The #NHS is actually quite easy to improve. This is how you do it:
1. Vote out the Tories
2. Focus on the social determinants of health. Wealth inequality causes health inequality. Tax unearned wealth (rentier billionaires & tax evaders)
3. Invest and promote public health 4. Understand that health spending has a fiscal multiplier effect and promotes economic growth
5. Invest in social care services
6. Use monopsony (dominant buyer in healthcare market) power of NHS for procurement of drugs and medical technology
7. Abolish purchaser-provider split

THREAD on #Consultants #Strike:
As a consultant oncologist, this is how I am going to support the strike:
I will work tomorrow because I have 2 MDTs, which can’t be cancelled because it would delay cancer treatment decisions by a week for about 80 patients. 1/ On Friday I have cancelled my radiotherapy planning clinic and my afternoon follow up clinic. I will enjoy a long weekend. However, all the patients will get seen tomorrow instead, with an extra ad hoc clinic and remote radiotherapy planning. 2/

THREAD: A tribute to Simon Stevens, outgoing #NHS CEO.
When I first heard Simon Stevens was going to be CEO of the NHS, I was convinced he was going to accelerate the privatisation of the NHS, as he was appointed by a Tory Government, and was formerly CEO of UnitedHealth 1/11 Over time, he has proved me wrong. In fact, I now believe he did an enormous amount of work to slow down #NHS privatisation, despite the concerted efforts of Lansley and Hunt to drive forward a Tory market driven agenda 2/11

THREAD: We were a few hundred thousand votes away from the most powerful and militarized nation on earth becoming an authoritarian dictatorship. We must understand why we got so this close to this disaster. /1 In my opinion this is a direct result of neoliberal ideology, which has resulted in gross wealth inequality. The gap between rich & poor is higher than ever, leading to a large proportion of the population being left behind with poor prospects & enduring very difficult lives. /2

I disagree with the Barrington declaration for the following reasons:
1 We don’t know enough about natural history of #COVID19 eg what are long term complications? risks of re-infection? severity of re-infection?
2 Spread can occur via asymptomatic cases, increasing transmission 3. You can’t effectively cocoon the elderly population. Younger people live with, work with, and look after older people
4. Infection spreads like wildfire through care homes and nursing homes. It’s devastating
5. If R number gets out of control, the health system will collapse

As a cancer specialist I think it’s important to respond to the #HealthSecretary’s comments about cancer treatment not being available if #COVID19 gets out of control. Firstly, it’s important to state that #Hancock and his own Government’s failures have contributed to the problem Secondly, I think it’s unlikely that those in most need will miss out. We have learnt an enormous amount about managing cancer in a #COVID19 environment and are now much better prepared. At present we are managing generally very well, although surgical waiting lists are a problem

THREAD on healthcare for US voters:
Republicans repeatedly claim that “socialised” medicine means taking healthcare away from people. I come from the UK, the home of socialised medicine since 1948 in the form of the NHS.
I have worked as a doctor in the NHS for over 25 years The NHS may not be perfect, but it’s loved & respected by the UK public. It’s founding principles are universal healthcare for all, free at the point of use, regardless of the ability to pay. Every citizen gets access to care.
It’s funded by taxpayers, so the state insures us all

Oncologists and cancer surgeons need to open up a debate about which surgical patients should receive radiotherapy instead. My suggestions will follow.
Coronavirus: NHS waiting list 'could hit 10 million this year' - BBC News #COVID19 bbc.co.uk/news/health-52… I specialize in thoracic & urological malignancy, so will only start #cancerdebate in these areas.
Prostate
1. Offer Active Surveillance or SBRT instead of prostatectomy for vast majority of low risk & low-intermediate risk disease
2. SBRT for intermediate risk disease.

An early lockdown would have:
1. Minimised overall number of infections
2. Lowered R0 number
3. Saved lives
4. Reduced long term morbidity
5. Reduced burden on health services, allowing more non-#COVID19 services to have stayed open
6. Limited geographical spread around country 7. Allowed earlier release of lockdown
8. Reduced economic damage
9. Improved test, trace, isolate effectiveness
10. Bought more time and resources to help rebuild public health teams
11. Built trust in our political leaders, essential for ongoing public health messages

THREAD: Summary of UK’s #COVID19 Crisis
1. Viral pandemics are top of Government’s risk register
2. Despite this, Cygnus report showed we were unprepared
3. We had advanced warning in January
4. PM put his free market ideology ahead of public health (Feb 3rd “Superman” speech) 5. Herd immunity strategy adopted instead of strict early lockdown, which eventually came but far too late
6. PM’s “hand shaking” speech was a public health calamity
7. Sporting events like Cheltenham, Liverpool/Madrid, & Rugby internationals were a public health calamity

