Today's NHS - our current challenges

Weve all seen the headlines and news reports. The NHS is currently facing the biggest challenge in its existence.
While on a day-to-day basis most areas of the service are running perfectly well at present, we are already seeing
signs of the strain the system is under in areas such as hospital care, A&E and GP services.
The reasons for the service reaching this crisis point are many, but here are the main ones:

An ageing population
The NHS was set up to treat people with diseases. Many of the diseases that would have killed people 65 years ago,
have been cured, which is brilliant. While that means people are living for longer, it also means that they are,
probably, living with one or more illnesses (long-term complex conditions) such as diabetes, heart and kidney
disease. In turn, that means ongoing treatment and specialist care.

Lifestyle factors
The way we live now is also having a negative impact on our health. Drinking too much alcohol, smoking, a poor diet
with not enough fruit and vegetables and not doing enough exercise are all major reasons for becoming unwell and
needing to rely on our health services. Increasing numbers of overweight children show us that this problem is
currently set to continue.

The change in public expectations

Originally, tackling disease was the main job of the NHS. Now, we all expect so much more. From advice on
healthcare management through to mental health and social care, contraception, antenatal and maternity services,
vaccination programmes and the fast, efficient processing of our medication and appointments. All of this with a
growing population due to living longer and higher birth rates with lower infant mortality.

Accident and Emergency departments

More and more people are visiting A&E departments and minor injury units which is stretching the ability of the
departments to cope. A lot of the visits are unavoidable, but some are visiting because of inconsistent management of
their long-term health conditions, the inability to get a GP appointment or insufficient information on where to go with
a particular complaint. Winter sees an even bigger rise in visitor numbers with staff finding it harder by the year to
cope.

Rising costs
The current financial crisis, rising costs of services, energy and supplies; innovations and technological
breakthroughs that require more INVESTMENT
along with higher numbers of people to cater for all

spell out a huge economic disaster for the NHS.

It is estimated that without radical changes to the way the system works, as demand rises, and costs rise too, the
NHS will become unsustainable, with huge financial pressures and debts. If we make no changes we face a 30
billion funding gap for the NHS nationally by 2020 .

Advances in medicine and technology

The great news amongst all of this gloom is that there has never been a better time to face an overhaul. Huge
advancements in medicine and surgery, alongside IT and technological innovations mean that there is a wealth of
ideas and efficiencies that could potentially be implemented to bring our NHS up to modern standards to meet the
needs of us all in the 21st century. Utilising these new approaches within a major restructure the NHS could go on to
be a reassuring source of health care and wellbeing, as well as an inspirational model of good working practice for
years to come.
pioneering therapy using bone marrow stem cells to treat lung cancer patients has
been announced in the UK.

A new combined cell-gene therapy for lung cancer will be tested on National Health Service (NHS)
patients this year, after receiving 2m (US$3m) of funding from the Medical Research Council
(MRC). Scientists at University College London (UCL) will conduct the world's first human clinical
trials of a combined stem cell and gene therapy for the disease, which is notorious for its high
incidence and low survival rates. In the UK, lung cancer is the second most common form of
cancer, responsible for 34,000 deaths each year while in the USA, it is the third most common
form of cancer, killing 158,000. Globally, lung cancer is the single most common cause of cancerrelated death in men and women, responsible for 1.6 million deaths in 2012. Five year survival
rates are among the poorest of the 200 cancer types: only 9.5% in the UK and 17.5% in the
USA. There has been slow progress in terms of improving these mortality figures, with only small
incremental increases since the 1970s.
UCL's new experimental treatment could change that. Early tests have shown it can significantly
reduce and in some cases eliminate tumours in mice. Researchers will now test the treatment in

human volunteers firstly to check that the treatment is safe, then in 56 lung cancer patients to
see how effective the gene/cell therapy plus chemotherapy is compared with standard care.
Sam Janes, Professor of Respiratory Medicine at UCL and the study's leader: Lung cancer is very
difficult to treat, because the vast majority of patients are not diagnosed until the cancer has
spread to other parts of the body. One therapy option for these patients is chemotherapy, but
even if successful this treatment can normally only extend lives by a handful of months.
Chemotherapy can also cause widespread toxic side-effects. We aim to improve prospects for
lung cancer patients by using a highly targeted therapy using stem cells, which have an innate
tendency to home in on tumours when theyre injected into the body. Once there, they switch on
a kill pathway in the cancer cells, leaving healthy surrounding cells untouched. If clinical trials
are successful, our treatment could be transformative for the treatment of lung cancer, and
possibly other types of tumour in future.

