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The NHS was already collapsing long before the arrival of Covid | Polly Toynbee

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When is the NHS overwhelmed? When it has used up ways to describe the state it’s in. Ask Alastair McLellan, editor of the Health Service Journal. “We’ve run out of language,” he says. “We’ve exhausted the adverbs and adjectives, the thesaurus has run dry.” But when exactly did the NHS cross a red line? “I won’t provide a definition of what being overwhelmed would constitute,” Boris Johnson says wisely. Yet it’s happening now, and there’s no sign of the situation improving.

TV news may need images of stretchers laid out on winter pavements, but ambulances were already queueing for hours outside A&Es before the pandemic. We hear of ambulance services telling patients with heart attacks and strokes to get a lift to hospital. Even during the winters before Covid, we’d grown used to trolleys lined up in corridors and 12-hour admission waits. GP appointments had long grown scarce. Cancer delays are the longest on record. Expect no tipping points: “This is the new normal,” a London teaching hospital medical director warns me.

The admirable NHS “copes”. It triages and triages again, treating people according to available beds and who is nearest to death. That’s rationing, a word politicians shun. Waiting used to be the traditional rationing mechanism in a financially capped system. There’s no mystery as to why this is happening: waiting lists rise and fall according to the level of funding. Seasoned observers used to assume queueing was a permanent function, until New Labour all but abolished waiting times, ensuring everyone was treated within 18 weeks from GP to hospital. During the post-2010 austerity years, funding increases fell behind the country’s growing, ageing population. By 2017, waiting lists had risen to just over 4 million.

Let’s hope that despite the record infection rates we’ve seen in recent days, hospitalisations stay low enough so that the NHS still “copes”. If so, Johnson will get away with his high-risk plan B, with its new year pubbing and clubbing in the face of scientists’ concerns. But you wouldn’t praise someone for surviving a dash across the M1 with their eyes shut, especially if we all had to run across with him.

Covid may calm to a low permanency within months, but what then for the NHS? In the trail of the pandemic is a fast-rising 6 million-strong waiting list – Sajid Javid even warns of far higher. Nigel Edwards, the Nuffield Trust’s chief executive, along with anyone else you ask, warns of exhausted staff and rising vacancies, with people quitting and retiring early, while long Covid and untreated illnesses add to the burden. According to the Royal College of Nursing, half of nurses are over 50, one in five leaves during training, one in three in their first year, while social care is even more bereft.

A new report from the health and social care select committee blames the government for refusing to build a future workforce strategy. Perversely, former health secretary Jeremy Hunt’s amendment to the health and care bill, calling for a regular independent assessment on workforce estimates, was knocked down by the government in November, and Hunt’s demand for one kicked away again at PMQs this week. Staffing costs take up 70% of the NHS budget, so the Treasury knows that putting numbers on the needs of the next decade will expose severe underfunding.

It takes 10 years to train a consultant and four years to train a nurse, but their training was one of the first things to be cut in 2010: more nursing places have been added since, but entire cohorts are still missing. The NHS England (NHSE) People Plan last year offered kindly advice on retaining staff, but the Treasury banned it from adding hard numbers for future needs. Health Education England held out for training funds, a sum that has still not been fixed, but the body has been punished and demoted, merged into NHSE and losing its voice to speak out.

On Christmas Eve, NHSE produced 10 goals for the year, a wish list to send up the chimney asking for everything: “outstanding care”, “tackling the elective backlog”, “growth” in mental and community services – and much more. (There was no mention of Covid lessons or the need for permanent emergency preparation for the next contagion.) There will be no money for anything but bare-bones “coping”. The Financial Times’ annual poll of 100 economists predicts we will trail other rich countries in economic recovery this year. John Appleby, chief economist at the Nuffield Trust, warns that although the government promises the NHS £5.4bn in extra funding, hospitals have already overspent by £4-5bn, so much of that funding will vanish in repaying debts. Covid emergency money stops in April.

The big question – for government and voters – is how much more they want to spend on health. Labour proved it’s not a “bottomless pit”, but you get what you pay for. Forget the groundswell of calls for “reform” from ignoramus Tory voices who imagine French and German “insurance” schemes magic up more private money. The only major difference from our national insurance is that they pay more and get more per head – beds, doctors, nurses and results. In this forever undertaxed country the tax revenue is 33% of GDP, while the 14 EU states pay an average 39%, according to the IFS.

Would we pay that EU average? A bigger question: should we really spend such a high proportion on the NHS and care, weighted towards the last years of people my age, while education suffers? Teachers have seen their pay cut by 8% since 2007, while FE and schools are miserably threadbare, denuded of arts and sports.

The unavoidable answer is yes, voters will put the NHS first: once the emergency passes the government will face angry patients. The sobering experience of Labour’s years, says Ben Page of Ipsos Mori, is that people waiting for hip and knee surgery notice no cut in waiting times until they drop right down to three months: anything above is unacceptable. But after the years of underfunding restoring the NHS to its 2010 state is unthinkable: that’s another 10-year project that requires high funding. The government itself may feel “overwhelmed” when public complaints at its decade of damage swells into an NHS political crisis, too late for any easy solutions.

