Tory tax cuts putting pressure on the NHS | Letters

‘Voters deserve no soundbites,’ Marr tells May

Whenever Theresa May finds herself in a corner over the NHS she repeats the mantra: you require a strong economy to have an NHS in the first place (Marr grills May, 1 May). That is a classic example of a necessary but not a sufficient condition. It obviously helps to have a strong economy but a nation has to get other decisions right.

The US has a strong economy but a seriously deficient public health service due to large reliance on insurance companies for facility and corporations providing health cover for employees.

Cuba has a weak economy but an excellent health service due to the right decision on prioritising public health.

In the UK the NHS is in difficulties due to the Tory government prioritising tax breaks for corporations and the better off instead of using the finance to meet the needs of an ageing population with increasing quantities and complexities of treatments required. PFI and privatisation have also not helped.
Nigel de Gruchy
Orpington, Kent

• The political shock-horror of the shortage of nurses misses the point of why so many NHS staff are not British or/and are leaving. At the weekend I had a cardiac physiologist to stay – ie, not a doctor or a nurse but an essential member of the team dealing with heart attacks on emergency call-out at night, and for checking heart problems during the day. The night on-call emergency rotas are made to follow a full day’s work, so no sleep for up to 24 hours is common. It is worse when you are sent home at about 4am and drop into an exhausted sleep only to be woken again to go to work an hour or two later (or not daring to sleep in case the phone rings). My guest says jobs are harder to fill in hospitals where you can be on call for a night in between two normal days – ie, up to 36 hours’ continuous working for patients who are in immediate danger of death.

These staff do not have the powerful BMA doctors’ union acting for them, and such practices have become normalised and in agreement with unions. Politicians claim to be making the best use of taxpayers’ money. Not in my name please! Sleep deprivation is the reason my guest and many others are looking to leave the job they otherwise found satisfying after years of training and building up their expertise.
Name and address supplied

• I wish to point out the connection between the two articles on cancer drugs and end-of-life care in Friday’s paper. In the cash-constrained NHS, expenditure in any area means that money cannot be spent elsewhere. So when £1.27bn goes on very expensive new cancer drugs (Report, 28 April), not curative and with zero or marginal outcome benefit, it cannot be spent on specialist palliative care or “hospice at home” services. The consequence is that those same patients, within weeks, cannot be supported in their wish to die at home (Report, 28 April). Many more people would have been helped by the latter investment.
Dr Charles Turton
Burgess Hill, West Sussex

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Tory tax cuts putting pressure on the NHS | Letters

Police cannot continue to fill gaps left by mental health cuts, report says

Police cannot continue to pick up the slack for cuts in other public services, especially the shortage in mental health provision, Her Majesty’s chief inspector of constabulary has warned.

In an annual state of policing report, Sir Tom Winsor highlights a “modern tsunami of online fraud” and increased police awareness of crimes against the elderly and child sexual exploitation as among the increasing daily pressures facing officers.

“The police are considered to be the service of last resort. In some areas, particularly where people with mental health problems need urgent help, the police are increasingly being used as the service of first resort. This is wrong,” says the chief inspector.

Winsor, who was appointed by Theresa May when she was home secretary, says the failures of other public services, especially in respect of children’s and adolescent mental health, too often leave the police to fill the gaps long after the chances of effective intervention have been lost.

His annual report identifies 18 of the 43 forces where the need for improvement has been highlighted in at least one of HMIC’s inspection themes of effectiveness, efficiency and legitimacy. Only one, Bedfordshire, was rated as “inadequate” for one category.

Winsor says that in many cases, police leaders are “still too sluggish” to ensure their plans are sound to the new demands on their forces. He says for too long a culture of insularity, isolationism and protectionism has prevented chief constables from making the most effective use of new technology: “The blinkers have to come off,” he says.

Winsor also warns that the police are behind many other organisations in their use of technology, saying it should be giving them unprecedented ability to exchange, retrieve and analyse intelligence.

“The provision of mental healthcare has reached such a state of severity that police are often being used to fill the gaps that other agencies cannot. This is an unacceptable drain on police resources and it is a profoundly improper way to treat vulnerable people who need care and help,” he says.

“The obligation of the police is to prevent crime. This is not only because this makes society safer – both in reality and in perception – but also because it is far cheaper to prevent a crime than it is to investigate and arrest the offender after the event. The same is true of mental ill health, which is not a crime.

“It is an old adage that an ounce of prevention is better than a pound of cure, and this is particularly true when the cure fails and an emergency intervention is required to protect the safety of an individual in distress and, often, people nearby.

“By the time depression or some other mental disorder has been allowed to advance to the point that someone is contemplating suicide, or engaging in very hazardous behaviour, many opportunities to intervene will have been missed by many organisations.

“When that intervention takes place on a motorway bridge or railway line, or when someone is holding a weapon in a state of high distress, the expense to all concerned is far higher than it should be. The principal sufferer is the person who is ill, especially when it is realised that his or her suffering could have been much less or even avoided altogether,” concludes Winsor.

Police cannot continue to fill gaps left by mental health cuts, report says

Cuts and Brexit add to pressure on the NHS | Letters

The government’s statement that there are 11,200 more doctors and 2,100 more nurses on the wards since 2010 (Hospitals offer doctors £95 an hour as staffing crisis grows, 15 April) is not the experience of those of us in frontline NHS work. Last year 30% of foundation doctors (those who have finished medical school and are at the point of choosing the specialty to train in up to consultant level) chose not to apply for specialist training straight away and went off to do something else. Many will come back, but many won’t. This year the reluctance to carry on rose to 50%. It appears Jeremy Hunt has been the best recruiter for the Australian and New Zealand medical services. People who chose to train as doctors are clearly reviewing their options.

Why this has happened is plain to see. An underfunded NHS, a new contract imposed on the junior medical workforce, increased tuition fees at medical schools and subsequent debt have, together with Brexit, produced a perfect storm of unhappiness and uncertainty about the future in the NHS and in the country. The fallout from Brexit is that there are 10,000 NHS doctors who qualified in the European Economic Area – and a recent British Medical Association survey found that 42% plan to leave.

The UK already has fewer doctors per person than other leading European economies at 2.8 per 1,000 people: Germany has 4.1, France 3.3 and Italy 4.2. If you think that waiting two weeks for a GP appointment or more than four hours in A&E is unacceptable at the moment, then just wait for 2019 when we finally do Brexit. There will be no extra £350m a week for the NHS as promised on the side of a bus.
Dr Michael Maier
London

• The junior doctor contract reforms had their roots in providing a “seven-day service” – a reasonable idea given many hospitals run a skeleton staff over the weekend. A smaller hospital with a staff of 10 or 15 junior doctors for 150 inpatients would cut down to three or four at the weekend. I dreaded the weekend ward cover: patients and nurses clamouring for attention and emergencies requiring you to be in several places simultaneously.

