Fruit and Nuts

Steve Ford, of Nursing Times, advises me that the health commissars in Essex have earmarked another large wedge of taxpayers’ money to provide salaries and tee-shirts for a group of bright young things to go out into the community to tell people to stop smoking, to stop drinking and to start eating bananas. The Essex commissars intend to "ensure that all parts of the community are reached".

Excellent. This gives an opportunity for Dr Crippen to announce another NHS BLOG DOCTOR competition. Please write in not more than 800 words an account of the first meeting between one of these bright young things and either the Filthy Smoker or Mr & Mrs Kitchen. The competition is open to all, including the Filthy Smoker and the Kitchens

The Filthy Smoker has of course been holding the fort for the DK who, as aficionados will know, has just returned from his foreign nuptials and so is now ensconced in connubial bliss. Congratulations to both the Kitchens. Will marriage have a calming influence on the DK? Will his righteous indignation be tempered by a surfeit of uxorious pleasure? Not if his affectionate portrait of Alan Johnson is anything to go by.

Have a banana.

The Essex stuff is all plausible crap. Hard to criticise because you fall foul of the Vera Lynn syndrome. (Will someone please tell poor old Vera where Afghanistan is and why we are fighting out there?). Look at the Essex PCT website. It's the "healthy young thing" approach. "It's never too late to change" says Essex PCT. Trouble is, for most of people who look at PCT websites, it is too late to change. Please understand this. Most people have never heard of PCTs. They only hear of them when they start to research the failings in their health care. Why they are not getting the most modern treatment for their macular degeneration. Why they can no longer see a doctor about their cancer, unless they go privately. Why only private patients are getting Tarceva (see "A tale of two cancers"). Don't get lung cancer.

Have a banana.

It's not as easy at that. Lung cancer has been in the news recently because some arsy oncologist in Yorkshire has said that poor people have a worse prognisis from lung cancer because GPs do not bother to do Chest X-Rays on them.

All lung cancer patients in the UK are let down by the NHS. Because, having made the diagnosis, most chest physicians lose interest and pass the parcel. There are not enough oncologists who are interested in lung cancer and what interest there is is often confined to the private patients. I have just had an NHS patient with disseminated lung cancer who was kept on a medical ward in a DGH for six weeks with intractable bone pain. During that six weeks the consultant did not visit him once. He would have been better at home or in the hospice. At least his pain would have been properly controlled. When he did come home, I asked him if he wanted to see the Macmillan nurses at home. He said, "Oh! Please God, no. She was all over me. She kept stroking me."

Have a banana.

I've got news for arsy oncologist. Poor people get worse medical care than rich people. It's a universal truth throughout the world. If you are a chronically unemployed manual worker in late middle-age who has chain smoked for thirty years, you do not look at PCT websites and decide to go out and buy a banana. You do not know what the PCT is. You do not go to the doctor if you can possible avoid it and, when you do, you probably ignore the advice. Finally, when your lung cancer is diagnosed, the chest physician falls asleep with boredom. There is a long delay before you get the radiotherapy or chemotherapy, and your care is swiftly delegated to quacktitioners and hand-patters. You may well not get Tarceva. Depends where you live.

Have a banana.

It's a resource issue. We need more chest oncologists. We need more radiotherapy kit. We need more radiographers. We don't need to waste money on swine flu hysteria (see Nothern Doc's hysterical take on swine flu) Most of all, we don't need a bunch of bananas.

The DK and the Filthy Smoker become angry about the Essex commissar's approach because it is patronising and intrusive. I agree with them. But most of all, it is a waste of money. The hospital is on fire, burning to the ground. Why is no one doing anything? Where are the fire-fighters? They are in the local school lecturing children on the dangers of matches.

Have another banana.