More than a decade of frozen funding has brought the NHS to a shocking new stage of crisis, in which cancer treatment in one of the country’s leading hospitals last month had to be rationed for lack of staff, with some patients denied continuing care. Patients are having to be selected for treatment on the basis of how likely they are to survive and recover, meaning that palliative care is being cut back.

Nottingham University Hospitals NHS Trust said  they “expect to be in a position to restart chemotherapy for all patients who require it in October.” But while the Trust has admitted to the problem, the state of affairs was only initially revealed in a blog by cancer specialist Lucy Gossage, who says:

“Right now we don’t have the staffing capacity to deliver chemotherapy to all our patients and so, for the first time, the prioritisation list has come into force. And that means that, currently, we are unable to offer chemotherapy that aims to prolong life or palliate symptoms for many people with advanced cancer. We hope this is very temporary, but it’s indicative of a system on its last legs…”

The Nottingham restrictions are in line with contingency plans drawn up in March 2020 as the pandemic was growing to its peak, but come at a time when waiting lists are growing and the focus is on reducing the level of pent-up and delayed demand for cancer treatment.

Last month an IPPR report Building back cancer services in England warned that up to 20,000 cancer diagnoses could have been missed during the pandemic.

In the year following the first lockdown, 369,000 (15%) fewer people than expected were referred to a specialist with suspected cancer.  There was a 13% drop in radiotherapy treatments, and 7% fewer chemotherapy sessions. There were also fewer diagnostic tests: 37% fewer endoscopies, 25% fewer MRI scans and a 10% drop in CT scans between March 2020 and February 2021.

The result is that even if the level of services is cranked up by 5% per year it could take until 2033 to get waiting times back to pre-pandemic levels, because of increased demographic pressures on service demand.

However if activity could be increased and maintained at 15% higher than 2019 levels:

“most backlogs across the cancer care pathway could be addressed by next year. That would prevent many cancer-related deaths. Achieving this relies first and foremost on a larger workforce, more diagnostic and treatment equipment, and more physical space to provide care.” (p 7)

All of this requires funding, and a commitment to increase training to expand the specialist workforce. The Royal College of Radiologists in its appeal for extra funding from the coming Comprehensive Spending Review, points to the dire shortage of key specialists (“the NHS radiologist workforce is now short-staffed by 33% and needs at least another 1,939 consultants to keep up with pre-COVID-19 levels of demand for scans”), funding and equipment:

“Any equipment that is more than ten years old can be considered obsolete or inadequate for conducting certain procedures and must be replaced; yet previous industry surveys have shown one in ten CT scanners and nearly a third of MRI scanners in UK hospitals exceed this threshold and hence pose a risk to patients. The UK also has fewer scanners than the majority of comparable OECD countries – 9.5 CT scanners per million population while France has 18.2 and Germany has 35.1.”

NHS England argues that in June and July this year, more than 50,000 patients started treatment for cancer, an increase of one third  compared to the reduced level of treatment  in the same period last year. However there is little sign of progress on the roll-out of Community Diagnostic Hubs promised by NHS England a year ago, or the £1bn network of surgical hubs called for by the Royal College of Surgeons as a way to focus resources on reducing waiting lists.

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