Waiting time increase for breast symptom tests in Lancashire sparks NHS talks

NHS leaders in Lancashire have met to address concerns over a sudden deterioration in hospital performance against a key cancer waiting time target.

The short-notice gathering of managers and clinicians was arranged by NHS England in response to lengthening waits in the county for patients whose GP has identified breast symptoms which require further investigation.

Breast symptoms should be investigated by a specialist within two weeks of a patient being referred by their GP

Breast symptoms should be investigated by a specialist within two weeks of a patient being referred by their GP

Although cancer might not initially be suspected by medics, such patients should be seen by a specialist within two weeks of being referred to hospital. NHS England’s target is for 93 percent of those patients to be seen by a specialist in that timeframe.

In February, three out of the four hospital trusts offering a cancer diagnostic service in Lancashire all came within three percentage points of achieving the national standard. However, by March – the latest month for which published figures are available – there had been a significant drop in performance at all but one of them.

Lancashire Teaching Hospitals (LTH) – which runs the Royal Preston and Chorley and South Ribble Hospital – saw 71 percent of patients within a fortnight, while at University Hospitals Morecambe Bay – which runs the Royal Lancaster Infirmary – the figure fell to 54 percent.

East Lancashire Hospitals bucked the trend, increasing its performance to 96 percent.

But at Blackpool Teaching Hospitals – the only Lancashire trust not meeting the standard in February – performance plummeted even further from 54 percent to just 10 percent a month later. That put it in the bottom five NHS trusts in England on that measure.

Following the meeting, which took place on Monday, healthcare bosses across Lancashire and South Cumbria concluded that the rise in waiting times on the Fylde coast was the result of “difficulties with workforce and imaging [scanning] capacity”. They said a county-wide plan was being developed to ensure referrals are as speedy as possible.

But at LTH, providing assistance to other trusts could be having an impact on its own previously solid performance. The organisation exceeded its two-week waiting time target in 11 out of the 12 months of 2018 – before the sudden dip in March this year.

“There has been a 50% increase in breast referrals and we are doing everything possible to ensure patients are seen within the two week standard,” Faith Button, the trust’s chief operating officer, said.

“This increase is a combination of local and out-of-area referrals and is consistent with the national trend.”

A recent LTH board meeting heard that some of the trust’s patients are being seen by NHS clinicians at the private Euxton Hall Hospital in Chorley because of pressure on the “physical capacity” of the health service in Lancashire.

“You have to line up the consultant, the radiographer and somebody to read [the scans] all at the same time. It’s a one-stop shop, but logistically quite challenging,” Ms. Button explained.

Jessica Morris, who analyses NHS trends for the health thinktank the Nuffield Trust, said the situation in Lancashire mirrored a decline in national performance, where the 93 percent target has not been met for almost 18 months.

“Only 79 percent of patients with breast symptoms were seen by a consultant within two weeks of a GP referral in March 2019. Alongside this, there has been an overall decrease in outpatient appointments for people with breast symptoms since 2014.

“This fall in capacity is just one sign of the enormous pressure that the NHS is under, with staff shortages and stretched resources,” Ms. Morris added.

A spokesperson for the Integrated Care System (ICS) in Lancashire said: “Waiting times for women referred for suspected breast cancer across the Fylde coast have risen recently due to some difficulties with workforce and imaging capacity.

“To address those concerns, senior clinicians and managers from across Lancashire and South Cumbria are working together to develop a plan to ensure that those women are seen as quickly as possible.

“The first focused meeting of those clinicians was held on 10th June, and the aim is to put in place practical steps that will have an impact as soon as possible, whilst longer term solutions are sought.

“The benefit of working together as an Integrated Care System is that organisations are able to collaborate to deal with challenges such as this across the whole of the region, rather than just focusing on individual services or organisations.”

Each of the individual hospital trusts featured in this report – and the Department for Health – were all approached for comment. Blackpool Teaching Hospitals referred to the ICS statement.

WAITING TIMES RETHINK?

An England-wide review of waiting time standards is currently underway.

The two-week referral target for patients exhibiting breast symptoms to be seen in outpatients could be replaced with a new standard which guarantees that there will be a maximum 28-day wait for such patients to receive a definitive diagnosis.

“Recognising that our current standards measure the time to be seen by a doctor, rather than time to being provided a diagnosis of cancer, the independent cancer taskforce recommended the introduction of a new faster diagnosis standard,” a recently-published interim report by the NHS national medical director, Professor Stephen Powis, notes.

The number of people being referred for all urgent cancer tests has doubled since 2010, with just under two million people receiving a two-week referral for suspected cancer in 2017/18.