The Burnt-out NHS

Doctors in Scotland are suffering “stress and burnout” as growing NHS workloads take their toll, medical leaders today warned.  BMA Scotland chairman, Dr Keighley has warned that the fall in hospital bed numbers over a number of years has led to rising waiting lists and more pressure on Accident and Emergency.

Health boards and the Scottish Government are struggling to deal with the pressures of an ageing population, Westminster-led funding cuts and rising expectations from patients which include a shift towards a seven day working week in hospitals. New contracts are now being proposed for doctors, along with “radical” changes to training and greater weekend working. Dr Keighley insisted doctors are ready to look at new ways of working.

The crucial contact between doctors and patients has particularly suffered, according to Dr Keighley.

The “inexorable rise of managerialism” in the NHS has been a “major cause of dysfunction”, he added, and there is a need to return to clinical priorities. “I disagree with suggestions that managerial and process change holds the solution to sustaining high quality care and believe instead that it is only by working with doctors and other healthcare professionals that a solution will be found.

The Unpaid Over-worked "Angels"

The NHS in Scotland is close to breaking point, with most nurses claiming they are forced to work overtime to meet patient needs, a new report has found. A majority of nurses say patient care is suffering because of the pressure they are under, according to a staff survey by the Royal College of Nursing (RCN). Nurses are going unpaid for the extra hours they work because this was not agreed in advance, the report reveals, and time back in lieu cannot be taken because this would leave colleagues even more short staffed.

Nearly 2,000 nursing posts have been axed in Scotland in recent years. The survey finds that 54 per cent of nurses are working beyond their contracted hours each week in order to meet demands, with 58 per cent saying they are under too much pressure. More than half (55 per cent) say they are not providing the level of care they want to as the pressure builds. Only 38.1 per cent in Scotland say they would choose nursing as a career if they had to do it all again.

Norman Provan, of RCN Scotland, said the report must act as a “wake-up call” for NHS chiefs and the Scottish Government. “It is both unfair and unsustainable to continue to rely on the goodwill of nurses to keep health services running. It is apparent that health services are only managing to meet demand because of nurses willing to go the extra mile, for free.” he said.

The welcomed immigrants

ONE PEOPLE FOR WORLD SOCIALISM

With training numbers cut, budgets frozen – it costs on average £70,000 to educate and train a qualified nurse in England – and the winter coming, foreign nurses represent a quick fix. Public spending cuts combined with nursing training places falling from almost 21,000 in 2009 to fewer than 18,000 this academic year means there is a significant shortfall in hospitals.

 One NHS employee said: “If you need a lot of nurses quickly, then the best thing to do is jump on a plane and bring them back from an EU country. They’re happy and the hospitals are happy.”

Howard Catton, RCN director of policy, said: “When employers are getting on planes to recruit nurses, you know you have a crisis in workforce supply. That is happening right here, right now.”

Forty trusts have already recruited from overseas in recent months, resulting in more than 1,360 nurses coming to work in England. A further 41 hospital trusts will follow suit. Spain and Portugal are the most popular sources. As more than 10,000 nurses fight for only 460 jobs in Spain because of its economic recession.

This story is nothing new. The NHS has always relied significantly on foreign workers. In 1963 the Conservative Health Minister, Enoch Powell, who later led the call for stricter controls on immigration, launched a campaign to recruit trained doctors from overseas to fill the manpower shortages caused by NHS expansion. Some 18,000 of them were recruited from India and Pakistan. Powell praised these doctors, who he said, 'provide a useful and substantial reinforcement of the staffing of our hospitals and who are an advertisement to the world of British medicine and British hospitals.'

Under the proposed new legislation for charging migrant workers for using the NHS, these nurses may end up having to pay for using the services of the doctors and fellow nurses in the very same hospitals as they work!!

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Your Choice - Mending or Ending Capitalism

In America Obamacare, reforms to the health system of that coutry has been called “creeping socialism” by the free-marketeers and the American public has been barraged by propaganda against any form of “socialized medicine”. The problem of medical costs for people in the United States is a severe and often tragic one. In the UK we possess the much acclaimed National Health Service. The NHS is very far from perfect, but it works far better than the health system in the US, where almost all care is bought and sold in the market place. The NHS is the centrepiece of the welfare state. For over 90 percent of the population it provides their only access to health care. It is immensely popular, despite its inadequacies. The well being of workers concerns the ruling class and, for sure,  this is reflected in the priorities of the NHS. Acute medicine for the able bodied of working age is better funded and includes the most prestigious areas of medicine. Those caring for the elderly and the physically and mentally handicapped remain the “Cinderella” services.

