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News Article
NHS England to replace cancer targets
Patient Safety Learning posted a news article in News
The two-week wait cancer target should be scrapped and replaced with a different measure, as part of an overhaul of cancer standards, NHS England has said. After piloting a new measure which aims to see 75% of patients given the all-clear or a diagnosis within 28 days of referral, NHS England has recommended .The new “faster diagnosis target” would replace the current ‘two-week wait’ target, which is for 93% to have seen a specialist within two weeks, but not necessarily had a diagnosis. This proposal, and other changes to the way cancer waiting time targets are organised, will be consulted on until 6 April. The nine current cancer targets were created in 2000. The current headline measure along with the two-week wait — a two-month wait from urgent GP referral to first treatment — has not been hit since December 2015. The document containing the proposals said the current two-week standard saw some patients given an appointment at which no test was taken, purely to hit the target. For some suspected cancers, “many trusts… offer outpatient appointments to ensure they hit the target”, without improving diagnosis. The move to scrap the two-week wait was welcomed – with significant caveats — by Cancer Research UK Cancer Research UK chief executive Michelle Mitchell said: “The new Faster Diagnosis Standard is a more meaningful target than the current two-week wait that will hopefully improve early diagnosis. If all trusts met the 75 per cent target, it would be an improvement to where we are now. However, in the long-term to improve cancer survival, we’d like to see a 95 per cent target originally proposed in the 2015 cancer strategy in Sajid Javid’s upcoming 10-year plan for cancer. “We recognise the target was set lower because of a shortage of cancer specialists, critical to diagnosing cancer across the NHS. The government must provide the extra investment they have promised to grow the NHS workforce. Every moment of delay risks more people waiting for diagnosis and treatment.” Read full story (paywalled) Source: HSJ, 10 March 2022 -
Content ArticleIn this episode of The King's Fund podcast, host Helen McKenna speaks with Professor Dame Lesley Regan and Dr Janine Austin Clayton about women’s health journeys from start to finish. They explore why women can struggle to get medical professionals to listen to them and the impact this has on diagnosis and treatment, as well as the mental and physical effects on women themselves.
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Content ArticleLanguage barriers, reduced self-advocacy, lower health literacy and biased care may hinder the diagnostic process. This US study in BMJ Quality & Safety looks at patient-reported diagnostic errors, what contributes to them and the impact they have, and examines the differences between respondents with limited English-language health literacy or disadvantaged socioeconomic position, and their counterparts. The authors conclude that: interpreter access should be viewed as a diagnostic safety imperative. social determinants affecting care access and affordability should be routinely addressed as part of the diagnostic process. patients and their families should be encouraged to access and update their medical records.
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Content ArticleTo mark Rare Disease Day 2022, the Department of Health and Social Care has published England’s first Rare Diseases Action Plan.
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News Article
Ovarian cancer symptoms are being ignored, UK charity warns
Patient Safety Learning posted a news article in News
GPs and women are still ignoring key symptoms of ovarian cancer despite better awareness of the disease, a charity has warned, prompting fears that yet more patients will be diagnosed late and “die needlessly”. Symptoms include frequently having a swollen tummy or feeling bloated; pain or tenderness in the tummy or the pelvis; having no appetite or feeling full quickly after eating, and an urgent need to pee or needing to pee more often, according to the NHS. However, Target Ovarian Cancer is concerned that despite successful campaigns to boost awareness of the disease, many are still failing to act on the vital signs. “Key symptoms are being ignored – both by those experiencing them and their GPs,” a spokesperson said. A poll of 1,000 women for the charity found 79% did not know that bloating was a symptom, while 68% were unaware abdominal pain was a sign, and 97% did not know feeling full was another. Most women (99%) did not know that needing to pee more urgently was also a sign, while evidence suggests women can often be told by their GP that their symptoms are more a symptom of irritable bowel syndrome (IBS), Target Ovarian Cancer said. Ovarian cancer kills about a third of women with the disease in the first year after diagnosis, and is often diagnosed in the late stages. There are about 7,500 new ovarian cancer cases in the UK every year. “These figures are incredibly disappointing,” said Annwen Jones, the chief executive of Target Ovarian Cancer. “We know we’ve shifted the dial in the past 10 years through the dedication of thousands of Target Ovarian Cancer’s campaigners, but it is not enough. Knowing the symptoms is crucial for everyone. “We need to make sustained and large-scale government-backed symptoms campaigns a reality. Progress is possible. If we do this, fewer people will be diagnosed late, fewer will need invasive treatment, and, ultimately, fewer will die needlessly from ovarian cancer.” Read full story Source: The Guardian, 22 February 2022 -
