Exclusive: Give urgent cancer surgery the same priority as covid patients, NHS England tells service

A joint letter from Amanda Pritchard, chief operating officer of NHS England and NHS Improvement, Cally Palmer, national cancer director, and Peter Johnson, national clinical director for cancer, was sent to regional cancer directors on Friday. It set out what the centre expects as regions consider cancelling urgent cancer operations because of the pressures created by the pandemic.

The letter makes it clear the regional directors must oversee any local plan to reschedule urgent cancer care. It cites the experience of London and the East of England which have had to cancel hundreds of cancer surgeries already this month.

The letter said regional directors must:

• “ensure that, where local decisions are being taken to redeploy surgical and anaesthetic staff, that provision for P1 and P2 [the most urgent] cancer surgery is prioritised alongside that for patients with covid”;
• “stress test their local systems to ensure that the elements that helped to sustain cancer services at the level we saw during the first wave are in place”;
• “satisfy themselves that effective procedures are in place to escalate any proposal” to reschedule “one or more [cancer operation] lists”; and
• centralise both high-complexity work like brain surgery and high-volume procedures.

Other areas are now facing the same issues that London and the South East first encountered a month ago, with hundreds of cancelled surgeries because of covid pressure and reduced access to independent sector beds.

One senior figure told HSJ: “NHS England want to avoid what’s happened in London and the South East happening in the rest of the country”.

HSJ reported last week the capital had more than 1,000 P2 cancer surgery patients outside the 62-day target and without an appointment date.

London also has less theatre capacity than in April because several large private hospitals have gone back to treating private patients.

Cheshire, the West Midlands and other areas have reported cancellations of P2 surgery — which refers to patients requiring treatment within four weeks. The only higher priority is P1, where patients need treatment within three days or less.