Last Tuesday (28th March) I was horrified to wake up to the beeping sounds of the Macmillan Cancer Centre chemotherapy unit played on Radio 4’s Today programme. I was due to go for a consultant appointment there that very day to discuss my current cancer situation and was expecting to be referred for more chemo. I did not want to be reminded of the three tones of the chemotherapy infusion pump! The presenter Nick Robinson was talking about the upcoming NHS’s Five Year Forward View due out on 31st March and was meeting patients at the Macmillan Cancer Centre where he had also been treated a while ago. It must have been scary for him too.
He was discussing why there was such a gap between the rate of cancer deaths in the UK compared with many other European countries such as the Netherlands, Germany and Belgium, and raised the importance of an early cancer diagnosis. A GP will arrange a speedy hospital consultation with an appropriate consultant for a patient with what are called ‘red flag’ symptoms (that is a lump in your breast, bleeding from your bowel). But, as Fran Woodard, Macmillan Cancer Support’s Policy and Impact Director, said, ‘For a patient with vague symptoms, for example weight loss, fatigue or abdominal pain, it’s harder to understand what type of cancer that might be. And at the moment what the system doesn’t do is to ensure that those patients with more difficult to diagnose symptoms get to the right type of cancer doctor at speed.’ Such patients can have several visits to the GP and then may do a circuit of various hospitals undergoing all sorts of tests and seeing a variety of consultants. Fran Woodard pointed out that ‘the evidence base is that we need to get tests at speed, diagnoses at speed, treatment at speed. That what impacts on survival.’
I’ve written about my own experience of this in my memoir Chasing Ghosts, where the GP thought I might have bowel cancer. It was only after ten weeks, many consultant visits and some very expensive tests at London’s Royal Free Hospital did the consultant think I might have a recurrence of my ovarian cancer. So off I went to University College Hospital, which specialises in this cancer, to start the whole diagnosis process again, including further consultations and a biopsy. Meanwhile my secondary liver tumour was growing at quite a fast rate.
In an attempt to save more lives the Five Year Forward View states that the NHS will roll out a new faster cancer diagnosis standard so that patients will get into the system and obtain a diagnosis within 28 days. This has potential to save many more lives. But as Nick Robinson pointed out will a new target really do anything when other NHS cancer targets are being missed? While targets are not the answer it makes sense that the real answer is to get people to the right specialist in the least possible time. The NHS is well aware that action to meet the target is more important than the target itself and therefore plans to set up ten new rapid Diagnostic and Assessment Centres which can rapidly mobilise the right type of diagnostic test, be it an endoscopy, CT scan etc. The results should go back to GPs within one week of referral and they will be able to refer patients to the appropriate consultant.
Back in 2014 I asked the Royal Free to look into what had happened to me. Instead of going through the complaints system I went straight to the Chair of the Trust. He called me in to investigate my case and apologised for the excessive delay. The hospital’s investigation was thorough and the thinking at that time was to explore options to get a faster diagnosis for patients such as me. However, I have no idea whether the Royal Free has since improved the time taken for cancer diagnosis.
I welcome the NHS Five Year Forward View. I only regret it comes too late for me.