As COVID-19 infections continue to increase at an unprecedented rate, and the UK enters the toughest phase of the pandemic so far, the National Health Service (NHS) finds itself under the most pressure seen in its 72-year history. With the majority of intensive care beds occupied by patients with COVID-19, Kings College Hospital in London was one of the first to take the drastic action to cancel urgent cancer surgeries. However, it is not alone, as other NHS hospitals in London, Manchester, Birmingham, Cambridge, Essex, Scotland, and Northern Ireland, to name just a few, have also started to cancel urgent cancer surgeries.
It would be prudent for the UK Health Secretary, Matt Hancock, to announce a regional approach to tackle cancelled surgeries in the various health trusts immediately. As some UK hospitals reach capacity, the implementation of an effective, centrally coordinated response from the NHS would be advantageous. Paramedics and other urgent care professionals are not uniformly empowered to refer patients to community or specialist services. Improving and connecting all referral pathways would help to facilitate an improved flow of patients to hospitals that are not yet at capacity.
In addition to the hundreds of cancer operations being cancelled as hospitals are inundated with patients with COVID-19, more than 3800 patients with cancer in London are already waiting beyond the 62-day target for their first cancer treatment, and more than 1000 individuals needing urgent cancer surgery do not yet have a date for their treatment. Estimates suggest that in London alone, more than 500 patients with cancer need to be treated per week to stay on top of demand, but most hospitals that were meant to remain COVID-19-free are now compromised. The Nightingale hospitals, set up across the UK to help provide care for the anticipated increases in patients with COVID-19, are still not fully operational. Despite the cancellation of urgent cancer surgery, they are now being earmarked for recovering patients who are not ready to be discharged from hospital, as well as for mass COVID-19 vaccination centres. Staff recruitment is a major problem, and an urgent appeal has gone out for doctors and nurses to work at the Nightingale hospitals. If these emergency hospitals were staffed properly and used to their full potential, the impact of COVID-19 on cancer surgery might be reduced.
While the NHS faces immense pressures from COVID-19, and with all but the most urgent elective activities, including cancer surgery, postponed, it is shocking that some non-time-critical elective care is continuing in the private sector. Unfortunately, unlike during the first wave of the pandemic in 2020, the NHS is unable to make use of private sector capacity this time around. When the first lockdown began in March, 2020, all private providers in England were on an unprecedented national block contract with NHS England, to ensure that NHS patients who needed urgent surgery were prioritised over private patients with less urgent needs. However, two-thirds of the private sector capacity that was block-purchased by the NHS, costing hundreds of millions of pounds, went unused. With only a third of chemotherapy capacity used, despite grave concern about delays for some patients with cancer and general under-use, this arrangement ended in August, 2020. The Royal College of Surgeons has called on the Government to bring in the private sector again as a matter of urgency. Regrettably, this partnership has not been renewed because the UK Government is currently unwilling to fund NHS England to refer patients to a private sector that remains below capacity.
The cost of cancelling urgent cancer surgery and the impact on lives cannot be underestimated. A COVIDSurg collaborative study published in May, 2020, predicted that during the 12-week peak disruption of hospital services caused by COVID-19 last year, at least 28 million elective operations were cancelled or postponed worldwide, including more than two million cancer operations. Delaying time-sensitive cancer surgery could lead to deteriorating health, worsening quality of life, and avoidable deaths. Even just a 4-week delay in cancer treatment increases the mortality risk by 4–8%. Despite the ongoing extraordinary efforts of all NHS staff, it is imperative that the COVID-19 crisis does not cause unmitigated suffering for the many people with cancer in the UK. The lives of all patients should have equal importance.
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