Letters: Cancer proposals will fail without recruitment of more specialist staff

SIR – I have concerns about the proposals for cutting waiting times for cancer diagnosis (report, August 16). 

In the past 20 years there have been growing difficulties in recruitment of staff – not just consultant radiologists, but also skilled radiographers who perform scans, as well as specialist nurses needed for interventional procedures, including biopsies. There are not enough suitable applicants, even though in recent years we hired excellent colleagues from overseas.

Reporting complex scans is difficult and time-consuming, even for radiologists who specialise in this area. Performing imaging-guided biopsies is also a highly skilled process, and not all radiologists have the experience and ability to do this. Then there’s the issue of interpreting the nature of biopsy specimens. This requires skilled pathologists, who are in short supply.

The hospital in which I worked was among the first in our region to have access to a community diagnostic centre, which was jointly operated by our trust and a private imaging company. It has helped, but its impact is limited and it is dependent on the same limited pool of qualified staff.

Who is going to perform and report the increased number of scans, and perform and interpret the resulting biopsies? Artificial intelligence may eventually help, but systems I’ve seen are in early stages of development. 

Training for specialist roles needs to be significantly increased. We should also consider whether the time of existing staff is being well spent. For instance, some topics on which staff must spend time as part of continuing education seem irrelevant to many imaging roles. Furthermore, diagnostic imaging is highly IT-dependent, and time is also wasted by IT malfunctions. 

Dr Jon Bell
Retired consultant radiologist 
Taunton, Somerset

SIR – You report (August 15) that patients will be increasingly able to access healthcare via apps, thus avoiding seeing a GP. Yet healthcare professionals use all their senses when dealing with patients, and often make decisions based on a holistic approach. 

Online services allow patients to present the information they want their healthcare provider to see. Details can be omitted and manipulated. Patients can hide behind their screens and vital factors are held back. I worry that mistakes will be made.

Susan Hardy
Hitchin, Hertfordshire

SIR – I rang my GP surgery and was put into the triage system. When a doctor phoned I said my shoulder was giving me lots of pain and I’d like a cortisone injection similar to the one I’d had three years ago. He agreed, but said that, as he now lived in the New Forest, he’d refer me to a doctor who could do it. 

How can a doctor living more than 100 miles from the surgery possibly give his patients a true consultation?

Ken Palmer
Maidstone, Kent

Charities in Ukraine

SIR – The shock of receiving a negative response from the Charity Commission to my application to register as a charitable organisation was slightly mollified by reading Charles Moore’s article, “Charity Commission puts bureaucracy before Ukraine” (Comment, August 1). 

Lord Moore refers to an organisation in Hertford, seeking to benefit its partners in Ukraine by becoming a charitable organisation and attracting gift aid and tax relief. The application was turned down in a nine-page letter.

My own carefully worded application (for ongoing collaborative project work in Moldova and the UK) mentioned working in Ukraine in the short term, mainly because it is the country adjacent to the organisation’s principal country of activity. 
Although I was clear that the organisation always collaborates with others on the ground and that any short-term support would be delivered through local partners, I was advised to obtain licences, carry out risk assessments and provide training and safeguarding policies for anyone travelling to the war zone. 

As I had mentioned Ukraine, the letter sought to lecture me on how I should be seeking advice from the Foreign Office and that I should “donate or work with established charities working in Ukraine”.

As it happens, I am also a trustee of a small but highly effective British charity that has been established in the region for the past 30 years. On the first day of the conflict, the BEARR Trust launched an appeal for funding and has been sending (and continues to send) modest but effective tranches of money to local NGOs on the ground. Well before any of the funds trickled down from the Disasters Emergency Committee and other large charities, these small and carefully targeted grants were reaching bank accounts in towns and cities under fire. 

As we are small, and because the charity is run by a group of trustees and one administrator, all of that appeal money goes directly to the beneficiary. The same cannot be said for the big charities.

I certainly agree with the commission’s statement that sometimes the aid is less appropriate than other carefully targeted 
support, but most of the groups with whom we have worked in the past 18 months have striven to be joined-up in order to maximise their energy and efficiency.

Jane Ebel
Salisbury, Wiltshire

Grand greeting

SIR – We planned to be called by the Afrikaans names of Ouma and Oupa by our grandchildren (Letters, August 16). 

Our first grandchild decided to call me Noonah but had no problem with calling my husband Oupa.

My favourite memory was the greeting from my granddaughter, then aged four, whom I hadn’t seen for six months, when she met me at Cape Town airport, joyfully announcing: “Noonah you haven’t changed a bit – you’ve still got your yellow moustache!”

