We were pleased that Nick Cohen highlighted the impact of the systematic reduction in public health funding on vital prevention and clinical services (“You don’t have to be poor to be an addict. But it helps”, Comment). Like the drug and alcohol services he referred to, there is a growing deficit between need and the availability of sexual health services. In London, a number of sexual health clinics have closed recently and patients are reportedly being turned away.
We are on the verge of a crisis in sexual health services, but the stigma and blame attached to public health issues such as drug and alcohol use can also be a critical barrier to convincing hearts and minds (and voters) to fight against this predicament in sexual health. Despite this, the fight is on. Already, 5,000 people have signed a petition to protect sexual health services.
The impact of the cuts will be compounded by the removal of the ring-fence on public health funds, due in April 2020. Then, sexual health, drug and alcohol services will be competing for increasingly scarce funds alongside other council services such as social care. A plan to reverse the damage done and to protect public health and prevent avoidable consequences is desperately needed.
Deborah Gold, chief executive, National Aids Trust
Ian Green, chief executive, Terrence Higgins Trust
Professor Chloe Orkin, chair, British HIV Association
Dr Elizabeth Carlin, president, British Association for Sexual Health and HIV
The otherwise excellent editorial on the NHS (“Stop apologising to patients and raise the cash for the NHS, Mrs May”) repeats the misleading statement that the NHS was ranked top in the Commonwealth survey of 11 healthcare systems. While it did receive top ranking in the category of “care process and equity” it was 10th for “outcome”.
Translated, this means that however good we are at initiating health care, the result of this care is poor compared to other countries. This was illustrated in the survey by survival after heart attack, cancer and stroke. After 40 years as a NHS physician, my admiration for the service is unwavering, but the public needs to know that its effectiveness is under real threat from politicians who are unwilling or unable to support the service without self-serving and disingenuous rhetoric.
Dr Richard Banks
Gloucester
In discussion of the current crisis in the health service and, to a lesser extent, your recent report on train overcrowding on Southern, (“Is this the best we can do with the country’s trains?”, In Focus) I have seen no reference to what happens when queues are involved. I suspect that, like most people, our politicians are unaware of this branch of statistics, but some simple examples explain why waiting times skyrocket when the system is under stress.
If an A&E department is 85% busy normally, then a 1% increase in the load leads to an 7% increase in average waiting time, at 90%, then the same 1% increase leads to a 11% increase in waiting time and at 98%, the 1% increase leads to a 98% increase in waiting time.
Any attempt to maximise the efficiency of use of a system like A&E has to take this phenomenon into account; indeed, it should set clear priorities when attempting such a change. It also explains why minor changes in demand lead, as over the last month compared to December 2016, to major changes in waiting times.
Jim Blair
St Andrews
Fife