This laudable idea has been mangled into a catastrophe. Alterations of weekend pay rates and caps on maximum number of days worked means staffing now suffers globally and continuity of patient care becomes a casualty of doctors being shoved from one post to another. The gaps reduce quality of life, meaning jobs are unfilled and the situation worsens.

Can you blame someone wanting high rates to cover a shift with massive responsibility, no breaks and the risk of GMC suspension and lawsuits if they slip up in an impossible workload? The NHS, in trying to iron out gaps and make staffing cheaper, is paying out more in danger money to those brave or foolish enough to take it.
Dr William Watson
Cambridge

• Katie Johnston is right (How to start a social care revolution in seven easy steps, 10 April). If we want value for money in the NHS, to continue spending more and more on hospitals – the most expensive component of the service – to the relative exclusion of other, more widely used parts, is doomed to failure. Hospitals need help, but a key way to do that is to invest elsewhere. That requires a change in strategic approach far greater than the initiatives currently being pursued by NHS England.

It means using digital technology to allow people to be more involved in accessing and managing services without leaving home. It means investment in expanding general practice and other primary care facilities. And it means building intermediate care and social care facilities as a matter of urgency, not least to reduce demand on hospitals and to allow the timely discharge of patients. Currently, our acute hospitals are receptacles into which we tip ever more medical and social care. And then we wonder that hospitals cannot cope.

These changes would reduce demand on hospitals, provide better value for money and offer a greatly improved service for us all, whether or not we need hospital care. Most patients do not.
Andrew Willis
Chester

• Perhaps Jeremy Hunt would like to explain why he picked a fight with junior doctors over the imposition of a new contract, ostensibly to allow safer staffing at weekends, when hospitals are now increasingly unable to fill rota gaps without resorting to imploring doctors to provide additional cover at exorbitant pay rates.

Labour has gained plaudits for its proposal on provision of free school meals. Is it not time for a comparable initiative on health? The party should cease its internecine warfare, remind the electorate that the last Labour government increased NHS spending five times faster than the coalition and set up a commission to gain general agreement on a bold plan for a permanent solution to the NHS funding crisis.
Dr Anthony Isaacs
London

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Cuts and Brexit add to pressure on the NHS | Letters

Hundreds of children"s playgrounds in England close owing to cuts

Hundreds of children’s playgrounds have been closed or are being closed by cost-cutting local authorities across England, with councils blaming “unprecedented budget constraints” for the decision to get rid of parks and sports facilities.

A series of freedom of information requests to local authorities found that 112 playgrounds were closed in the 2014-15 financial year, and a further 102 in 2015-16.

Councils also revealed that they had 80 more closures in 2016-17, followed by plans for 103 in the current budget period and at least 51 closures planned for 2018.

But the more recent figures most likely understate the number of closures, because around a third of councils said they had not yet finalised their plans, according to the Association of Play Industries, which submitted the FOI requests.

Mark Hardy, chair of the API, said that government investment of around £100m would be required to reverse the trend in closures.

“With increasing childhood obesity and the health benefits of activity and play well known, now is not the time for community playgrounds to be closing. This action goes against the government’s clear intention to get children more active and needs to be stopped as quickly as possible,” Hardy said.

Gary Porter, the Conservative chair of the Local Government Association, said councils “want to do everything they can keep our parks and playgrounds intact but are doing this in the face of unprecedented budget constraints.

“Given ongoing funding reductions, many councils continue to have to make difficult decisions about which services are scaled back or stopped altogether. Decisions like this are never taken lightly and councils are exploring new ways to fund and maintain these facilities.”

A spokesperson for the Department for Communities and Local Government said: “Our historic four-year funding settlement means that councils have almost £200bn to spend over the course of this parliament – allowing them to prioritise the services that communities and local people value.”

Hundreds of children"s playgrounds in England close owing to cuts

Cancer patient"s family stands to lose £50k under benefit cuts

“My death, on or before Thursday, changes my family’s wellbeing to the tune of tens of thousands. It is utterly unbelievable.”

Alan’s voice cracked, not just with emotion but the brutal impact of four years of cancer that started in a tonsil before spreading to his lungs and chest, delivering a terminal diagnosis in June, 2015.

By December, last year, the 51-year-old husband and father (who has asked the Guardian not to use his real name in order to protect his family) was given between one and five months to live.

His mind quickly focused on the lives of his wife, Kate, and their children, a 10-year-old daughter and 14-year-old son, after his death. He feared the “whirlwind of emotional and financial distress and turmoil” heading towards them as he grappled to draw up a plan.

Then came a bitter blow that has led Alan to speak out urgently against a Conservative policy being rolled out this week, despite voting for Theresa May’s party all his life.

The father and businessman, who was forced to give up work due to his illness, realised that if he survived beyond midnight this Wednesday 5 April, his family could be stripped of tens of thousands of pounds of critical financial support over the next decade.

Changes to the widowed parent’s allowance mean a benefit of around £112 a week until the youngest child leaves full-time education, perhaps in 10 years’ time, will be replaced by £350 a month (£80 a week) for a maximum period of just a year and a half.

“Based on the ages of our children and on my probable death – I would imagine this year – I had calculated that we would be entitled to about £58,000,” said Alan, who lives with his family in Barnet, London. “The new calculation shocked me. My life is now deemed to be worth £6,300.”

A government spokesperson said the financial gap would be reduced somewhat by the new system being tax-free. They also said families were eligible for a slightly higher lump sum payment immediately after the death of £3,500 rather than £2,000.

But Alan said the increase was “smoke and mirrors” and that the tax change did nothing to alleviate the many years of lost income.

After years paying into the system, Alan described the change as “daylight robbery”.

“The amount of money I’ve built up in my full state pension is more than the government would be paying out in the current widowed parent’s allowance. Assuming I started my pension at 68 and that the average male expectancy 81 – that is £120,000.”

He said the move was “callous and brutal” and that it showed no compassion, stressing that his family is “just about managing” and would be struggling even more after his death.

Kate agreed: “I feel like they are stealing from us. They’ve taken what Alan is owed.”

The couple also said that a letter to their local MP, Matthew Offord, copied to the prime minister, Theresa May, and the chancellor, Philip Hammond, on 24 February had not yet been answered. A follow-up on 10 March also received no reply, he said.

“Time is slipping away,” said Kate, describing her shock at what she sees as being blanked. “The sand is going through an hourglass. It is disappearing. Every day we look and say ‘he’s alive – will he be tomorrow?’”

She said it was difficult to find words to describe “the hell we’ve lived for four years” through painful bouts of treatment with sickening side-effects, her husband being fed through a tube to the stomach, ambulances, hospital appointments, worsening diagnoses and then the terrible news: “There is nothing more we can do.”

“Our legs move and our bodies move but we can’t really breathe,” added the 48-year-old psychotherapist. “Now we’ve been over-looked, ignored, let down. It is like nobody cares.”