The National Health Insurance Scheme started in 1912, it was decided to pay the money to the different health insurance agencies already in existence. Some were cooperative undertakings, some were run by trade unions, and some by insurance companies, so that there arose the anomaly of a national, compulsory insurance scheme being administered through separate, private insurance organizations. The benefits tended to vary. Employed workers were covered by but not their wives, children and other dependents. A sick insured worker had the care of a doctor and free medicine, but none of the ancillary necessities were provided – X-ray, hospitalization, surgery, etc. Low wages and recurring unemployment made even care by a doctor and free medicine a doubtful blessing for the average worker. While the sickness benefit remained fixed by law, some of the wealthier organizations gave additional services, dental care, eyeglasses and so on, while the poorer ones gave only the minimum. There were also local health authorities which were responsible for certain aspects of public health These included clinics, midwifery, maternity and child welfare, water supplies, sewage and refuse disposal, control of epidemics and the provision of domestic help for families unable because of illness to look after themselves. The main difficulty lay in the fact that there were over 400 authorities, many of them too small and too poor to carry out their functions. As a general rule, medical help received by this means was not of a high standard.

In 1942, Sir William Beveridge, a Liberal member of Parliament, proposed a comprehensive health service which would “ensure that for every citizen there is available whatever medical treatment he requires in whatever form he requires it...”
The Labour party steered the necessary legislation through parliament and in November 1946 the National Health Service Act became law and came into effect on July 5, 1948.

The National Health Service is available to every man, woman and child in the country without any qualification. Everyone is free to choose his or her own doctor and the doctor is free to accept or reject a prospective patient.

The NHS was regarded as a charge on national income in the same way as education and the armed services. It is recognized that it is as necessary to spend money on healthy bodies and minds as it is to provide education for the people. Welfare provision is contradictory. On the one hand it benefits workers but on the other it also reflects capital’s interest in the reproduction of labour power. The state represents capital’s interest in maintaining the conditions for the reproduction of labour power, but this imposes a cost on capital. There is a constant tension between the desire for healthy, well trained workers and the costs of such provision. In 1951 the Labour government, introduced legislation imposing charges on dental treatment. The following year the Conservatives added additional charges to the service. Pricing  has been expanded over the decades by both parties but  nevertheless remains largely a “free” service available to all. The priorities of the NHS have no bearing on what patients can pay – only to what they need.

“The National Health Service is the envy of the world.”  said Enoch Powell, minister for health in 1962.
“The National Health Service is safe with us.” said  Margaret Thatcher, prime minister in 1983.

The attack on the NHS today takes two forms. The first is the outright demand for privatisation of the entire health service and a full return to the market where people who can’t afford medical fees don’t get treated.  The other attack pretends to favour the principles of the NHS but then argues for the gradual erosion of those principles by moving towards a two-tier system, a private insurance model for wealthier patients while leaving the NHS the unprofitable areas of care, for the chronically sick, the mentally handicapped and the like.

The NHS is a very good example of a past reform vigorously opposed by conservative forces such as the doctors lobby, the BMA, at the time. It was very much in the interests of the great mass of the people, and especially of working class people. It was also, from the beginning, something of a compromise, but a compromise more in our favour than otherwise. Despite all its faults the principles the NHS incorporates are socialist ones. There will always be some system of priority and how is the NHS rations is on the basis of need. He or she who needs more, gets priority over him or her who needs less. It is not rationing by the size of a person’s wallet or purse.

With the deepening crisis of capitalism it is now the National Health Service is fighting for its life. “Saving” money is seen as important, however, reducing the profit level of the multinational drug companies is no part of plans. The NHS continue to allow brand name drugs to be prescribed when generic prescriptions would lower costs. While pharmaceutical company profits have risen enormously the original conception of the NHS has been quietly abandoned.

 Attacks on the health service are deeply unpopular. One of the easiest ways of dismantling the NHS is to impose strict budgets and  make the working conditions and pay so unattractive and unrewarding that it literally becomes impossible to staff it. Closing a ward here and a ward there, or shutting this or that local hospital and no-one notices that it is gone until it is too late.

