Analysis

‘Extremely worrying’ trend of cancelled cancer surgery in almost 60% of hospitals

NHS 62-day targets missed 11 months in a row as thousands of patients opting for elective surgery wait longer than necessary for treatment. 
Cancelled operation

NHS 62-day targets missed 11 months in a row as thousands of patients opting for elective surgery wait longer than necessary for treatment

This winter is proving to be the most difficult for the NHS in years. Hospitals are struggling with bed shortages, leading to delays in emergency departments (EDs) and a large number of elective operations being cancelled. But what about cancer care?

It has been clear for some time that waiting time targets are being missed.

In England the 62-day target for treatment to start after an urgent referral from a GP has been missed for 11 months in a row.

Over the past year alone it has meant almost 25,000 patients have had to wait longer than the target timescale for their treatment to begin.

62 days

target for first treatment after an urgent

...

NHS 62-day targets missed 11 months in a row as thousands of patients opting for elective surgery wait longer than necessary for treatment


Photo: iStock

This winter is proving to be the most difficult for the NHS in years. Hospitals are struggling with bed shortages, leading to delays in emergency departments (EDs) and a large number of elective operations being cancelled. But what about cancer care?

It has been clear for some time that waiting time targets are being missed.

In England the 62-day target for treatment to start after an urgent referral from a GP has been missed for 11 months in a row.

Over the past year alone it has meant almost 25,000 patients have had to wait longer than the target timescale for their treatment to begin.

62 days

target for first treatment after an urgent referral

Getting worse

And, despite extra investment after the launch of NHS England’s cancer strategy in 2015, there are signs the situation is getting worse not better. The numbers being referred are rising, while year-on-year performance is falling.

It is a similar story elsewhere with Scotland, Wales and Northern Ireland also missing their key targets.

UK Oncology Nursing Society president Richard Henry says: ‘There has been a lot of focus on England, but the rest of the UK is just as affected.

‘Cancer staff everywhere have been working incredibly hard to keep services going, but a shortage of beds and staff compared to demand means it has been a struggle.’

Bottleneck

So where are the problems in the cancer pathway being seen most? It is well known that there is a bottleneck when it comes to waiting for a diagnosis – hence England’s cancer strategy setting a new four-week target for diagnosis.

But there are signs cancer patients are also finding themselves subject to surgery postponements – something the health service has always tried its best to avoid.

Cancer care – surgery and other treatments like chemotherapy – is known as priority one and, as such, it is postponed only as a last resort.

0

number of UK nations hitting their target

But freedom of information requests by the BBC’s Inside Out programme found the number of operations cancelled on the day has been gradually rising over the past four years.

The programme obtained answers from just under half the health boards and trusts in the UK and found the number of cancellations rose from 403 a year to 810 in 2015-16.

Research by the Royal College of Surgeons suggests the problem has continued into this winter. It asked members whether their trusts had started cancelling booked operations in the first two weeks of the year.

Consultants from 85 trusts and boards responded saying cancellations were happening in almost 60% of hospitals because of bed shortages and a lack of intensive care facilities.

59%

of trusts or health boards in England that cancelled cancer surgery during January 2017

Macmillan Cancer Support executive director of policy and impact Fran Woodard describes the trend as ‘extremely worrying’.

‘Stressful period’

‘Having cancer can be the most stressful period of someone’s life and the mental preparation that goes into getting ready for an operation often significantly adds to this.

‘No one should have to go through the anxiety of waiting for treatment a day longer than is necessary.

‘Also, crucially, experts believe this could affect someone’s chance of survival.’

But it is not just surgery that is being affected. University Hospital Southampton NHS Foundation Trust consultant chemotherapy nurse Elaine Lennan says chemotherapy patients are also experiencing delays.

‘We’re having to rearrange treatments because the beds are not available,’ she says. ‘That does not show up against the target necessarily, but it is having an impact on patients.

‘It means we are spending a lot of time rearranging appointments and dealing with that disruption.’

Winter pressures

Dr Lennan says the pressures have made it ‘particularly difficult’ this winter compared to others.

But she adds: ‘We mustn't forget that cancer patients also contribute to the demand on EDs. Acute oncology services are working hard to minimise that – but the key is early identification of problems and patient education and empowerment.’

RCN cancer and breast care forum chair Sue Cruickshank agrees it is proving a ‘challenging’ period.

But she points out the effect of the pressures is ‘not even’ across the country.

A closer look at the cancer waiting time figures shows a six-fold variation between the best and worst performers in the proportion of patients not being seen in the 62-day timescale.

‘It’s a mixed picture and it is hard to know why,’ Dr Cruickshank says. ‘But I think wherever nurses are there’s a particular difficulty in terms of cancer care at the moment.

‘There’s so much negativity and scrutiny – you don’t get that in other professions – and it can make it hard to remain positive. That’s important when you are caring for cancer patients. It’s making the care we provide more difficult.’

UK cancer waiting times targets
  • England Target is for 85% of patients to start treatment within 62 days of an urgent GP referral. In November 2016 82.3% did, down from 83.5% in the same month the year before. The seven other targets were met.
  • Northern Ireland At least 95% of patients should begin treatment within 62 days. In September 2016 just 63.6% did, down from 69.6% in 2015. All five trusts missed the target.
  • Scotland The 62-day target also stands at 95%, but includes patients referred through EDs and the screening programmes, as well as GPs. In September 2016 87.1% started treatment in that timescale, down from just under 90% in 2015.
  • Wales A goal of 95% has been set. In November 2016 86.6% of patients were seen in time. But it is the one part of the UK showing an improvement. The year before it was 84.3%.
 
‘Fuelled by anger’ over cancelled surgery

Lynne Roper, from Devon, was diagnosed with cancer last year in her mid-fifties. She was quickly booked in for surgery to remove her brain tumour, but it was cancelled at the last minute by Derriford Hospital because of a lack of beds.

Ms Roper, who was a paramedic, was told of the cancellation just before she went into theatre. She was in a gown and ready to go.

She chronicled her experiences in a blog she kept until her death.

After the cancellation she wrote that she felt ‘shredded’ by what happened.

‘I was fuelled by anger, an anger I could not fully express to the equally upset staff at the hospital who are powerless to do anything about the situation we are all in.’

She was rebooked for surgery shortly afterwards. In the remaining months of her life she went on to explain how the growing pressure on the NHS was affecting staff.

She wrote: ‘Only the young and fresh can keep with the pace and the relentless pressure of underfunding and understaffing.

‘The whole resourcing issue that is the end result of so-called “efficiency savings”, known as “cuts”, if like me you can speak plain English.’

 

Sources: NHS England, Royal College of Surgeons

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