The benefit change was like “being thumped in the face when you can’t take any more”, she claimed – describing her acute anxiety for the future.

The government has argued that the policy change is fair because these days women are more likely to work and so are less dependent on their spouse’s income.

But Kate says that she can already only work part-time as she cares for her sick husband and strives to be there for her children’s school pick-ups. Life after his death will trigger a “new nightmare of struggle”, she argued, with no magic bullet at 18 months.

Alan said he voted Conservative and felt “utterly let down”. He described reading the Tory 2015 manifesto from cover to cover and stressed that there was no mention of this reform. “There is no political mandate – it is a moral outrage.”

As well as speaking to the Guardian, Alan and Kate spoke emotionally about their case on LBC radio alongside a number of bereaved families who also expressed their shock.

A DWP spokesperson said: “We’re modernising the support we offer, replacing an outdated system that doesn’t reflect people’s lives today. The new Bereavement Support Payment is simpler, easier to understand, tax-free and doesn’t affect the amount received from other benefits, so families can access wider welfare support.”

They argued that families could be compensated by increases to other benefits.

Charities admit that the changes affect families in different ways but said that DWP figures suggested that overall 91% of parents will be supported for a shorter period, while 75% will be worse off in cash terms of as a result of the change. Working families with young children will lose £23,500 on average, they suggest.

Cancer patient"s family stands to lose £50k under benefit cuts

Cancer patient"s family stands to lose £50k under benefit cuts

“My death, on or before Thursday, changes my family’s wellbeing to the tune of tens of thousands. It is utterly unbelievable.”

Alan’s voice cracked, not just with emotion but the brutal impact of four years of cancer that started in a tonsil before spreading to his lungs and chest, delivering a terminal diagnosis in June, 2015.

By December, last year, the 51-year-old husband and father (who has asked the Guardian not to use his real name in order to protect his family) was given between one and five months to live.

His mind quickly focused on the lives of his wife, Kate, and their children, a 10-year-old daughter and 14-year-old son, after his death. He feared the “whirlwind of emotional and financial distress and turmoil” heading towards them as he grappled to draw up a plan.

Then came a bitter blow that has led Alan to speak out urgently against a Conservative policy being rolled out this week, despite voting for Theresa May’s party all his life.

The father and businessman, who was forced to give up work due to his illness, realised that if he survived beyond midnight this Wednesday 5 April, his family could be stripped of tens of thousands of pounds of critical financial support over the next decade.

Changes to the widowed parent’s allowance mean a benefit of around £112 a week until the youngest child leaves full-time education, perhaps in 10 years’ time, will be replaced by £350 a month (£80 a week) for a maximum period of just a year and a half.

“Based on the ages of our children and on my probable death – I would imagine this year – I had calculated that we would be entitled to about £58,000,” said Alan, who lives with his family in Barnet, London. “The new calculation shocked me. My life is now deemed to be worth £6,300.”

A government spokesperson said the financial gap would be reduced somewhat by the new system being tax-free. They also said families were eligible for a slightly higher lump sum payment immediately after the death of £3,500 rather than £2,000.

But Alan said the increase was “smoke and mirrors” and that the tax change did nothing to alleviate the many years of lost income.

After years paying into the system, Alan described the change as “daylight robbery”.

“The amount of money I’ve built up in my full state pension is more than the government would be paying out in the current widowed parent’s allowance. Assuming I started my pension at 68 and that the average male expectancy 81 – that is £120,000.”

He said the move was “callous and brutal” and that it showed no compassion, stressing that his family is “just about managing” and would be struggling even more after his death.

Kate agreed: “I feel like they are stealing from us. They’ve taken what Alan is owed.”

The couple also said that a letter to their local MP, Matthew Offord, copied to the prime minister, Theresa May, and the chancellor, Philip Hammond, on 24 February had not yet been answered. A follow-up on 10 March also received no reply, he said.

“Time is slipping away,” said Kate, describing her shock at what she sees as being blanked. “The sand is going through an hourglass. It is disappearing. Every day we look and say ‘he’s alive – will he be tomorrow?’”

She said it was difficult to find words to describe “the hell we’ve lived for four years” through painful bouts of treatment with sickening side-effects, her husband being fed through a tube to the stomach, ambulances, hospital appointments, worsening diagnoses and then the terrible news: “There is nothing more we can do.”

“Our legs move and our bodies move but we can’t really breathe,” added the 48-year-old psychotherapist. “Now we’ve been over-looked, ignored, let down. It is like nobody cares.”

The benefit change was like “being thumped in the face when you can’t take any more”, she claimed – describing her acute anxiety for the future.

The government has argued that the policy change is fair because these days women are more likely to work and so are less dependent on their spouse’s income.

But Kate says that she can already only work part-time as she cares for her sick husband and strives to be there for her children’s school pick-ups. Life after his death will trigger a “new nightmare of struggle”, she argued, with no magic bullet at 18 months.

Alan said he voted Conservative and felt “utterly let down”. He described reading the Tory 2015 manifesto from cover to cover and stressed that there was no mention of this reform. “There is no political mandate – it is a moral outrage.”

As well as speaking to the Guardian, Alan and Kate spoke emotionally about their case on LBC radio alongside a number of bereaved families who also expressed their shock.

A DWP spokesperson said: “We’re modernising the support we offer, replacing an outdated system that doesn’t reflect people’s lives today. The new Bereavement Support Payment is simpler, easier to understand, tax-free and doesn’t affect the amount received from other benefits, so families can access wider welfare support.”

They argued that families could be compensated by increases to other benefits.

Charities admit that the changes affect families in different ways but said that DWP figures suggested that overall 91% of parents will be supported for a shorter period, while 75% will be worse off in cash terms of as a result of the change. Working families with young children will lose £23,500 on average, they suggest.

Cancer patient"s family stands to lose £50k under benefit cuts

Benefits cuts: are you about to lose a Motability car, scooter or wheelchair? | Frances Ryan

Up to 500 Motability vehicles are now being removed from people each week in the UK due to personal independence payments (PIP) cuts, according to research by Muscular Dystrophy UK. The number of disabled people now affected by the new benefit rules has climbed to 51,000.

The Guardian is continuing a video investigation into the impact of cuts on disabled people and is looking for people to tell their story. As part of this, we’re looking to speak to people who have recently been told they will lose their Motability car, scooter, or wheelchair (and have not already returned their vehicle).

How will losing your vehicle affect you? Do you worry you’ll struggle to leave your home and get to work or medical appointments, or to socialise? Share your experience below.