As critics of reformism, the Socialist Party are not, of course, opposed to particular reforms. But it has to be understood that no gain is permanently guaranteed so long as the means of production  remain in the hands of the capitalist minority. The never ending struggle to protect the benefits of the National Heath Service is proof of the pudding. To permanently achieve a decent society we must break the power of the capitalist class.

Not so confidential

A leading Scots GP claims the NHS is profiting from allowing pregnant women's details to be sold to commercial companies, often without their full knowledge or consent. Glasgow GP Dr Margaret McCartney also warns that the NHS and professional bodies such as the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of General Practitioners (RCGP) are guilty of a conflict of interest by collaborating in the advertising of thousands of products to pregnant women and new mothers.

She also criticises Bounty, a promotions company which supplies 2.6 million Bounty bags a year to new mothers, including 812,000 newborn packs distributed through NHS maternity wards. Many of the mothers who sign up to receive Bounty Bags while in hospital are not aware they are agreeing to their email address and telephone number being used by commercial companies, she argues. In some cases they do not even realise the person collecting the information is not an NHS employee, while the inclusion of a child-benefit application form in the packs gives them an "air of officialdom".

Dr McCartney said: "The lack of knowledge about what signing over your details means is troubling in a hospital environment, which should take consent and confidentiality seriously. The hours after birth are hardly an optimal time to obtain formal consent. Do we want parents placed under advertising pressure and for NHS doctors, radiographers and midwives to be the conduit?"

We need a need-based health service

The NHS is failing to provide needs-based care in areas of blanket deprivation, GPs working in Scotland's poorest areas will tell MSPs. The GPs from The Deep End group, which represents 100 practices in the poorest parts of the country are expected to warn that the health service's approach is a "recipe for widening health inequality" when they appear before the Public Audit Committee.

The report warned that the distribution of GPs in Scotland does not reflect the higher levels of poor health and greater need in poorer areas and that "deep-seated inequalities remain between the least and most deprived communities" despite research showing higher rates of multimorbidity (more than one chronic medical condition) in patients from the most deprived areas.

This, combined with "dysfunctional links between general practice and other parts of the NHS", is "a partial explanation of 20 years of failure in addressing inequalities in health. The GPs called for more time for doctors seeing patients in deprived communities, as well as better integration with other services such as social work and addiction services. "The focus should be on sustainable development, with an emphasis on continuity and the productive power of long-term relationships."

Nursing the figures

It’s estimated 5000 NHS workers, including around 2500 nurses, have lost their jobs in the last three years. NHS chiefs spent £94million on temporary nursing staff last year – to fill the gaps left after they axed the 2500 nurses. The cost of using supply and agency nurses in Scottish hospitals soared by £4million compared to 2010, a report has revealed. And the number of staff hours taken up by temporary nurses rose by 1.5million to 6.3million.

Ellen Hudson, of the Royal College of Nursing Scotland, said: “It is vital that bank nursing is available to cover shortages when staff are off sick.However, the bank should not be used to cover long-term vacancies caused by recruitment freezes as it would be much better for patients if they’re filled with permanent staff.”

The RCN said the small increase in the number of nursing and midwifery staff was largely accounted for by the inclusion of nursing and midwifery “interns” in the workforce figures. The internship scheme is available to newly qualified nurses who cannot gain employment. They work a 22.5 hour week and the internship lasts one year. So is not a true reflection of the nursing workforce.

Drugging our old folk

Elderly patients in care homes across Scotland are being prescribed powerful drugs for long periods of time without proper checks on whether the medication is needed. In some cases, frail patients are being kept on multiple and potentially harmful doses for up to two decades without doctors or staff questioning whether they are necessary. Patients are often kept on a mix of drugs for health problems that may have resolved over time.

The Royal Pharmaceutical Society in Scotland (RPSS) in a report calls for more powers for pharmacists to review patients’ medical records. Pharmacists say they are becoming “increasingly concerned” about patients’ safety.

 Drugs regularly handed out to elderly patients include anti-psychotic medicines for dementia. These are classed as high-risk because of their links to heart problems and strokes, yet some patients remain on these far longer than is required. Other drugs could be causing drowsiness and dizziness, leading to falls and loss of appetite.

 Henry Simmons, chief executive of Alzheimer Scotland, said: “The dangers of inappropriate or long-term prescribing without regular review are clear: an increase in falls due to dizziness and unsteadiness, an almost doubling of mortality rates and double the risk of stroke in people with dementia.”

