More than medicine
Our ideas for the Welsh Government Appendix - Coronavirus and cancer
Coronavirus and cancer During the coronavirus pandemic, we demonstrated that when decisions needed to be made quickly, they were. However, while we’re still enduring this crisis, we’re also entering another one – with pent up demand, curtailed capacity and delayed diagnosis setting a cancer time-bomb, ticking under the NHS. In this section we set out a number of ideas we think the current Welsh Government needs to tackle to ensure cancer services recover as quickly as possible. Squashing the cancer curve
The Welsh Government should
make full use of Rapid Diagnostic The early acute phase of the pandemic essentially turned the Centres as part of a bold and NHS into a coronavirus service, with all resources diverted to decisive plan to clear the backlog of the national crisis. Thankfully, we managed to avoid the NHS screening and treatment. being overwhelmed with COVID-19 cases. However, many other services such as cancer screening and treatment, were put into deep-freeze. Individuals stayed away from primary care, with the message to visit a GP if concerned by potential cancer symptoms lost, and sometimes ignored, amidst the panic surrounding COVID-19. The number of people entering the Single Cancer Pathway – for investigation of symptoms – collapsed in April 2020. The first full month post lockdown saw just 40% of the people seen during the pre-lockdown period. Although figures improved modestly in May, thousands of people who could have been expected to have been referred to the Single Cancer Pathway were not. For the months of April and May alone, this is the equivalent to an entire month’s worth of patients ‘missing’ over the space of two months. As of June 2020 there are an estimated 21,000 cancer referrals missing from the Single Cancer Pathway.50 As lockdown begins to ease, and people start to adjust to life with COVID-19, we sincerely hope that anyone worried about potential cancer symptoms, who put off going to the GPs during the lockdown, will now actively seek support. However, releasing this ‘pent up demand’ into an NHS that already had real capacity challenges for diagnostic services prior to lockdown, risks overwhelming the NHS with a new kind of peak – undiagnosed cancer. Lives not lived We all know that the later a person is diagnosed with cancer the worse their chances of survival. Yet 21,000 fewer people entered the Single Cancer Pathway between March and June 2020 than expected. These are thousands of people whose cancer could be diagnosed later, or not at all. We have prevented COVID-19 deaths, at the almost certain expense of lives lost from cancer further down the line. We have shifted deaths from one disease to another, and we need to be open and transparent about that.
50
Stats Wales, 2020. Cancer waiting times; monthly.
TheWelsh Government should commission research to estimate the increase in mortality from cancer that will be attributable to the pandemic and account for these deaths in any assessment of the impact of the COVID-19 crisis.
Data and transparency One of the great innovations during the COVID-19 crisis has been the use of the Tableau platform. This provides regular, interactive and accessible information regarding infections and deaths, to the general public. Public facing cancer informatics are currently spread between the WCISU database and Stats Wales, with significant interpretation required to make sense of the figures contained within.
The Welsh Government should upgrade and consolidate publicly facing informatics to a level that can be understood by everyone ensuring openness and transparency for all service users.
Communication, communication, communication. During the COVID-19 crisis we have seen a vast migration of services online. This is undoubtedly a welcome development, widening access for many and enabling the pooling of resources across the NHS. However, we must avoid falling into the trap of assuming that everyone has access to digital technologies.
The Welsh Government should secure gains made in enabling digital service delivery, including remote consultations, while ensuring the digital divide is closed.
As screening services restart, there is ground to make up. We already know that BAMER communities and other hard to reach groups engage less with screening services – and we can’t afford for them to fall even further behind in terms of health outcomes.
The Welsh Government should ramp up targeted interventions, to secure take up of screening among harder to reach communities.