This week’s leadership message comes from Professor Sean Duffy, Clinical Director and West Yorkshire and Harrogate Cancer Alliance Lead

Cancer services are still here to help – a message worth repeating

Even stronger collaboration, new ways of delivering services and progress on innovation during the initial stages of the COVID outbreak mean a West Yorkshire and Harrogate system even better prepared to keep cancer and other routine services ‘open for business’ during a potential second  surge. But it’s vital we convey the message to our patients that we’re still here to help.

It is very sobering to reflect on the past six months and the impact that the COVID pandemic has had on cancer services and for patients with worrying symptoms.  When lockdown started on the 23rd March there was an immediate impact: across the country all care was prioritised to reduce the potential harm to patients, the public responded by self-isolating and social distancing, the health system had to make difficult decisions with patients about treatments.

What did this mean for West Yorkshire and Harrogate cancer care?

We saw a dramatic and immediate reduction in patients coming forward and being referred for investigation. This was manifest in a 70% reduction in urgent Two Week Wait referrals. Surgical treatments had to be prioritised to comply with safety requirements and to release facilities and staff to provide the necessary ventilatory capacity to support COVID patients. Our surgical and managerial teams were, however, able to maintain operating at 60% of historic rates, in contrast to areas like London where surgery rates dipped to 30%. Other forms of treatment like chemotherapy were adjusted to reduce potential harm and had a temporary dip over a very brief period. Radiotherapy treatments were again adjusted for safety reasons, but overall volumes of treatment were maintained.

Once the peak of the pandemic receded at Easter our Alliance responded very quickly to regain the lost ground and to deal with the backlog of people waiting for diagnosis and any requiring prioritised treatment.  Our analytics team had modelled that there were two big issues to deal with - the reduction in people coming forward with symptoms (of which at least 10% of whom will have cancer as a diagnosis) and the backlog of patients awaiting diagnostic tests or treatments.  The system responded to this message and our providers built up COVID free facilities. These zones or hubs were created in order to ensure that cancer care in particular remained a priority. This enabled us to fulfil the challenge set by the Alliance and the Health and Care partnership of maximising our ability to diagnose cancer at a curable stage of the disease. In addition, the use of the negotiated independent sector capacity has helped enormously. In some areas it lends itself to undertaking some cancer related diagnosis and treatment, in others it is providing extended capacity for non-cancer work, freeing up NHS estate to be used for additional cancer work. Our data indicates that the reduction in backlog of patients has been tackled effectively and consistently. It has meant the number of people waiting beyond 62 days for diagnosis or treatment following urgent referral has been reducing steadily since July.

Since the dramatic dip in referrals at the start of the pandemic, our Two Week Wait referrals have now come back to normal rates (in contrast to the rest of England where the rate remains at a stubborn 80% of normal). A number of national and regional information and publicity campaigns with messaging #HelpUsHelpYou and #StillHereToHelp have contributed to this, but we know there’s more to do. We have repeated feedback from provider colleagues that people offered diagnostic test appointments are concerned about engagement with services, preferring to “wait until it is over”. 

Our patients’ voice and how they have helped us

As an Alliance, our patient engagement has continued throughout the pandemic, and we are grateful in particular for the ongoing commitment and enthusiasm of our community/patient panel members and the charity Yorkshire Cancer Community for continuing to share their experiences and their expertise in support of service delivery, transformation and innovation in the context of COVID-19.

This included feedback that, for the most part our patients would prefer to continue to receive care as locally as possible and that any variation from established pathways should be the exception and only when required to expedite time critical investigation or treatment.

Patients have reported positive experiences when they do engage with services. They have helped us to define what patients want to see in order to feel reassured and confident, and we have shared this with local services to inform their restoration.

Looking to the next six months, what do we anticipate for cancer care in our Alliance?

Over the next six months we plan to restore as much activity as we can within those COVID constraints. As a Cancer Alliance, our overall aims of the next phase of recovery are concentrated in two areas:

• Minimising delays to diagnosis and treatment of people who are on our cancer pathways, focusing on those pathways and procedures most impacted by the pandemic.
• Mitigating the risk of deterioration in outcomes for tumour groups and/or populations who may have been disproportionately impacted by COVID and where a proactive approach is needed to encourage them to come forward and present with their worrying symptoms.

At its September meeting, the Alliance Board agreed to three key system-wide objectives, building on national priorities, for all statutory partner organisations to adopt to align our recovery efforts for the next six months; to support the reset, and to reduce the risk of the poorer clinical outcomes for patients to which COVID has exposed us. Read more in this letter detailing the cancer programme objectives.

We believe the objectives are ambitious but grounded in reality. Our expectation is that they will be included in local plans, and the Cancer Alliance Board will provide the assurance around their collective delivery, on behalf of the Health and Care Partnership.

In brief, they focus on managing the immediate growth in the numbers of people requiring cancer diagnosis and/or treatment by maximising capacity for diagnostics, surgery and other treatment modalities in COVID-free settings; implementing a programme of innovative practice to support clinical assessment and triage; establishing Rapid Diagnostic Centre Services in all our local places; supporting the restart of all cancer screening programmes, including targeted lung health checks, and accelerating work on personalised support.

Also, we will continue to minimise the length of time patients are waiting for diagnosis or treatment on both urgent and treatment pathways, with immediate priority given to those who have been waiting the longest.

The final overarching objective is to reduce unmet need and tackle health inequalities. We’ll do this by analysing and sharing cancer diagnosis pre and post COVID, and use this data to determine where we need to focus our efforts to encourage people to come forward with concerns that may be cancer, so they can be referred appropriately. Lung cancer, for example, is one area where referrals have dropped significantly and are recovering more slowly.

As we heard this week COVID and the impact on our population is here to stay. We are already seeing the pressure on individual parts of our system in Bradford, Kirklees and Calderdale, this makes all the more important for us to be working collaboratively to help each other.

We need to continue to relay the message that the healthcare system is willing and able to safely take care of patients with a suspected or established cancer diagnosis.  The public are still wary about coming forward as we have seen that even when offered appointments there is the public concern about taking the offer up.  Just how much the recent increase in infection rates and hospital admissions will translate into a reluctance to seek advice and help will be played out over the coming months but we remain prepared to meet these challenges. We know so much more now than we did in six months ago, we are more resilient now in terms of being able to deal both with the COVID pandemic but also the care of patients with cancer.

We are prepared.