EventuntilCVDPREVENT will provide a foundation for professionally-led quality improvement in individual GP practices across Primary Care Networks (PCNs). It will support primary care in understanding how many patients with CVD and/or the six main high-risk conditions are potentially undiagnosed, or under or over treated. These include atrial fibrillation, high blood pressure, high cholesterol, diabetes, non-diabetic hyperglycaemia and chronic kidney disease. The audit will provide data to highlight gaps, identify inequalities, and opportunities for improvement. This event will be the first publicised presentation of the CVD publication, being presented live by Dr Pete Green, Clinical Lead CVD Prevent & Chair, Heart UK. This event has been sponsored by Daiichi Sankyo UK. This webinar is for Govconnect registered members who are UK healthcare professionals and allied personnel in commissioning, AHSN and health policy only. Speakers: Dr Yassir Javaid, Clinical Advisor for Cardiology, Royal College of GPs Dr Pete Green, Clinical Lead CVD Prevent & Chair, Heart UK Vishal Mashru, Head of Medicines & Research, Cross Counties & North Blaby PCN Dr Ravi Pawa, Country Medical Director, Daiichi Sankyo Register
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News ArticleThousands of men are being urged to check their risk of prostate cancer amid warnings that more than 14,000 have missed a diagnosis during the pandemic. New figures show that the disease accounts for a third of those not treated for cancer during the pandemic, making it the cancer most likely to have been missed and putting lives at risk. Experts said many men had held off visiting their GP which meant they could now be missing out on vital treatment. NHS figures suggest nearly 50,000 fewer cancer diagnoses across the UK in the Covid crisis, including 34,000 in England. Experts said prostate cancer made up the largest group of missed cases, followed by breast cancer, of which around 8,000 cases have gone undiagnosed. Prostate Cancer UK and NHS officials are urging men to use an online tool to assess their risk, with those found to be at high risk urged to then visit their GP. Read full story (paywalled) Source: The Telegraph, 17 February 2022
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News Article
Waits for diagnosis and decision rise to over 38 weeks
Patient Safety Learning posted a news article in News
Waiting times to diagnosis and decision rose by more than a week in December, reaching 38.6 weeks at month end. This matters because many urgent conditions are only detected when the patient reaches diagnosis, including nearly a quarter of all cancers, and such very long waits put those patients at risk. Looking at the whole referral-to-treatment waiting list, which includes patients who have a diagnosis and decision, waiting times remained roughly steady at 43.4 weeks, compared with the standard of 18 weeks that is still required by legislation. Waiting times are a function of both the size and shape of the waiting list, and in December the former got worse and the latter improved. There were 6,067,326 patients on the waiting list as December ended, which is the first time the official figures have topped six million. As many as 310,813 of them had waited over a year (strictly, 52 weeks), and 20,065 over two years (104 weeks). The NHS’s backlog recovery plan has committed that “By July 2022, no one will wait longer than two years for an elective treatment”. Read full story (paywalled) Source: HSJ, 10 February 2022 -
News ArticleTwo years of the pandemic have meant drops in essential screening and detection in Australia, while cancer patients undergo treatments alone and isolate to avoid Covid risks. When Claire Simpson turned 50 in early 2020, she received a letter telling her to get a mammogram. Then the pandemic hit, and Victoria went into lockdown. “Like many people, I put it off until we were coming out of that lockdown, but by then it was September and I couldn’t get an appointment until December,” she says. In February 2021 she was diagnosed with breast cancer and had a mastectomy. Tests showed she was positive for the aggressive HER2 receptor, so she began 12 weeks of chemotherapy as well as a treatment called Herceptin, which she received an IV infusion of every three weeks. Simpson says the delay in screening “really, really delayed diagnosis for me, by a good six months”. “I can’t help but feel that [an earlier screening] could have probably saved me from having to have chemotherapy and this Herceptin infusion therapy that I’m having,” she says. Her last Herceptin treatment was last Wednesday. She has been living in self-imposed lockdown, terrified as the Omicron wave built that she would have to isolate due to Covid and disrupt her treatment. That self-imposed isolation will continue until her final surgery, an elective operation scheduled for mid-year. Cancer screening dropped by 10% in Victoria alone in the first year of the pandemic. In 2021, referrals to the Peter MacCallum Cancer Centre, a leading treatment and research facility in Melbourne, were down 40%. “That is certainly going to bounce back at some point,” says Prof Sherene Loi, an oncologist and researcher at Peter MacCallum. “It is potentially going to be a real problem in a few years’ time. At the moment we have a lot of very young cancer diagnoses, a lot of breast cancer … we are just flat chat.” Read full Source: The Guardian, 13 February 2022
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Content ArticleDiagnosis lies at the heart of the medical encounter, yet it has received much less attention than treatment. It is widely assumed that negligent diagnosis claims should be governed by the Bolam test, but in this paper, Liddell et al. demonstrate that this is not always the case.
