57,000 men, with an average age of 41, found that those who were able to increase their cardiorespiratory fitness by 3 per cent each year were 35 per cent less likely to develop prostate cancer, than those who did not. Researchers measured the amount of oxygen the body uses while exercising at a high intensity to determine their fitness level, also known as the VO2 max. A person can increase their fitness or oxygen capacity through regular exercise, such as by running, cycling or swimming, at least three times a week. The men were assessed over an average of seven years during which time 592, or around one per cent, of the 57,652 participants were diagnosed with prostate cancer. The men were categorised into groups depending on how much their fitness level changed each year. Those with an increase in their fitness level of 3 per cent or more, a reduction by 3 per cent or more, and those who remained stable. The rate of prostate cancer was highest in the group whose fitness levels fell and lowest in the group whose fitness levels increased. Simon Grieveson of Prostate Cancer UK said that the new research ‘’adds to previous studies showing possible links between exercise and a lower likelihood of getting prostate cancer’’.

The Times

Junior doctors may strike during the general election campaign, The Times can reveal, after union bosses met last night to discuss their ongoing pay dispute with the government. Leaders of the British Medical Association (BMA) held an emergency meeting to discuss ‘’next steps’’, including more industrial action, in their standoff with the government. Before the meeting, the BMA’s junior doctors’ committee told members that they would ‘’use our (strike) mandate during and after the election, regardless of who is in No 10.’’ Junior doctors have a mandate to keep striking until September. By law, they have to give two weeks’ notice of upcoming strikes, meaning that walkouts could happen at any point from June 13 and include July 4, when the general election is being held. A strike would have the potential to derail election campaigning for both of the main parties. It would pose an awkward dilemma for Labour, which is keen to highlight the dire state of the NHS but also reluctant to commit to the 35% pay rise demanded by the BMA. The Conservatives are keen to present Labour as being in hock to unions, including the BMA, and are likely to accuse the doctors’ union of seeking to influence the election. The BMA could tell its members about the outcome of discussions yesterday evening as soon as today (Wednesday).The BMA has not staged any strikes since February and had been holding intense talks with the Department of Health via a mediator, in an effort to end the dispute. However, last week the co-chairs of the BMA junior doctors’ committee, Dr Robert Laurenson and Dr Vivek Trivedi, told members that Rishi Sunak’s decision to call the general election had ‘’fundamentally changed the landscape’’. They said that if ‘’no credible offer had been made by last night they would use their strike mandate. In the email, seen by The Times, they wrote: ‘’In six weeks’ time, the country will go to the polls. Rishi Sunak’s decision to call an election fundamentally changes the landscape – now is the time for the government to table their final offer for 2023-24.’’ Junior doctors have held ten rounds of strike action since March last year. The last strike by junior doctors – from February 24 to 28 this year –  led to 91,048 appointments, operations and procedures being postponed.

Computer failures within the NHS have been linked to the deaths of three patients and more than 100 incidents of serious harm at hospital trusts, freedom of information requests have found. Emily Harkleroad, 31, died from a blood clot in her lung after being left without the care she required when a new computer system failed to identify which patients were most in need. The requests also found that 200,000 medical letters had not been sent, which could mean appointments or diagnoses were missed, despite NHS England investing £900 million in the past two years on new improved systems. The request, sent by BBC News, found that nearly half of the hospital trusts using electronic patient record (EPR) systems had reported issues which could affect patients. Professor Kamila Hawthorne, the chairwoman of the Royal College of GPs, said: ‘’Now that we know there is a problem, it is crazy not to do something quickly in order to save lives and keep people safe.’’ Professor Joe McDonald, a former NHS clinical leader told the BBC: ’’The thing about paper is when you make a mistake you make them one at a time. With electronic patient record systems, it gives you the opportunity unfortunately to make the same mistake thousands of times.’’ There were 126 instances of serious harm across 31 trusts also linked to the IT issues. Harkleroad collapsed in December 2022 and was taken to A&E at University Hospital of North Durham, where a blood clot in her lung was diagnosed. There were delays in giving her the blood-thinners that she needed and a new computer system installed only months earlier failed to identify which patients were critically ill and needed to be prioritised, an inquest was told. Harkleroad died the following morning. The coroner called on the hospital trust and software supplier Cerner, now owned by Oracle, to take action to prevent future deaths, according to BBC News. Oracle told the BBC: ‘’While there is no suggestion that software was at fault in this case, we continue to work closely with our NHS partners to implement successful programmes that help them deliver the safest and most effective care for the 16 million citizens our systems support in the UK.’’ Professor Erika Denton, national medical director for transformation at NHS England, said: ‘’Electronic patient record systems have been shown to improve safety and care for patients, including helping clinician detect those at risk from conditions, such as sepsis and preventing medication errors.’’ The Times understands that some NHS trusts dispute the numbers of deaths revealed in the requests.

Feeding children peanuts from an early age can protect them from peanut allergies throughout childhood, research has found. A diet that includes regular doses of peanuts from weaning until the age of five reduced the rate of peanut allergy in adolescence by 71%, suggesting 100,000 cases of peanut allergies could be prevented globally each year. Allergy charities have said that the findings could mean future generations have a chance of being allergy-free. In recent decades there has been a threefold rise in peanut allergies, which can trigger a life-threatening reaction. About 2% of children in North America, western Europe, Britain and Australia suffer from them. The researchers advised parents to introduce peanuts from about four months of age, or shortly after weaning, and to feed peanuts to children as a soft paste or as peanut puffs. The research, published in the journal NEJM Evidence, is part of the Learning Early About Peanut Allergy clinical trial, which is partially funded by the US National Institutes of Allergy and Infectious Diseases. In the first part of the trial, the researchers asked half of the 500 participants to consume peanuts from infancy until five years old, with the second half avoiding peanuts during that time. When the scientists followed up on the children at age 6 or 12 and older, they found that 15.4% of the children who avoided peanuts had developed an allergy to them, compared with just 4.4% of those who had eaten them from an early age. The children were given peanuts in gradually increasing quantities to determine whether they could consume them safely.

Hospital waiting lists would nearly halve over the next five years under a pledge from Sir Keir Starmer to make clearing the NHS backlog the ‘’first step’’ of his government. Labour will commit to ensuring that no patient has to wait longer than 18 weeks for scans, treatments or operations. Eliminating these long waits would bring the present waiting lists of 7.5 million back to the pre-pandemic level of 4.3 million. The party says it will adopt a radical reforming agenda that is like ‘’New Labour on steroids’’ when it comes to the NHS, comparing the dire state of the health service to the situation inherited by Sir Tony Blair in 1997. Labour has promised reforms including an extra 40,000 NHS appointments and operations each week by paying NHS staff to work more weekends and evenings, as well as an overhaul of culture and management in the NHS. As part of £1.3 billion in extra funding, greater use would be made of spare private sector capacity and the number of MRI and CT scanners would double. The overall NHS hospital waiting list for England stands at 7.54 million. Labour has not set a target for the overall waiting list, instead focusing on accelerating treatment so everyone is seen within the existing NHS target of 18 weeks after a GP referral. This has not been met since February 2016. Latest data shows that 3.2 million people – almost half the total waiting list – have been waiting longer than 18 weeks to get seen. This is up more than ten-fold in the past decade.