A sharing, caring Scotland

A total of 2,025,400 people had put their names forward for the NHS Organ Donor Register as of 31 March - almost 40% of the population. Across the UK, the number of people on the organ donation register stands at 30%.

Three people in the UK die every day because of a lack of access to organs. The Scottish government also said the number of people who died while waiting for organs fell from 38 in 2010-11 to 36 in 2011-12. The tragic fact is that more than 600 people in Scotland are still waiting for a life-saving transplant.

Docs Get Ready to Fight

The British Medical Association is poised to ballot its members on industrial action for the first time in 40 years. Under the Dept. of Health plans, doctors' pension contributions would increase immediately by up to 2.4%, with continued increases over the next two years. It also wants to raise the retirement age to 68 and end the final salary scheme for hospital doctors. Although the DoH proposals are intended to apply to NHS workers throughout the UK, Scotland has its own devolved NHS pension scheme which is overseen by the Scottish Public Pensions Authority. However, if the Scottish Government decided to break with the reforms it is likely Holyrood would have to pick up the tab for any shortfall.

Dr Dean Marshall, outgoing chairman of the BMA's Scottish General Practitioners Committee, said doctors north of the Border had been let down by Holyrood's inaction and the Scottish Government's "complicity" with Westminster on the issue.

Dr Marshall said: "Is it fair for NHS staff to be taxed for the Government's failures to properly regulate the banking sector? And while the Scottish Government argues it does not agree with these plans it appears to be going along with the UK Government and is therefore complicit in taxing public-sector workers for the failures of the private sector. Scottish ministers could seek to do something different and I urge them again to find that solution – not just invite us to new talks"

Dr Marshall said doctors were unhappy that pension reforms were being "foisted" on them just four years after they agreed substantial changes to their package.

He added: "We agreed to tiered contributions where higher earners contributed more than lower paid workers. We agreed to the increased retirement age of 65 and we agreed to a cap on employer contributions so that the taxpayer would not pay for any future shortfall in the scheme. These changes worked and the NHS Pension Scheme is in surplus to the Treasury to the tune of £2 billion, and this is projected to continue into the future."

The old neglected again

Older patients are “not safe” on hospital wards in Scotland because of a lack of qualified nurses to care for them according to Royal College of Nursing (RCN) findings. The report suggests there is just one nurse caring for nearly ten patients on old people’s wards. A survey of almost 1,700 nurses found that 78 per cent said comforting and talking to patients was not done or done inadequately on their last shift because of low staff numbers. Some 59 per cent said promoting mobility and self-care was left undone or unfinished, with 34 per cent saying they could not provide patients with food and drink, and 33 per cent claiming they were unable to fully help patients to the toilet or manage incontinence.

The RCN warned there was a danger that “care becomes compromised” and said that many nurses say “they are too busy to provide the standard of care they would like”. The report said: “Older people in Scotland are being let down by a lack of professionally qualified nurses in hospitals, despite nationally agreed planning for the nursing workforce. Despite older people often having the most complex needs, the evidence suggests that they regularly suffer from a severe shortage of nurses and healthcare support workers (HCSWs), coupled with an inappropriate skill mix of HCSWs to nurses."
The RCN called for a “patient guarantee” to set out the number of nurses needed on older people’s wards.

It emerged the number of nurses in Scotland’s hospitals plummeted by thousands in just over two years, with further nursing posts lost during the last few months of 2011. The RCN said the number of nursing and midwifery staff employed in Scotland had fallen by 2,190 between September 2009 and the end of 2011.

According to the RCN Scotland director, Theresa Fyffe, the number of nurses employed was at a six-year low. She said: “As health boards come under increasing financial pressure to deliver the same services to more and more people, they are saving money when nurses leave by not replacing them or by replacing them with nurses and healthcare support workers at lower-paid bands."

The charity Age Scotland demanded dramatic improvements to care services in the community, to keep older people “safe and out of hospital”.

NHS rationing

What is the value of a few precious extra months of life? It's a very difficult question to answer, but if Scottish Medicines Consortium's is to be believed then, it is not worth £2.5 million.

Prostate cancer is the most common cancer in men in Scotland, with 2700 cases diagnosed every year. It kills two men every day. There are 19,000 Scottish men currently living with the disease.

Last October, Alex Salmond, the First Minister, signed up to a charter calling for better treatment for patients.

