• Variation is shrinking but a large gap between the best and worst performing areas persists
  • More improvement seen in rates from worst performing CCGs
  • Barriers to early diagnosis exist in public perception and understanding as well as performance primary care
  • For all CCG data click here

The variation in the rates of cancers diagnosed in A&E departments across England is narrowing according to the latest data but some areas still have rates nearly double other parts of the country.

In 2012 the range between the clinical commissioning group with the most patients diagnosed with cancer in accident and emergency and the CCG with the fewest was 15 per cent, according to data published by Public Health England. Last year it was 12 per cent.

The rate for the best performing CCG has improved by less than 1 per cent since 2012, whereas the rate for the worst performing has come down by 4 per cent.

The proportion of cancers diagnosed in emergency departments is a proxy indicator for late stage diagnosis and lower survival rates, according to PHE.

It can also indicate poor performance in primary care, though research shows several other factors contribute to a high proportion of A&E diagnoses.

This month Prime Minister Theresa May announced early cancer diagnosis will be a key priority for the NHS over the next 10 years. By 2028, it will have increased the number of people diagnosed with early stage cancer by 50 per cent.

CCGs told HSJ a lack of awareness of the signs of cancer among patients, difficulty diagnosing some cancers early, high levels of social deprivation and smoking, and low uptake of screening programmes contributed to higher rates of emergency diagnoses.

Last year the worst performing CCG in England, Bradford City, reported 26 per cent of cancer patients were diagnosed in emergency departments. This was almost double the results from the best performing CCG, Surrey Downs.

Ian Fenwick, clinical lead for cancer at Bradford City, said the CCG was focussed on “improving screening services and encouraging higher uptake, diagnosing cancer earlier, and better support services for those who have been diagnosed with cancer.”

“We are working with West Yorkshire and Harrogate Health and Care Partnership to tackle cancer across the area, placing more emphasis on prevention by improving lifestyle choice and improving cancer treatment pathways.”

Research by the CCG in 2016 found barriers to early diagnosis included fear of receiving a cancer diagnosis, as well as poorly presented information and English not being a first language.

It has been among the 10 worst performing CCGs for four of the past six years. There are seven urban CCGs with diverse populations and high levels of deprivation that repeatedly appeared among the top 10 CCGs since 2012.

Leicester City has been in the top 10 for five of the past six years. Paul Danaher, the CCG’s cancer clinical lead, told HSJ the lack of progress on its emergency diagnosis rate needs special attention to find out if there are specific reasons behind it.

He said Leicester City is taking steps to improve cancer referral and diagnostic processes, as well as improve public awareness of cancer symptoms and increase uptake of national screening programmes.

Leicester City has high levels of deprivation and diversity “which can also present challenges in terms of making sure people are aware of signs and symptoms of cancer and are responsive to screening programmes,” a spokeswoman told HSJ.

A pilot lung screening programme in Manchester, cited by the prime minister, has had success in lowering the barriers to early diagnosis by delivering health checks and CT scans in supermarket car parks. 

Philip Crosbie of Manchester University and principal investigator on the Lung Health Check pilot told HSJ it offered a “one-stop-shop design so there aren’t multiple appointments”.

It proved highly effective at diagnosing cancers early. This is crucial for lung cancer because it is more likely to be symptomatic at a late and so incurable stage, Dr Crosbie added. “We can see this in the proportion of people diagnosed after an A&E admission [who are] right at the very end of the disease’s natural history.”