Clearing the decks in hospitals, in order to respond to the first wave of patients with Covid-19, has avoided the desperate scenes that were seen in hospitals in the north of Italy and in New York City, but has come at a cost.
The most acute has been the transfer of infected people from hospitals into care homes, without the precautions to avoid widespread outbreaks. This must never be allowed to happen again.
We now need to tackle the impact of the disruption to most of the rest of the non-emergency, daily work of the NHS – all those hundreds of thousands of people with life-threatening or disabling conditions whose diagnosis or treatment has been put on hold.
The Institute of Cancer Research has shone a light on the impact of delays in surgery for a range of common cancers, in terms of years of life lost, and that such delays have a greater impact for some tumours (bowel and bladder) than for others and allow cancer to progress so that more extensive (and costly) treatment is needed.
This should focus thoughts on prioritising certain areas of treatment, and take the opportunity to address some of the shortcomings that were present before the pandemic, including the delays to identifying cancer, from a combination of late presentation by patients and barriers to accessing primary care and bottlenecks at many stages of the diagnostic pathway due to lack of scanners and the people to operate them and reduced pathology laboratory capacity.
We need to make sure that our surgeons can work to their full capacity, by giving them access to the operating theatre time necessary to cope with their daily workload in NHS hospitals, rather than insisting this work be done in private hospitals; maintain the higher level of critical care beds so that patients no longer have their surgery cancelled because of lack of critical care capacity; redress the savage cuts to hospital bed numbers that mean that a surgeon’s patients are scattered through the hospital, so it takes much longer to find them and supervise the care they are receiving; and restore to surgeons the administrative and clerical support that has been withdrawn from them, so that they can devote their time to care of their patients. There may be up-front costs, but greater cost-effectiveness: saving money and saving lives.
We have shown that we can respond to one crisis, given the determination to do so. Let’s seize the opportunity to tackle the backlog of cancer treatment in a way that will deliver long-term improvements within our NHS.