The Scottish Medicines Consortium has denied Scottish men a drug that prolongs life. It said the cost of abiraterone at £3000 a month did not justify the health benefits – even though it can extend lives by more that three months .

In a letter to the Scottish government, sufferer John Thomson writes "It is a disgraceful decision, cruel and unjust, that abiraterone is not available simply because of cost. How do you evaluate the cost of drugs against someone’s life?...This drug not only gives men an extra few months but also some quality to those last few months...It is unfair for some people to access the drug and not others. Money should not be an issue."

Another union ready to fight

Doctors are threatening their first wave of industrial action in nearly 40 years, after they overwhelmingly rejected proposed changes to their pension plans. Under the final offer proposed by the UK government, some doctors will see their pension contributions rise from 8.5 per cent to 14.5 per cent of their salary. They will also have to work longer before they can retire. Existing methods of pension accrual will be replaced by a career average revalued earnings scheme for all doctors and there will be no automatic lump sum, currently enjoyed by some doctors upon retirement. According to the BMA, the proposed changes would see doctors working until 68, an age beyond which many feel “competent and safe”.

A UK-wide survey by the organisation of 130,000 doctors and medical students – including 6,638 in Scotland – found an overwhelming majority opposed to the pension reforms, with almost two-thirds prepared to take some form of industrial action. More than a third (36 per cent) of doctors aged 50 and over said they intended to retire if the changes went through. It is unlikely they will agree to an all-out strike. However, one option is for a form of work-to-rule, which could see the cancellation of some clinical procedures, particularly at weekends.

http://www.scotsman.com/news/health/gps_set_for_first_industrial_action_in_37_years_1_2064378

health and safety??

Hospital chiefs are discouraging “whistleblowing” nurses from reporting their concerns about patient safety and staffing levels, nursing leaders have warned. More than one-third of nurses in Scotland (37%) said they had been discouraged, or told directly, not to report their concerns to their NHS health board or employer.

The Royal College of Nursing (RCN) revealed more than 80% of nurses in Scotland said they had highlighted problems. But, in more than half of cases, no action was ever taken. The overwhelming majority (84%) of nurses in Scotland fear they will be victimised if they speak out about the problems.

Theresa Fyffe, RCN Scotland director, said: “It is extremely worrying that nurses are being explicitly told not to raise concerns, particularly after all we have learned about the consequences of ignoring issues around patient safety. The survey clearly shows nurses are committed to improving care for patients, but more than half, 55%, say no action was ever taken when they raised their concerns...We are very concerned that nurses are not being listened to particularly as we know more than 2000 nurses have been cut from the NHS workforce in Scotland since September 2009, and staff are feeling over-stretched and under pressure. In these circumstances it is more important than ever they are listened to when they raise their concerns about patient safety and about staffing levels.”

http://www.heraldscotland.com/news/health/third-of-nurses-told-they-should-not-whistleblow-1.1138132

making cancer victims suffer

New research by a leading charity reveals that hundreds of cancer patients are living close to the breadline due to their illness, with 73% experiencing a loss of income and increased costs such as hospital travel and higher utility bills. Cancer patients in Scotland are skipping meals and worrying about losing their homes because of a drop in income and higher living costs.

Around 30,000 people in Scotland are diagnosed with cancer each year, costing many of them thousands of pounds.

Elspeth Atkinson, director of Macmillan Scotland said: “Cancer is an expensive disease to live with, but this research shows just how close to the breadline many cancer patients really are."

Research has shown that more than half of all terminally ill cancer patients do not claim benefits they are entitled to. Complicated benefits forms, a lack of awareness of entitlements, embarrassment or simply feeling too ill or emotionally drained, prevents many people accessing welfare benefits.

http://www.heraldscotland.com/news/health/cancer-patients-forced-to-live-in-poverty-1.1130821

Cancer of Capitalism

Professor David Cameron, an expert in breast cancer from Edinburgh University, said new treatments were increasingly being developed which targeted specific subtypes of cancer, helping make them more effective.

"These drugs are expensive. Some of that is the real cost of developing them and some of that is if you are only going for a subset of cancer then your total predicted sales will be less," Prof Cameron told The Scotsman. "The business model of the company will be that in order to develop the money to develop the drug your subsequent sales in the patent lifetime have to be sufficient to cover all your costs. So actually, the cost for rarer cancer is likely to be higher and not lower."

