Agenda item

(indicative timing: 11am – 12pm)

In attendance for this item were:

Herefordshire and Worcestershire Clinical Commissioning Group:

Mari Gay, Managing Director and Lead Executive for Quality and Performance

The HOSC had requested a report on cancer diagnosis and treatment wait times in Worcestershire. The Managing Director and Lead Executive for Quality and Performance at Herefordshire and Worcestershire Clinical Commissioning Group (CCG) provided a summary of performance and what was being done.

Cancer had remained a system priority during the pandemic, although this was not to say that other services were not important.  The report set out the current performance in Worcestershire against key cancer standards, including a new standard on 28-Day Faster Diagnosis Performance. During the pandemic, referrals had reflected the national picture, so that during the first wave, the public lacked confidence in coming forward with concerns, which had then changed to near pre-pandemic levels and then high levels since March 2021, presenting particular challenges in the specialities of Breast, Colorectal, Skin and Urology.

Performance against the 2-week wait (2ww) referrals and the 62-Day performance was some way behind where it needed to be, and was challenging, due to access to diagnostics, staff sickness and numbers of referrals. In general referral numbers across the different cancer specialisms reflected the national picture.

The report set out what was being done within the specialisms of Breast, Colorectal, Skin and Urology, to address the challenges faced. These included insourcing of breast imaging to support additional weekend clinics (until March), putting in additional capacity for colorectal cancer care and enabling GPs to photograph patients’ skin concerns for earlier assessment of skin cancer.

Teams were continuing to work through backlogs and fortunately at the moment, monitoring of cancer outcomes across the Covid recovery period was not indicating increased harm to patients.

A new non-specific symptom pathway was being introduced and Worcestershire for patients with symptoms suggestive of cancer but which do not meet the criteria for a site specific 2-week wait referral.  It was expected to go live on 13 January 2022.

The Trust was also participating in the GRAIL/Galleri Study, through the West Midlands Cancer Alliance, which one of 8 Alliances taking part in a pilot to invite participants aged 50-77 to receive blood tests that could detect early stage cancers.

Workforce was the biggest concern and the Integrated Care System was liaising with the Council’s Strategic Director of People in order to focus efforts.

During the discussion which took place the following main points were made:

·         The CCG Managing Director (the Director) believed the variance in 2ww referrals was due to a lack of confidence in the public coming forward during the first wave of the pandemic, which was also the feedback from the focus group; people did not know what to do during Covid or did not want to bother health staff – however, importantly an increase in cancers was not emerging as a result. Some variances could not be explained however, for example very high referrals in skin cancer.

·         HOSC members were reassured to a certain extent by the information provided about cancer treatment and wait times and were very appreciative of all the work being done.

·         When compared regionally and nationally, Worcestershire was performing well for access to GP (best in the region), was in the mid range for 2ww referrals (an area of struggle nationally). The current Covid wave was concerning, including how it would affect the workforce.

·         The report stated that whilst referrals to the Acute Trust were high, the resulting activity was amongst the highest in the region, therefore a HOSC member asked whether this meant performance in Worcestershire was better than other Trusts?  The Director explained that this was the case for some specialisms but not for others. The CCG was liaising with neighbouring hospital trusts about spare capacity but this looked doubtful, however if the Alexandra Hospital (the Alex) could be kept Covid free, there was a really good chance to improve all specialisms.

·         Very few cancer patients opted to have treatment outside of Worcestershire, however this was monitored by the CCG, which had access to the full statistics.

·         It was evident that during the first wave of the pandemic, people were reluctant to go to hospital for cancer treatment, however the subsequent swell in referrals was a good indicator that they were now happier to come forward.

·         As part of the reset and redesign of services (from the pandemic), services were being redesigned with a view to becoming more sustainable in high referral areas, which would also respond to population increases in Worcestershire. An example was 7-day access for breast cancer, something the Director believed was needed, and which could be sustainable based on the assumption that women were likely to be prepared  to travel for treatment of this nature.

·         It was explained that in Worcestershire fortunately it had been possible to keep cancer surgery going during the pandemic. The Alex Hospital was being used for general surgery and Kidderminster Hospital for day case surgery.

·         When asked how cancer follow ups were balanced against the need for new patient treatments, the CCG Director explained it was a balance of risk and that the priority of diagnostics was urgent, with the fragile workforce being an additional strain.

·         During the pandemic, 80% of referrals had been carried out by the independent sector, as part of a national contract which ended in March 2021, which had worked really well in Worcestershire. The split between private and NHS sector was now 50/60% and the independent sector was now understandably keen to regain its private patients.

·         The aforementioned use of technology to enable GPs to photograph patients’ skin concerns was a very efficient way of managing resources although it would be important to have clinicians on board.

·         In response to a question about why there was to be a new building for Breast cancer at Kidderminster Hospital, it was explained that following a detailed options appraisal, it was hoped to get three Hubs based on based on local demography and deprivation.  There would be Hubs at Kidderminster, Hereford and the third Hub was to be decided.

·         The Cabinet Member with Responsibility (CMR) for Health and Well-being understood the need to centralise some services and asked what was being done to tackle the clear concerns about capacity?  The CCG Director highlighted the need to train more staff such as GPs, scanners, nurses and to make opportunities as attractive as possible. She acknowledged the CMR’s follow up question about how to overcome any negative perceptions about working at WRH and explained the importance of celebrating Worcestershire’s successes – for example Stroke Services and the Children’s Unit, which were highly regarded.

·         Comment was invited from the Healthwatch Worcestershire representative present (Simon Adams, Managing Director), who praised how Cancer Services in Worcestershire had been maintained during the pandemic, in contrast to many areas. Moving forward he encouraged an ambitious approach for both commissioners and clinicians but acknowledged the challenge of recruiting and retaining consultants.

·         The Healthwatch Worcestershire representative asked about data on people not coming forward with cancer concerns who had then presented at A&E and was advised that although there had been increases in two specialisms, this was not the case otherwise.

·         In response to a concern about the transfer of the Garden Suite Chemotherapy Treatment Unit from The Alex to Kidderminster Hospital, the Director reminded HOSC members that this was a temporary change in response to the pandemic and that everyone would be kept informed.

·         HOSC members acknowledged that as part of redesign, more services may move from the WRH site and the Director acknowledged that although changes may be tricky for patients, there was very little space at WRH.

The Chairman praised the work taking place and thanked the Director for her attendance.