North by North West: Why the North West waits

The backlog of “urgent suspected cancer” cases spiked up alarmingly in the first 2020 wave of the pandemic, but was successfully reduced by the summer of 2021, almost to pre-covid levels.

Since then, however, the backlog has crept gradually back up, boosted by each new wave of the virus.

According to new internal data seen by NxNW, there were 4,152 cases in the North West already waiting more than 62 days at the end of June 2022, which was two-and-a-half times the pre-covid total of 1,670.

This is a larger increase than the England-wide total, which has slightly less than doubled, probably due to the North West suffering more intense covid pressures than most other regions.

Lancashire and South Cumbria had the largest increase, with the numbers more than tripling to 965. L&SC does not benefit from a specialist cancer hospital, so perhaps had a bit less scope to maintain green pathways and protect its theatres. It also tends to have more severe staffing pressures.

The system’s cancer alliance also said there has been a strong recovery in referrals (which fell dramatically in 2020), which is good news for total diagnoses but does mean it’s been difficult to keep up with demand. It expects its 62-day treatment times to pick up pace later this year, once community diagnostic hubs and investments in endoscopy are up and running.

Cheshire and Mersey’s performance against the main national cancer targets, in terms of the proportion of cases treated on time, was the best in the region prior to covid, and still is.

But its backlog of delayed cases has almost tripled, reaching 1,574 at the end of June. Its cancer alliance, hosted by The Clatterbridge, also said there had been a heavy focus on faster diagnosis, with five community diagnostic hubs already established, and another four on the way. 

There was also an impression during covid of a lack of collaboration between key provider trusts in Liverpool, where the majority of services are provided. This was one of the drivers for NHS England asking for a review of the city’s provider configuration.

By contrast, much has been made of Greater Manchester’s efforts to pool resources and provide mutual aid across its hospitals, with The Christie able to provide crucial “green” pathways, but also coordinating the efforts to protect surgical theatres and maximise activity.

The new backlog total for GM suggests this has made a difference, because despite higher-than-average covid pressures, it only doubled, roughly in line with the national rise. 

Review of potential harms

A new concern around cancer pathways has been discovered at Liverpool University Hospitals in the last month, with an “administrative system issue” creating significant risk for hundreds of patients.

In a report to the board this month, chief executive James Sumner said around 1,800 patients on the two-week urgent referral pathway who had not attended their first appointment had not automatically been rebooked – as per national guidance.

In around 12 per cent of the cases, this has not been communicated to their referring GP, which poses a risk that patients will simply be forgotten.

A review has commenced to establish whether patients still require appointments and have suffered harm, while the Care Quality Commission and NHSE have been informed. The cases cover a range of tumour groups and the reviews are likely to take six weeks.

Jim Gardner, executive medical director, said: “We have a team of experts, including colleagues from the Cheshire and Merseyside Cancer Alliance, working rapidly to review the cases. We will contact all patients who require a follow-up appointment directly.

“We take all safety incidents seriously and we are extremely sorry for the concern this will cause our patients and their families.”

At last…

In better news, the trust announced last week that it has finally received the keys to the new Royal Liverpool Hospital, and is set to move services across by the end of September. It has already been giving training sessions to staff to prepare for the new facilities.

The project has been delayed by several years due to the collapse of the main contractor, Carillion, and other construction issues.

Meanwhile, the trust is ploughing on with the mergers of several specialties between the new hospital and its Aintree site.

Breast surgery, kidney services, urology, and planned general surgery is all set to be consolidated at the new Royal, with vascular and emergency general surgery consolidated at Aintree.

Hopefully, some lessons have been learnt from the abandoned integration of gastroenterology departments.