Analysis: The areas struggling most with cancer targets

Clinical commissioning groups in Essex, Kent and Lincolnshire are disproportionately represented in the worst performers against the national 62 day target – and in many cases their performance has got worse over the past two and a half years.

The standard is for 85 per cent of patients to start treatment within two months of an urgent cancer referral. However, the worst performing areas were more than 20 percentage points below that figure in quarter two of this year.

CCGs covering populations in the South East account for 12 of the 20 worst performers nationally over the past 10 quarters. The most recent data is for quarter two of 2017-18.

• Explore the data for the last 10 quarters

Worst performing CCG areas against the 62 day target over the last 10 quarters

CCG	Average performance from Q1 2015-16 to Q2 2017-18
Thurrock	61.62%
Basildon and Brentwood	67.19%
Thanet	70.42%
North East Essex	71.26%
Ashford	71.29%
South Kent Coast	71.56%
South West Lincolnshire	71.60%
Canterbury and Coastal	71.96%
Lincolnshire East	72.83%
Hastings and Rother	72.87%
Barking and Dagenham	73.17%
Swale	73.40%
Stoke on Trent	74.19%
Havering	74.31%
Southend	74.36%
Mid Essex	74.41%
Redditch and Bromsgrove	74.65%
Lincolnshire West	74.80%
Greenwich	75.12%
South Worcestershire	75.28%

Worst performing CCG areas against the 62 day target in Q2

CCG	Performance in Q2 2017-18
Thurrock	61.32%
Ashford	63.49%
North East Lincolnshire	64.04%
East Staffordshire	64.77%
Hardwick	64.84%
South West Lincolnshire	66.67%
Lewisham	67.11%
Mansfield and Ashfield	67.69%
Lincolnshire East	68.06%
Swale	68.85%
Birmingham and South Central	68.94%
North East Essex	69.82%
Canterbury and Coastal	70.87%
Redditch and Bromsgrove	71.07%
Bexley	71.78%
Swindon	71.96%
North Lincolnshire	72.36%
Basildon and Brentwood	72.63%
Lincolnshire West	72.88%
Corby	72.97%

Over the 10 quarter period for which data is available – beginning in quarter one of 2015-16 – Thurrock CCG and Basildon and Brentwood CCG had the lowest average performance at 62 and 67 per cent respectively. Thurrock also had the worst performance in the country in quarter two of 2017-18 at 61 per cent.

Leaders at the two CCGs blamed the performance on issues at their main provider Basildon and Thurrock University Hospitals Foundation Trust.

In a joint statement, the CCGs said the trust had let overall waiting times slip while it tried to address a backlog of long waiters.

It said: “Both Thurrock CCG and Basildon and Brentwood CCG acknowledge that cancer performance is below the required constitutional standard. The CCGs have been working with our system partners across the Mid and South Essex sustainability and transformation partnership, particularly our acute trusts and cancer alliance, to improve cancer performance at the three STP hospitals including our local hospital, Basildon and Thurrock University Hospital FT.”

The CCGs added that the trust aimed to hit the target by April.

The 20 worst performing CCGs over the 10 quarters also included Southend and Mid Essex CCGs, the main providers for which are currently exploring a merger with Basildon and Thurrock University Hospitals. Southend University Hospital FT and Mid Essex Hospital Services Trust are currently in a “group model” with the other trust.

Basildon and Thurrock said it had reduced the number of patients waiting more than 62 days from 200 to around 80. It said harm reviews were being carried out.

A trust spokeswoman said: “It must be recognised that most of the patients were not waiting for a cancer treatment but were undergoing tests to determine a diagnosis. Most of these patients did not have cancer.

“Some of the actions we have taken to achieve this include: a weekly review of all patients on a suspected cancer pathway to expedite next steps; the introduction of a number of one stop and straight to diagnostic pathways, including for patients with suspected lung cancer, allowing decisions to be made sooner; increased diagnostic capacity; and calling all patients regarding their appointment date rather than sending letters, which has reduced the number of rebooked appointments.”

North East Essex CCG was the fourth worst performer over the 10 quarters and its 2017-18 quarter two performance was below 70 per cent.

The CCG said its local trust, Colchester University Hospitals FT, had decommissioned dermatology work and the service was now provided by a different provider. Since July, dermatology services in the area have been provided by private firm Community Outpatients, which won a five year block contract. The contract is worth £2.5m a year.

The CCG said: “Improvement plans have addressed underlying cultural and process management issues throughout the trust and we have seen a steady sustained improvement in operational delivery during this time.

“Therefore, when there have been downturns in performance we are able to attribute this to specific reasons, for example, at the end of quarter three in 2016-17 the trust had an operational issue relating to histology reporting, which impacted performance into quarter four. This was a one off issue that was quickly resolved but it affected every tumour site and this had a detrimental impact on performance.”

A spokesman for the Kent CCGs said retention of clinicians and insufficient diagnostic services, such as MRI scanners, drove the poor performance in that county.

He said: “We are working hard to overcome these barriers; an ongoing recruitment strategy is in place and a new MRI scanner has recently become operational.”

Maidstone and Tunbridge Wells Trust is lead provider for cancer services across east Kent, with the Kent Oncology Centre based at the hospital.

Two of the 20 worst performing CCGs over the three years were on the London/Essex border. Barking and Dagenham and Havering had average performances of 73 and 74 per cent respectively.

Although both also missed the 85 per cent target in quarter two of 2017-18, they saw significant increases in performance year on year.

A spokeswoman for the UCLH Cancer Collaborative, which the CCGs are part of, said: “There has been a 9 per cent increase (443 additional patients) in the number of cancer patients living in north central and east London receiving their first cancer treatment here in the last year. This growth in demand has come during a period of significant financial constraint across the NHS.

“We are working hard as a region with hospitals, primary care, regulators and commissioners to make sure that people with cancer are being treated within 62 days from urgent referral.

“The significant improvement in both Barking and Dagenham and Havering is the result of sustained and significant work at every level of the health system in those areas, and in the specialist centres to which their patients are referred.

“We do, however, recognise that there is more to do to reduce waiting times for cancer patients, particularly for patients where their treatment pathway spans multiple hospitals and requires complex diagnostics.”

A spokeswoman for NHS England said: ”Last year over 1.7mn people were urgently referred by their GP - half a million more than three years ago - and latest data shows record numbers receiving first treatment for cancer following an urgent GP referral.

”NHS England is working with NHS Improvement to put additional support into the system to meet the cancer waiting times standard and Cancer Alliances are also working to support improvements to help manage demand and capacity more appropriately.”