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Let's beat cancer sooner

When you’re worried that something may be seriously wrong with your health, you want to know what the problem is, and for it to be fixed as soon as possible.

So imagine if your doctor agrees that something’s wrong, and refers you for a test.

You wait for the test. You have the test. You wait for the results.

When the results come back, you’re told you have cancer – and you need treatment.

And then you wait for your first round of treatment.

In the words of Margaret, diagnosed with cancer in 2014, this process was “agonising”.

“I just wanted something doing – I kept thinking, it’s six weeks on and it’s still growing.”

Now imagine all that taking more than two months.

But tens of thousands of people don’t have to imagine. Despite the NHS in England promising that at least 85 per cent of people should start their treatment for cancer within two months of an urgent referral from their GP, this target has been missed constantly since the beginning of 2014.

And the latest figures, published today, aren’t pretty.

This means that since the beginning of 2014, more than 50,000 people in England have had to wait in limbo for more than two months to start treatment.

That’s unacceptable.

The number of people waiting more than two months is still increasing. We can now see that 2015 was the worst year since the NHS started recording waiting times in 2009.

Waiting times are a barometer for how well cancer services are doing and the pressure they’re under. It’s clear that the health service needs more resources to ensure patients don’t have to wait this long.

This isn’t just about figures, missed targets and percentage points. Behind these stats are real people, waiting far too long to find out whether they have cancer – and if they do, to start treatment that could save their lives.

Why is this happening?

Health professionals (GPs, dentists, pharmacists) know how important it is to diagnose cancer early. It makes a big difference to a patient’s chances of successful treatment. And as a result of new NICE referral guidelines – brought in last year to help diagnose cancers earlier, and efforts to get more people to see their doctor if they spot suspicious symptoms, or go for screening if they want it, more people are now being referred for diagnostic tests.

Over 1.5 million urgent GP referrals for suspected cancer were made last year – an increase of 50 per cent in the last four years. This is a good sign as we want more people to have their symptoms checked if they could be cancer.

Unfortunately, as the waiting time statistics make clear, the rest of the NHS can’t keep up. Instead of finding out results and starting treatment (or getting the ‘all clear’), patients are waiting longer than they should. And, as we’ve revealed previously, some of them are waiting a very long time indeed.

Around 24,300 patients waited more than 62 days for treatment during the last financial year (2015/16). And of these patients, more than four in 10 (43 per cent) were left waiting between two weeks and one month beyond the target before starting treatment. And around a quarter (26 per cent) had to wait an extra month on top of the goal of within 62 days.

This means less than a third of patients were treated ‘just after’ the target, compared with the majority of patients who had to wait much longer.

And this is, once again, simply unacceptable. The NHS isn’t ‘just’ missing this target, and patients are being failed as they are left waiting longer and longer for treatment.

Things can only get better?

The waiting times problem has been going on for more than two years – and it won’t get better on its own. In fact, it looks like the problem is only going to get worse as the population ages, and more people need tests.

As an example, by 2020, it’s predicted that the NHS will need to do more than 750,000 extra endoscopies (tests used to diagnose gastrointestinal cancers) every year. That’s more than the population of Leeds.

This means the NHS needs more up-to-date machines, and enough staff to operate them. Unfortunately, this demand hasn’t been met, and the cracks are already starting to show, with high staff vacancy rates, high amounts of overtime working, and too much money spent on temporary staff.

As an example, we only have around 48 radiologists (doctors who diagnose diseases using imaging techniques such as X-rays and scans) per million people in the UK, compared with 92 in Germany, 112 in Spain and 130 in France.

This isn’t sustainable – the government needs to take action now so that patients aren’t left waiting.

Solutions

So we know what the problem is. And we know that, without action, it could get worse.

But there is a solution.

Last July, the Independent Cancer Taskforce published the cancer strategy, which set out many recommendations for how the NHS and the Government in England could help improve cancer services.

And in September 2015 there was some good news: to put this into practice, the Government announced it would spend up to £300 million more per year on diagnostics by 2020. They also agreed to introduce a 28-day turnaround between being referred for a test and being given either a diagnosis or the all clear, and give all patients a copy of their test results.

Since then we’ve been waiting for more detail on how this money will be spent. And now it’s arrived, in the form of a plan from the NHS published today.

We’re pleased to see that there are steps being taken, and the plan states that the NHS needs to:

Focus on ensuring that diagnostic services are ready and able to respond to this rising demand so that people are diagnosed quickly

And they’ve put some of the £300 million earmarked for diagnostics into a fund, which will help local areas increase the number of tests they can do.

Health Education England – the organisation in charge of training doctors and other health professionals – has also said that work is underway to address the shortage in experts needed to carry out these tests.

So it’s extremely good news that NHS England has published its plan to put this into practice. This is crucial if the health service is to give patients best chance of a cure, and if it’s serious about seeing survival in the UK match the best in the world.

Of course, we’ve only been talking about England in this article. That’s because, as we discussed earlier this week, health policy is dealt with separately in the different UK nations. The ways that waiting time targets are measured is different in each country in the UK – so comparisons should not be made between countries, only each country against their own measures (more about this here).

But we know waiting times are an issue in other nations too. And the anxiety caused by waiting for a cancer diagnosis doesn’t respect borders. Patients like Margaret use words like “agonising” to describe their wait, no matter where they live.