As an #NHS cancer consultant , I have a public duty to raise the alarm that the Government is failing cancer patients during the #COVID19 crisis. A key cancer treatment that will be crucial to tackling the upcoming surge in cancer cases is still being rationed by NHS England 1/ Stereotactic radiotherapy (#SABR or SBRT) is a method of radiation delivery that can accurately deliver very high doses of radiation to localised cancers. It’s used to treat a wide variety of cancers including lung, prostate, kidney, and liver cancers. 2/

THREAD on cancer treatment in #COVID19 pandemic.
The @CovidSurg collaborative have estimated that in the UK, >500,000 operations have been cancelled, including 36,000 cancer surgeries. Globally, the figures are 28.4m and 2.3m. (During peak 12 weeks of disruption) #cancer 1/ Although surgical activity is increasing again and cancer surgery is being prioritised, we are far from returning to normal levels and there is going to be an enormous backlog of cases. This will be particularly detrimental to overall cancer outcomes 2/

It’s hard to imagine a country in more trouble with the #COVID19 pandemic than the United States:
1. An incompetent, narcissistic President in power
2. 50 States with differing positions on how to manage the outbreak
3. Popular #fakenews channels like Fox spreading disinformation 4. Very delayed response to the #COVID19 pandemic resulting in highest numbers of cases and deaths in the world, and one of the highest rates of deaths per million
5. Early signs of public unrest & protests to end the lockdown
6. An armed population
7. Powerful anti-Vax lobby

THREAD: I’ve been a consultant cancer specialist for 15yrs. Seasonal flu has NEVER seriously impacted my clinical practice.
On the contrary #COVID19 has had a dramatic impact, so all those on social media calling to end lockdown need to understand the seriousness of this pandemic For starters, I’ve been assigned to the #COVID19 wards rota. Somewhat scary for a non-acute physician, but actually a privilege to be able to help the dedicated teams on the frontline.
Meanwhile, the cancer service must continue.....

It’s 100% the responsibility of Government to ensure the nation is prepared to tackle a #pandemic to the best of its ability. Exercise #Cygnus uncovered gaping holes in preparedness in 2016. By failing to address those findings, the Government have failed the nation #COVID19 I think it’s also important to understand what we mean by preparedness. Some stockpiling is warranted, but I don’t think anyone would expect a Government to have 50,000 spare ventilators in a warehouse. The point of preparedness is to have ready to go “off the shelf policies”

Trying to achieve “herd immunity” to #COVID19 through infection rather than a vaccine is a very bad idea. This is not only because health services will be overwhelmed, leading to a rise in all cause mortality, but also because we don’t know the natural history of this disease 1/4 If natural immunity is low or short-lived, re-infection rates could be high. There’s also the possibility of long term, difficult to treat complications after recovery from #COVID19 such as pulmonary fibrosis, pulmonary hypertension, & cardiac failure. #naturalhistory 2/4

THREAD: The Government’s failure to protect #NHS staff with proper PPE and implement staff testing for #COVID19 has put vulnerable patients at even greater risk.
These are the reasons:
1. Thousands of staff are self-isolating, including upto a quarter of all doctors 2. Failure to test staff means that large numbers of these staff remain self-isolated when they don’t have #COVID19 infection. Negative test is not perfect, but most could return to work by risk assessing

THREAD: Let’s talk about fear
Fear is a big issue at present. A certain level of fear can be a good thing. It can lead to positive behavioral change so that people take head of Government advice to help reduce transmission of #COVID19 by social distancing and staying at home #1 On the other hand, fear can lead to mental health problems such as severe anxiety, depression and alcohol problems. It can affect normal day to day functioning and increase stress at work. It can also lead to damaging behaviors such as panic buying that fuels further fear #2

#1 THREAD: Some on twitter (mainly the right wing commentariat) are struggling to understand why #COVID19 pandemic is worse than the usual influenza outbreaks, saying it’s all hype, and calling for restrictions to be ended. I hope (but doubt) this will help them to understand #2 The #COVID19 pandemic is a much greater threat to us and our healthcare systems than the flu because:
1. It’s an *additional* problem to the flu season, which is ongoing and a reason why hospitals are already full. (Particularly in the UK, where austerity has cut NHS capacity)

THREAD: Now is not the time for blame, and there will doubtless be major public inquiries once the #COVID19 pandemic is over. However, I have some nagging thoughts and questions that I just can’t get over, so help my out if you can, because I’m no expert The first question is that the CMO and Chief Scientific Advisor stated that it was inevitable the 60-80% of the population would become infected. I believe this was one of the initial reasons for the “herd immunity” and “cocooning” the elderly approach

https://twitter.com/bbcr4today/status/1238390547783528448

THREAD: Should we continue to offer concurrent ChemoRT and Durvalumab in selected stage III NSCLC patients during the #COVID19 outbreak?
I think yes, and this thread explains why #radonc #medonc #lcsm Chemo added sequentially to RT gives ~5% absolute Overall Survival (OS) benefit to RT alone at 5 years. ChemoRT given concurrently adds a further 4.5% absolute OS benefit at 5 years (Auperin meta-analysis). #lcsm #radonc #medonc #covid19