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Solar storms may cause up to 5500 heart-related deaths in a given year

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In an approximate 11-year cycle, the sun blasts out charged particles and magnetised plasma that can distort Earth’s magnetic field, which may disrupt our body clock and ultimately affect our heart



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17 June 2022

A solar storm

Jurik Peter/Shutterstock

Solar storms that disrupt Earth’s magnetic field may cause up to 5500 heart-related deaths in the US in a given year.

The sun goes through cycles of high and low activity that repeat approximately every 11 years. During periods of high activity, it blasts out charged particles and magnetised plasma that can distort Earth’s magnetic field.

These so-called solar storms can cause glitches in our power grids and bring down Earth-orbiting satellites. A handful of studies have also hinted that they increase the risk of …

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UK Covid infection rate rising, with more than a million cases in England | Coronavirus

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Coronavirus infections are rising in the UK, figures have revealed, with experts noting the increase is probably down to the more transmissible BA.4 and BA.5 Omicron variants.

The figures from the Office for National Statistics (ONS), based on swabs collected from randomly selected households, reveal that in the week ending 11 June an estimated one in 50 people in the community in England are thought to have had Covid – around 1.13 million people.

The figure is even higher, at one in 45, in both Wales and Northern Ireland, while it was highest in Scotland where, in the week ending 10 June, one in 30 people are thought to have been infected.

While the figures remain below the peak levels of infection seen earlier this year, when around one in 13 people in England had Covid, the findings are a rise on the previous week where one in 70 people in England were thought to be infected. Furthermore, the data reveals increases in all regions of England, except the north-east, and across all age groups.

Experts say that a key factor in the increase is probably the rise of the Covid variants of concern BA.4 and BA.5.

“Infections have increased across all four UK nations, driven by rising numbers of people infected with the BA.4 and BA.5 Omicron variants,” said Kara Steel, senior statistician for the Covid-19 Infection Survey.

While Steel said it remained too early to say if this was the start of another wave, others have warned it may already have begun, with increased mixing and travelling among other factors fuelling a rise in cases.

Among concerns scientists have raised are that BA.4, BA.5 and another variant on the rise, BA.2.12.1, replicate more efficiently in human lung cells than BA.2.

Prof Azra Ghani, an epidemiologist at Imperial College London, said the latest figures were not surprising, and might rise further.

“This increase in infection prevalence is likely due to the growth of the BA.4 and BA.5 Omicron subvariants, which as we have seen elsewhere in Europe, appear to be able to escape immunity generated from previous Omicron subvariants,” she said.

“It is therefore possible that we will continue to see some growth in infection prevalence in the coming weeks and consequently an increase in hospitalisations, although these subvariants do not currently appear to result in any significantly changed severity profile. This does however serve as a reminder that the Covid-19 pandemic is not over.”

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NHS to offer women in England drug that cuts recurrence of breast cancer | Breast cancer

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Thousands of women in England with breast cancer are to benefit from a new pill on the NHS which reduces the risk of the disease coming back.

The National Institute for Health and Care Excellence (Nice) has given the green light to abemaciclib, which cuts the chance of breast cancer returning after a patient has had surgery to remove a tumour.

Trials showed that patients who had the drug with hormone therapy had a more than 30% improved chance of their cancer not coming back after surgery, compared with hormone therapy alone.

“It’s fantastic thousands of women with this type of primary breast cancer will now have an additional treatment option available on the NHS to help further reduce the risk of the disease coming back,” said Delyth Morgan, the chief executive of charity Breast Cancer Now.

“The fear of breast cancer returning or spreading to other parts of their body and becoming incurable can cause considerable anxiety for so many women and their loved ones.

“New effective treatments such as abemaciclib, which can offer more women the chance to further reduce the risk of the disease recurring, are therefore extremely welcome and this is an important step change in the drug options available for this group of patients.”

The twice-a-day pill is suitable for women with hormone receptor-positive, HER2-negative, node-positive early breast cancer at high risk of recurrence who have had surgery. About 4,000 women will benefit initially, Nice said.

Helen Knight, the interim director of medicines evaluation at Nice, said the draft recommendation came less than a month after abemaciclib received its licence.

“The fact that we have been able to produce draft recommendations so quickly is testament to the success of our ambition to support patient access to clinically and cost effective treatments as early as possible,” said Knight. “Until now there have been no targeted treatments for people with this type of breast cancer.

“Abemaciclib with hormone therapy represents a significant improvement in how it is treated because being able to have a targeted treatment earlier after surgery will increase the chance of curing the disease and reduce the likelihood of developing incurable advanced disease.”

Abemaciclib works by targeting and inhibiting proteins in cancer cells which allow the cancer to divide and grow. It normally costs £2,950 for a packet of 56 150mg-tablets, but the manufacturer, Eli Lilly, has agreed an undisclosed discounted price for NHS England.

“Thanks in part to this latest deal struck by NHS England, NHS patients will be able to access another new targeted drug for a common and aggressive form of breast cancer,” said Prof Peter Johnson, the cancer director of NHS England.

“Abemaciclib, when used alongside a hormone therapy, offers a new, doubly targeted, treatment option, helping to increase the chances of beating the cancer for good, as well as meeting the NHS’s commitment to delivering improved cancer care under our long-term plan.”

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