Benefits cuts: are you about to lose a Motability car, scooter or wheelchair? | Frances Ryan

The poorest will lose out from prescription cuts

The Conservative government is once again aiming to take more from the poor (GPs ordered to stop prescribing some drugs to save cash, 28 March). These treatments will effectively be removed from those currently entitled to free prescriptions (eg recipients of income support or pension guaranteed credit, those having a long-term disability, holding a valid medical exemption certificate or maternity exemption certificate). Doctors have long been advising those who pay for their prescription to buy these over-the-counter medicines at retail price, rather than pay the £8.40 prescription charge. Nothing changes here; it is those who cannot otherwise afford these medicines who will go without.
Aidan Shanks
Eastry, Kent

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The poorest will lose out from prescription cuts

Drug which cuts "bad" cholesterol can help prevent heart attacks and strokes

A new drug can prevent heart attacks and strokes by cutting bad cholesterol levels, scientists have found.

An international trial of 27,000 patients found that those who took the drug evolocumab saw their bad cholesterol levels fall by around 60% on average.

The patients in the trial were already taking statins, which are used to reduce low-density lipoprotein (LDL) cholesterol. Despite this, the patients who took evolocumab saw their bad cholesterol levels fall even further. They were also less likely to suffer from a heart attack or stroke than those who took the placebo.

The study found that for every 74 people who took the drug for two years, one heart attack or stroke would be prevented.

However, the findings, published in the New England Journal of Medicine, found that the drug had no impact on the rate of cardiovascular mortality.

Prof Peter Sever, from Imperial College London – which led the UK branch of the study, said: “This is one of the most important trials of cholesterol-lowering since the first statin trial, published 20 years ago. Our results suggest this new, extremely potent class of drug can cut cholesterol dramatically, which could provide great benefit for a lot of people at risk of heart disease and stroke.”

There are approximately 2.3 million people living with coronary heart disease in the UK, according to the NHS. It is responsible for more than 73,000 deaths a year in the UK, and occurs when fatty substances build up in the arteries, making it harder for blood to get to the heart.

Prof Sir Nilesh Samani, medical director at the British Heart Foundation, said: “Coronary heart disease is the single biggest killer in the UK and worldwide and ‘bad’ LDL-cholesterol is a major cause.

“While statins have had a significant impact in reducing the risk of heart disease for millions of people, they are not tolerated by everyone and only reduce cholesterol by a certain amount.

“A promising new approach is blocking the action of PCSK9, a molecule which reduces the breakdown of LDL-cholesterol in the liver. Creating new treatments which use this approach could prove life-saving for patients with high cholesterol and those who can’t tolerate statins.”

Drug which cuts "bad" cholesterol can help prevent heart attacks and strokes

NHS staff: tell us about the impact of social care cuts | Sarah Marsh

The government’s austerity programme is squeezing funding to both social care and the NHS – leading to serious problems in both. The Care and Support Alliance this month has found almost 9 out of 10 GPs think reductions in social care are leading to extra pressures in their surgeries. Even more (93%) think that the lack of social care is leading to extra pressure on A&Es and contributing to increased delayed hospital discharges.

We’re looking for NHS staff who have been affected by the cuts for Frances Ryan’s Hardworking Britain column, which looks at the stories of individuals whose lives have been negatively impacted by government policy.

Share your experiences

Are you a GP seeing the impact of social care cuts? Or do you work in A&E and cannot discharge patients because there’s no support for them at home? Share your stories and views.

NHS staff: tell us about the impact of social care cuts | Sarah Marsh

Life-saving alcohol services face devastating cuts

When a man in his early 20s, who was an alcohol-dependent heroin user, turned up at hospital with a gastrointestinal bleed, Helene Leslie didn’t think he had long left to live.

Yet three weeks later, Leslie, an alcohol liaison nurse at the Royal Infirmary of Edinburgh, saw him in intensive care and was tasked with trying to get him to give up drinking: “I was surprised that he was alive given how sick he’d been,” she remembers. “I thought I wouldn’t get anywhere, but amazingly, with support, the guy’s really turned his life around and hasn’t drunk for 10 years. People like that keep me going.”

Leslie, 53, who has been an alcohol liaison nurse for 24 years, was one of the very first. But in 2001, the Royal College of Physicians called for there to be an alcohol specialist nurse in every hospital in the UK. What has happened since then, and have they had an impact?

“On the whole, it’s been a success,” says Prof Sir Ian Gilmore, ex- president of the Royal College of Physicians and chair of the Alcohol Health Alliance. “They keep patients out of hospital. There’s good evidence that the nurses are able to send patients home. They can deliver interventions that have been shown to be highly cost-effective.”

Dr Kieran Moriarty, consultant gastroenterologist at Bolton NHS foundation trust and alcohol lead for the British Society of Gastroenterology, did an evidence-based review looking at the impact of specialist alcohol workers. It cited a study at St Mary’s hospital in Paddington, London, which showed that for every two referrals to an alcohol health worker, there was one fewer reattendance to A&E the following year.

Gilmore says that in 2000 there were fewer than 10 alcohol care teams, whereas now the majority of acute hospitals have some sort of service.

Alcohol-related admissions are still rising – more than 1 million were related to alcohol consumption in 2013-14 – despite a fall in per capita consumption in the UK in the past few years. And it’s not just people getting drunk and fighting, says Gilmore. The NHS estimates that about 9% of adult men and 4% of adult women in the UK show signs of alcohol dependence. Alcohol is also a contributing factor in many diseases, including cancers – and the number of people with alcohol-related brain damage is rising.

Amid this pressure, however, cuts are being made to public health budgets responsible for alcohol services. In 2015-16, 46% of local authorities implemented cuts in alcohol services, and this has risen to 72% for 2016-17.

Moriarty is concerned: “A lot of the good is going to be lost. Alcohol nurses can play a major role in prevention and identification of alcohol problems at an early stage.”

Gilmore is keen to emphasise their impact: “A brief intervention – a semi-structured interview of up to 20 minutes by a health worker – is highly effective in changing behaviour even six months down the line.”

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Life-saving alcohol services face devastating cuts

Have you been affected by NHS hospital closures and cuts to services?

There’s no more controversial decision the NHS makes than removing services from hospitals, or even closing them. To investigate the causes and consequences of that kind of change, on Friday the Guardian is spending the day at the Royal Brompton hospital, where NHS England has said that, subject to public consultation, it will stop paying for congenital heart disease services.

The hospital and its supporters say that it makes no sense to close the service, which it describes as among the best in the country. But advocates of the change say that concentrating services in fewer locations makes for better care, and that the Royal Brompton doesn’t meet agreed standards.

The Royal Brompton isn’t the only hospital affected. Newcastle, Manchester and Glenfield hospital in Leicester are facing the same proposals. More generally, NHS England’s sustainability and transformation plans (STPs) are likely to mean the closure of 19 hospitals, including five major acute hospitals. Some experts say that this is an essential part of moving the fulcrum of the NHS from hospitals to a new set of community services integrated with social care – a move they say is vital for the health of patients and the NHS alike. But others say it’s just cover for swingeing cuts.

