Over 100,000 Scotland patients in test backlog

Deeply concerning new figures released in Scotland show a backlog in the number of people waiting for diagnostic tests.

These latest figures show that around 101,000 patients in Scotland were waiting for a key diagnostic test at the end of December 2020, an increase of 15.3% on the same time last year.

Eight tests are considered in the Public Health Scotland report, including several that are relevant to the diagnosis of cancer.

The findings are set against a backdrop of severe NHS pressures due to the pandemic. It’s clear that urgent action has been needed to support cancer services – and this was acknowledged by the Scottish Government at the end of last year as part of its National Cancer Recovery Plan.

But the problems can’t all be attributed to COVID-19 service disruption.

The Scottish Government standard that no one should be waiting more than 6 weeks for a diagnostic test hasn’t been met since June 2010.

And while Cancer Research UK has been calling for action for many years to reduce the time people are waiting, progress remains slow, particularly when it comes to one of the main contributory factors – staff shortages.

To ensure that everyone gets the tests they need when they need them, we need to take a long-term view, to allow the time required to train and employ more of the health professionals involved in delivering and interpreting tests which can diagnose cancer.

Elections in Scotland

In the next few months, political parties in Scotland will be publishing their manifestos ahead of the Holyrood Elections which are likely on May 6th. It’s a chance for them to consider how they could make a tangible difference to improving cancer survival by committing to a clear plan to deliver the number and type of staff required over the next decade.

“It’s hard to see how things will improve significantly unless long-standing staff shortages are addressed as a priority,” said Kirsty Slack, Cancer Research UK’s public affairs manager in Scotland.

Alongside the historic issues that have resulted in people waiting too long to receive a test and diagnosis, the pandemic has undoubtedly hit cancer services hard.

This was established late last year when Public Health Scotland reported that 4,000 fewer people in Scotland had a “pathologically confirmed” cancer diagnosis (where the cancer is diagnosed using a sample of tissue) than would have been expected between March and June 2020.

Pandemic recovery

Shortly after it emerged there had been a significant drop in cancer diagnoses, the Scottish Government published its National Cancer Recovery Plan. It was the first government in the UK to set out how it was going to support cancer services to recover from the pandemic.

This plan is a positive step, setting out the Scottish Government’s actions to respond to COVID-19 in the context of cancer, redesigning and improving services over the next 2 and a half years. Included is an additional £17 million of funding for the health service, on top of an already committed £97.5m.

Over £5m will go towards improving the services that deliver diagnostic tests, with the lion’s share (£3 million) invested in the delivery of new Early Cancer Diagnostic Centres (ECDCs). These aim to create a fast-track service for those with a range of serious but non-specific symptoms, such as fatigue, weight loss and nausea which will be assessed and tested by a team of specialists during one visit.

But while the Recovery Plan recognises that the NHS workforce is under strain and proposes some positive actions to improve the situation in the short term, steps need to be taken to make sure Scotland’s NHS workforce is fit for the future.

These include:

• Assessing and being clear on where there are bottlenecks in the workforce, setting out how many staff are needed to address both current and future demand. This includes publishing staffing figures across core cancer related professions.
• Investing to recruit and retain staff in key disciplines.
• Exploring the potential to upskill staff to deliver elements of diagnostic tests. For example, considering where technical staff can be more involved in processes such as dissection in pathology, rather than relying on consultants for every step.
• Putting new digital innovations which can accelerate people’s diagnoses into practice. These can be simple solutions such as setting up digital networks allowing scans and other materials to be shared safely in an electronic way, rather than sending hard copies by post or courier. This can reduce the burden on clinicians in parts of the country where staffing shortages are more acute, as they can call on support from areas where the squeeze isn’t as severe.

“Early diagnosis followed by swift access to the most effective treatment can give patients the best possible chance of beating cancer,” adds Slack. “The staff shortfall needs to be fixed quickly. But, realistically, it takes a long time to train diagnostic professionals from scratch and so any strategy to address the issue needs to take this into account.”

In the meantime, it’s important that patients know the NHS is still open for business and staff are giving the best care they can. It’s essential that anyone who notices any changes to their body gets them checked out.

How to reduce waiting times is a complex issue and, as well as there not being enough skilled staff, we also need to see investment in kit to make the system more efficient. Staff are often reliant on outdated equipment and this can slow down how quickly patients receive their results.

In the 1970s, less than a quarter of people with cancer survived their cancer. But over the last 40 years, survival has doubled – today half will survive their disease.

Cancer Research UK’s ambition is to accelerate progress and see three-quarters of people surviving the disease within the next 20 years. Diagnosing more cancers earlier will be essential to achieving this ambition.

As we live longer lives, more of us will be diagnosed with cancer. So not only will the services dedicated to diagnosing cancer need to catch up now, continued improvements will be crucial if they’re to keep up with demand.