Dr Fran Woodard on how waiting standards continue to decline as cancer services buckle under pressure
There’s an often-repeated assertion that “insanity is doing the same thing over and over again and expecting different results”.
The release of a damning report on NHS waiting times by the public accounts committee, along with the latest tranche of cancer waiting times data, reiterated what Macmillan has known for some time: waiting standards continue to decline as cancer services buckle under pressure.
Doctors and nurses are doing everything in their power to halt the tide, but faced with increasing patient need and ever decreasing resource, it’s a losing battle.
The numbers speak for themselves. Since January 2014, when the target was first consistently breached, nearly 140,000 patients have waited longer than 62 days to start treatment after an urgent GP referral for suspected cancer.
Behind the numbers are people whose worlds have been turned upside down by a cancer diagnosis and who are now stuck in limbo, anxiously waiting to start treatment and move on with their lives.
At crunch point
Sustained and entirely predictable declines in NHS performance are met with the same exclamations of concern, well-rehearsed arguments about cause and effect and the inevitable round of weary responses from those who can be held accountable.
Meanwhile, people living with cancer continue to face longer, anxious waits to see a specialist and start a treatment pathway. With the number of people living with cancer ever increasing, the situation is only set to get worse.
But there could be an opportunity for change. The waiting times standards review currently being led by Professor Steve Powis offers a rare opportunity for an honest, much-needed exploration of why waiting times are not being met and what we can do about it.
This comes at a critical time – the current system is at breaking point.
Macmillan has been vocal in calling for the guarantee of public consultation before any new cancer waiting times standards are confirmed, and for the need to involve people living with cancer, clinical professionals and the public in their development
One of the key concerns highlighted by the public accounts committee last week centred on a “lack of curiosity” from the national bodies responsible for setting and managing waiting times about the impact of longer waits on patient outcomes and harm.
At Macmillan this is something we are desperately concerned about.
A new standards review may also help with admitting the scale of the challenge and the root causes of the decline in performance standards over the last few years. This includes acknowledging the difficulty in driving up the performance of cancer services without investment in the NHS’ most precious resource, its people.
With the Spending Review delayed by the current political turmoil, one thing is clear: people living with cancer simply cannot wait until the storm blows over before more funding for cancer services comes in. The wait to start treatment is long enough as it is.
Standards fit for the future
To create standards fit for the future we must not simply replace what currently look like impossible to meet standards with easier targets and Macmillan is resolute that any new cancer waiting times must drive improvement in experience and outcomes for people living with cancer. Anything less is unacceptable.
While we are open to considering simpler overall targets, they must still provide an accurate barometer of system performance and we must continue to have the ability to interrogate the data and understand why things aren’t working and where bottlenecks are.
Without this, we won’t be able to develop timely solutions. We know, for example, that there is variation in service performance across cancer tumour types due to differing and sometimes intensely complex care pathways.
Agreeing new waiting times must also be an open, transparent and collaborative process to ensure there is public confidence in standards moving forwards.
Macmillan has been vocal in calling for the guarantee of public consultation before any new cancer waiting times standards are confirmed, and for the need to involve people living with cancer, clinical professionals and the public in their development.
It’s clear the tide must change, but this simply won’t be possible without tackling the underlying cause: the workforce crisis. The government must urgently prioritise funding the NHS People Plan in the Spending Review to ensure that there is the money and resource to give people with cancer the care they deserve.