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News Article
People in England surviving cancer for longer, NHS reports
Patient Safety Learning posted a news article in News
Growing numbers of adults and children in England are surviving for longer after being diagnosed with cancer, with increases in lifespan seen in almost all types of the disease. Survival for one year and five years rose among adults diagnosed between 2015 and 2019 compared with those whose illness was identified between 2006 and 2010, NHS Digital reported. Survival is highest in adults who have melanoma of the skin, one of the main forms of skin cancer. Nine out of 10 men now survive for five years, as do almost 95% of women. However, survival remains stubbornly low for other forms of the disease, including pancreatic cancer and mesothelioma, which is mainly caused by prolonged exposure to asbestos. Just 6.3% of men and 7.8% of women who develop mesothelioma are still alive five years later. NHS Digital found that “in England one-year non-standardised net survival has improved, with patients diagnosed between 2015 and 2019 having a higher one-year survival than patients diagnosed between 2006 and 2010. “This trend was seen for all cancers and both genders except for bladder cancer. The largest improvement was 1.6 percentage points on average per year for lung cancer in females.” Greater survival after five years “was seen for all cancers and both genders except for bladder cancer and colon cancer,” the NHS’s statistical arm added. “The largest improvement was myeloma in females, [which was up] 1.4 percentage points on average per year.” However, Anna Jewell, the chair of the Less Survivable Cancers Taskforce, warned that the chances of survival remained low for people with a number of some forms of the disease. “Although overall cancer survival rates have generally increased in the past decades, we are not seeing the same improvements in prognosis for patients diagnosed with less survivable cancers, including those of the lung, liver, brain, oesophagus, pancreas and stomach.” Read full story Source: The Guardian, 4 February 2022 -
News Article
Improving cancer care a huge challenge post-pandemic
Patient Safety Learning posted a news article in News
Improving cancer care will be a huge challenge, ministers are being warned as they promise a new 10-year strategy for England. Figures suggest there have been 34,000 fewer diagnoses since Covid hit - 50,000 if you include the whole UK. It risks an increasing number of late diagnoses which reduces the chances of survival, cancer charities said. It comes as the government is promising to invest in new technologies and equipment to spot cancer quicker. Health Secretary Sajid Javid said the new "war on cancer" strategy will be published later this year. "It will take a far-reaching look at how we want cancer care to be in 2032. Looking at all stages from prevention, to diagnosis, treatment and vaccines," he said. Mr Javid pointed out the NHS was already taking steps, including evaluating new blood tests to spot cancers early and opening a network of testing centres. Lynda Thomas, of Macmillan Cancer Support, said given the impact of the pandemic people with cancer needed "support more than ever". "We have been sounding the alarm for a long time," she added. But she said while improving diagnosis and treatment was crucial, it was like "building sandcastles while the tide comes" without extra staff to tackle the backlogs and demand for care. Read full story Source: BBC News, 4 February 2022 -
Content ArticleThis manual sets out the process for deciding how topics are identified, selected and routed for NICE guidance developed by the Centre for Health Technology Evaluation (CHTE). This includes diagnostics, highly specialised technologies, interventional procedures, medical technologies and technology appraisal guidance. See also NICE health technology evaluations: the manual.
