'I spent my savings rather than wait for the NHS'

Hospital services are facing mounting pressure.Staff shortages, rising demand and a squeeze on budgets mean waiting times are rising in many places.

And while the health service still sees most patients quickly - whether they turn up at an accident and emergency unit, need cancer treatment or have to have an operation - growing numbers are having to wait longer than they should.

So what is it like for those caught up in the system?


'I waited so long I gave up and spent most of my life savings'

Image copyright Supplied Image caption Christine Moon, pictured here with her partner, Geoff, waited for months for a coronary bypass on the NHS

Christine Moon, 66, was on holiday in Bali in 2015 when she started feeling chest pains.When she returned to her home in Wellingborough, Northamptonshire, she went to see her GP and ended up in hospital having all number of tests on heart.

"Eventually, they said, 'I'm very sorry, but we've decided you have a 90% block in your coronary artery,'" she told BBC News.

This was in August last year.She then waited until November to see a consultant, who said she needed a coronary bypass but there would be an additional 18-week wait.

So, 18 weeks later, she rang the hospital.

"I was told they were way behind and they had absolutely no idea where I was on the waiting list," Ms Moon told BBC News.

"No-one at the hospital could tell me when I was likely to have my operation."

Every week, patients in more critical need of a bypass were being referred to the hospital, effectively bumping her further down the queue, she said.

"I couldn't do any housework, I couldn't do stuff that I normally did.My symptoms were getting worse, but I wasn't going to have a heart attack."

In April this year, 32 weeks after being diagnosed, she gave up on waiting and paid £16,000 to have the operation privately.

"I had to think long and hard about it, but it was really hanging over me," Ms Moon told the BBC.

"I was more and more depressed, and just not able to get an answer out of anyone."

Having the operation had given her "bags of energy" and her life back, she said.

But, she is angry and has spent much of her savings.

Ms Moon told the BBC:"Eighteen weeks seems to be this magic number they come out with that is just lies.

"Would I still be on a waiting list if I had not gone privately?I may well have been."

If you can't see the NHS Tracker, click or tap here.[1]

'Doctors want something they can fix in 10 minutes'

Image copyright Supplied Image caption Holly has had many complex health conditions since she was a child

Holly Wilson was nine years old when she started seeing doctors on a regular basis.She had a condition where her white blood cells infiltrated her bowel, causing inflammation and pain.

Since then, the 22 year-old, from Chichester, has been in and out of hospital.

"The list is endless," she said, of the number of medical conditions that cause her day-to-day pain.

Her entire body is affected, including her connective tissue, joints and gut, and once she had a cyst on her ovary "the size of a grapefruit".

"At one point, I was in hospital 30 times in a year," Ms Wilson told the BBC.

"There are a lot of problems - I'm very, very complicated.I'm always known as the difficult, complex patient."

She has noticed waiting times increase, and recently had to wait more than 10 hours for a medical slip to give to her employer to allow her to return to work.

Her most recent medical issue is a fast heart rate and palpitations.

Doctors are trying to diagnose what is causing it, but it can take up to 18 months between being referred for tests and getting the results.

"The long wait for this diagnosis - it's a lot of not really knowing, which makes it stressful," Ms Wilson told the BBC.

"Doctors want something they can fix in 10 minutes."

"They're trying to see so many people in such a short amount of time."

But Ms Wilson's three folders of medical history do not make this easy.

"Doctors look at all these notes, and they're just too much for one person to take them in," she said.

"I don't feel the notes are being read or paid attention to as much as they should be."

Ms Wilson doesn't want to "bash the NHS".

"They have done a lot for me.Without them I wouldn't be alive," she said.

"It's just frustrating as I have been in and out of hospital since I was very small and I have noticed the change."


'My wait was so long I launched a formal complaint'

Image copyright Supplied Image caption Andy Goble waited almost a year for an operation that would fuse his talonavicular joint

Andy Goble, 48, had painful arthritis in his feet.He had one foot operated on and then, a couple of years later, in August 2016, doctors said they needed to operate on the other.

"The idea of the operation is to fuse two bones in the foot to stop them grinding together and stop the pain," he told the BBC.

The condition means he struggles to walk any great distance and lives in continual pain.

Even though he works from his home, in Southend-on-Sea, the condition has affected his work as a web designer.

"I am self-employed and find it impossible to work all day," he said.

"I am also unable to drive much of a distance if I need to visit clients.

"This is starting to cause me financial problems."

The father of two has also had to take painkillers, which tire him out.

He waited an "absolute age" to receive a date for the operation, which was then cancelled a week later.

And in May, after many phone calls, he decided to launch a formal complaint.

"Then, all of a sudden, everyone jumps and gets involved," Mr Goble told the BBC.

