Trust ordered to review 62 day cancer target slump

Maidstone and Tunbridge Wells Trust has been told its underperformance has “triggered both regional and national scrutiny.”

The trust, which provides many of the cancer services in Kent, has not consistently met the 62 day standard since 2013 and has seen performance steadily decline since. The standard requires 85 per cent of cancer patients referred as urgent to have started treatment within 62 days.

A letter from the regional office of NHS Improvement says the trust’s May performance puts it in the worst five performing trusts nationally and leaves it 19.1 per cent behind its improvement trajectory.

“As a cancer centre, this level of performance is unacceptable, particularly given the assurances that NHS Improvement have received relating to the deliverability of the cancer recovery plan you submitted in April 2018,” Claudia Griffith, regional chief operating officer for the south wrote.

She added that assurances from the executive team that improved delivery against the standard is a “high priority” was not reflected in the board minutes.

At the end of May, the trust had 56 patients with a confirmed diagnosis of cancer who had been waiting more than 62 days to start treatment. It had 42 patients – some with a diagnosis, some who were suspected of having cancer but had not had this confirmed – who had been waiting more than 104 days.

The number of 62 day waiters has now declined slightly to 52 but the 104 day waiters have increased to 62.

The trust has now been told to prepare a report for national cancer director Cally Palmer, to detail the process for clinical harm review for all patients waiting a “prolonged” time and to have weekly oversight meetings with NHS Improvement to monitor improvements. The trust says its clinical harm reviews carried out since receiving the letter in mid July have not shown any patients coming to harm.

Increased demand for outpatient appointments within two weeks and a reduction in capacity between January and March have impacted on waits, according to trust board papers.

Part of this drop in capacity was due to sudden middle grade vacancies with 60 per cent of posts being vacant – but many patients were unable to attend appointments due to heavy snow at the end of February and early March. This has meant that a decision to treat is now taken over 50 days after the patient is first referred – compared with 40 in 2013-14.

Urology, haematology, head and neck, GI and breast patients are most likely to face waits over 62 days. The trust has seen increased two week referrals for many of these tumour sites over the last year.

A trust spokesman said it was an “absolute priority” to get back to the national standard of 85 per cent for 62 day waits. “Providing timely, high quality care to our patients is imperative and we have a robust, joint action plan in place with West Kent CCG to improve performance as quickly as possible. We are undertaking additional clinical reviews of patients to make sure they are receiving appropriate and high standards of care during this period.

“We have appointed additional nursing and administration posts to manage a straight to test model for suspected colorectal cancers and also a new approach to annual follow up appointments for breast cancer patients.

“Our priority focus is to recover the lost ground on meeting the national standard and to ensure patients have access to high quality treatment and the care they need.”

The trust is a cancer centre, providing cancer surgery for its catchment area, oncologists who supervise chemotherapy services across Kent and Medway, and is the only commissioned provider of radiotherapy services for the county.