As part of our coverage on Friday, we want to hear from our readers. Is your hospital being affected? What are your concerns? Can you understand the rationale behind the plans? Do you think you or your child could have received better care, or do you worry about the loss of local services? If you work at a hospital, are you worried about the plans, or do you believe they will raise the standard of care?

Share your stories and concerns.

Have you been affected by NHS hospital closures and cuts to services?

New screening test cuts bowel cancer risk by a third, study finds

A one-off screening test being introduced across the NHS cuts the risk of developing bowel cancer by a third, a long-term study has found.

The test, which is being rolled out across England, will invite men and women to have bowel scope screening around the time of their 55th birthday.

This is in addition to the current test from the age of 60, the faecal occult blood test (FOB), which is posted to people’s homes.

FOB detects blood hidden in small samples of faeces, with further tests recommended if blood is detected.

Research published in the medical journal the Lancet has found that the bowel scope test reduces the risk of all cases of the cancer by a third. Experts predict it will save thousands of lives every year.

It works by threading a tiny camera attached to a thin flexible tube into the lower part of the bowel. As well as detecting tumours, it helps spot small growths, called polyps, on the bowel wall. If left untreated polyps can become cancerous, and any found during a bowel scope can usually be removed immediately.

Bowel scope screening will not detect cancers higher up in the bowel and patients may need a colonoscopy if they have persistent symptoms.

But the research found the new test was able to prevent 35% of bowel cancers overall and 40% of deaths.

In the lower bowel, the test prevented more than half of potential cancers from developing in that area.

Researchers from Imperial College London followed more than 170,000 people for 17 years on average, of whom more than 40,000 had the bowel scope test.

There are more than 41,000 new cases of bowel cancer every year in the UK, and about 16,000 deaths.

Prof Wendy Atkin, Cancer Research UK’s bowel screening expert and lead author at Imperial, said: “Although no screening test is perfect, this study shows that bowel scope is effective in reducing cancer deaths for at least 17 years.

“Bowel cancer can be prevented. And the bowel scope screening test is a great way to reduce the number of people diagnosed with the disease so it’s vital that no one misses out on the opportunity to get the test.”

Julie Sharp, Cancer Research UK’s head of health information, said: “Like other types of screening, bowel scope is meant for people without symptoms. It’s a great way to help reduce the number of people developing or dying from bowel cancer, but it can’t pick up everything.

“So it’s still important to take part in the rest of the bowel screening programme and not ignore the home testing kits when they arrive.”

The government estimates the bowel scope test will take at least another three years before it will be offered to everyone eligible across England. This is in order to train specialist staff to carry out the tests. Governments in Scotland, Wales and Northern Ireland have not yet committed to introducing the test.

The research was funded by the Medical Research Council and National Institute for Health Research. About half of bowel cancers occur in the lower part of the bowel and the rectum – the area covered by the bowel scope test.

The health secretary, Jeremy Hunt, said: “This report is really encouraging – prevention and early diagnosis are key to improving outcomes, and this new screening test could help us save thousands more lives.

“Cancer survival is at its highest rate ever, but more must be done: we are investing £300 million a year by 2020 to increase diagnostic capacity for all cancers, so we can save more from this devastating disease.”

New screening test cuts bowel cancer risk by a third, study finds

New screening test cuts bowel cancer risk by a third, study finds

A one-off screening test being introduced across the NHS cuts the risk of developing bowel cancer by a third, a long-term study has found.

The test, which is being rolled out across England, will invite men and women to have bowel scope screening around the time of their 55th birthday.

This is in addition to the current test from the age of 60, the faecal occult blood test (FOB), which is posted to people’s homes.

FOB detects blood hidden in small samples of faeces, with further tests recommended if blood is detected.

Research published in the medical journal the Lancet has found that the bowel scope test reduces the risk of all cases of the cancer by a third. Experts predict it will save thousands of lives every year.

It works by threading a tiny camera attached to a thin flexible tube into the lower part of the bowel. As well as detecting tumours, it helps spot small growths, called polyps, on the bowel wall. If left untreated polyps can become cancerous, and any found during a bowel scope can usually be removed immediately.

Bowel scope screening will not detect cancers higher up in the bowel and patients may need a colonoscopy if they have persistent symptoms.

But the research found the new test was able to prevent 35% of bowel cancers overall and 40% of deaths.

In the lower bowel, the test prevented more than half of potential cancers from developing in that area.

Researchers from Imperial College London followed more than 170,000 people for 17 years on average, of whom more than 40,000 had the bowel scope test.

There are more than 41,000 new cases of bowel cancer every year in the UK, and about 16,000 deaths.

Prof Wendy Atkin, Cancer Research UK’s bowel screening expert and lead author at Imperial, said: “Although no screening test is perfect, this study shows that bowel scope is effective in reducing cancer deaths for at least 17 years.

“Bowel cancer can be prevented. And the bowel scope screening test is a great way to reduce the number of people diagnosed with the disease so it’s vital that no one misses out on the opportunity to get the test.”

Julie Sharp, Cancer Research UK’s head of health information, said: “Like other types of screening, bowel scope is meant for people without symptoms. It’s a great way to help reduce the number of people developing or dying from bowel cancer, but it can’t pick up everything.

“So it’s still important to take part in the rest of the bowel screening programme and not ignore the home testing kits when they arrive.”

The government estimates the bowel scope test will take at least another three years before it will be offered to everyone eligible across England. This is in order to train specialist staff to carry out the tests. Governments in Scotland, Wales and Northern Ireland have not yet committed to introducing the test.

The research was funded by the Medical Research Council and National Institute for Health Research. About half of bowel cancers occur in the lower part of the bowel and the rectum – the area covered by the bowel scope test.

The health secretary, Jeremy Hunt, said: “This report is really encouraging – prevention and early diagnosis are key to improving outcomes, and this new screening test could help us save thousands more lives.

“Cancer survival is at its highest rate ever, but more must be done: we are investing £300 million a year by 2020 to increase diagnostic capacity for all cancers, so we can save more from this devastating disease.”

New screening test cuts bowel cancer risk by a third, study finds

NHS admin staff keep services running - but we"re being hit by cuts

Secretaries, waiting list and medical records clerks, clinical audit facilitators, business analysts and IT technicians and other support staff pull together to keep essential lifesaving NHS services running smoothly. To a staff nurse, the help of a ward clerk to retrieve a patient’s medical history can be just as crucial as that of a senior consultant. Data quality officers ensuring patients are properly admitted and discharged on computer systems can have an immeasurable impact on the management of bed capacity.

Yet those of us in NHS support services work in less-than-ideal circumstances. I work in an office that is a converted ward. Save for wheeling out most of the medical equipment, it remains an abandoned clinical area. I’m always wary when manoeuvring around our cramped kitchenette – imagine the embarrassment of accidentally leaning on one of the emergency call buttons and having the rapid response CPR team come crashing in.

