ONCOLOGY
diagnostic centres for cancer, cardiac, respiratory and other conditions. For patients with suspected cancer, these should incorporate the rapid diagnostic centre service model.
l During recovery, triage tools should be used to prioritise patients according to the likelihood of having serious disease. FIT levels for patients with possible bowel cancer and NT-proBNP for heart failure are examples.
l Commissioners working with acute Trusts and pathology services should ensure that phlebotomy services are easily and safely accessible within the community six days a week.
l New diagnostic technologies should be rapidly evaluated – e.g. near-patient virus testing for COVID-19, advanced genomic technologies, artificial intelligence in imaging and endoscopy and wearables.
l CT scanning capacity should be expanded by 100% over the next five years to meet increasing demand and to match other developed countries. In the COVID-19 recovery phase, priority should be given to ensuring each acute site with an A&E has access to a minimum of two CT scanners so that patients known to be COVID-19 negative can be kept separate from those who are COVID-19 uncertain or COVID-19 positive. Other additional scanners should be deployed to community diagnostic hubs.
l MRI, PET-CT, plain X-ray equipment (including mobile X-ray equipment) and ultrasound and DEXA scanning equipment should, as a minimum, be expanded in line with growth rates prior to the pandemic and all imaging equipment older than 10 years should be replaced.
l Pathology and genomics equipment and facilities should be upgraded to facilitate the introduction of new technologies, to support COVID-19 testing and drive efficiency.
l There should be a major expansion in the imaging workforce – an additional 2,000 radiologists and 4,000 radiographers (including advanced practitioner radiographers, who undertake reporting) as well as other support staff and key ‘navigator’ roles. Additional training places should be provided for radiologists and radiographers and initiatives will be needed to meet demand, as well as expansion in assistant practitioner and support staff roles.
l There should be an increase in advanced practitioner radiographer roles, including for reporting of plain X-rays (to a minimum of 50%); and expansion of assistant practitioner roles to take on work currently undertaken by radiographers.
l Training academies for endoscopy should be established to enable expansion of
SEPTEMBER 2021
screening colonoscopy and back-filling of symptomatic colonoscopy. More specialist practitioners and endoscopy nurses will also be needed.
l Improving connectivity and digitisation across all aspects of diagnostics should be prioritised to drive efficiency, deliver seamless care across traditional boundaries and facilitate remote reporting.
Public Policy Projects
The patient – or more to the point, gaining their engagement – will also be central to recovery of services. Public Policy Projects (a global policy institute), in partnership with MSD (which develops medicines and vaccines for many of the world’s most challenging diseases), have also outlined a series of recommendations to not only improve oncology services, in response to the pandemic, but to address longstanding issues, such as poor waiting times and sub-standard survival rates by international standards.
How to re-engage patients with cancer pathways5
states that NHS England’s “fine ambition of diagnosing 75% of cancers by 2028 is not on track to be delivered, with early diagnosis hovering at around 55% for several years”. It states that the UK is “severely compromised” by a chronic shortage of diagnostic capacity, with much of the current equipment being obsolete. The report also finds stark variations in regional performance across the country and describes the state of UK cancer care as a “postcode lottery.”
Analysis of 2017/18 data by the National Audit Office of the percentage of patients treated within 62 days of a GP referral revealed that the performance of clinical commissioning groups varied from 59% to 93%, against a standard of 85%. The report strongly recommends that integrated care systems (ICSs) be given greater responsibility
for cancer services in their area. A key recommendation of the report is to ensure the NHS takes steps to restore public confidence on the safety of cancer services by publishing steps to ensure they are COVID-free. Concerns about catching COVID became intertwined with pressure to “protect the NHS” and fear of contracting COVID led many patients to postpone seeking help or to miss appointments. This issue was compounded a lack of trust in Government information, where mixed messages only served to add to the confusion. Marginal gains will not be enough to
restore services to pre-pandemic level and the report says that “the aim must be to finally deliver world-class cancer care through service transformation”. The report calls for strengthening of the relationship with key cancer charities, many of which have suffered from heavy funding cuts over the past year, a close examination as to the benefits of remote cancer care, the immediate reopening of cancer treatment trials to deliver potentially lifesaving treatments to patients and recommends that real-time data be harnessed to revolutionise service.
In summary, the PPP report has identified the following key recommendations: l A long-term funding plan for capital investment and workforce for next CSR to facilitate major scale up of UK cancer service capacity.
l Strategy to transform diagnostic services proposed by Professor Sir Mike Richards must be implemented as quickly as possible.
l Unacceptable variations in regional performance must be addressed through targeted measures and ICSs need clear responsibility for driving service improvements.
l Cancer services must be delivered at COVID safe hubs and public confidence
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