The caring unpaid over-worked angels

Nurses are "propping up" the health service by consistently working over their contracted hours and providing last-minute shift cover.

The Royal College of Nursing (RCN) Scotland found just one in 10 nurses feel they have good staffing levels where they work. 96% of nurses reported working in excess of their contracted hours, with a quarter saying they did so every shift. One in six said they rarely or never took the breaks to which they were entitled. 29% said they missed their meal time at work at least three times a week. One in five nurses said that in the last six months they had spent a week or more at work despite feeling too ill to be there. Another 29% said they provided last-minute cover for absentee staff at least on a fortnightly basis.

The Royal College of Nursing (RCN) Scotland said there were "serious concerns" for patient care in the NHS

Why Bother?

A senior consultant surgeon has spoken out against screening patients for bowel cancer in Scotland’s most deprived areas...because they are likely to suffer from other serious conditions which could kill them anyway.

Angus Macdonald, consultant colorectal surgeon at Monklands Hospital in Airdrie, said that in his experience in Lanarkshire, an area of high deprivation with one of the country’s lowest life expectancies, many patients with small tumours were more likely to die from other conditions before the cancer claims their life.

Health officials estimate that the NHS’s bowel cancer screening programme, for people between the ages of 50 and 74, could prevent 150 deaths annually. But Macdonald argues for some sections of the population it would not actually change the age at which a patient will die. “When you roll out a screening programme there is a very real possibility that you will identify cancers in the people who would normally have died from something else. We might operate on them and as a result we might actually shorten their lives.”

Research carried out by Macdonald, which is due to be published in the Journal of Colorectal Disease , adds weight to the principle of addressing the underlying determinants of ill-health such as socio-economic deprivation rather than of early detection and treatment of cancer as a principle health improvement strategy in such populations.

He said: “For the elderly time is precious. We’ll have some people coming up to their 50 years of marriage who have put together plans for over five or six years to save up for that once-in-a-lifetime holiday. When you tell them they have cancer they say they’ll cancel the cruise. I say, don’t. Go away and enjoy yourself if you can. It doesn’t matter if you have your operation just now or in two months, it is not going to make any difference at the end of the day.”

Economic formulas not medical ones decide treatment

Previously reported here has been the inherent failure of the National Health Service due to the constraints of capitalism to offer full effective treatments . Another report confirms Socialist Courier's diagnosis .

Some of the UK's top cancer consultants warn that NHS drug 'rationing' is forcing patients to remortgage their homes to pay for treatment. The specialists accuse the government drugs advisory body of 'rationing' too severely and call for a "radical change" in the way decisions are made.

In their letter, the 26 cancer specialists say the decision shows how "poorly" NICE assesses new cancer treatments."Its economic formulas are simply not suitable for addressing cost-effectiveness in this area of medicine," they write. "We have seen distraught patients remortgaging their houses, giving up pensions and selling cars to buy drugs that are freely available to those using health services in countries of comparable wealth."

Defending its policy of restricting palliative medicines .

"There is a finite pot of money for the NHS, which is determined annually by parliament,"NICE's chairman said."If one group of patients is provided with cost-ineffective care, other groups - lacking powerful lobbyists - will be denied cost-effective care for miserable conditions like schizophrenia, Crohn's disease or cystic fibrosis."

Capitalism is at its terminal stage , time to apply euthanasia to such a heartless system .

nhs charges

A poll by Macmillan Cancer Support suggests nearly half of cancer patients in England are being forced to cut back on basic necessities in order to pay for their prescriptions.

Breast cancer survivor Amanda Whetstone says she regularly skips breakfast and lunch to save money to pay for her prescriptions.

"Although my cancer treatment - the surgery, chemotherapy and radiotherapy - has finished, I still need medication. As a result of my cancer I'm now on three different drugs. They cost me about £44 a month. That may not sound much to some, but I'm struggling financially. I'm now on statutory sick pay because I've been too unwell to work. My income is £360 per month and, quite frankly, I have barely enough money to live on.I budget for everything. I don't go out because I can't afford to socialise. I can't even invite friends over for a meal because I can't afford the food.I don't eat breakfast or lunch. The meals I do buy are ones that are on special offer.I can't afford fresh fruit or meat. I know that isn't healthy, but I simply can't afford to buy healthy food."

"Fighting cancer is hard enough without the terrible financial worry that comes with it.I feel penalised because I have a disease that the government doesn't consider should make me exempt from prescription charges."