The NHS is facing a post-coronavirus crisis in undiagnosed disease and increased waiting times for diagnostic tests and treatment, according to an analysis by the New Statesman.
When the pandemic hit the UK earlier this year, the government’s main initial objective was to prevent hospitals from becoming overwhelmed. Millions of non-urgent operations were cancelled to free up beds, and the public was asked to stay at home to protect the NHS.
This objective has, so far, been fulfilled. Only a couple of hospitals had to close their doors to new patients and the number of people dying in hospital in the past seven weeks has actually been lower than the five-year average.
The public took the request to stay home to heart, with A&E department attendances and emergency admissions to hospital both declining significantly.
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However, the shutting down of routine NHS services has caused waiting lists to grow and the fact that people avoided healthcare settings means that thousands who likely need treatment have not sought help during the crisis. Nearly 2.5m fewer diagnostic tests have been carried out than usual during the pandemic as capacity was reduced.
The figures, from NHS England, show that there has been a 45 per cent reduction in these routine tests across March to May relative to the five-year average, including a 50 per cent reduction in non-obstetric ultrasounds, a 62.6 per cent reduction in colonoscopies and a 67 per cent reduction in gastroscopies.
Despite a fall in the number of tests being carried out, the length of time people are having to wait for these tests is increasing dramatically, as NHS resources are directed elsewhere. As many as 571,459 people who had a test in May (58.5 per cent) had waited more than six weeks for it. This is a massive increase compared with the 43,230 people who had waited for this long in May 2019 (4.1 per cent).
Analysis by Cancer Research UK shows there has been a 44 per cent rise in patients waiting for tests to diagnose bowel, stomach, bladder and oesophageal cancer.
“We’re over the peak of the pandemic now, so it’s worrying there is an increasing number of patients whose lives are on pause while they wait for tests that could impact their chances of survival,” said Michelle Mitchell, Cancer Research UK’s chief executive.
“It’s crucial the government works closely with the NHS to ensure it has the staff and equipment it needs to get services back on track before this situation gets even worse. But part of the reason the number of tests has reduced so dramatically is that people are delaying seeking help if they are worried about symptoms. So it’s more important than ever that anyone who is concerned about a change to their body speaks to their GP as soon as possible.”
The rise of the “invisible” cancer patient is an area of particular concern, with nearly 11,000 fewer patients than normal starting cancer treatment during the coronavirus crisis. In the past five years, the average number of people starting cancer treatment in England in April and May was 47,600. However, in April and May 2020, just 36,800 did so.
This deficit is likely to be even bigger given that – for demographic reasons – the number of people starting cancer treatment every month tends to trend upwards.
This fall is a direct consequence of a big drop in the number of people getting referred to a specialist after being checked out by their GP for potential cancer symptoms.
As many as 145,000 fewer of these referrals took place in April and May as GP appointments fell.
Almost all hospital trusts saw a drop in the number of people being referred for cancer treatment but there was considerable variation in the scale of these drops.
Guy’s and St. Thomas’ Hospital Trust, which includes the hospital where Boris Johnson was treated for coronavirus, has seen the biggest drop in the country with 70.3 per cent fewer people referred to see a cancer specialist at the trust in April and May compared with 2019.
The Queen Elizabeth Hospital Trust in King’s Lynn saw a similar decrease, with 591 people seeing a cancer specialist in April and May 2020, down from 1,981 in the equivalent months of 2019. Despite a lower number of patients being referred, waiting times have soared with just 69.9 per cent starting treatment within two months of being referred to a specialist by their GP. This is a record low.
A study published last week in The Lancet Oncology journal found that up to 9,000 additional lives could be lost due to delays in cancer treatment with the situation becoming worse depending on the length of the delay to treatment.
The study’s authors said: “Our estimates suggest that, for many cancers, delays to treatment of two to six months will lead to a substantial proportion of patients with early-stage tumours progressing from having curable to incurable disease.
“Investment in expansion of capacity for NHS diagnostics and treatment is a priority if cancer services are to become more resilient to future extrinsic disruption, which could include additional waves of Covid-19.”
Measures have started to be introduced by the NHS to try combating this backlog, with some of the Nightingale hospitals to be converted into cancer testing centres.
The tricky part is to ensure this backlog is tackled in a way that protects patients from the spread of coronavirus. If a resurgence or second wave of coronavirus does arrive then the Nightingale hospitals may, once again, be needed to treat people affected by Covid-19.
The practicalities of keeping some hospitals Covid-free may become unworkable, reducing the health service’s capacity to conduct other procedures. In this scenario, the backlog in non-coronavirus care is likely to grow even bigger.
An NHS spokesperson said: “Despite responding rapidly to the coronavirus pandemic and the need to ensure over 100,000 patients could receive hospital care, NHS staff also provided more than five million urgent tests, checks and treatments during the peak of the virus.
“Local teams have made significant progress since May in bringing back services in a way that is safe for patients and staff, and updated guidance from NICE earlier this week, which reflects the continued decline in infections and the increased availability of testing, will help them now go further and faster.”