Plates and cutlery stand stacked precariously atop the tiny dining table and fridge (kindly donated by another admin department, who were throwing it out). A locked walk-in cupboard adjacent to the kitchen would be ideal for storing these. However, due to budget and staff restrictions, logging a job with estates to get a new Yale lock installed has proven fruitless on several occasions. Jobs deemed non-essential are often cancelled. With a leaking radiator pipe, broken window and an unexplained beep from above the ceiling tiles failing to see a quick response, reporting anything else can make one feel rather hypercritical.

The already cramped office still holds a partly dismantled bed hoist, condemned imaging machines and a box of surgical tubing, seemingly forgotten. We have jokingly discussed eBaying the lot to raise funds to buy desk lamps; dim strip lighting doesn’t quite work in an office.

I was lucky enough to suffer a full-scale-beyond-repair PC meltdown one day, so IT had no choice but to provide me with a reconditioned model from their storeroom. However, some of my colleagues are working on machines so old they take upwards of 20 minutes to boot up in the morning. The high-pitched whine of the struggling fans is maddening. Stretched IT staff struggle to keep up with demand. While problems with direct patient impact understandably take priority, waiting three days for a simple but essential fix is excessive.

For a team dependent on computers for their jobs, this can mean time wasted recording information on paper, only to have to transfer it to a digital source once systems are back up and running. It’s easy to see how this can contribute to huge backlogs and missed deadlines. Panicked managers pleading staff to take budget-stretching overtime is often the result.

Cheap or outdated equipment with a tendency to crash or throw up errors only adds to the problem. False economy reigns supreme, when an inadequate version is eventually replaced with the one we should have had all along. An ancient printer once cost my department half a day of productivity, as IT spent hours searching for a withdrawn ink cartridge so we could run off essential documents.

A friend in another department is responsible for requesting essential office supplies. To ensure he’s not buying luxury items the trust can’t afford, all orders are approved by executive-level staff. A recent attempt to gain a few pencil sharpeners saw 12 members of staff told to share three. Mouse mats are definitely off limits.

Understaffing is not just a problem on the frontline. Although there have been cuts and restrictions to what is made available, access to support and training for admin staff is still admittedly good, and it’s not uncommon to hear of a new recruit using NHS resources to gain experience and qualifications before handing in their notice to take a similar role in the private sector. Vacancies are often not re-advertised. While the wary jump ship, those left behind are expected to absorb the roles of colleagues, often without a wage increase.

I am proud to say I work for the NHS. It means much more to me than private sector benefits like a shiny new Apple Mac to work on or an all-expenses paid Christmas do. I enjoy knowing that I am, albeit in an indirect way, contributing to saving people’s lives. There is a sense of community in the health service I don’t sense in corporate organisations; we still join unions, strike together, are aware of each other’s problems.

Yet, just like the healthcare professionals feeling the stress and strain of the continued NHS cuts, we support staff feel we can do only do our best when we’re comfortable at work and morale is high. Since beginning my NHS career, although I’ve advanced and been promoted, I also feel that things are sliding backwards. While frontline medical staff are still undoubtedly in the most direct line of fire, we feel the impact under the surface too and there’s a definite feeling that things are getting worse.

• Some details have been altered to protect the identity of the writer

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NHS admin staff keep services running - but we"re being hit by cuts

Health cuts most likely cause of major rise in mortality, study claims

An unprecedented rise in mortality in England and Wales, where 30,000 excess deaths occurred in 2015, is likely to be linked to cuts to the NHS and social care, according to research which has drawn an angry response from the government.

The highly charged claim is made by researchers from the London School of Hygiene & Tropical Medicine, Oxford University and Blackburn with Darwen council, who say the increase in mortality took place against a backdrop of “severe cuts” to the NHS and social care, compromising their performance.

The Department of Health (DH) responded by accusing the authors of the paper and accompanying commentary, published in the Journal of the Royal Society of Medicine on Thursday, of bias.

The researchers ruled out other possible causes of the increase, including cold weather, flu and the relatively low effectiveness of the flu vaccine that year, noting that fatalities from the virus rose “but not exceptionally”.

After examination of NHS performance data for the period, which shows the service missing almost all its targets, they concluded: “The evidence points to a major failure of the health system, possibly exacerbated by failings in social care.”

The rise in deaths from 2014 to 529,655 in 2015 was the biggest in percentage terms in almost 50 years and the mortality rate was the highest since 2008. The excess deaths were largely among older people who are most dependent on health and social care, the authors said.

Excess deaths per month in 2015 compared with 2006-2014

The research further warned that the “spike” was showing signs of becoming an established pattern, with provisional official weekly mortality data from 2016 showing deaths from October onwards increasing by 7% compared with the five-year average.

While accepting their findings would generate controversy, the authors expressed surprise that the rise and the reasons for it had not previously been scrutinised.

Prof Danny Dorling from the University of Oxford said: “It may sound obvious that more elderly people will have died earlier as a result of government cutbacks, but to date the number of deaths has not been estimated and the government have not admitted responsibility.”

The researchers observed that the increase in mortality came as waiting times rose in A&E departments – despite unexceptional attendances – for admissions, diagnostic tests and also consultant-led care. Ambulance response times also increased as did operations cancelled for non-clinical reasons. Staff absence rates rose and more posts remained empty as staff had not been appointed.

The authors said health service austerity had been exacerbated by £16.7bn of cuts to the welfare budget and a 17% decrease in spending for older people since 2009, while the number of people aged 85 and over had risen almost 9%.

Age-standardised death rates per 100,000 population for all ages

Barbara Keeley, the shadow social care minister, said: “The Tories have created a crisis in social care. They have cut billions of pounds from council budgets and care is suffering as a result.

“In the March budget, the government must provide extra funding urgently and deliver a sustainable settlement to deal with the crisis in health and social care.”

The Lib Dem leader, Tim Farron, called it “a national scandal that in one of the richest countries in the world, vulnerable older people are missing out on the services they need and may even have died due to poor care”.

The report’s co-author, Dominic Harrison, the director of public health at Blackburn with Darwen council, said the research “raises a red flag that is telling us that the health and care system may have reached the limits of its capacity to safely and effectively care for the population that funds it. Our analysis suggests that the most likely cause of that failure, when all other possible explanations have been excluded, is insufficient resources and capacity”.

The paper will make uncomfortable reading for the government at a time when it is under substantial pressure to boost spending for both the NHS and social care amid fears they are at breaking point.

Number of patients spending more than 12 hours from decision to admit to admission

A DH spokesman described the study as “a triumph of personal bias over research”. He added: “Every year there is significant variation in reported excess deaths, and in the year following this study they fell by nearly 20,000, undermining any link between pressure on the NHS and the number of deaths. Moreover, to blame an increase in a single year on ‘cuts’ to the NHS budget is arithmetically impossible given that budget rose by almost £15bn between 2009-10 and 2014-15.”

