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NHS struggling to provide safe cancer care, say senior doctors
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Stock photo of a radiologist looking at a brain scan image on a computer
screen
IMAGE SOURCE,GETTY IMAGES
By Jim Reed
Health reporter
The NHS is struggling to provide safe and effective care for all cancer
patients, say senior doctors.
The Royal College of Radiologists is warning that all four UK nations
are facing "chronic staff shortages", with patients waiting too long for
vital tests and treatments.
Half of all cancer units are now reporting frequent delays for both
radiotherapy and chemotherapy.
Ministers say a workforce strategy for the NHS in England is due shortly.
The plan, which is meant to spell out how the government will plug
staffing gaps over the next 15 years, has been repeatedly delayed, to
the frustration of some in the health service.
It comes as new figures show 22,533 patients in England were waiting
more than two months for either cancer diagnosis or treatment at the end
of April, up from 19,023 at the end of March.
The wider NHS waiting list, which includes cancer and non-cancer
treatment, also increased further to 7.4 million people, the highest
number since records began in 2007.
Carol Fletcher
Image caption,
Carol Fletcher, 57, from Usk in South Wales, says she has faced multiple
delays for cancer treatment since being diagnosed last summer.
In June 2022, Carol Fletcher, from South Wales, finally had her routine
screening appointment for breast cancer, which was itself overdue.
"It took another eight weeks after my mammogram before I was told there
might be something wrong," she said.
Since her cancer diagnosis, there have been more waits - for scans,
tests, surgery and then chemo.
"I was told that I might not get results back [quickly] after my
mastectomy because they haven't got enough pathologists, so there was
another eight-week delay for chemotherapy," she said.
"I can't plan for the future and it's had a huge impact on my family."
Presentational grey line
NHS services across the whole UK have been struggling to meet cancer
targets since well before Covid.
The pandemic increased the backlog, with scans and treatment disrupted
by lockdowns.
Across England, Scotland and Northern Ireland, one key target is to
start treatment within two months of an urgent referral by a GP.
In Wales the measure is slightly different as it includes all urgent and
non-urgent referrals.
Graph showing UK cancer performance
All four nations are operating well below those levels. In England just
61% of patients start treatment in that time against a target of 85%.
Growing delays are, in part, the flip side of a medical success story.
Scientific progress in cancer care has been remarkable, with
cutting-edge drugs offering hope where previously there was little that
could be done.
New techniques are more effective but often far more complex for doctors
to deliver.
At the same time the UK population is getting older - and as cancer risk
is strongly linked to age it means more more demand for expensive
scanners, along with more staff to analyse those scans, and more
specialist doctors and nurses.
The Royal College of Radiologists (RCR) describes the situation as a
perfect storm - and says the workforce is struggling to keep up.
Graph showing predicted shortfall in senior doctors
Across the four UK nations, it calculates there is now a 15% shortfall
of specialist cancer doctors - or clinical oncologists - who deliver
chemotherapy and radiotherapy.
Without action, it says this gap will grow to 25% - or a shortage of 368
full-time consultants - by 2027.
Just as concerning is an even larger shortage of consultant radiologists
- highly trained doctors who interpret scans to diagnose cancer or
monitor its progression.
'Perfect storm'
The RCR says for each month a patient waits to start cancer treatment,
the risk of death is increased by about 10%.
In its annual survey, 44% of cancer service managers say they are now
"highly concerned" about patient delays, up from 29% in the previous year.
"There are examples in almost every cancer centre where parts of the
service just aren't running as well as we would like," said Dr Tom
Roques, a consultant oncologist and vice-president of the RCR.
"We're having to tell patients all the time that we can't quite treat
them as quickly as we would like, or in the way that we'd like, and
that's a stressful thing to have to do."
Keith photo
Image caption,
Kevin O'Hara was diagnosed with kidney cancer after a motorbike accident.
Kevin O'Hara, 60, from County Durham, broke five ribs in a motorbike
accident last November.
A scan of his upper body also picked up a shadow near one of his kidneys
that was later diagnosed as cancer.
He was offered drug treatment meant to slow the growth of the tumour and
- in early February - was told the waiting list for surgery would be
three to four months.
That period has now been and gone but he is still waiting for a date for
his operation.
"Every day you are waiting and waiting and nothing changes," he said.
"I come home from work and go to the door and, when there's no envelope
that says NHS on the top, I just get so depressed."
Graph showing cancer referrals in England
There is another trend in cancer care which is often overlooked.
The last decade has seen a dramatic increase in people coming forward to
get checked after spotting a possible symptom such as an unusual lump,
strange mole or unexplained weight loss.
The reasons for that are complex and include a bounceback in demand
since Covid, stronger guidance for GPs to refer to cancer specialists,
major NHS publicity drives and the work of campaigners such as
"Bowelbabe" Deborah James.
Cancer doctors view the spike in demand as a "very good thing", as a
growing proportion of patients are now diagnosed earlier when cancer is
easier to treat.
But it also puts more pressure on NHS services, with waiting times for
diagnosis and other scans one of the key bottlenecks in the system.
Since Christmas there have been some signs of progress, with the NHS in
England reducing the backlog of long waits for treatment and hitting one
of its other standards - for faster diagnosis - for the first time.
Media caption,
In Blackpool, the NHS has hit its skin cancer targets by changing the
way patients are diagnosed, in an approach which is now being rolled out
across England.
The RCR also says there is a "chink of light" - with recruitment of
oncologists rising over the last three years, particularly in parts of
the country with the worst staff shortages.
It wants each UK nation to increase medical school places and training
posts, and says more also needs to be done to stop experienced staff
cutting their hours or leaving the profession early.
The Department of Health said that the total number of full-time staff
in the cancer workforce in England had risen by 51% to 33,093 since 2010.
A spokesman added: "We want to build on this progress and will publish a
workforce plan shortly to ensure we have the right numbers of staff,
with the right number of skills."
The Scottish government is also expected to publish its new 10-year
cancer strategy within weeks, setting out ways to attract and retain
more staff.
The Welsh government recently published a cancer improvement plan and
says it is now investing heavily to train more staff and build more
diagnostic and treatment centres.
In Northern Ireland, the health department said it is "extremely
disappointing" that cancer targets are being missed. It has recently
opened two new rapid diagnostic centres and started a "cancer strategy
workforce review".
Data visualisation by Liana Bravo.
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