Penelope Billington
Burton on Trent, Staffordshire

SIR – As our three grandchildren are Finnish, their Finnish grandparents are known to them as Mummi and Ukki. 

However, as we, their British grandparents, live in Scotland, they decided that we should be designated the titles of Mummi-mac and Ukki-mac – an original solution that works well.

Ceri Wells
North Berwick, East Lothian

SIR – Our children decided on Knitting Granny and Sewing Granny.

Malcolm Watson
Ryde, Isle of Wight

Farrell’s red card

SIR – It is clear that members of World Rugby’s judicial panel had the forthcoming Rugby World Cup in France at the forefront of their minds when they downgraded Owen Farrell’s red card for a dangerous tackle against Wales (report, August 16). If England’s captain had received the four or six-week ban he deserved, the tournament would have lost a star player, thus degrading the spectacle, and probably damaging it financially.

The panel’s argument – that a late change in direction from the ball carrier was mitigation – is nonsense. Any such change did not alter the fact that Mr Farrell was standing too upright to effect a safe tackle. It is a position he has taken before in a number of incidents for which he has been punished. It comes from his early days playing Rugby League, where such tackles are common.

It is a disgrace that the victim will miss his next two games through injury whereas the culprit gets to play on. I do hope World Rugby decides to review this decision.

Alan Law 
Former referee
Streatley, Berkshire

SIR – In Wales 65 years ago, we were trained to tackle “shoulder at the waist”. This could result in the tackled person having their arms free to hand off the tackler, or else be able to pass the ball onwards. 

Some years later, two New Zealanders showed us the League method of wrapping your arms around the chest of an opponent, trapping their arms. It was OK if the tackled person was bigger than you, but if they were shorter, then your shoulder would be in contact with their head. Many games were won, but many opponents were carried off the field.

Robert Gwilliam
Prestwick, Ayrshire

SIR – Rugby has reached the point where the first man picked for the team is the defence lawyer. 

Paul Archer
Derby

The lesson of Ypres

SIR – Canon Alan Hughes (Letters, August 16) is right about the beauty of the rebuilt Ypres. I was there six years ago. The contrast With the photographs of devastation taken at the end of the First World War and the city I saw is truly amazing. Another such city is Nuremberg. I wish our cities had been treated with the same care. Instead, we are left with concrete monstrosities.

Sara Donovan
West Wickham, Kent

How to mute the sound of rustling wrappers

SIR – The rustling of sweet and snack wrappers is not restricted to Proms concerts (Comment, August 14). It is even worse in cinemas. However, as I also enjoy sweets and snacks at the pictures, I buy them beforehand and put them in a soft, noiseless bag, so everyone is happy. Unless you like peanut brittle, of course, in which case there is no hope.

Jim Corbett
Cork, Ireland

SIR – People munching popcorn during a Prom might be considered acceptable compared with the disruption caused by six young people in the row behind me eating their way through a complete Chinese takeaway meal.

That was several years ago, when apparently such noise and smells were not disputed by the stewards or other audience members, but I moved to a vacant seat elsewhere in the interval. That was my last Prom.

Mary Hilton
Ditchling, Sussex

Universities should not favour foreign students

SIR – Clare Marchant, head of the university admissions system (report, August 15), appears to think there is nothing wrong with foreign students potentially excluding British students.

Places should be awarded on academic criteria, not financial ones, but pressure is clearly building to make university funding a major factor. 

In the 1970s, students at Warwick rebelled at the commercial imperatives of their new university. This resulted in a book, Warwick University Ltd, published by Penguin, which set out the case. Sadly, concerns about university education nationwide endured and in 2013 it was reissued. Two obvious trends have emerged. First, university finances have deteriorated and wealthy foreign students are an attractive way to fill the funding gap. Secondly, whatever universities are spending their money on, it can’t be teaching and support staff, who are currently engaged in a lengthy and bitter industrial dispute. 

Universities should admit on merit. Foreign students are very welcome if they meet the criteria, but if they are admitted to meet a funding crisis, that is a different matter. 

Trevor Fisher
Stafford

SIR – It is absurd that there is no variation in the cost of, say, a medical degree and a less intensive humanities course. Consequently, universities must derive large profits from arts courses, which require less input from lecturers.

If the favourable treatment of international students over British applicants is because the former pay four times more, then a fundamental problem exists that must be resolved. 

Chris Learmont-Hughes
Caldy, Cheshire

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