Patients 'pressurised' into treatment to hit cancer target

A report into urological treatment across England from the Getting It Right First Time programme found that early treatment for the cancer, which often develops slowly, was a “common concern”.

The GIRFT report said some trusts “felt they had been forced to focus disproportionately on the ‘clock stop’ point of providing first treatment within 62 days of referral from primary care”.

The target had a similarly perverse effect for muscle invasive bladder cancer.

The report said there was often a long delay in getting people “definitive” treatment for the cancer, which can develop quickly, once a trust had met the target by “undertaking preliminary treatment”.

The team, led by consultant urologist Simon Harrison, recommended an overhaul of the waiting times standards to “identify how these adverse effects of a positive aim could be avoided”.

GIRFT is an NHS Improvement run programme to improve quality and efficiency in different clinical specialisms. The urology programme involved made visits to each of the 134 trusts providing urology services in the NHS.

While the review identified many positive developments in the field, fundamentally there was a workforce shortfall, lack of clear training for nurses and significant variation in outcomes.

There are roughly 750,000 episodes of care a year with some hospitals performing fewer than 200 urology procedures, others more than 10,000.

The report said: “For urology overall, the picture is positive, with large numbers of patients receiving effective and timely treatment. However, there are valid concerns within the speciality that certain pathways are not as effective as they should be; that, with an ageing population, patient numbers are set to grow faster than staff numbers, and that there is a small group of providers that are routinely struggling to meet key performance targets.”

The most recent referral to treatment time data, for April, showed that only 47 trusts met the national waiting times target for urology. While, 92 per cent of patients on an elective pathway are supposed to wait no more than 18 weeks for treatment. The April data showed six trusts where 30 per cent or more of patients had exceeded this limit.

These were Queen Elizabeth Hospital, King’s Lynn Foundation Trust, University Hospitals of the North Midlands Trust, Wye Valley Trust, Kettering General Hospital FT, Bradford Teaching Hospitals FT and Wirral University Hospital FT.

These trusts accounted for 11,300 of the 210,800 people waiting for urological treatment in April.

The report said it was important to note “just how demoralised the small number of providers that are constantly failing have become”.

It added: “Even while doing many things right from the process perspective, the sheer imbalance between patient numbers and available resources is proving almost insurmountable for these providers.

“With recruitment also a challenge, they are seeking additional support and have found little available.

“The network model is potentially part of an answer here; targeted support from programmes such as GIRFT is another.”

Urology area networks would help “build sustainable services”, the report said.

Dr Harrison said clinicians and managers had shown a willingness to look at their services “without rancour or defensiveness”. 

The Royal College of Surgeons welcomed the report, including proposals to enhance training for specialist urological nurses, physician associates and surgical care practitioners.