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Content ArticleIn this primer for Patient Safety Network, the authors examine the issues surrounding diagnostic error and delay during the Covid-19 pandemic. They discuss the following issues: Biases in the diagnostic process - availability bias, anchoring bias, implicit biases Diagnostic testing for active SARS-CoV-2 Infection Clinical implications of diagnostic error
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EventThis Westminster Health Forum policy conference: will examine what is needed to improve diagnostic speed and outcomes. It will also be an opportunity to discuss the future outlook for medical device regulation in the wake of Brexit, with the MHRA having consulted on a more transparent and flexible approach. Further sessions look at supporting continued research and innovation, with the Government launching strategic and funding plans, including investment in modernising diagnostics as part of wider efforts to address waiting lists. Additional areas for discussion include: industry partnerships staff recruitment and retention learning from the response to COVID-19 opportunities for driving efficiencies. Keynote sessions with: Professor Sir Mark Caulfield, Professor of Clinical Pharmacology, Queen Mary University of London; Chief Executive Officer, Barts Life Sciences; and former Chief Scientist, Genomics England Dr Sarah Byron, Programme Director, Centre for Health Technology Evaluation, NICE Professor Louise Jones, Chair, Genomics and Reproductive Science Specialty Advisory Committee, Royal College of Pathologists; and Professor of Breast Pathology, Barts Cancer Institute Stephen Lee, Director, Diagnostics Regulation, Association of British Healthcare Industries Professor Michael Messenger, Principal Scientific Advisor for In Vitro Diagnostics, MHRA Doris-Ann Williams, Chief Executive, British In Vitro Diagnostics Association Register
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News Article
Family of Cornwall girl, 6, misled over cause of death, coroner finds
Patient Safety Learning posted a news article in News
A six-year-old girl thought to have died from sepsis was in fact suffering from a blood condition triggered by E coli infection, an inquest has found. Coco Rose Bradford was taken to the Royal Cornwall hospital in the summer of 2017 suffering from stomach problems and later transferred to the Bristol Royal hospital for children, where she died. The following year an independent review flagged up failings in her care in Cornwall and the Royal Cornwall hospitals trust apologised for how it had treated her. Her family were left with the belief she had died of sepsis and could have been saved if she had been given antibiotics. But on Friday, coroner Andrew Cox, sitting in Truro, found that Coco died from multiple organ failure caused by haemolytic uraemic syndrome (HUS). The inquest heard there is no proven treatment for HUS. Cox said Coco’s family had been misled over the sepsis diagnosis, which he said was deeply regrettable, adding: “As a matter of fact, I find Coco had overwhelming HUS, not overwhelming sepsis.” During the inquest, the court heard Coco’s family felt staff at the Cornish hospital were “dismissive, rude and arrogant” and did not take her condition seriously. Cox found that although staff had recognised the risk of HUS from the moment Coco was admitted, this was not clearly set out in a robust management plan. The coroner also said a lack of communication had made Coco “something of a hostage to fortune”. Read full story Source: The Guardian, 14 January 2022 -
EventuntilAt a time when deaths from coronary heart disease and stroke are markedly declining, despite the COVID-19 pandemic, deaths from heart failure are increasing. The management of this devastating long-term condition is estimated to account for 2% of the entire NHS budget, with 70% of this spent on acute hospital admissions. Both prevalence and incidence of heart failure increase steeply with increasing age and with deprivation but outcomes for patients are improved with earlier diagnosis and treatment. Join the King's Fund for this free online event, where we will consider how heart failure is a growing population health problem and the solutions to help overcome the challenges this condition presents. These include preventing the underlying causes of heart failure, as well as identifying risk factors for the condition, such as access to diagnosis, particularly for older people and those from more deprived communities. Register
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Content ArticlePancreatic cancer is the fifth most common cause of cancer death in the UK, with an annual incidence of nearly 9,600. On average, 23 people die each day from the disease. The UK has one of the worst survival rates in Europe, with average life expectancy on diagnosis just 4 to 6 months and a relative survival to 1 year of approximately 20%. Only 3% of people survive for 5 years or longer. This figure has not improved much in over 40 years, and it is not yet clear how the more recent trend of increased surgery and adjuvant chemotherapy will affect survival. There are often delays in access to diagnosis and treatment and this NICE guideline will help to improve this.
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Content ArticleProfessor Ahmet Fuat, North East and North Cumbria Cardiac Network Heart Failure Lead, shares how one tool is helping reduce the current pressures and deliver better outcomes for patients. NT-proBNP testing – a NICE recommended diagnostic tool – is being used to rule out heart failure in primary care. In the North East and North Cumbria, patients must have an NT-proBNP test to be referred for an echocardiogram. This mandated testing helps them to streamline the diagnosis journey for heart failure patients by confirming or ruling out heart failure at the earliest possible opportunity, and reducing unnecessary referrals for echos. For patients, this saves time and distress, and for GPs and Nurse Practitioners, which reduces the number of repeat visits these patients often need to make.