The hospital had "bent over backwards" to get the surgery done, he said, scheduling operations "at weird and wonderful times", with his taking place on a Sunday morning 15 weeks ago.

He can now walk again, but his foot remains very painful as it recovers.

"Because it's not life threatening - it's just pain-relief surgery - you come bottom of the list," he said."It's always the lowest priority."

"There is knock-on pain to other joints, such as the knee, hip and back.So, while you're waiting, the condition gets worse and affects your life more and more."


'I waited almost six weeks for an urgent appointment when I had late-stage cancer'

It was February 2014 when Susan Down, now 65, first thought something was wrong.

"It was quite sinister what I found, the lump," she told the BBC.

"I'd had it for quite a few weeks, and it was getting worse."

She saw a GP, who gave her creams for piles.

A couple of weeks later, when things hadn't improved, the GP gave her a referral for an emergency appointment.

Despite it being deemed urgent, her local hospital wasn't as quick to respond as she had expected.

"I was quite anxious.I kept calling the hospital," Ms Down told the BBC.

Five and a half weeks later, she got an appointment.

"Then they were running around like headless chickens," she said, giving her six different tests over the next fortnight.

Her daughters and partner went with her to the appointment.She was told she had stage-four anal cancer and that her tumour was 2.5cm (1in).

"It hadn't metastasised, but it was very big and pushing it's way to the front," Ms Down told the BBC.

"If it had gotten right through to the front, I would've been poisoned."

Her diagnosis caused her to retire from her job, as a support worker for adults with learning disabilities.

It took a couple of months before she was fitted with a stoma, and then she had to wait a couple more months before she could get radiotherapy.

"The doctor said, 'Lets get on with it or else you will die,'" Ms Down told the BBC.

The radiotherapy machine at her local hospital was not appropriate for her so she had to be treated in a specialist hospital in Hertfordshire, a two-hour drive from her home in Kent.

She had six weeks of radiotherapy followed by two weeks of chemotherapy.

"At first they couldn't say it had shrunk, because it was so big," Ms Down told the BBC.

"But after a few months they said it as going in the right direction.

"Looking back I think, That was awful.'"

Now, Ms Down spends half her week looking after her one-year-old granddaughter, Charlotte.

She appears to be clear of cancer, but has long-term problems from the treatment....

References

  1. ^ click or tap here (bbc.in)

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Pre-sex HIV drug 'no-brainer" for NHS

Gay menImage copyright Getty Images

A drug to dramatically cut the risk of HIV infection during sex would save the UK around £1bn over the next 80 years, say scientists.

The team at University College London says Prep, or pre-exposure prophylaxis, is a "no-brainer" for the NHS.

The study predicts that giving Prep to men who have sex with men would prevent one in four HIV cases.

NHS England is currently funding a trial of Prep in 10,000 patients, but does not offer the treatment routinely.

Prep is already available in Scotland[1].The health service in England fought against paying for Prep in the courts[2], but agreed to trialling it in selected clinics.

image

Media playback is unsupported on your device

Media captionHow taking pre-exposure drugs revolutionised one gay man's relationship with sex

Preventive pills

Prep disables HIV before it gets a stranglehold in the body and trials show it can cut the risk of being infected by up to 86%.[3]

The financial analysis, published in the Lancet Infectious Diseases[4], looked at the cost-effectiveness of a national roll-out of Prep, focusing on the highest risk group - men who have sex with men.

It showed offering Prep would cost the NHS money initially as it paid for both Prep and lifelong care for people already infected with HIV.

It could take up to 40 years to become cost-effective, when savings from the falling number of new HIV cases equal the cost of Prep.

Eventually, after 80 years, the pills would deliver a saving of £1bn, say the researchers.

Dr Alison Rodger, part of the UCL team, told the BBC:"Not only is it a highly effective treatment, it will save money.It's a no-brainer so it's a good thing to do."

Image copyright Getty Images

The researchers' mathematical model predicted:

  • In the first year Prep was available, 4,000 men would start taking it, rising to 40,000 within 15 years
  • Men would take Prep for 4.5 years on average
  • Men would take two pills before sex, followed by one-a-day until they had gone two days without condom-less sex
  • Men would average five pills a week

It is still cost-effective with a daily Prep pill, but it takes longer to become cost-effective.Both options are being investigated as part of the NHS England trial.

The other major unknown is the long-term cost of the drugs, which may fall as cheaper alternatives become available.

Dr Michael Brady, medical director at the Terrence Higgins Trust, said:"It is important that all who need Prep can access it, and evidence like this reinforces the need for Prep to be fully commissioned and given a long-term, sustainable home on the NHS in England."

Dr Paul Revill, from the centre of health economics at the University of York, said the NHS needed to be "far sighted [and] invest now and reap long-term gains".

