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

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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 requiring further investigation.

Patients with breast symptoms should be seen by a specialist within two weeks of being referred to hospital by their GP.

Patients with breast symptoms should be seen by a specialist within two weeks of being referred to hospital by their GP.

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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, Lancashire Teaching Hospitals (LTH) - which runs the Royal Preston and Chorley and South Ribble Hospital - saw 94 percent of patients within a fortnight. But the following month, that figure had dipped to 71 percent, in line with a deterioration in performance elsewhere in the county.

That decline was sharpest at Blackpool Teaching Hospitals, which met the waiting time standard for just 10 percent of its breast symptom referrals in March - the fourth worst performance in England.

It is possible that a ripple effect of the seaside trust’s struggles may have been felt in Central Lancashire, with Fylde coast patients being referred beyond Blackpool trust's borders.

“We have had a 50 percent increase in breast referrals and we are doing everything possible to ensure patients are seen within the two week standard,” Faith Button, LTH’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 it's quite challenging,” Ms. Button explained.

LTH had a previously solid performance against the breast symptom referral standard, achieving the target in 11 out of 12 months in 2018 - before slipping back this March.

Following the NHS England 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.

Elsewhere in Lancashire, University Hospitals Morecambe Bay - which runs the Royal Lancaster Infirmary - saw 54 percent of breast symptom referrals within two weeks in March, a fall of almost a third. East Lancashire Hospitals was the only trust to buck the trend, increasing its performance to 96 percent.

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 Monday 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.”

Blackpool Teaching Hospitals (BTH) and the Department for Health were approached for comment. BTH issued its comment via the ICS.

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.