End 'patchwork care'

Published on Saturday 11 July 2009 20:00

BETSY Morrison from East Kilbride describes herself as "one of the lucky ones". Discovering a lump in her breast, she immediately feared the worst. She went straight to her GP. And there, she remarks, her luck came in.

"He saw me on the Tuesday, and got me booked into the hospital on the Thursday. I had a mammogram a week later."

Her sister-in-law was not so fortunate. "She had to wait for ever. I got my biopsy and my operation in the same week. She had to wait about two months between each stage."

The tales of the two women, both suffering from cancer, provide a telling example of the kind of patchwork care on offer across the NHS. As we reveal today, in a hospital by hospital breakdown of the waits being suffered by cancer patients, there are still hundreds across Scotland who are spending agonising weeks and months waiting for treatment to begin.

The problem of how to improve cancer care in the NHS in Scotland has been a bugbear for health chiefs for years, and has seen millions of pounds, and thousands of hours, poured into its solution. Successive health ministers in Edinburgh have acknowledged that cancer treatment is one of their biggest headaches. Finally, it seems, improvements are being made.

Last month, the Scottish government announced that a long-held target to treat "urgent" patients within 62 days of their GP's referral had been met for the first time. Standing before the Scottish Parliament, First Minister Alex Salmond declared he was "proud it has now been delivered under this administration".

The move means that patients presenting with cancer symptoms at their GP are now almost guaranteed to begin receiving treatment within two months. However, it is not the entire story.

The real picture only emerges in the distinction between "urgent" and "non-urgent" cases. Cancer sufferers who start their journey at their GPs fall into one of these two categories. Either the GP diagnoses obvious cancer symptoms and flags the patient up as "urgent" or decides they need a hospital check-up.

One GP explained: "Basically there are three types of patients we see. There are people who don't have anything wrong with them. Then there are people who are obviously extremely unwell. In the case of someone with cancer, you flag them up to get seen within two weeks."

The GP added: "Those cases are easy. The difficulty is with the third type: the ones you just aren't sure about. They are the ones who wait."

It is the "non-urgent" cases which are now an increasing cause for concern. The figures show just how many people are involved. In 2008, 9,585 patients were referred by GPs as "urgent" cases – and were seen quickly as a result. But the Scottish Government estimates that some 27,000 people are actually diagnosed with cancer every year. That suggests that the majority of cancer sufferers in Scotland are actually falling outside the "urgent" category.

Unlike the figures for "urgent" cases - which are published on the Scottish Government's website every three months - the waiting figures for all cancer patients in Scotland are not publicly available.

The data for 2008 made available to Scotland on Sunday shows up some shocking cases of patients. A patient with a urological cancer (most commonly prostate, kidney or testicular) waited 375 days after being referred from the GP before finally receiving treatment at the Western Infirmary in Edinburgh. Another patient with gastrointestinal cancer had to wait 332 days before being seen at Aberdeen Royal Infirmary. At the same hospital, a woman with breast cancer faced a wait of 172 days between GP referral and treatment.

The Scottish Government's own cancer care strategy paper declares that "waiting times are closely linked with increased anxiety and concern for patients and their families". So why are we waiting?

The Health Boards responsible provide similar reasons for the delays: cancer patients presenting at GP clinics may simply be slipping through the net. A spokeswoman for NHS Greater Glasgow explains: "A referral may have generic symptoms such as anaemia or heartburn with no underlying suspicion that cancer is present. The GP might therefore refer the patient as routine." GPs, who regularly come under criticism from hospital doctors for referring patients they needn't, simply don't pick up often difficult and hidden symptoms. Only later is the cancer diagnosis finally picked up.

Such an excuse might be understandable, say patient groups, were it not for the sheer length of the waits being faced. Even with improvements in recent years, Scotland still lags way behind England. Since January, all patients south of the Border have been assured an 18-week maximum wait from GP to hospital treatment. The most recent analysis showed a 97 per cent success rate. In Scotland, the hope is that the same target will be met by 2011. Ministers are also pledging that more of the current "non-urgent" cases will be seen within the 62-days limit by 2011. So can it be done?

Health Boards insist they are making progress. NHS Lanarkshire, to take one, argues that,

with its "urgent" referral rate up by 25 per cent since 2007, it is on track to improve further. Rosemary Lyness, director of acute services, is pledging to tighten up the referral process so that even patients deemed to carry a "suspicion" of cancer are red-flagged. She says: "We have now received our processes and are working with our colleagues in primary care to ensure that all patients with suspected cancer are seen quickly."

Health secretary Nicola Sturgeon is pressing for further improvements. But cancer specialists have long warned that the excessive political focus on "urgent" cases means that the more routine referrals will become slower.

For patients, action is demanded. Michael Summers of the Patients Association declares: "It is just scandalous that people are having to wait this long in the modern age. No part of the United Kingdom should have to suffer it. It's just totally, totally unacceptable".