The must-read stories and debate in health policy and leadership

The politics of cancer

An accident and emergency department has to be one of the worst ways to find out you have lung cancer.

Data from the most recent National Lung Cancer Audit shows the places where this is most common – and is a little surprising.

Strongly associated with areas with high smoking and deprivation rates, it seems unusual that Hampshire had three of the worst-performing clinical commissioning groups in this area.

The county has pockets of deprivation certainly but doesn’t usually top lists like this.

In February, NHS England announced a four-year scanning programme to try to make sure more cases were picked up in the earlier stages, and Southampton CCG is one of the 10 target areas.

For all its relative efficiency it is widely acknowledged that NHS cancer outcomes are not where they should be, largely because cancers are picked up too late. A lot of this is down to the relative lack of scanners, which is a capital funding issue. Which makes it a political issue.

Questions emerge from tragedy

On the evening of 3 June, three terrorists crashed a van into people crossing London Bridge before marauding with knives through the restaurants and bars, courtyards and alleyways around Borough Market.

In all, 48 people were injured, 19 critically, and 11 killed, including the three attackers who were shot dead by police. An inquest to determine the events that night that caused those deaths continues at the Old Bailey, presided over by the chief coroner of England and Wales, Judge Mark Lucraft QC.

The hearings so far have recounted a terrifying and chaotic few hours when London’s emergency services worked feverishly to regain control.

On Monday, the London Ambulance Service Trust’s operations director was up before the coroner to explain the performance of their people throughout that night. The trust has come in for criticism because three hours elapsed between police shooting the attackers and specialist paramedics entering a courtyard where five of the victims died.

LAS’ operational director, Paul Woodrow, acknowledged that it took paramedics too long to deploy to the scene. However, this was because the courtyard was in the “hot zone” which was excluded to all but armed police.

It transpired that at least two paramedics knew there were casualties in the courtyard, being treated by two police officers. But word never got through to the police that they would have to make their own way to the ambulances as help could not come to them.

That Saturday was already an unusually busy one for the LAS and in the early stages of the terror attack it struggled to get situational awareness of a dynamic incident, said Mr Woodrow. The inquest continues.