COMMENT with DR REHAN HAIDRY
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Clearing backlogs in gastroenterology
Dr. Rehan Haidry, a consultant gastroenterologist and interventional endoscopist at University College Hospital and the Cleveland Clinic, reflects on events that have contributed to backlogs in gastroenterology and argues that the NHS must embrace a symbiotic relationship with private clinics to tackle the problem. The NHS has always been a public/private partnership and, over the past 20 years, independent sector healthcare providers (ISPs) have helped expand capacity by treating NHS patients. This symbiotic relationship has helped many patients but also allowed for shared learning for both healthcare systems. My specialism, gastroenterology and endoscopy, had long waiting lists even before the pandemic, and this partnership allowed around 20% of NHS funded treatments to be delivered by ISPs. Typically, this would be a mix of investigative endoscopies, screening endoscopic procedures and urgent cancer care to tackle already unmanageable NHS waiting lists. COVID-19 was the bittersweet catalyst for a phenomenal team effort, here in the UK, whereby 8,000 beds, 1,200 ventilators and 20,000 staff were made available by ISPs to the NHS at cost. But while surges in COVID-19 hospital admissions dominated the headlines, there was a more pervasive crisis happening; the backlog. The NHS waiting list has now, in 2022, swelled to around 7 million.
Data shows that the share of NHS treatments delivered by the independent sector has either stayed the same or increased in all specialties – except in gastroenterology. Here, it has shrunk in the past year. This is in part due to rising utilisation of the private sector (as many patients seek to use medical insurance or personal resources to fund earlier procedures due to long waiting lists), but also, to some extent, a move away from endoscopies (which ISPs tended to provide when needed) towards innovative and game-changing diagnostic tools – such as Cytosponge and Pill Cam: l The Cytosponge, known as ‘the sponge on a string’ is a highly accurate sampling tool which is swallowed and then pulled back retrieving an abundance of cells. It’s quicker and less labour intensive than endoscopy – and more accurate. It was pioneered at UCLH where our gastrointestinal nurses run the pathway. It is now standard of care across the NHS.
l Pill Cam gives is a very clever camera the patient swallows at home. It takes pictures to give the consultant a gullet to rectum view of the GI tract, in place of endoscopy and/or colonoscopy. It has revolutionised diagnostics at our department at UCLH since it was rolled out in March 2021.
The fast-tracking of technologies and innovations such as these, during the pandemic, was hugely positive. However, the number of gastroenterology treatments across the NHS and ISPs is not yet at pre-pandemic levels; 38% patients who need urgent cancer treatment will now wait more than 2 months. This is a particular concern for me as I work with one of the deadliest forms of cancer – oesophageal cancer – where treatment at stage 1 offers the very best chance of survival. Since May 2020, my colleagues and I, at UCLH, have been treating NHS patients who need urgent endoscopic oesophageal cancer treatment within private practice. The speed of referral has, in some cases, been life-changing for patients anxious to have treatment and likely to reduce the significant impact of disease progression of this nasty cancer.
About the author
Graham Johnson is managing director of BIOHIT HealthCare Ltd, based in North West England. It is the UK subsidiary of BIOHIT Oyj, a Finnish biotechnology company specialising in the development, manufacture and marketing of products and analysis systems for the early diagnosis and prevention of gastrointestinal diseases.
NOVEMBER 2022
In the ISP setting, we were able to provide a highly bespoke and minimally invasive technique called ESD (Endoscopic Submucosal Resection) to remove the cancers from the oesophagus – often as a day case. It is a testimony to our private healthcare partners that they are able to carry out these very specialised, novel procedures in the independent sector with the same safety and efficacy. As a result, we were able to ensure there was a dynamic throughput of these patients in the pandemic period and it has carried on now as referrals soar. However, this is not the situation across the UK and there are huge regional disparities. While the NHS is in a capacity crisis, there is much more capacity that can be utilised across ISPs’ gastroenterology clinics. I believe the NHS must commit that, if a cancer patient cannot be seen within two months to start treatment, then they are seen within private practice.
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