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Content Article
The less survivable cancers: symptoms and key facts
Patient Safety Learning posted an article in Cancers
Today, 11 January 2022, the Less Survivable Cancers Taskforce (LSCT) launches its first ever Less Survivable Cancers Awareness Day, to raise the profile of these cancers and to highlight the critical importance of early diagnosis in improving survival. -
News Article
Scotland: Cancers with low survival rate 'being detected too late'
Patient Safety Learning posted a news article in News
People with some of the deadliest forms of cancer are being diagnosed later than ever as a result of disruption to healthcare caused by the Covid pandemic, campaigners have warned. Stomach, lung, pancreatic, brain, stomach and oesophageal cancers have some of the poorest long-term survival rates and have always been disproportionately diagnosed late following an emergency hospital admission. However, campaigners are concerned that the poor prognoses for these patients have been exacerbated by factors such as a reluctance to attend A&E or bother GPs during the pandemic, and by bottlenecks in the numbers of patients waiting for tests such as CT scans or endoscopy. A drive to raise awareness of the symptoms for these cancers – which are not subject to any routine screening programmes – along with a push for more investment into research for treatments has been launched today to mark the first Less Survivable Cancers Awareness Day. Dawn Crosby, head of Scotland and Northern Ireland for Pancreatic Cancer UK and a member of the Less Survivable Cancers Taskforce, said: “We know that delays in diagnosis lead to much poorer outcomes for patients with these rapidly-advancing cancers. We also know the trauma associated with receiving a diagnosis in an emergency setting for both patients and families." “These cancers are currently difficult or impossible to treat at later stages and the time from diagnosis to death is often brutally short compared to more survivable cancers. “The situation is critical and has been exacerbated by the Covid-19 pandemic. The Taskforce is calling for a significant increase in research funding, as well as a commitment to increasing resources for early diagnosis for less survivable cancers so we can close the deadly cancer gap.” Read full story Source: The Herald, 11 January 2022 -
News Article
Swift action needed to prevent 'cancer catastrophe' as NHS fails to meet target
Patient Safety Learning posted a news article in News
Swift action is needed from the Scottish Government to prevent a “cancer catastrophe”, campaigners have claimed, as new figures showed the NHS has again failed to meet a key waiting times standard. Ministers have set the target of having 95% of patients begin treatment within 62 days of being referred for help because cancer is suspected. But the latest data showed another decline in performance against this in the period July to September, with only 83.1% beginning treatment in this timeframe – down from 84.1% in the previous quarter and below the 87.3% that was achieved in July to September last year. None of Scotland’s health boards met the goal of starting to treat patients within two months of referral – and nor was this target achieved for any cancer types. The latest figures from Public Health Scotland showed that in NHS Orkney, only two out of five (40%) of patients referred with an urgent suspicion of cancer began treatment within two months, the lowest rate in Scotland. And less than three quarters (71.8%) of those suspected of having bowel cancer began treatment within two days, compared to 76 per cent of those with cervical cancer, 91.5% of those with lung cancer and 92.7% of those with breast cancer. It comes as the number of people being referred to help increased by almost a third from the same time last year. Read full story Source: The Scotsman, 14 December 2021 -
Content ArticleWaiting is a feature of public healthcare systems but must be managed to avoid adverse impacts on patients. The NHS sets performance standards for waiting times for elective and cancer care. Its performance against these was deteriorating before the COVID-19 pandemic and has worsened since it began. Millions of patients’ care was disrupted, meaning backlogs increased. This report looks in detail at backlogs and waiting times for elective and cancer care in the NHS in England. It explains how the current increased backlogs and waiting times have arisen, including the impact of the COVID-19 pandemic. The report sets out: how waiting times performance for elective and cancer care are tracked in the NHS, and how long patients have been waiting relative to the performance standards; the causes of increasing longer waits before the pandemic and the disruption caused by the pandemic; and the steps the Department and NHSE&I have already taken to address the increasing backlogs and waiting times, and the constraints and challenges the NHS faces in making a full recovery.
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News ArticleThe NHS may be missing more than 9 million referrals, while patients face a “postcode lottery” for cancer treatment and routine operations, a parliament watchdog has warned. Millions of patients have either avoided or been unable to obtain healthcare during the pandemic leaving the NHS with a potential unknown backlog of operations, which could push the national waiting list to 12 million by 2025. A report from the government’s National Audit Office today also warned patients across England are facing a postcode lottery in terms of waits with some hospital waiting lists far larger than others following the pandemic. Eve Byrne, head of campaigns and public affairs, at Macmillan Cancer Support, said: “This report confirms what we hear day in, day out from people living with cancer. Chronic staffing shortages are already having a devastating impact on cancer patients, and we have major concerns that is only set to worsen without urgent action. She said the government’s plan to tackle operations backlog must be backed up by steps to ensure enough nurses staff. “Without these critical pieces of the puzzle, we risk increasing numbers of people facing later diagnoses, poorer care and potentially worse chances of survival. This has to change,” she added. Read full story Source: The Independent, 1 December 2021
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Content ArticleThis study in the journal Rheumatology looked at the experience and views of rheumatology patients and clinicians regarding telemedicine. The Covid-19 pandemic has forced a rapid transition towards telephone consultations, but there are still many research gaps in understanding the safety and acceptability of telemedicine.
