Agenda item

[To receive a report on Cancer Services from the Royal Wolverhampton NHS Trust]. 

The Chief Executive of the Royal Wolverhampton NHS Trust stated that in his capacity as Chairman of the West Midland’s Cancer Alliance he had been asked to attend a meeting with the Health Minister later that day about the deteriorating position nationally.  The 62 day cancer target had not been hit since December 2015.  The Trust was in a difficult position, particularly in relation to some of the specialist services it offered and in robotic surgery.  The Queen Elizabeth and Heartlands Hospital in Birmingham were not fully utilising their robot.  The robot at Newcross Hospital in Wolverhampton was virtually at full capacity.  Some patients chose to wait longer for treatment, breaching the time standards themselves, so they could be operated on by a robot, rather than conventional surgery.

The Chief Executive of the Royal Wolverhampton NHS Trust commented that a particular issue at the present time was late tertiary referrals. 66% of tertiary referrals from the Black Country and beyond were coming in late.  Late was defined by the national cancer waiting times as being received after 38 days.  The fact that so many tertiary referrals were being received late meant it was increasingly difficult to meet the 62 day target.  The recovery action plan had originally been based on average referrals into the Trust of 1380 per month.  The figure had remained static for both 2016/17 and 2017/18.  For 2018/19 referrals had been averaging in excess of 1550 per month.  He did not believe that the numbers had reached a high peak and would fall down to previous levels.  The high number of referrals were causing physical capacity issues both with the machines and lack of staff to cope with the demand.  He believed that many of the staffing problems were down to not enough doctors being trained nationally over the last 15 years.  The pension tax cap also deterred some consultant medical staff from working overtime. 

The Chief Executive of the Royal Wolverhampton NHS Trust commented that there was a particular concern about the spike in referrals at speciality level.  The Breast Service had capacity to see 340 patients per month and ran additional lists at weekends to support short term increases.  This model had been sustainable in the past.  Referrals had reached 500 in the months of October, November and January.  Some positive news was that the five year survival rate for breast cancer was very good and was levelling up to European partners. 

The Chief Executive of the Royal Wolverhampton NHS Trust stated that the mobile machines the Trust were using were only operating at 60% efficiency.  They were costing £100,000 a week to run.  He required £14 million in capital funding for two static MRI machines. There was a huge problem with capital in the NHS, he had raised it with the Health Minister.  He had outsourced all non-cancer MRI work, to free up capacity for cancer services.  He cited as an example a person needing an MRI scan for their back, which would now be done at the Nuffield.  The Trust was using all of the available capacity in the private sector.  There were certain limitations to what the private sector could do as they did not have the intensive care back up facilities.  He was not prepared to send scan results oversees because the quality of work was not up to the high standard he expected, when it had been used in the past.  2,500 more doctors were in training, but it would take 12 years for this to have full effect.  The Scrutiny Officer asked about the financial impact of having to use the private sector for scans.  The Chief Executive of the Trust responded that the Trust was going to be £10 million in deficit at the end of the year, the Trust had not had a deficit in ten years.   

A Member of the Panel commented that she had been displeased with her husband’s standard of recent cancer treatment at Newcross Hospital.  Not knowing the appointment times long enough in advance had been particularly problematic.  Whilst accepting that the staff were working hard, she was critical of the communication between them.  The Chief Executive of the Royal Wolverhampton NHS Trust advised her to contact the Patient Advice Liaison Service (PALS) with any specific complaints.  Overall scheduling within cancer treatment services would improve in the next three weeks, after the service had received their new linear accelerator.

A Member of the Panel asked about patient pathways and at what stage they were informed about their life prospects.  Her concern was to ensure that patients received the right level of support at the appropriate time.  The Chief Executive of the Royal Wolverhampton NHS Trust commented that processes would vary depending on the nature of the cancer and the patient.  He suggested that Healthwatch representatives should come into the Trust to talk to the staff working in cancer treatment services about pathways and support.  The Panel requested that Healthwatch report back to the Panel, the information they obtained from the visit.  The Chief Executive commented that it was important to be mindful of the heavy workload and pressures staff were under.  Asking staff to continuously work overtime did not improve the service or communication, as efficiency would decrease.         

The Consultant in Public Health remarked that Public Health were aiming to increase the number of people undertaking cancer screening in the City.  The uptake of screening in Wolverhampton was low compared to other areas in the West Midlands.  There was a risk of putting even more pressure on cancer pathways, however this risk was outweighed by the fact that early diagnosis gave better outcomes for the patient and generally reduced overall treatment costs.  There was no doubt that prevention was better than cure.  The Chief Executive agreed with the Consultant in Public Health’s analysis.  There were some hard to reach people in some of the communities in Wolverhampton, who were presenting late with cancer symptoms and consequently had poorer outcomes. 

A Member of the Panel raised the point that the publicity about the importance of bowel screening needed to be improved.  The Consultant in Public Health reported that the NHS were changing bowel cancer screening to a single sample test, which he hoped would improve the uptake. The Chief Executive of the Royal Wolverhampton Trust stated that the Trust working collaboratively with Public Health needed to increase their efforts to improve cancer screening throughout the City.  There needed to be a hard-hitting message.  He suggested that there should be a new effort in about three months’ time, after he had put some more resources in place in cancer services.  He was acutely aware that Public Health had received significant cuts to their resources, which made it harder for there to be people pushing the message in communities.  The later people presented with cancer symptoms the more it cost the NHS.  Investment in cancer screening would change the financial profile of the NHS in the future.  The Consultant in Public Health agreed that there had been a reduction in their resources, but they did have an absolute resolve to improve cancer screening.  He was pleased that the Trust wanted to work with them to improve cancer screening rates, as it was an absolute priority for Public Health.  A Member of the Panel commented that cultural attitudes towards cancer screening needed to change to improve uptake.  The Director for Strategy and Transformation at the CCG commented that at a care home in Germany he had previously worked at, it had been a requirement to record the stools of the residents each day. 

The Director of Strategy and Transformation of the CCG stipulated that the referral rate from the primary sector had increased into cancer services, particularly for breast cancer.  He was happy to confirm that there was nothing to suggest that these had been inappropriate referrals.  The Chief Executive of the Royal Wolverhampton NHS Trust also confirmed that the referral rate had increased, which coincided with the confirmed cancer diagnosis rate, proving that they were not inappropriate referrals.