Senior health leaders have raised concerns about the care of cancer patients during the impending nurses’ strikes – including warnings that some chemotherapy appointments are being rescheduled.
In a letter seen by Sky News political editor Beth Rigby, the head of cancer care for NHS England, Dame Cally Palmer, called on Royal College of Nursing (RCN) union boss Pat Cullen to protect “life-saving” and “urgent” cancer surgery from walkouts, which begin on Thursday.
In another letter obtained by the Times, chief nursing officer for England, Dame Ruth May, says chemotherapy appointments are being rescheduled, and asked for assurances about the care of dying patients during the strikes in England, Wales and Northern Ireland on 15 and 20 December.
Dame Cally said she was “extremely concerned about the absence of national derogation for urgent cancer surgery”.
A derogation is an exemption, either of an individual or a whole service, from taking part in strike action.
She went on: “I understand how enormously difficult these issues are for all concerned, but our common aim is to ensure we do not cause harm to people undergoing vital cancer treatment to achieve cure or extension of life.
“It’s important there is a clear and consistent decision on urgent cancer in line with the national derogation for chemotherapy and critical care.”
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The RCN insists there will be a derogation for emergency cancer services, as well as for mental health and learning disability and autism services, and said the public was behind its action.
“The public backs our campaign and knows that patients need a strong nursing workforce, but at the moment there are record losses jeopardising safe care,” the union said.
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Dame Cally said the strikes were likely to lead to cancelled operations for cancer patients in P1 and P2 categories.
In her letter, she explained P1 surgery “is life-saving, and time critical, and must be maintained”, while P2 is “urgent cancer surgery which has an optimal time window”.
She said rescheduling procedures “is likely to lead to delayed operations and poorer outcomes” and many of these patients will move into the P1 category, requiring life-saving procedures as a result of re-scheduling.
The RCN, however, insisted cancer patients would get emergency and clinically urgent surgery, and in its response to the letter assured that was “not in doubt”.
A spokesperson for the union added: “This is a politically-motivated smear from a government that is failing cancer patients.”
In their correspondence, the chief nursing officer for England, and her counterparts in Scotland, Wales and Northern Ireland, wrote to Ms Cullen raising a series of concerns about patient safety.
“Many chief nurses/directors of nursing are, of course, RCN members themselves and some have expressed feelings of having been let down by the RCN,” they wrote.
The chief nursing officers said chemotherapy is being rescheduled from the strike days at some hospitals despite the union agreeing it would be exempt nationally.
They wrote that “there are examples of some trusts being asked to submit derogation forms for chemotherapy and organisations now preparing to reschedule chemotherapy from 15th and 20th December”.
The chief nurses also asked for assurances that community nursing services providing “end of life care and good pain and symptom relief” continue in order to “alleviate unnecessary distress” for palliative patients and their families.
The RCN said on Tuesday it had agreed further exemptions to the strike action, including emergency cancer services and “front-door” urgent care assessment and admission units for paediatric-only A&E departments.
“This letter is already out of date, as we have met senior clinicians today and agreed key points. The safety of patients is everybody’s top concern,” the union’s spokesperson said.
The heated letters exchange came at a time when a new report shows the NHS is treating fewer patients than it was pre-pandemic despite more funding and staff – suggesting a long-term COVID impact on the health service’s performance.
The Institute for Fiscal Studies has said the NHS carried out 14% fewer emergency admissions, 14% fewer outpatient appointments and 11% fewer elective and maternity admissions in the latest month of data than it did in the same period in 2019, according to the IFS.
Why did talks break down?
Talks between the unions and the government to try to avert strike action broke down on Monday, after Health Secretary Steve Barclay was accused of refusing to negotiate on pay.
The union is demanding a pay rise of 5% above the RPI rate of inflation, which was 14.2% in October, but Ms Cullen has hinted that she could compromise if the government negotiates on pay.
Ministers have repeatedly insisted they can’t afford to give inflation-busting pay rises and say they have accepted the independent pay review body’s recommendation of a £1,400 rise.
Meanwhile, members of the Rail, Maritime and Transport union (RMT) began the first of two 48-hour strikes at Network Rail – and 14 train companies – on Tuesday which will last until Friday.
The strikes come at a time of planned industrial action in a whole number of UK spheres, including healthcare – with paramedics also planning to walkout – postal workers, Border Force agents, firefighters, driving instructors, bus operators, airport baggage handlers and even coffin makers.
The UK is on a “slippery slope towards death on demand”, according to the justice secretary ahead of a historic Commons vote on assisted dying.
In a letter to her constituents, Shabana Mahmood said she was “profoundly concerned” about the legislation.
“Sadly, recent scandals – such as Hillsborough, infected blood and the Post Office Horizon – have reminded us that the state and those acting on its behalf are not always benign,” she wrote.
“I have always held the view that, for this reason, the state should serve a clear role. It should protect and preserve life, not take it away.
“The state should never offer death as a service.”
On 29 November, MPs will be asked to consider whether to legalise assisted dying, through Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill.
Details of the legislation were published last week, including confirmation the medicine that will end a patient’s life will need to be self-administered and people must be terminally ill and expected to die within six months.
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14:46
Minister ‘leans’ to assisted dying bill
Ms Mahmood, however, said “predictions about life expectancy are often inaccurate”.
“Doctors can only predict a date of death, with any real certainty, in the final days of life,” she said. “The judgment as to who can and cannot be considered for assisted suicide will therefore be subjective and imprecise.”
Under the Labour MP’s proposals, two independent doctors must confirm a patient is eligible for assisted dying and a High Court judge must give their approval.
The bill will also include punishments of up to 14 years in prison for those who break the law, including coercing someone into ending their own life.
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However, Ms Mahmood said she was concerned the legislation could “pressure” some into ending their lives.