In vitro tumour (red), seeded with stem cells (green), which burrow down through gel and into the tumour. The process shown here is 12 ho
Left video shows just the tumour; middle video shows just the stem cells; right video shows the green cells rushing into the tumour.

The new treatment works by genetically modifying bone marrow stem cells to express an anticancer gene called TRAIL. Being encased within a cell protects the genetic material from being
degraded by the body, so that when it reaches the tumour it is able to trigger a signalling
pathway that kills the cancer cells.
Each patient will receive almost a billion cells over three infusions, three weeks apart (injected
one day after receiving chemotherapy). Over the next three years, 100 billion cells will be created
at the Royal Free Hospitals 2.1 million, state-of-the-art cell manufacturing lab. A key advantage
of the treatment is that the cells can be used off the shelf and do not need to be from a close
relative or tissue match. This is because they have relatively few proteins on the surface and do
not induce an immune response in the recipient.

This will be the first cell therapy for lung cancer and the biggest manufacturing of cells of its
kind, said Professor Janes.

Comments

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4th February 2015

One in two people in the

UK will get cancer,
experts forecast
New research has predicted one in two people in the UK will develop cancer at some
point in their lives according to the most accurate forecast to date from Queen Mary
University of London and Cancer Research UK.

 Ilexx | Dreamstime.com - Cancer Cell

With today marking World Cancer Day, a new study published in the British Journal of
Cancer highlights the urgent need to bolster public health and cancer services, to cope with a
growing and ageing population and the looming demands for better diagnostics, treatments, and
earlier diagnosis. Prevention must also play an important role in the concerted effort required to
reduce the impact of the disease in coming decades.
The UKs cancer survival has doubled over the last 40 years and around half of patients now
survive the disease for more than 10 years. But, as more people benefit from improved
healthcare and longer life expectancy, the number of cancer cases is expected to rise. This new

research estimating the lifetime risk finds that, from now on, one in two people will be diagnosed
with the disease.
This new estimate replaces the previous figure, calculated using a different method, which
predicted that more than one in three people would develop cancer at some point in their lives.
Age is the biggest risk factor for most cancers, and the increase in lifetime risk is primarily
because more people are surviving into old age, when cancer is more common.

Estimated cumulative risk for 1960 cohort. Credit: British Journal of Cancer.

Professor Peter Sasieni, who led the study at Queen Mary University of London, comments:
Cancer is primarily a disease of old age, with more than 60% of all cases diagnosed in people
aged over 65. If people live long enough then most will get cancer at some point. But theres a
lot we can do to make it less likely like giving up smoking, being more active, drinking less
alcohol and maintaining a healthy weight. If we want to reduce the risk of developing the disease
we must redouble our efforts and take action now to better prevent the disease for future
generations.
Harpal Kumar, Cancer Research UKs chief executive, says: Were living longer and that means
were more likely to develop a range of age-related health issues. We need to plan ahead to make
sure the NHS is fit to cope. If the NHS doesnt act and invest now, we will face a crisis in the

future with outcomes from cancer going backwards. But NHS investment isnt the only answer.
We need a concerted approach and a broader sense of how we can save lives and money by
preventing more cancers. Growing older is the biggest risk factor for most cancers and its
something we cant avoid. But more than four in ten cancers diagnosed each year in the UK could
be prevented by changes in lifestyle thats something we can all aim for personally so we can
stack the odds in our favour.
Dr Emma King, Cancer Research UK head and neck surgeon: Were seeing more patients than
ever before and the numbers are increasing year on year. But the resources for treating these
people have stayed the same. If were going to give them the best possible chance of beating the
disease then well need greater investment and support now and in the future. Preventing more
cancers and diagnosing the disease as early as possible, when treatment is more likely to be
effective, could have a significant impact on survival. We also need the infrastructure to better
tailor treatments to patients based on the molecular makeupunderpinning their individual
cancers.
In a separate study, University College London has predicted that on current trends, by 2050,
cancer will rarely kill anyone under the age of 80, due to ongoing advances in preventing and
treating the disease. At present, a low dose of aspirin taken daily may be the single most
effective action to protect against cancer for those aged between 50 and 65, according to UCL.