He added:"With a combination of frequent HIV testing, immediate treatment, and Prep availability, there is now the prospect of bending the curve of new HIV infections downwards in a way that did not seem feasible just a few years ago."

A spokesperson for NHS England said:"The Lancet study makes an important contribution to the growing evidence for cost effectiveness of PrEP, highlighting the factors which will determine this, such as price and duration on PrEP."

Follow James on Twitter.[5]...

References

  1. ^ available in Scotland (www.bbc.co.uk)
  2. ^ fought against paying for Prep in the courts (www.bbc.co.uk)
  3. ^ by up to 86%. (www.nice.org.uk)
  4. ^ published in the Lancet Infectious Diseases (www.thelancet.com)
  5. ^ on Twitter. (twitter.com)

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Check NHS cancer, A&E and operations targets in your area

The NHS is under unprecedented pressure.Rising numbers of patients need hospital care - whether in an accident and emergency department, for cancer treatment or for planned operations and care, such as knee and hip replacements.

For each there are strict targets local services are expected to meet across the UK.But what are the chances of being seen in time where you live?Use our interactive tracker to find out.

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Figures are assessed against targets before rounding

When was the target last hit?

When was the target last hit?

When was the target last hit?

If you can't see the tracker, click or tap here.[1]

How the NHS tracker works

This guide uses the latest published data on performance against three key NHS waiting-time measures:

  • A&E treatment
  • cancer care
  • planned operations and care, such as knee and hip replacements

This data is currently published either monthly or quarterly depending on where you live in the UK, and there are differences between how the targets are measured in each part of the UK.

The A&E target

The way the A&E target is measured is almost identical.In each case services across the UK are given four hours in which to treat and discharge or admit or transfer a patient.

They are all expected to do that in 95% of cases, although ultimately Scotland wants it services to get to 98% once 95% is achieved.There are also slight differences in the way the start time is measured.

The cancer target

There are similarities in the way cancer care is measured.Each expects patients to be treated within 62 days of an urgent referral.

In Scotland this can be following a GP or A&E referral or following a screening test.

Elsewhere it is broken down individually by referral route.So for the rest of the UK the BBC has chosen GP referral as the area to focus on as this is the most common route.Again the thresholds services are expected to achieve vary.

The planned operations and care target

The one that varies the most is for planned hospital care, which is also known as non-emergency treatment.

In England, Wales and Scotland the target measures the point at which you get a referral from your GP to the point when your treatment starts - in effect the whole patient journey.

In Scotland and England services have 18 weeks, in Wales it is 26 weeks.

Meanwhile, in Northern Ireland there are a range of targets for different parts of the patient journey.The BBC has chosen the last part, from when the decision is taken to admit the patient for treatment to when that treatment starts.It therefore does not include the tests and appointments that follow a GP referral, which can take weeks or even months.Services in Northern Ireland have 13 weeks to achieve this target.

The thresholds vary too.None is expected to achieve these goals 100% of the time.In Northern Ireland services have to achieve the target in 55% of cases, whereas in Wales it is 95%, in England 92%, and in Scotland 90%.

How local is defined

In England data is provided down to individual hospital trust level, some of these run more than one hospital.The BBC has excluded specialist trusts for cancer, children's care, women's services and orthopaedic treatment and instead focused on the 135 general hospital trusts - what most people would consider their local service.

Elsewhere performance is broken down to health board level, known as health and care trusts in Northern Ireland.They are in charge of services for a region or large city and often run more than one hospital.

We have chosen these boards because while some data is provided down to individual hospital level it is not done across all three targets.

How far back performance is tracked

The BBC has tracked back performance to the point at which the latest target was set or to when the records allow.

When a target has been missed for five years, we have just labelled it as that.

When targets have been hit more recently, we have provided the month they were last hit.

There are only two targets where it has not been possible to go back five years:

  • in Scotland for A&E as the target threshold was reduced from 98% to 95% in October 2014
  • in Northern Ireland for planned operations and care because its 13-week target threshold of 55% was set only in April 2016

The full list of dates from which the performance of local services is available are:

For England:

  • A&E:June 2010
  • Cancer:January 2009
  • Planned operations:April 2012

For Northern Ireland:

  • A&E:April 2008
  • Cancer:April 2009
  • Planned operations:April-June 2016

For Scotland:

  • A&E:October 2014
  • Cancer:January 2012
  • Planned operations:January 2011

For Wales:

  • A&E:October 2009
  • Cancer:October-December 2009
  • Planned operations:September 2011

Research by the BBC data team, Ransome Mpini, John Walton, Christine Jeavans and Nick Triggle.Design by Sumi Senthinathan.Development by Chris Ashton, Evisa Terziu, Becky Rush and Alvin Ourrad....

References

  1. ^ click or tap here (bbc.in)

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