The fall the DH refers to is the reduction in excess winter deaths, which compares those between December and March with those in the rest of the year. Excess deaths over the year are measured relative to the average in recent years.

Harrison said the point the authors were making was that in months such as January 2015, which saw a spike in deaths, there was an insufficient service response to a surge in demand. He termed this a “fail event” and warned there could be recurrences over the next five years without a rise in funding. He added that preliminary figures pointed to a possible significant increase in excess deaths last month.

“I have few doubts that our findings will be strongly contested,” he said. “This report has been published in good faith in a peer-reviewed academic journal by senior health professionals who are concerned to understand the causes of avoidable death in the population – precisely so that we can avoid it happening again.”

Health cuts most likely cause of major rise in mortality, study claims

IFS warns of steep cuts and tax rises to fill £40bn black hole

The government is on course to impose steep cuts in public spending from April and increase taxes by the end of the decade to their highest level as a share of national income since 1986–87 to combat the UK’s persistent budget deficit.

But slower economic growth following the Brexit vote will still leave the UK with one of the largest black holes in public spending in the developed world, meaning the next government must find £40bn to eliminate the budget deficit in the next parliament, according to the Institute for Fiscal Studies.

“For all the focus on Brexit the public finances in the next few years look set to be defined by the spending cuts announced by George Osborne,” said IFS director Paul Johnson.

“Cuts to day-to-day public service spending are due to accelerate while the tax burden continues to rise. Even so the new chancellor may not find it all that easy to meet his target of eliminating the budget deficit in the next parliament.

“Even on central forecasts that is going to require extending austerity towards the mid-2020s. If the economy does less well than hoped then we may see yet another set of fiscal rules consigned to the dustbin.”

The leading tax and spending thinktank said downgrades in GDP growth over the next four years will strain the public finances, which are already on course to be £13bn worse off in this financial year than forecast, after weak growth in tax receipts.

Highlighting the pressure on the chancellor, Philip Hammond, the IFS’s annual assessment of the public finances found that Britain’s ageing population and increasing demands on the NHS will blow a large hole in the government budget over the next two parliaments.

It said: “Demographic and non-demographic pressures are projected to put upward pressure of 1% of national income on health, social care and pension spending by 2025.

“Taking into account possible negative effects from lower growth, the government may need to enact further measures worth £40bn (in 2016–17 terms) in order to eliminate the deficit in the next parliament,” the report said.

Deep cuts in welfare benefits are due to take effect from April alongside cost cutting in Whitehall department budgets. Yet the government still plans to pay for large giveaways in the form of a higher income tax personal allowance at the basic and higher rate and was expected to maintain freezes on fuel duty that totalled £4.5bn a year.

The IFS said the promised spending and slower growth would force the government to implement tougher austerity, even though the chancellor has abandoned his predecessor’s pledge for a budget surplus by 2020.

It said: “Real levels of day-to-day public service spending have actually fallen very little overall in the last three years. The rate of reduction is set to speed up after this year, with cuts of nearly 4% due between 2016–17 and 2019– 20.

“In addition, tax is rising as a share of national income and by 2019–20 is due to reach its highest level since 1986–87.”

It said a deficit in 2016-17 of 3.5% of GDP, or £68.2bn, was £12.7bn higher than the Office for Budget Responsibility, the Treasury’s independent forecaster, had predicted in March 2016.

“This increase was not a result of a downgrade to the forecast for economic growth, but arose as a result of weak growth in tax receipts – in particular, income tax, National Insurance contributions (NICs) and stamp duty land tax – and faster growth in local authority spending,” it said.

Hammond said in the autumn statement last year that he plans to boost public investment spending beyond pre-crisis levels as a proportion of overall public spending, with much of the extra cash to be spent on transport infrastructure.

However, many departments will need to make further savings on day-to-day spending by the end of the parliament.

The IFS said: “Public spending, especially on health, pensions and overseas aid will be higher as a share of national income than in 2007–08, while spending on schools, defence and (in particular) public order and safety will be lower.”

IFS warns of steep cuts and tax rises to fill £40bn black hole

Cuts can"t stop genuine people power, but professionals can | Richard Wilson

It is becoming increasingly clear that many of our public service systems undermine people power.

Problems like obesity, depression, addiction and finding a job require us each to take individual action. Of course there are all kinds of support to help us keep fit, ace job interviews, or live without drugs, but control always lies with the individual, not the state. We decide what food to put in our mouths or whether to go to the gym.

But this vital truth seems to have been absent in designing our public services.

Take, for instance, a GP appointment. Most last 10 minutes; the GP asks a few questions and then tells you either to take some medicine, adopt new habits or see someone more qualified. The trouble is, we don’t do what we’re told. The World Health Organisation has estimated [pdf] that only 30%–50% of us take our medication as prescribed, in what is being described as an “epidemic of non-compliance”. Many of the changes required are intimately connected to our sense of who we are and what others think of us – and it’s very hard to change a habit. Anyone who’s tried having a “dry January” will know the challenge.

Ideas about co-producing public services, with professionals and users working together, have been around for years. What’s interesting right now is the new movement of practitioners delivering “people-powered services” that aim to improve self-efficacy at a low cost and with high impact.

One example is homelessness charity Groundswell, which provides peer support to people experiencing homelessness to help them address their health needs. Athol Halle, Groundswell chief executive says that when you provide support in this way, there are health benefits for individuals – and cost savings for the NHS. That’s why Groundswell receives in the region of £500,000 from health commissioners. It is not alone. Club Soda is working to reduce alcohol dependence, Brightside Trust is working in youth unemployment, Community Catalysts in adult social care, and Self Management UK in health. All of these organisations are based on putting users in charge of their service.

However, this is much easier said than done. Supporting people to take control is a subtle discipline in which most people working in public services have not been trained.

Here are five basic principles of how to help people take control that you can adapt according to your circumstances:

• Accept the user wherever they are.


• See users as having all the resources they need to start taking action.


• Change is only possible if the user wants it.


• Users’ solutions are the best solutions.


• Never assume users think like you.

At first glance these five principles might seem plain wrong. Not everyone has all the resources they need, especially in this era of deep cuts.

But for services where individual action is a requirement, the essential ingredient is user motivation. So whether they do in fact have everything they need is not what’s important; what matters is that they believe in themselves enough to make a start.

For most professionals it takes a fundamental reorientation to start supporting individuals to take action themselves. Anand Shukla, chief executive of Brightside Trust, says it is often quite a leap for professionals to support people to make decisions and to take action. What’s crucial, says Shukla, is to identify right from the start people’s priorities and wishes, rather than jump in and tell them what you, as a professional, think they should do.

These principles need to inform not just conversations between service professionals and users but the whole way public services are designed: system design. Without that, the work of people like Halle and Shukla will be stifled by systems that claim to want people power but, in fact, work against it.

