Cancer waiting times
Almost 45 per cent of red flag cancer patients in Northern Ireland were not treated in the recommended time at the end of 2020, with the latest figures showing an overall decrease in the number of cancer patients being treated within 62 days after an urgent GP referral.
Department of Health targets state that 95 per cent of urgent GP referrals for suspected cancer should be treated within 62 days. It is a target which has never been met in Northern Ireland. A pledge to develop a new strategy and implementation plan on cancer by December 2020 within the New Decade, New Approach agreement by December 2020 has still not happened and the extent of the challenge is highlighted in projections that rates of cancer in Northern Ireland are expected to rise by 43 per cent for men and by 40 per cent for women by 2026.
If the ministerial target of a 95 per cent rate were to be achieved, those in receipt of an urgent GP referral with suspected cancer would still have a one-in-20 chance of not being treated within the allotted 62 days; as things stood in December 2020, that likelihood was almost nine-in-20, just under 4.5 out of 10. 59.4 per cent of those given urgent GP referrals for suspected cancer were treated within 62 days in October, this rate dropped to 53.2 per cent in November before slightly rising to 55.3 per cent in December.
The figures, released in March by the Department of Health, survey cancer treatments over the months October-December 2020, and they show a widespread failure across all trust areas, as could be seen in over 60 per cent of patients being treated outside targeted times in the Northern Trust area in November. All five trust areas recorded failures to even approach the 95 per cent targets, rates achieved range from a low of 38.1 per cent in the Northern Trust area in November to a high of the Western Trust’s 71.7 per cent in October.
While it could be assumed in some quarters that this poor performance is related to the Covid-19 pandemic and the pressure it has placed on the health system, figures for December 2019 show that only the Northern Trust area suffered a decrease in the rate of referrals treated within 62 days from December 2019 to December 2020. In the other four trust areas, none of the final three months of 2020 had 62-day treatment rates as low as they had had in December 2019, pointing to this as an issue that far predates Covid-19.
The total number of patients who were treated following an urgent GP referral did, however, fall, possibly pointing to a reduction in those presenting with symptoms due to restrictions on GP visits. As well as this fall, trusts have cancelled surgeries for ‘red flag’ patients, with more than 4,000 procedures cancelled in 2020. December 2020’s number overall patients treated of 333 was a fall from the 387 and 377 of the preceding November and October respectively and an annual decrease from the 351 of December 2019 as well.
The December rate of 55.3 per cent meant that 184 people were treated within the target time while 333 in receipt of urgent GP referrals were treated in the month, meaning that 149 patients were treated outside of the target time. Of these 149 patients left to wait over 62 days for their treatment, over a third (50 or 35.6 per cent) were diagnosed with a urological cancer.
December 2020’s total of 333 people treated was the lowest of the second half of 2020, with only the 324 and 279 treated in June and May respectively lower throughout the entire year. The 184 treated within the 62-day target is, in raw numbers terms, an improvement on five months in 2020, with the 149 treated after 62 days lower than the amount in the same situation in six of 2020‘s months.
Further targets set in 2009 have also been missed, although by much smaller margins, but the fact still remains that an Executive recalled in part because of a health crisis and nursing strike has not broached health targets that are over a decade old upon its return. A ministerial target also set in 2009 stating 98 per cent of patients diagnosed with cancer should receive their first definitive treatment within 31 days of a decision to treat has also not been met.
Unlike the 62-day target, where failure was widespread across trust areas, a patient’s chances of having their treatment start on time does depend on where they are being treated. For instance, both the Belfast and Northern trusts recorded a monthly rate of less than 90 per cent once in the final three months of 2020 while the Western Trust’ lowest rare across the same time period was 97.9 per cent.
October saw 96.6 per cent of patients treated within 31 days, a rate which fell to 93.1 per cent in November and rose slightly to 93.4 per cent in December. This December rate was a slight decrease on the December 2019 rate of 93.7 per cent.
In real terms, this means that 795 people out of 823, 778 out of 836 and 740 out of 792 were treated within the target time in October, November, and December respectively. However, this leaves a total of 138 people not treated within the target time across the last three months of 2020.
9,677 people altogether were given a decision to treat in 2020, with 9,145 of them being treated within the target 31 days, leaving 532 people to be treated outside of target times. In the case of targets being achieved, patients given a decision to treat would have a one-in-50 chance of not being treated within 31 days, a rate that would have seen 194 people treated outside the 31-day target in 20202. However, this target has never been met and for the year 2020, those with cancer diagnoses had a slightly over one-in-20 chance of not receiving their first definitive treatment within the 31 days.
Missed opportunities for early diagnoses and treatment have become an unfortunate fact of life for cancer patients in Northern Ireland long before the pandemic; the Pathways to Diagnosis report published in 2020 found that one-fifth of the 46,068 cancer patients diagnosed from 2012-2016 were diagnosed through an emergency route, leaving a poor net survival rate at three years of just 23 per cent. Research by the Northern Ireland Cancer Registry, published in November 2020, did point to a specific issue arising from the squeeze placed on the health system by the pandemic.
The Registry said that 1,130 fewer cancers were diagnosed from March to September 2020 than in the same period in 2019, a 23 per cent decline, meaning that early detection chances will have been missed.
As the health service begins to recover from the damage wrought by the pandemic, Health Minister Robin Swann MLA will be aware that the problems in treating cancer are long-term and any exasperation caused by the pandemic is just that, exasperation of already existing issues. With the publication of the latest cancer waiting figures, Swann stated that the Cancer Recovery Plan, the strategy to rebuild and stabilise cancer services, is being finalised.
Further targets set in 2009 have also been missed, although by much smaller margins, but the fact still remains that an Executive recalled in part because of a health crisis and nursing strike has not broached health targets that are
Swann said the plan will “address the immediate issues in cancer services with the aim of getting us to a place where services are stronger than before” and that it will be “fully aligned with the priorities in the draft Northern Ireland Cancer Strategy”. While no definitive date for the plan’s publication has been announced as of yet, Swann has detailed that it will “increase capacity to address backlogs in screening, diagnostic and treatment services” and, along with expanded in-house capacity, “provide additional diagnostic and surgical capacity through the independent sector and other UK and Republic of Ireland providers”.