“It cannot be overstated what a profound shift in our culture assisted suicide will herald,” she wrote.
“In my view, the greatest risk of all is the pressure the elderly, vulnerable, sick or disabled may place upon themselves.”
Labour MP Kim Leadbeater, who put forward the bill, said some of the points Ms Mahmood raised have been answered “in the the thorough drafting and presentation of the bill”.
“The strict eligibility criteria make it very clear that we are only talking about people who are already dying,” she said.
“That is why the bill is called the ‘Terminally Ill Adults (End of Life) Bill’; its scope cannot be changed and clearly does not include any other group of people.
“The bill would give dying people the autonomy, dignity and choice to shorten their death if they wish.”
In response to concerns Ms Mahmood raised about patients being coerced into choosing assisted death, Ms Leadbeater said she has consulted widely with doctors and judges.
“Those I have spoken to tell me that they are well equipped to ask the right questions to detect coercion and to ascertain a person’s genuine wishes. It is an integral part of their work,” she said.
In an increasingly fractious debate around the topic, multiple Labour MPs have voiced their concerns.
In a letter to ministers on 3 October, the Cabinet Secretary Simon Case confirmed “the prime minister has decided to set aside collective responsibility on the merits of this bill” and that the government would “therefore remain neutral on the passage of the bill and on the matter of assisted dying”.
She talks about a “slippery slope towards death on demand”. Savage. The state should “never offer death as a service”, she says. Chilling.
So much for Sir Keir Starmer attempting to cool the temperature in the row by urging cabinet ministers, whatever their view, to stop inflaming or attempting to influence the debate.
Ms Mahmood talks, as other opponents have, about pressure on the elderly, sick or disabled who feel they have “become too much of a burden to their family”.
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2:41
Details of end of life bill released
She hits out at a “lack of legal safeguards” in the bill and pressure on someone into ending their life “by those acting with malign intent”.
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Malign intent? Hey! That’s quite an assertion from a secretary of state for justice and lord chancellor who’s been urged by the PM to tone down her language.
It’s claimed that Sir Keir ticked off Wes Streeting, the health secretary, after he publicly opposed the bill and launched an analysis of the costs of implementing it.
Will the justice secretary now receive a reprimand from the boss? It’s a bit late for that. Critics will also claim Sir Keir’s dithering over the bill is to blame for cabinet ministers freelancing.
Shabana Mahmood is the first elected Muslim woman to hold a cabinet post. Elected to the Commons in 2010, she was also one of the first Muslim women MPs.
She told her constituents in her letter that it’s not only for religious reasons that she’s “profoundly concerned” about the legislation, but also because of what it would mean for the role of the state.
But of course, she’s not the only senior politician with religious convictions to speak out strongly against Kim Leadbeater’s bill this weekend.
Gordon Brown, son of the manse, who was strongly influenced by his father, a Church of Scotland minister, wrote about his opposition in a highly emotional article in The Guardian.
He spoke about the pain of losing his 10-day-old baby daughter Jennifer, born seven weeks prematurely and weighing just 2lb 4oz, in January 2002, after she suffered a brain haemorrhage on day four of her short life.
Mr Brown said that tragedy convinced him of the value and imperative of good end-of-life care, not the case for assisted dying. His powerful voice will strongly influence many Labour MPs.
And what of Kim Leadbeater? It’s looking increasingly as though she’s now being hung out to dry by the government, after initially being urged by the government to choose assisted dying after topping the private members bill ballot.
All of which will encourage Sir Keir’s critics to claim he looks weak. It is, or course, a private members bill and a free vote, which makes the outcome on Friday unpredictable.
But the dramatic interventions of the current lord chancellor and the former Labour prime minister are hugely significant, potentially decisive – and potentially embarrassing for a prime minister who appears to be losing control of the assisted dying debate.
Red Bull driver Max Verstappen has won the Formula One world title for a fourth straight year.
His victory was confirmed after finishing fifth at the Las Vegas Grand Prix. Mercedes’ George Russell won the race.
The 27-year-old Dutchman becomes just the sixth driver in Formula One history to win four titles or more, after outscoring Lando Norris who took the chequered flag in only sixth.
Verstappen is now guaranteed the world crown with two races still remaining, with his domination cementing his name among Formula One’s greats.
“Oh my God man,” said an emotional Verstappen after securing the world title. “What a season. Four times. It was a little bit more difficult than last year.”
Lewis Hamilton raced back from 10th to second place to complete an impressive one-two finish for Mercedes. Carlos Sainz finished third for Ferrari, one place ahead of his team-mate Charles Leclerc.
Russell’s third victory was the most dominant of his career so far, crossing the line 7.3 seconds clear of Hamilton.
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Michael Schumacher and Lewis Hamilton have each won a record seven, with 1950s Argentine legend Juan-Manuel Fangio on five ahead of Alain Prost, Sebastian Vettel and now Verstappen on four.
Having won every Drivers’ Championship since claiming his first in the controversial end to the 2021 season when he beat Hamilton in deeply contentious circumstances, Verstappen now joins Hamilton, Fangio and Vettel in winning four titles consecutively.
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Only Schumacher has achieved a run of five.
The team were hit by controversy earlier this season, with Red Bull’s principal sponsor, Christian Horner, facing allegations of controlling behaviour by a female staff member. Horner, who denied the accusations, was cleared, and a subsequent appeal was thrown out.
Horner congratulated Verstappen on the radio, telling him: “Max Verstappen you are a four-time world champion. That is a phenomenal, phenomenal achievement. You can be incredibly proud of yourself.”
Red Bull is on course to finish third in the constructors’ championship this year. This century only Hamilton in 2008 with McLaren, and Verstappen in 2021, have won the drivers’ title when their team did not win the constructors’ championship.