Twenty four hospitals breach waiting times for bowel cancer tests

Twenty four hospitals in the North of England and Yorkshire and the Humber do not meet the NHS standard of less than 1 per cent of patients waiting more than six weeks for tests that could diagnose bowel cancer.
Scunthorpe General HospitalScunthorpe General Hospital
Scunthorpe General Hospital

In one hospital in the region, 25 percent of patients are waiting beyond the six week waiting time target.

Figures released last week by NHS England for February 2017 reveal that nearly 2,000 people in England are waiting longer than the six week target set by the Government. The two key tests to diagnose bowel cancer are colonoscopy and flexible sigmoidoscopy – a camera on a thin, flexible cable inserted through the anus to look at different parts of the bowel. These tests are known as endoscopy procedures.

The three hospitals with some of the highest percentage of patients waiting more than six weeks for colonoscopy appointments are: Central Manchester University Hospitals NHS Foundation Trust (21%), Northern Lincolnshire and Goole NHS Foundation Trust (20%), Mid Yorkshire Hospitals NHS Trust (13%).

The two hospitals with some of the highest percentage of patients waiting more than six weeks for flexible sigmoidoscopy appointments are: Mid Yorkshire Hospitals NHS Trust (25%) and Northern Lincolnshire and Goole NHS Foundation Trust (13%).

More than 15,900 people die from bowel cancer every year in the UK; it’s the nation’s second biggest cancer killer and the fourth most common cancer. However it shouldn’t be. It’s treatable and curable, especially if diagnosed early.

These tests can detect cancer at the earliest stage of the disease, when it is more treatable, and even prevents cancer through the removal of pre-cancerous growths (polyps) during the procedures. Nearly everyone diagnosed at the earliest stage of bowel cancer will survive but this drops significantly as the disease develops, so getting timely access to these tests is vital.

Increasing demand for these tests and a lack of capacity in hospitals is the root cause of long waiting times for appointments. The demand for colonoscopy and flexible sigmoidoscopy has been increasing dramatically over the last few years – a trend that is set to continue. It is estimated that nearly a million more of these procedures in England alone will be needed year on year to meet this increasing demand. This is due to a number of factors including an ageing population and increase in symptom awareness.

The high demand and lack of capacity for endoscopy is impacting the Government’s pledge to deliver what they’ve already committed to:

* Delivering the NHS bowel scope screening programme to people aged 55

* Introducing the Faecal Immunochemical test (FIT) to the screening programmes in England replacing the current Faecal Occult Blood (FOB) test that is used. As this is a test that can be adjusted to make it more or less accurate at detecting blood in the stool, it is essential that it is introduced at a level that reduces the amount of missed cancers and prevents cancer from developing. A lack of capacity at hospitals could prevent FIT being introduced at its most sensitive level as this will increase the number of people being referred for bowel cancer tests.

* Delivering the cancer strategy for England’s recommendations to improve earlier diagnosis and survival rates for bowel cancer by 2020.

The government have pledged to review the current demand for endoscopy services and develop an action plan by March 2017. Although they have published the review on current demand, the action plan has not. The government have also committed to spend £300 million on early diagnosis for cancer but it is not clear how the investment will be spent and whether endoscopy units will benefit from this.

Asha Kaur, Head of Policy at Bowel Cancer UK, says: “These figures are very disappointing. It is unacceptable that patients are being made to wait more than six weeks for endoscopy tests. How soon someone is seen determines how early a diagnosis can be made. We know that if diagnosed at the earliest stage more than 9 in 10 will survive for five years or more. However this drops significantly as the disease develops.

This substantial increase in demand is creating unprecedented pressure on hospitals that do not have adequate capacity to meet this demand. Trusts and CCGs need to work together to forecast future demand to ensure they have the capacity to meet this demand. The government also needs to invest to increase capacity to alleviate the pressure on hospitals so they can meet the NHS standard of less than one per cent waiting no more than six weeks for an appointment. They have already made some commitments to increase the capacity of endoscopy but they do not scratch the surface.

“Given the wide ranging impact that increasing demand and a lack of capacity is having on the ability to provide timely access to tests that can diagnose bowel cancer, the case for urgent investment is clear. Investing in early diagnosis services for bowel cancer is critical to ensuring endoscopy units has sufficient workforce and infrastructure to carry out tests and that all units are working as efficiently as possible.

“That’s why we are calling for a national endoscopy strategy and a training programme as a solution to the mounting pressure on endoscopy units. We hope to work with Government, NHS England and medical professions to ensure a sustainable endoscopy service that has the capacity to meet future demand.”