Tackling inequalities will be at the heart of the recovery and restoration of cancer services across our area, says Cancer Alliance Clinical Lead, Professor Sean Duffy, in his latest message to the West Yorkshire and Harrogate Health and Care Partnership
Once again, we have reached that point in the year when all eyes, ears and energies are focused on planning and priorities for the year ahead – working to national guidance but by building our plans ‘bottom up’ , with a focus on delivering at place what’s really important to local communies.
But as we all know, things are different this year as we look back on more than 12 months since the start of the pandemic, and look forward to restoration and recovery in the context of Covid against the backdrop of an ongoing mammoth vaccination programme.
We are grateful to all our colleagues in cancer services across West Yorkshire and Harrogate who have worked so hard to minimise the impact of Covid and to prioritise cancer care and treatment over the past year, in such extraordinary and challenging circumstances.
Clarity around what is expected during 2021/2022 has now been published by NHS England. We have an ambitious but achieveable work programme to deliver over the next 12 months and beyond.
Working alongside our colleagues in local places, will focus over the next six months on reducing the number of patients waiting more than 62 days, back to the levels they were at in February 2021. We will push for 75 per cent of patients to be told whether or not they have cancer within 28 days of a referral, in line with the new Faster Diagnosis Standard. The shortfall in first treatments will be addressed by March 2022.
These technologies will improve the diagnostic pathways not just for those who are have a positive cancer diagnosis, but also those who face an anxious wait before finding out that they do not.
NHS Plan priorities such as the restoration of the Targeted Lung Health Check programme, paused as the pandemic took hold, and the accelerated use of the Rapid Diagnostic Centre model in the most challenged pathways will also be high on our list of priorities.
Across the West Yorkshire and Harrogate system, we are working hard to reduce the numbers of patients who are waiting longer than they would have done had it not been for Covid. However, although waiting lists are an issue, they will not deter us from actively seeking out those people who have not yet come forward.
In line with the rest of the country, GP referrals across a number of tumour sites fell considerably in the first stages of the pandemic. Those numbers have been steadily increasing as the months have gone on, although we still have work to do in some specific areas, such as lung cancer.
Early diagnosis saves lives. With a focus on tackling inequalities, across tumour sites and across communities, we will look to boost the numbers of people who are informed and feel confident enough to talk to their GP if they have worrying signs and symptoms.
We will also encourage more people to take up their invitation for breast, bowel and cervical screening – particularly those in groups who the evidence shows are the least likely to take part in simple tests that help save lives.
Underpinned by the principle of ‘leaving no-one behind’, we are now looking beyond crude high level activity and backlog statistics so we can tackle the divisions and disproportionate impact that Covid has had on specific communities and particular cancer pathways.
Our dedicated analysts will now regularly present detailed breakdowns for consideration by our Cancer Alliance Board, to help ensure that our attention and resources – and those of our cancer colleagues in local places – can be focused where they are most needed, and can make the most difference.
As we reset and restore, we will be proactive in working with the affected communities, as well as the clinical and other members of our tumour site Optimal Pathway Groups, to tackle the inequalities that lead to compromised outcomes and poorer quality of life for those living with and beyond cancer.
In short, to coin a phrase, we will be driven by the data, alongside another critical factor –the voices of people affected by cancer, the experiences of patients needing to access care, treatment and support during the pandemic and beyond.
Over the last 12 months, we have continued to work alongside members of our Cancer Alliance community/patient panel – hosted in partnership with Healthwatch Wakefield - who have embraced digital technology with enthusiasm and still meet regularly to ensure our Alliance workstreams are informed by their experiences and views.
Mindful of the need to avoid digital exclusion, we also engage with individual panel members in other ways – by phone for example - to make sure that their experiences are not lost and they also have the opportunity to influence our work.
Recently, the panel have been informing the restoration of services system-wide by revisiting the insight report they produced in May/June 2020 about the barriers to accessing services during the pandemic and what is needed to build patient confidence.
These include the need to ensure cultural competence and sensitivity when people are asked to access a different hospital site to usual; recognition of the role of family members in delivering care to people from ethnic minority communities; the importance of connections across all tiers of care, and in particular, the need to look at patient experiences in primary care at a system level.
As a Partnership, we can draw upon our well-established commitment to collaboration and link with other priority programmes to ‘join the dots’ on these and other issues.
For example, our community/patient panel will work closely with the proposed Planned Care citizens’ panel to avoid duplication and ensure consistency. We are reviewing the role and remit of our Patient Experience Advisory Group to ensure we are achieving maximum influence and impact, particularly in terms of linkages with primary care.
The launch of our Cancer SMART programme, in partnership with Yorkshire Cancer Community – promoting the uptake of cancer screening; raising awareness of signs and symptoms and sharing prevention messages – enables us to achieve greater reach through the personal and professional contacts and networks across our area of our Cancer Champions and Digital Champions.
The graphics and content of three forthcoming campaigns to encourage uptake of bowel, breast and cervical screening are based on specific insight from people who have traditionally chosen not to take up their invitation.
We know that people with a learning disability experienced six times the COVID-related mortality of the general population, and the Cancer Alliance is keen to act to reduce health inequalities for this population group.
In December we worked with the Health and Care Partnership to produce and distribute a “Top Tips” document for patient-facing primary care staff. It contained key points of advice and resources around cancer issues – including screening - for patients with learning disabilities.
Our Healthy Communities Programme is working to improve collaboration between primary care and the bowel screening hub to offer more proactive support for people with learning disabilities to facilitate their participation in the bowel screening programme.
This week, after gathering insight and research about the barriers that cancer patients from ethnic minorities face in accessing health and wellbeing support, we brought together primary care teams and colleagues from the Third Sector to talk about how improved links between them could help overcome those barriers. We will now be looking to set up a pilot to take this work forward.
In driving this work, we are always conscious that our Cancer Alliance is the sum of its parts – all elements of our system that play a part in the experience of people affected by cancer. As we move forward into the ‘new world’ of innovation and integration as outlined in the White Paper, that connectivity will be more important than ever before.