We are sure far too many of you have heard the dreaded phrase “We are tracking this patient who has been referred in as Urgent Suspicion of cancer”. It seems as cancer trackers we have a reputation for asking too many questions and it must sometimes feel as if we are constantly asking for outcomes and updates on patients. We ask for clinics, tests, treatments to be booked so patients can progress through from their referral, to diagnosis, to treatment as safely and as timely as possible. For each type of cancer we have developed a pathway that each patient should follow, unfortunately we only have 62 days to complete this pathway regardless of the intended treatment. This means that any delays can have a major effect on the next step in the patient’s pathway. We understand that everyone is busy and it must feel sometimes that we are jumping the queue or pushing in with patients, but we have a responsibility to ensure that all these patients are meeting this national target.
We track the cancer patients through the healthcare system from urgent suspicion of cancer referral (USOC) to first treatment and do our best to ensure we meet the Government standards of 62 days for a patient’s referral to treatment and 31 days from decision to treat to treatment. Please don’t stop reading, we understand Government standards/targets can be seen to be divisive or box ticking exercises but if it was your friend or relative that possibly had cancer wouldn’t you want them to be diagnosed and treated as quickly as possible. The Government has helpfully provided a diagram to illustrate this target
So do cancer waiting times really matter in the great scheme of things? The Government states that, “the links between specific waiting times targets and better outcomes in terms of long-term survival are generally unclear. However, there is no doubt that waiting times are closely linked with increased anxiety and concern for patients and their families”. At the last Scottish Election waiting times for cancer treatment were shown in opinion polls to be among the top 3 concerns of the Scottish voter so they certainly matter to the public.
Unusually for a NHS standard the majority of suspected cancer patients that we start to track will not have cancer and will not be reported to the Government. It is fantastic news for all concerned when a patient is found to not have cancer but and it is a very, very small “but” this can lead to questions of why are you tracking patients that don’t have cancer? It’s tricky to explain and it reminds us of Donald Rumsfeld’s infamous quote “Reports that say that something hasn’t happened are always interesting to me, because as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns — the ones we don’t know we don’t know”. Hopefully, we can do a better job of explaining it than Donald Rumsfeld but basically we have to track all patients referred as urgent suspicion of cancer from referral to either having the all clear after diagnostic tests or to first treatment i.e. we don’t know until test results are through if a patient has cancer but the clock for the standard has already started counting. Sorry we are beginning to sound like Mr. Rumsfeld but you get the idea, in our job it’s a mix of “known unknowns” and “unknown unknowns” which certainly keeps us on our toes. As you can see from the chart below we receive a lot of referrals that need tracking but not that many of them are cancers. Overall about 15% of the patients we track will have cancer so the key for successful cancer tracking is to identify those patients with cancer as early as possible.
As NHS employees we all want the best for our patients and we can do this by ensuring we have systems that deliver safe and timely patient appointments, results, clinic outcomes and treatments for everyone. NHS Dumfries and Galloway is a large organisation and the cancer standard is one of many standards. It can be tricky to keep abreast of the different targets and standards but we need everyone who is helping with a cancer patient’s pathway to be aware of the standard and that the Cancer Police will be continuing to track and progress patients. If we focus on delivering a quality patient focused service we will meet this standard and others as a matter of course and may be in the not too distant future there will be no need for the Cancer Police as we will always be reporting how standards and patient expectations have been surpassed.
The Cancer waiting times team are Christine McDowall, Barry Turner and Megan Thomson who all work at NHS Dumfries and Galloway.