‘Horrifying low’ Crisis over urgent breast cancer checks at hospital
❝ There is quite a lot to worry about. The thing I’m really worrying about is our breast cancer. That’s horrifying. NBT chairwoman Michele Romaine
THE number of suspected breast cancer patients referred to Southmead Hospital for urgent checks has plunged to a “horrifying” low, according to the NHS trust’s own chairwoman.
Fewer than one in six women who showed potential symptoms of the disease, such as a lump or pain, to their GP in March were seen by a specialist within two weeks as required.
Health chiefs are now asking hospitals as far as Taunton and Gloucester for help with appointments until the diagnosis crisis eases.
The main cause is “significant workforce issues”, combined with a rise in referrals and the continuation of infection prevention control measures because of the pandemic, which have left about 800 people stuck on the two-week symptomatic breast cancer waiting list.
It came to light at two meetings over the past week – the board of North Bristol NHS Trust (NBT), which runs Southmead’s breast care centre, and the governing body of Bristol, North Somerset and South Gloucestershire (BNSSG) CCG, which commissions the region’s health services – as they discussed monthly figures for waiting targets.
NBT chairwoman Michele Romaine told the board: “There is quite a lot to worry about.
“The thing I’m really worrying about is our breast cancer. That’s horrifying.
“I know the really solid work that’s going on to talk to people who are on this pathway and to triage them but it doesn’t take away from the fact if you are one of these patients, this is massively adding to the stress you are carrying around this.
“So I really want us to focus on what we are going to do about it.
“It’s about us understanding how much of it is driven by infection prevention control and how much of it is staffing issues or we’ve got behind the curve.”
A report to the board said only 15.2 per cent of symptomatic breast cancer patients referred to the trust in March were seen within a fortnight. The target is 93 per cent.
Interim chief operating officer Karen Brown said a “deep dive” was under way to fully understand the situation and turn it around.
“We are struggling to deliver activity within 14 days and in some situations we are struggling to deliver it within 28 days and that is not where we would want to be as an organisation,” she said.
She said Somerset, Wiltshire, Avon and Gloucestershire Cancer Alliance, which brings together clinical and managerial leaders from different hospitals, health trusts and social care organisations to improve local cancer services, were helping with a “capacity and demand piece of work”.
But she added the situation was unlikely to change any time soon.
Meanwhile, CCG governing body members, who met on Tuesday, agreed to ask hospital trusts outside BNSSG if they could take some of the referrals.
Medical director of clinical effectiveness Peter Brindle said: “NBT performance for two-week-wait breast symptoms is down to 15.2 per cent. You don’t need me to tell you that is very bad.
“The cause of it is due to monthon-month increase in referrals, catching up with some of the backlog we’ve had over Covid, but the main issue is around the workforce.
“There is a staffing issue with several vacancies of radiographers and two radiologists down, and a breast cancer consultant who used to do their own scanning has retired. So there are significant workforce issues.”
Dr Brindle said NBT was taking urgent steps to address the situation, with temporary mitigations including training up senior nurses to do other duties, drafting in locums and outsourcing some roles.
“But the long and short of it is about 10 days ago we had to send out a communications message to GP referrers that they should inform their patients they are referring to a two-week pathway for breast symptoms but they will not necessarily be seen within two weeks,” he said.
“In fact, it’s most unlikely they will be seen within two weeks and it may be up to three to four weeks.
“Clearly this is an extremely difficult situation.
“NBT is doing everything it can, its board has instigated a deep dive and the team is bringing that back to the board listing all the mitigations to give a clear and accurate timeline of when this will be resolved.”
Julie Boardman, GP representative for inner city and east Bristol, said some of the actions could just perpetuate the problem.
“With the shortage of radiologists and radiographers, the solution of using the independent sector more actually just shifts the problem,” Dr Boardman said.
“So there will be radiographers who currently work in the NHS who are moving to work in the independent sector which reduces the workforce in the NHS, so it doesn’t necessarily solve the problem using that sector more.
“And the same will happen with radiologists. If they are being asked to do more in the independent sector then they might be able to do less in the NHS because there is an absolutely huge international shortage, It’s not just a shortage in the UK.”
CCG chief executive Julia Ross said: “That may be true but I don’t think there is anywhere else whose numbers are quite as low as this.
“I accept there is a national shortage but this is beyond that.
“Could we commission this service from the RUH in Bath or from Taunton & Somerset or Gloucestershire (NHS trusts), at least for a period until we get stabilised again, because this does feel very unacceptable in terms of the level of performance.”
Members agreed that course of action and to receive an update at their next meeting in July.