London Eye: The best and worst cancer waits by ICB

In all the rush to change clinical commissioning groups into integrated care boards (or systems) it’ll be interesting to see which areas retain a proper focus on performance management.

Arguably CCGs didn’t hold much power to actually enforce anything but they could at least focus minds at a corporate level on safety problems.

Review after review has shown patient harm following normalisation of sub-optimal practice, practice that often began for understandable short-term reasons.

The latest leaked cancer data shows London doing well compared to other regions on cancer (you wouldn’t want to have cancer or suspected cancer in the Midlands, where you’re more than twice as likely to have a 104-day-plus wait).

North central London has the capital’s worst performance, with more than 4 per cent of its total waiting list having waited more than three months. Compare this with 1.6 per cent at London’s best performer, the south west. North west London, north east London and south east London are the second, third and fourth.

North central London’s population is more than 2.5 times more likely to experience a long wait than people in the south west of the capital:

North central London CCG’s last ever board papers noted an increase in clinical incidents of harm linked to long treatment delays (12 in quarter three compared to three in quarter one of 2021-22) and cited “capacity delays, complex diagnostic pathways and patient choice” as common breach causes, with urology, breast, skin and colorectal the worst tumour sites for performance.

The CCG said it still supported “an agreed light touch phased approach for breach and clinical harm reporting due to ongoing system pressures”.

Either this means ’we’re giving people a pass on reporting clinical harm because demand is so overwhelming’, or ’we’re giving people a pass on reporting clinical harm because the staff who would assess are too busy treating people’.

Both are very worrying and the latter would fit with documents sent to Guy’s and St Thomas’ Foundation Trust’s governors board about there not being the clinical staff available to re-prioritise people who might have been given the wrong prioritisation code.

NCL’s quality committee said despite the agreed “light touch” approach, the “low return rate in some providers is a significant concern… greater internal and commissioner scrutiny is required to ensure that no cases of clinical harm are missed”.

So not only is increased harm occurring because of cancer backlogs, but also, the committee recorded, only “some providers have robust breach and clinical harm governance processes in place” – some clearly do not.

SEL new chairs

Later than promised, but south east London’s acutes do now all have chairs announced, and they’re not all the same individual, as some in the sector had feared. 

Guy’s and St Thomas’ Foundation Trust and King’s College Hospital FTs are retaining the shared chair arrangement that was first foisted on KCH following their being put in special measures. KCH chief executive Clive Kay stressed in an HSJ interview the arrangement was being retained because it made for the best governance, rather than because his trust was in the same straits it was five years ago.

KCH is in a better place than when it was put into financial special measues but there’s still a lot to sort out there.

Long-serving Royal Marsden Foundation Trust chair Charles Alexander will be taking up the GSTT/KCH post later this year.

An international cancer specialist with large private income, the Marsden, is quite a different proposition from GSTT/KCH which between them run most of London’s specialist ECMO centres, do vast amounts of training and research as well as running fairly stricken general hospital services for large populations.

Both trusts will be implementing the very expensive Epic IT system in the near future and GSTT is undergoing a large-scale restructure, attempting to integrate the Royal Brompton and Harefield Foundation Trust in the face of capital shortages which cast significant doubt on its medium-term strategy of re-siting the Brompton from Chelsea to Waterloo.

One senior figure in the capital said they suspected that Mr Alexander, while much admired, was not someone who would drive a big modernisation programme in his new role.

London Eye was told there was some back-and-forth between GSTT/KCH in coming to agreement on the joint appointment, but that mostly there had been a pleasant surprise to all involved that their governing bodies were able to agree on the hire.

Down the road at Lewisham and Greenwich Trust, Croydon Health Services Trust chair Mike Bell will take over from SE13 long-server Val Davison. It seems unlikely that London NHS veteran Mr Bell will continue much beyond his current nine years in Croydon.

Notable that the progress made by Lewisham and Greenwich so far was highlighted by the incoming chair.