So we want to see action in Northern Ireland, Scotland and Wales to improve their waiting times as well. And we’ll be working with governments across all the UK’s nations to make sure they keep cancer high on the agenda, and put plans into action.

It will take time to get the waiting time statistics back down again, but for the sake of the Margarets of the future, the action needs to start right now.

Rose Gray is a policy advisor at Cancer Research UK

Comments

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David Willis June 4, 2016

My experience of prostate cancer diagnosis and treatment was that referral and initial hospital appointment came quickly. But an MRI scan delayed things (they didn’t seem to give any priority but I was simply taken in turn). I had to cancel and re-book an appointment as a consequence and the fresh appointment was 7 weeks after the cancelled one. There was no clinical input in deciding the new date. The referral for biopsy was quick and the results came within 3 weeks. However, they transposed the Gleason numbers and said it was less urgent than it actually was. The doctor also told me that a particular treatment would be available, when it wasn’t as the Gleason score was too high whichever way the numbers were added up. The next appointment date was several weeks later than the doctor had asked: the youth on the desk asked me if the date was OK – I told him I didn’t know and he should ask the doctor, but he didn’t. Fortunately, the referring consultant had put in a ‘fail-safe’ appointment in case things didn’t move quickly enough and they gave the correct diagnosis there and arranged quick treatment. From there on the appointments and treatment went to plan.
It seemed to me that there was an issue with availability of appointment slots but no clinical or executive management of the issue. It was left to administrators and clinic nurses to manage and this didn’t necessarily involve any patient-specific clinical input.

Sarah June 3, 2016

My husband was taken to A&E in August ’15 with severe pain, jaundice and other symptoms of pancreatic cancer. It was after FIVE months of tests, scans, stents with me (his wife) constantly requesting follow-up, more A&E visits due to the pain, followed by an endoscopy and after more chasing, a biopsy, that he was told he had an inoperable tumour in February. We are now in final stages. In his case, as there was initially some “uncertainty” no-one would take overall responsibility until he had the biopsy and was referred to an oncologist.

Robert Harrison June 3, 2016

I have just undergone robotic radical prostatectomy at UCH Westmorland street London. My operation was a little later than expected but between my diagnosis and my operation they found I had a heart defect. I had a pre op before my surgery and within the space of 9 days I had a pacemaker fitted. I had my operation six weeks later. My experience has been of excellent treatment from the start of my diagnosis. The staff of UCH London have bent over backwards to try to get my operation done within the guidelines they are given. For what they have done for me I am eternally grateful.

David Bell June 2, 2016

The problem with a publicly funded health service is that it can only be fully funded when the economy is good. Ours isn’t and hasn’t been for most of my lifetime. Cancer treatment is extremely expensive so it is bound to suffer when cash is short. Any cash promised by any government under present conditions is borrowed money. Is it time to look at other European nations and consider whether a different funding system should be adopted in the UK? I am unemployed and so contribute nothing to the NHS. This seems wrong to me.The NHS used to be described as the envy of the world. It isn’t now and perhaps removing its running from the government is long overdue.

Albert Colin White June 2, 2016

First thing is to get a Government that doesn’t just talk figures. They did all this the last time they held the reins

Hilary Gilmore June 2, 2016

You should give us the opportunity to sign a petition to go to Gov’t.
There is also a problem getting an early appointment when referred. My daughter had to go privately to have a possible squamous cell carcinoma checked by a dermatologist.
I had that eexperience though my problem was not malignant, so the waiting time for an appointment was at least 3 months . This is too long when you are in pain, the condition is worsening and the GP wants an expert opinion.

sandy smith June 2, 2016

I would like to donate 10 pounds a month via direct debit. How can I do this easily.

Helen Mullineux June 2, 2016

The second graphic is difficult to interpret.Even though I have a scientific background, accustomed to using graphs and am quite good with figures it took me a long time to make sense of it.

Emma June 2, 2016

A beautiful and brave 34 year old lady I had the honor of knowing lost her life because she was made to wait 4 months before she received treatment for aggressive cervical cancer. Even though she had regular smear tests and went to the doctors when she noticed symptoms. By the time they decided to treat her it had already spread to her stomach and chest. If they’d acted straight away when it was contained, at least she would’ve stood a chance and she was just so young. Something really, really needs to be done to stop other people from dying unnecessarily.

Kai Ren Ong June 2, 2016

More money is good. But the government knows full well that failure to invest in staff over the years means there is a lack of ready trained experts to do the tests. Where are they planning to magic them from? Oh yes, poach them from other countries of course, so we don’t have to train our own at our expense. It’s a disgrace.

Michael H C Lamden June 2, 2016

I think this situation is utterly disgraceful, and more immediate action needs to be taken now.This Tory government needs to remember the saying, practice what you preach.

Maria June 2, 2016

My experience with the NH was fantastic. From an x-ray in Feb 2015 to a biopsey in March and operation in April then chemo in May I found no hold ups in fact most of my appointments were brought forward. All the staff were great and I felt very well looked after.

Jonathan Hardwick June 2, 2016

I think that these lapses are disgusting, but I know that the NHS is overstretched and possibly their priorities are in the wrong place. I found the Cancer Research UK website very helpful when I was diagnosed with skin cancer on my head, it was frightening, but I was lucky to been seen quickly and the operation to remove the tumour was successful.