This paper provides an update on secondary care in the North Central London area during the Covid-19 pandemic.
NaserTurabi, Programme Director for NCL Cancer Alliance, Derralynn Hughes, Professor of Haematology at the Royal Free London and Co-Clinical Director for NCL Cancer Alliance, and Clare Stephens, Barnet GP and NCL Board and Co-Clinical Director for NCL Cancer Alliance, introduced the item.
NaserTurabi noted that this item would focus on the cancer patient pathway and experience during the Covid-19 pandemic. He explained that, at the start of the pandemic, there were concerns about the spread of the virus and the vulnerability of cancer patients and some services had paused. It was noted that protective measures had been put in place and services were now around pre-pandemic levels. In terms of patients, NCL was ensuring that the pathways were Covid safe and had returned to pre-pandemic levels of diagnosis and treatment fairly rapidly. A key concern was the drop in presentation of new cancer cases. It was explained that cancers were normally diagnosed through multiple routes, such as via GPs, routine hospital appointments, screening, and emergency presentations. Based on a comparison of previous year cancer diagnoses, it was estimated that there were 600-650 missing cancer cases. It was noted that there was a national communications campaign encouraging people to present.
Clare Stephens explained that a cancer awareness measure assessment survey was undertaken in Camden and Islington in late summer; of the 1,300 respondents, 65% admitted to delaying getting help or advice for potential cancer issues, 55% said that they did not want to overwhelm the NHS and felt that they could wait, and others had stated that they were concerned about catching the virus.
Cllr Smith noted that there were a significant number of missing cancer cases and asked whether people knew about the Covid prevention measures and whether this had helped to reduce fears. Naser Turabi noted that there was a communications campaign called ‘Help Us to Help You’ which encouraged people to present when they had seemingly minor symptoms which could be cancer symptoms, such as changes in bowel movements and skin changes. It was noted that this was a national campaign and, furthermore, NCL hospitals had been featured on Channel 4 News and in the Evening Standard. It was also noted that significant effort was being expended by healthcare professionals and endoscopy numbers were actually higher than pre-pandemic levels.
Cllr Cornelius enquired whether there was still an issue with breast screening and endoscopy waiting times. In relation to endoscopy, it was noted that there were capacity issues as the air in the room had to be cleared between procedures. However, more appointments had been made available, including at weekends, and the service was due to be back on track by the end of next quarter. It was added that there had been significant progress and those with cancer concerns had been prioritised. Derralynn Hughes highlighted that no cancer patients were waiting for an endoscopy beyond the normal length on a 62 day pathway. In relation to breast screening, it was explained that the primary concern was that only 50% of people took up the invitation to attend screening. Although there were some concerns about capacity if additional people took up screening invitations, a working group had been established to support the breast screening service led by the Royal Free which was shared with North East London.
Cllr Freedman noted that the NHS had used some private healthcare for elective and urgent operations at the start of the pandemic and it was enquired whether this was still happening. Naser Turabi noted that some private capacity had been used initially, primarily in inner London. A new deal had been arranged nationally by NHS England whereby private hospitals could sign up to provide additional capacity but, at present, all cancer services had been returned to NHS hospitals and this was being managed within that capacity. Cllr Tomlinson enquired whether there were any issues with surgery waiting times. Naser Turabi noted that surgery waiting times were back to pre-pandemic levels.
The Chair noted that clinical harm reviews were undertaken for patients who had to wait more than 104 days for treatment; it was enquired whether these reviews were still taking place. Naser Turabi explained that clinical harm reviews were routinely carried out when a patient had waited more than 104 days for treatment and the patient pathway needed to complete before there was any analysis. It was noted that the results from the first three months of the pandemic had been analysed and Covid-19 had not been a major factor in any harm caused by delays. It was noted that some patients had chosen to wait for treatment if they were vulnerable to avoid the risk of Covid transmission. It was commented that the number of people waiting more than 104 days had decreased significantly and that there would be further analysis as further patient pathways completed.
The Chair also noted that there was anecdotal evidence that there may be more late stage cancer diagnoses as a result of people failing to present for routine testing and screening; it was enquired whether it was possible to proactively engage with any people who might have a missed cancer diagnosis. Naser Turabi explained that the figures relating to missed cancer diagnoses were estimates and there could be a fair amount of variation but he noted that targeted work would take place where possible to encourage people to seek medical attention. Derralynn Hughes added that the largest numbers of missing cancer diagnoses related to urology and prostate pathways and, as these cancers progressed fairly slowly, there may not be increased numbers of late stage cancer diagnoses. It was noted that work was underway to consider how to optimise these pathways and to understand people’s motivations for not coming forward; it was added that more information may be presented to the Committee in future.
It was noted that there had been recent news about a new blood test pilot which aimed to detect early stage cancers; it was asked whether NCL was involved in this. Naser Turabi noted that the ‘Galleri’ blood test had been developed by an American company called GRAIL. It was explained that UCLH and UCL already worked with GRAIL on a large lung screening trial; the population of NCL and North East London (NEL) had access to this trial. Part of the trial involved piloting the new blood test for patients at risk of lung cancer. It was explained that the blood test would require significant further testing but that, if it worked, it would be very exciting as cancer diagnoses currently relied on biopsies. It would also be important for increasing early stage diagnoses from the current rate of about 55% to the 10 year target rate of 75%.
The Chair noted that the Committee had requested a report on the post-Covid syndrome pathway which included some elements of secondary care in the form of referrals to individual clinics. It was enquired whether there was a particular area of secondary care that would benefit from the Committee’s input. Naser Turabi noted that the largest area of concern at present was missing cancers. It was commented that this involved public health and public communications issues and that local authorities would be important partners in sharing information. The Chair agreed and noted that an item on missing cancer patients would be added to the Committee’s work programme.
1. To note the report.
2. To receive a report on missing cancer patients.