If you’re a public service professional working in people-powered services – or an individual taking action – drop us a line and tell us how you’ve got on: public.leaders@theguardian.com

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Cuts can"t stop genuine people power, but professionals can | Richard Wilson

NHS pathology labs are ripe for privatisation and cuts

“Every sample is a patient … Every sample is a patient …”

I repeat it like a mantra, so that amid the relentless workload we don’t lose sight of who we work for. We say it as we navigate crumbling floors – in one of our labs, a hole in the lino flooring has been patched up with heavy-duty gaffer tape.

In my work, I see only names, not faces. But every sample is a patient, and every patient has hopes, fears, family and friends. Doctors and nurses get to see their charges in the flesh, whereas I see only the flesh. Paramedics and porters see the blood spilt, I see only the blood. Some names become familiar – a premature baby on the neonatal unit, a 90-year-old with a broken hip – but we never see them recover, never witness the reunions and taxi rides home. Not that my colleagues and I need it, but we never hear their thanks. When we stop receiving their samples, we can but hope for the best.

I work in a pathology laboratory and they are involved in 70% of all diagnoses within the NHS, but very little of what we do is known to the public, or indeed, to many of our healthcare colleagues. We are the definition of behind the scenes, providing doctors with the vital information they need to assess and treat patients.

We are the definition of behind the scenes, providing doctors with the vital information they need to assess and treat

The inner-city microbiology lab where I work as a technician processes thousands of samples a week, from A&E departments, GP surgeries, intensive care, maternity units, and everywhere in-between. We run a full seven-day service (including bank holidays), and with biomedical scientists covering the lab throughout the night, I’m happy to say that we make a mockery of Jeremy Hunt’s calls for a 24/7 NHS.

Sadly, and as with the NHS as a whole, we are short-staffed, under-funded and often ill-equipped. I’m often expected to attempt the workload of two members of staff. What little morale remains is nurtured from the ground up, an esprit de corps forged in a shared adversity, and in taking inspiration from colleagues going about their duties with a quiet efficiency.

Throughout the day porters and couriers deliver a constant stream of samples that are immediately triaged. Urgent specimens are processed within a matter of minutes. What might seem to the untrained eye to be an overwhelming mound of bloods, swabs, tissues and every bodily fluid imaginable is swiftly organised; well-rehearsed procedures are carried out so that every diagnostic test is performed with the minimum of delay.

The sheer amount of equipment and consumables necessary for the lab to function often surprises visitors and those new to the job. The NHS is truly a system, with every part reliant on the other. The labs do not stand alone, and indeed, would be worthless if they did so. Just as the pen is of little use without the paper, so the NHS cannot treat its patients without laboratories. The staff themselves are of course any lab’s greatest asset, a biomedical scientist needs years of education and training to become qualified.

Even though it can be difficult to find a moment in which to draw breath, we are forced to confront our fears about the future. The vital ancillary services of estates, cleaning, security and portering (to name but a few) have been tendered out to the private sector within the trust where I am employed, as they have been across the wider NHS.

Financial pressures are causing more and more laboratories to merge, and it is now the case that many individual trusts no longer directly own their pathology services – instead there are “joint ventures” and “partnerships” forced to bid against one another for customers and business.

While efficiency savings are possible, fewer labs equal longer transport times, and longer transport times equal potentially life-threatening delays. At night, our (private) courier company sometimes has to send a driver from 30 miles away to bring an urgent sample to the lab from a hospital five miles from us.

Given how behind the scenes we are, and how fragmented the NHS is becoming, there is an acute dread that pathology is ripe for the picking in terms of
the work we do being tendered-out to private contractors, or the joint ventures themselves morphing into entities no longer under the control of NHS trusts.

We want to cooperate with our colleagues, not compete against them, even if not many realise what we really do. We want to use the best diagnostic tools, not the cheapest ones. We want the time to treat every sample we receive as a patient, not a commodity. Help us to help you.

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NHS pathology labs are ripe for privatisation and cuts

Council job cuts have finally caught up with me – but I"m relieved

Every new year at the council brings with it a fresh cycle of angst and fear, because the battle to keep jobs begins all over again.

But this year, I no longer care about losing my job – in fact, the prospect of facing redundancy fills me with relief. Relief that I no longer have to face a relentless cost-cutting cycle.

Things changed for me last spring, when I was diagnosed with a serious illness. By the time June hit – which tends to be when the annual battle for existence kicks off – I was not at work to spend hours collating the service-saving information I have put together every year since the cuts began.

I manage a service that works with vulnerable families; we’re cheap and we don’t cause referrals to other services.

After several operations I returned to work to be told that my team and I were at risk. The formal consultation of our posts is widely accepted as tokenistic and my only priority now is to get the best exit from the council that I can.

The cycle of cuts I will be leaving behind normally goes something like this:

June kicks off with a catchy new phrase, adopted to avoid the word “cuts”. It could be “the transformation programme” or the “change agenda”.

Then there’s a reshuffle at the top of the council or highly paid consultants are bought in as a fresh pair of eyes. By July, rumours abound and I start to get anxious. Random demands for data hit my inbox from names I do not know.

By August it is clear I will have a job on my hands to save the service I work for. So I spend the month poring through our databases and submitting long documents showing how much money our service has saved the council.

More requests for data hit my inbox and I start to lose sleep, worrying that I won’t have a job by the following April. I don’t tell the members of my team about any of this. Why put them through this every year?

September heralds a peak in my anxiety, and my insomnia. All staff are summoned to workshops where a vision of the future is laid before them. I hear phrases like “everything must change” and “no job is safe”. I have to divert our meagre resources to paying staff to attend these events, while reassuring them that their jobs are safe because of all the money we save the council.

By October, across children’s services there is a general loss of focus. Morale plummets and people start leaving. Some because they think they will be made redundant. Some because they can’t stomach any more change. The cracks in the system widen further than ever before.

November is always when I am promised some concrete news. But the haste with which decisions about cuts are made means there are too many legalities to iron out and the November deadline expires.

December and the truth is out there. The people who belong to services that are safe try and make the most of January to May before it all starts again. The constant nausea disappears and I start to sleep soundly again.

I am exhausted by this annual cycle, by the insecurity about whether I will be able to pay the mortgage and put food on the table.

I have recovered from my illness. My future is bright. My future is not in the local council, even though I am still driven to want to help the most vulnerable in our society. I don’t know what the future holds but I know I won’t miss the misery of the constant uncertainty of working for a council.

When my surgeon gave me the good news I shook his hand vigorously and gratefully. As I drove back to work it occurred to me that lots of the families I have worked with have shaken my hand in the same way. But no-one in the council has ever shaken my hand and I don’t expect that to change as I hold my head high and work my way towards my redundancy date.

This series aims to give a voice to the staff behind the public services that are hit by mounting cuts and rising demand, and so often denigrated by the press, politicians and public. If you would like to write an article for the series, contact kirstie.brewer@theguardian.com

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Council job cuts have finally caught up with me – but I"m relieved