Plea from health professionals on behalf of post-menopausal women

Health professional?Within the last week, a group of health professionals sent an open letter to their fellow specialists about the plight of those post-menopausal women reporting bleeding.

Post-menopausal bleeding indicates a gynaecological abnormality, usually a cancer growth within the womb.

The letter (BMJ 2010; 341:c7407) contains details about how many women reporting bleeding actually get referred for secondary care. Referral rates for patients with postmenopausal bleeding ranged from 66.4% in 55-64 year old patients to 40.1% in those over 85.

Last year the Eve Appeal highlighted the low profile from which gynaecological cancers suffer. Their campaign (with contributions from cancer sufferers and oncology nurses and specialists) focused on the low number of post menopausal women reporting bleeding to their GPs.

Gynaecological cancers are the world’s fourth largest cancer killer of women, with over 1 million women worldwide being diagnosed with a gynaecological cancer every year. Of the gynaecological cancers, womb cancer is now the UK’s most common, with 7,500 cases diagnosed nationwide.

The Eve Appeal, in conjunction with the National Forum for Gynecological Oncology Nurses (NFGON), are focused on improving the chances of women everywhere in beating these killers, by work in improving prediction, diagnosis and timely treatment.

The latest plea by health professionals highlights how much work has to be done – not only in getting more women to see their GPs in such circumstances but also in making sure those women are getting the treatment they need to beat gynaecological cancer.

Health Secretary Andrew Lansley recently promised an improvement to the care framework within the NHS, which, if implemented properly, would improve detection and survival rates for womb cancer sufferers. It remains to be seen whether the financial pressure on the NHS, as with other public organisations, will be conducive to improving even the most vital of services.

To get more information about any of the gynaecological cancers, please visit the Eve Appeal at


Fatties may damage British economy, experts warn

London: As the British take the title of the fatest in Europe, experts warn that the obesity epidemic could damage the economy.

But this could all be changed if talented professionals die early or retire because of sickness.

Professor Martin McKee said that the British Treasury has identified the cost of obesity to the NHS as a major problem but research shows how much healthy people contribute to the health of the economy.

He said: “They remain in the workforce longer and are more productive while they are at work. This is vital as the overall age of the population rises and people are encouraged to retire later.

‘”t is a waste of money investing in training people if they die at 35 or retire in their 50s because of ill health.”

The team at the London School of Hygiene and Tropical Medicine, examined the link between health and wealth in rich countries, and found healthier people have higher earnings.

The study, published in the British Medical Journal, said the current economic wealth of rich countries ‘owes much to previous health gains’.

About 30 per cent of financial growth in the United Kingdom between 1790 and 1980 can be attributed to better health and dietary intake.

Professor McKee said: ‘The overwhelming conclusion is that good health has benefits beyond the individual.

‘The true purpose of economic activity is to maximise social welfare and not simply to produce more goods and services.

‘Since better health is an important component of social welfare, its value ought to be included in measures of economic progress.

‘This has been done successfully in the United States. Similar moves in Europe could provide a new perspective on the investments made through their welfare states.’

UK’s public health service cleans up after private clinics

London: NHS surgeons are being left to “pick up the pieces” after poor surgery at private treatment centres, warns a senior doctor in this week’s British Medical Journal.

“The number of patients we are seeing with problems resulting from poor surgery is too great,” argues Angus Wallace, Professor of Orthopaedic Surgery at the University of Nottingham.

There is no doubt that the expansion of orthopaedic services, provided by the Department of Health through private hospitals and independent sector treatment centres (ISTCs), has been a much needed development, but it has occurred at a price, he writes.

What has happened in ISTCs is that junior specialists have been imported from overseas and asked to provide total surgical care without help and supervision from a more senior colleague, a situation that is alien to many of them – hence the reason why the failures find their way to the NHS hospitals.

He suggests that this situation has arisen because of a political philosophy called “additionality.” When ISTCs were set up, there was concern that their development might result in NHS hospitals losing some of their own surgical staff. To ensure that this could not happen a six-month rule was imposed – an NHS surgeon could not work in an ISTC until he or she had stopped working for the NHS for six months.

While this ensured that the NHS hospitals were protected from losing their own staff, it also meant that the ISTCs did not have access to many, or any, senior surgeons who could act as senior consultants and help their colleagues when they ran into trouble.

“Now we are seeing the consequences of this philosophy – poor operations, inadequate supervision of surgeons, and a poor mechanism for remedying any problems that occur,” writes Wallace.

There are also concerns about how clinical governance and appraisal procedures are being addressed in ISTCs, creating a suspicion by NHS staff that corners have been cut in achieving the goals of high productivity and throughput.

But perhaps the issue that should be of most concern is that of training the country’s up and coming surgeons, adds the author. The “straightforward” cases, now dealt with by the ISTCs, had been the cases on which young NHS surgeons learnt their craft. This time honoured and soundly proven method of training has now, sadly, been denied. Consequently the competence of our next generation of surgeons is in jeopardy.

“We, as NHS staff, need to help, and many of us wish to, but we are frustrated by the artificially created divide between the ISTC and the NHS hospital,” he says. “The government has created a two-level health service that is creating many problems. I believe that we should now integrate the ISTCs with the NHS instead of running them as a private healthcare system paid for by the state.”