ONCOLOGY


The authors note that excess deaths


across all cancer care are likely to be much higher. They emphasise that they only look at four cancer types and focus on delayed diagnoses. Therefore, it doesn’t account for delayed or cancelled cancer treatments for those already diagnosed with cancer. The authors note several limitations including that they modelled the NHS as a whole despite variation across the country in terms of GP access, the burden of COVID-19, and the disruption to diagnostic services. They also note that the predicted survival of patients in 2020 will have slightly improved, while the proportions of patients presenting through different referral pathways has changed over time, which might affect the results.


‘COVID-protected’ safe spaces ‘COVID-protected’ safe spaces will be a crucial part of addressing the growing backlog and ensuring more people can safely receive treatment or be diagnosed quickly. However, Cancer Research UK points out that this will only be possible if all cancer patients and healthcare staff


– whether symptomatic or asymptomatic – are tested regularly for COVID-19. The charity has estimated that to test patients ahead of hospital appointments and cancer staff weekly, between 21,000 and 37,000 COVID-19 tests must be done each day across the UK. This means that doctors and nurses can care for their patients in a safe, ‘COVID-protected’ environment. Michelle Mitchell, Cancer Research UK’s chief executive, said: “The enormous strain COVID-19 has placed on cancer services is of great concern to us. The NHS has had to make very hard decisions to balance risk, and there have been some difficult discussions with patients about their safety and ability to continue treatment during this time. But we’re over the peak of the pandemic now, and cancer care is starting to get up and running again as ‘COVID- protected’ spaces are being set up. “To get cancer services back to normal levels while ensuring no one is put at risk, frequent testing of NHS staff and patients, including those without symptoms, is vital… The Government must work closely with the NHS to ramp up testing provision with rapid


results, as quickly as possible.” Professor Charles Swanton, Cancer


Research UK’s chief clinician, added: “We have seen the devastating impact this pandemic has had on both patients and NHS staff. Delays to diagnosis and treatment could mean that some cancers will become inoperable. Patients shouldn’t need to wait for this to be over before getting the treatment they need. We can create a safer environment for both staff and cancer patients if testing efforts ramp up quickly with test results delivered back within 24 hours or less. We know that carrying COVID-19 while asymptomatic or pre-symptomatic is a major concern where healthcare worker staff and patients can transmit infection. We need at least weekly testing of healthcare workers and elective admissions to protect patients and staff from future spread and hospital-related complications. Staff in hospitals around the country are working extremely hard and with more testing of staff and patients – with and without symptoms – we will have hospitals and centres protected from COVID-19 where patients can be treated safely.”


CSJ Resuming cancer services: ‘collaboration key’


Cross-organisational and multi-Trust collaboration could provide the key to safely resuming vital elective procedures, argues Keith Austin, CEO and founder of EMS Healthcare.


NHS Cancer Alliances, which bring together different Trusts to improve efficiencies in cancer diagnosis, treatment and care, are an excellent model for cross-organisational working. By bringing together multiple Trusts, resources can be shared and maximised, ultimately to improve uptake in cancer screenings based on local need. One of the key aims for 2019/20 is to deliver on all eight waiting time standards for cancer, by increasing capacity, encouraging collaboration and brokering agreements with suppliers to balance supply and demand across the cancer care system. For example, Cancer Alliances can arrange the use of a shared mobile screening unit across Trusts. It might be that different Trusts can access the unit on set days, or even that a single dedicated staffing team operates the unit, welcoming patients from multiple geographies. With waiting lists increasing – there are around 5,000 suspected cancer referrals per week by GPs into the secondary care system – the sharing of resources can help the NHS maximise testing and


NOVEMBER 2020


staffing capacity and provide additional testing space in a cost-effective manner. Individual Trusts have utilised mobile facilities to reduce waiting list pressures to great success before; for example, due to ageing endoscope reprocessing equipment across the University Hospitals of Leicester NHS Trust’s estates, its hospitals needed assurance that endoscopy departments could continue diagnostic services without disruption. The Trust commissioned a bespoke high-throughput mobile endoscope decontamination unit, which was placed onsite at Glenfield hospital. It increased capacity across the Trust and regional Alliance and helped to reduce the time for patients waiting for diagnostic tests for conditions including bowel cancer.


Additional hygiene measures will also pose a challenge to Trusts when resuming cancer screening procedures. Environments must be COVID secure – in the case of endoscopy departments for bowel cancer checks, ‘COVID minimised’. As well as extra cleaning and testing patients to ensure they aren’t currently infectious, these measures might even necessitate significant reconfiguration of wards to allow staff and patients to socially distance. Again, it will be most efficient for hospital departments to work collaboratively in these cases, to maximise staff and space available. Mobile medical units


can be adapted to meet COVID secure requirements; complete disinfection and fogging machines can be run at the end of each day, hand sanitisers and temperature testing can be provided throughout the unit, extra space for additional PPE storage can be provided, and facilities can be easily reconfigured so that social distancing is possible and patient flow is not interrupted from arrival to procedure to exit. It enables Trusts to upscale their physical space capacity quickly, flexibly and removes pressure from the existing hospital estate. Furthermore, these units can be


placed in hospital COVID ‘green zones’, or even self-contained in a non-hospital community setting, to reduce the risk of COVID-19 infection further. By taking screening procedures away from ‘red zones’, patients who may have otherwise been wary of attending appointments due to infection risk will be reassured that all measures are being taken to ensure their safety. While the NHS should not be expected to immediately bounce back to pre-COVID levels, it’s important for both public and private cross-organisational working as it gradually resumes non-COVID services. By maximising all available support, capacity could increase to help the health service handle growing waiting list levels and ensures we do not lose people to procedures initially impacted by the pandemic.


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