Over 130,000 patients a year are not receiving vital NHS cancer care on time
7 Nov 2016
Hospitals struggling with growing number of people suspected of having the disease as doctors warn delays may be harming chances of survival.
More than 130,000 patients a year are not receiving vital NHS cancer care on time because hospitals are struggling to look after the growing number of people suspected of having the disease.
Doctors are warning that a widespread and growing failure to meet waiting time targets was causing huge anxiety for patients affected and may even be harming their chances of survival.
A total of 132,138 patients in England last year did not see a cancer specialist within the required 14 days or start treatment such as surgery or radiotherapy within the supposed maximum 31 after diagnosis, or 62 days after initial consultation and tests, according to an analysis of NHS-wide performance data conducted by Cancer Research UK.
Delays in some hospitals were so severe that more than 6,000 patients who should have had their first treatment within 62 days of being urgently referred by their GP last year were forced to wait for 104 days or more, the figures collected by hospitals show.
101,140 patients with suspected cancer were not seen by a specialist within 14 days last year
“These figures are alarming. The number of people for whom these targets are being missed is a real source of concern,” said Prof Peter Johnson, Cancer Research UK’s chief clinician. “Delay creates additional anxiety for people. That matters for individual patients affected in a precise way because they have a prolonged period of uncertainty. Do I have cancer or do I not? And if I do have cancer, will it be curable?
“In some cases delays may even mean the chance to give curative treatment may be lost. Delays mean that there will be some people whose cancer gets worse while they wait for the result [of a test]. I’m pretty angry about that. This all reflects a system that’s failing to meet the needs of people with cancer or suspected cancer,” added Johnson, who is a leading NHS cancer specialist in Southampton and professor of medical oncology at Southampton University.
The figures show that 101,140 people with suspected cancer did not get to see a specialist within 14 days of being referred as urgent cases by their GP during 2015-16. Another 6,713 patients found to have the disease did not receive their first treatment within 31 days. And a further 24,285 were not treated within 62 days, despite being referred urgently by their family doctor.
Leading cancer doctors claim that a failure to invest in NHS diagnostic and treatment services in recent years has left hospitals struggling to cope with the 1.5 million people a year whom GPs now refer for tests because they suspect they may have the disease. They pinpointed a lack of scanners and key personnel such as radiologists and endoscopists to meet demand as key problems.
6,713 patients did not receive their first definitive treatment within 31 days of a cancer diagnosis last year
And they warned that the NHS is increasingly ill equipped to give timely care to the even greater number of people who will be diagnosed with cancer over coming years as a result of the ageing population and impact of lifestyle factors such as obesity, smoking and drinking. The NHS is testing, diagnosing and treating record numbers of people with cancer. But the number of patients not cared for within 14, 31 or 62 days is rising relentlessly. Last year’s total of 132,138 people affected was more than double the 63,701 such cases in 2011-12.
Doctors say that cancer waiting time standards, originally introduced by then prime minister Gordon Brown in January 2009, are vital to ensure early diagnosis of cancer and central to the NHS’s determined efforts to help tackle Britain’s poor record of late diagnosis of the disease. The targets specify that hospitals in England should ensure that 93% of those referred by a GP should see a specialist within two weeks, that 96% of patients diagnosed with cancer should receive their first treatment within 31 days and that 85% should start urgent treatment within 62 days of GP referral.
24,285 people diagnosed with cancer were not treated within 62 days after being referred by their GP last year
The NHS as a whole has breached the 62-day target in every quarter for the last two and a half years. In that time, 57,112 people have had to wait longer than that for supposedly urgent care, NHS England’s figures show. “We now have a situation where most hospitals don’t meet their targets to start treating people within 62 days of referral with radiotherapy, chemotherapy or surgery. That’s regrettable for patients because for an affected patient any extension of those 62 days is both psychologically challenging and damaging both for them and their loved ones,” said Dr Richard Roope, the Royal College of GPs’ spokesman on cancer.
“There’s always the worry that that delay might affect your outcome and that in some cases it will mean the cancer is more advanced at the time of treatment, which will then be detrimental to the outcome – it could reduce their chances of survival,” Roope added.
Although hospitals overall have hit the 14-day and 31-day targets, performance has been slipping. More hospitals have been missing one or both targets since early 2014. The number of patients who have not seen a specialist within two weeks has shot up from 45,414 in 2011-12 to 101,140 last year, while the number denied treatment within 31 days rose from 4,132 to 6,713 during that period.
“If you look after people with cancer it’s a desperate situation to be asking them to wait for their tests and to be planning to see them after a month because they won’t have their results until then, and we know that’s going to be a month of terrible worry for them,” said Johnson.
Dr Giles Maskell, until recently president of the Royal College of Radiologists, said: “There are gaps right across the NHS cancer workforce, including oncologists, therapists, nutritionists, nurse specialists and other groups. The shortage of radiologists – who interpret x-rays and scans – is so serious that one university hospital in the south-east recently had 11 of its 33 consultant radiologist posts unfilled because there were too few applicants, while another teaching hospital in the north-west has eight of its 36 posts unfilled, and seven have been vacant for over a year.”
The Department of Health declined to comment directly on the large numbers of patients not getting timely care. Instead, a spokesman said in a statement that: “Cancer survival rates have never been higher and just this week the NHS announced a new £130m investment to kickstart the upgrade of radiotherapy equipment and transform cancer treatment across England.
“The reality is the NHS is seeing over 90% more patients with suspected cancer within two weeks – that’s over 800,000 more people – and treating nearly 50,000 more patients following a GP referral compared to 2010.”
The cancer figures emerged as a TUC poll of 500 NHS staff found that funding pressures are jeopardising patient safety and damaging services, and that nine out of 10 believed the service was under more pressure than at any time in their working lives.