Up to 740,000 cancer cases needing urgent GP referrals could have been missed since first lockdown

NHS needs more beds, more staff or a different way of working the National Audit Office has said.

Rebecca Thomas
Health Correspondent
Wednesday 01 December 2021 09:29
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The NHS may be missing more than 9 million referrals, while patients face a “postcode lottery” for cancer treatment and routine operations, a parliament watchdog has warned.

Millions of patients have either avoided or been unable to obtain healthcare during the pandemic leaving the NHS with a potential unknown backlog of operations, which could push the national waiting list to 12 million by 2025.

A report from the government’s National Audit Office, on Wednesday also warned patients across England are facing a postcode lottery in terms of waits with some hospital waiting lists far larger than others following the pandemic.

The findings come ahead the government’s plan to tackle the NHS’ treatment and surgery backlog, which is expected to be published this week. In November the NHS recorded its highest ever waiting list at 5.8 million.

According to the NAO’s analysis NHS services in Birmingham and Solihull have racked up the longest waiting lists with 51 per cent of patients waiting more than 18 weeks, compared to 20 per cent in Surrey.

Birmingham and Solihull also had the worst for cancer waiting times according to the data, with 57 per cent waiting more than three months compared to Surrey, Kent and Cornwall.

The NAO said variations may reflect, differences in area such as poverty levels and rates of routine operations prior to March 2020, as well as the direct impact of the pandemic.

The findings come after NHS data in November revealed the number of patients waiting more than two years for treatment following a referral rose to a record 12,491.

The report also estimated there were between 240,000 and 740,000 “missing” urgent GP referrals for patients with suspected cancer between March 2020 and September 2021 and up to 60,000 patients missing first treatments during the same period.

The NAO warned: “The NHS was doing more work year-on-year before the-pandemic, but the demand for its services was increasing even faster. To keep pace, it would have needed either more beds and more staff or a different way of working, or most likely a combination of all three.”

When Covid-19 first hit England, the NHS rapidly agreed a deal with 27 private sector hospitals to carryout routine operations amid fears hospitals would be overwhelmed.

Under this national contract, during 2020-21, the NHS will have paid £2.1 billion to private sector providers under its in return for 3.3 million completed treatments, according to the NAO’s report.

Between March 2019 and February 2020 independent providers carried out eight per cent of routine operations for the NHS.

Following the pandemic the NAO said there was a “sharp” reduction in operations carried out by private sector hospitals in the initial stages of the pandemic but that this increased to pre-pandemic levels from June 2021.

It is not clear how many operations and treatments were expected to be carried out by private providers under the £2.1 billion contract, and NHS England has never officially released this information.

However, in November last year, the Health Service Journal reported just one third of capacity paid for by the NHS in private hospitals was used following the first pandemic wave.

Eve Byrne, head of campaigns and public affairs, at Macmillan Cancer Support, said: “This report confirms what we hear day in, day out from people living with cancer. Chronic staffing shortages are already having a devastating impact on cancer patients, and we have major concerns that is only set to worsen without urgent action.

She said the government’s plan to tackle operations backlog must be backed up by steps to ensure enough nurses staff.

“Without these critical pieces of the puzzle, we risk increasing numbers of people facing later diagnoses, poorer care and potentially worse chances of survival. This has to change,” she added.

As part of recommendations the NAO has said the government, NHS England and education body Health Education England, should develop a detailed plan to address shortages in the workforce over the next 12 months to three years.

The recommendation comes just after the government rejected an amendment to the Health and Care Bill by MP Jeremy Hunt which would have required the Secretary of State for Health and Care to publish independent assessments of NHS workforce gaps every two years.

Dr Tim Mitchell, vice president of the Royal College of Surgeons of England said: “The NHS faces huge challenges as staff continue to treat COVID-19 patients, while trying to reduce the vast waiting list for planned care.

He called for the government’s upcoming plan to include guidance on how it would set up “surgical hubs” and separate planned surgery from emergency care to allow for operations to continue safely during the pandemic.

The royal college vice president added: “Also we urge the government to amend the Health and Care Bill, to ensure there are independently verified assessments of workforce numbers. It will take investment both in surgical hubs and staff to bring waiting times down to acceptable levels.”

An NHS spokesperson said: “Treating more than half a million patients in hospital for Covid, as well as delivering a world-leading vaccination programme, has inevitably had an impact on some routine and non-urgent care, yet since the pandemic begun the NHS has performed millions of routine procedures and over 450,000 people have started treatment for cancer.

“NHS staff are now pulling out all the stops to recover elective activity levels, making good use of additional resources to open new surgical hubs and diagnostic centres, develop innovative ways of working and perform more operations, tests, checks and scans, so anyone who is concerned about their health should come forward so the NHS can help you.”

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