Competing pressures at hospitals in central Lancashire mean there will be some delays for the foreseeable future
It will take a “tremendous effort” from the trust that runs the Royal Preston and Chorley and South Ribble hospitals to clear a backlog of patients who have been waiting longer than two years for treatment.
That was the message from the organisation’s chief executive at a board meeting which heard that a national target to eradicate waits of 104 weeks or more by the end of June was just one of many challenging fronts facing the NHS in Central Lancashire as it attempts to restore pre-pandemic levels of activity – while still dealing with the effects of Covid and the delays caused by it.
Kevin McGee said that those competing pressures required a balance which was difficult to strike but must be achieved. The meeting was told that Lancashire Teaching Hospitals NHS Foundation Trust (LTH) had hit its own locally-set trajectory for reducing two-year waits by the end of March. But that still leaves 790 patients who have been on the waiting list for that length of time and who now need to be treated in less than tree months.
That target forms part of the NHS England plan for tackling the backlog of pre-planned – or “elective” – care that has built up during the pandemic. In February 2020, LTH did not have a single patient who had been waiting even 12 months for treatment. However, in common with the rest of the NHS, that figure quickly ballooned after Covid struck – and stood at 7,047 people as of January this year, the latest month for which published data is available.
There were more than 56,400 patients on the overall waiting list, up by over 22,000 compared to immediately before the pandemic – with exactly half of people on the current list having been waiting longer than the NHS standard of 18 weeks for treatment.
The NHS in Lancashire and South Cumbria has previously said that patients will be treated in order of clinical priority as work continues to clear pandemic-related backlogs. Meanwhile, board members heard that Central Lancashire is struggling to hit waiting targets for cancer appointments – although they are being given top priority by the trust.
LTH chief operating officer Faith Button said that the current cancer situation at the hospitals was “highly challenged” – and connected to wider pressures on diagnostic testing capacity in general. In February, 53 percent of LTH patients who had received an urgent GP referral for suspected cancer were seen by a consultant within a fortnight – against a national standard stipulating that at least 93 percent should get a rapid appointment.
Also that month, just a third of women with breast symptoms – where cancer is not necessarily suspected – were seen within the same two-week target. That was up from only 14 percent in January.
Papers presented to the board meeting revealed that cancer referrals are now exceeding pre-pandemic volumes – compounding the pressure on services. A national target that 85 percent of confirmed cancer patients should start their first treatment within 62 days of an urgent GP referral was met in just 38 percent of cases.
LTH says that it is focussing on faster diagnosis and a reduction in the size of its cancer backlog to pre-pandemic levels. It aims to reach that latter target by March 2023. In the meantime, the trust may seek so-called “mutual aid” from other hospitals in the Lancashire and South Cumbria region to assist with reducing delays. Plans specific to dealing with different types of tumour have been put in place and are being monitored weekly.
Commenting on the trust’s cancer performance, Faith Button told board members: “We are prioritising cancer patients, obviously, into the organisation – but one of the biggest blocks continues to be our diagnostic pathways. Our diagnostics remain challenged, particularly in endoscopy, and we have a number of outsourcing and insourcing [arrangements in place] – but this is still not stemming the amount of demand coming in to [enable us to] clear the backlogs and deal with referrals [of suspected cancer and other urgent patents].
“So the diagnostic part of the cancer pathway is a real focus at the moment – not just for us, but across the [healthcare] system,” Ms. Button added.
Board papers stressed that people requiring tests for suspected cancer or other urgent problems are seen within two weeks. However, that is putting pressure on – and causing delays in – more routine diagnostic activity.
Almost 46 percent of LTH patients in need of a diagnostic test in February had to wait longer than six weeks to receive one – far short of the national target for almost all patients to have the necessary tests within that timeframe. That aspiration has not been met at a nationwide level in over seven years and the position deteriorated markedly during the pandemic.
LTH says that the gap between demand and capacity for endoscopies in Central Lancashire remains “significant”. Changes have been made to recovery areas to increase the space available and a bid is currently being prepared for funding to create an additional room at the Royal Preston.
A company is being used to carry out endoscopies outside of usual hours during evenings and at weekends, while LTH is seeking support from other parts of the NHS in Lancashire where routine waits for the procedure may be lower. A recruitment plan has also been drawn up to increase the number of endoscopy nurses, while similar measures are in place to recruit newly-qualified radiographers and trainee sonographers.
Faith Button said that, more generally, the recruitment of 240 international nurses had “really helped to reduce our vacancy gap” – which currently stands within the expected range at 10 percent. She added that demand for temporary agency staff within the trust remains high and that worldwide requirement will continue in an attempt to bolster permanent staff numbers as the hospitals try to restore their activity levels. That necessity to return to something approaching normal was something that Kevin McGee said was proving tough while past and present effects of the pandemic continue to be felt.
“We are working now to remove all 104-week waiters by the end of June. That’s requiring tremendous effort from our staff – and, given the pressures that we’ve got both in terms of Covid activity but also staff sickness, [it’s] putting real pressure on the organisation. But it’s something that we’re having to manage.
“I have to say massive thanks to our staff for…being able to balance this requirement to keep our community safe and manage the pandemic, but really push[ing] now with the restoration of our activity. That’s what we’re here for – one doesn’t trump the other.”
‘It’s not a case of cracking the whip’
A senior NHS leader in Central Lancashire has warned that it will be a “long haul” before the health service clears the backlogs caused by Covid.
Denis Gizzi, chief officer of the Greater Preston & Chorley and South Ribble clinical commissioning groups (CCGs), was speaking at a joint governing body meeting of the organisations late last month. Held before the detailed waiting time figures for February had been discussed by the LTH board, the CCG gathering heard concern from one lay member about the rate of progress in reducing the number of people who had been on the Preston and Chorley hospital waiting list for over one or two years.
Ian Cherry said that “a lot of our population is suffering from the delays”. He queried what action was being taken across the healthcare system to cut waiting times and when it might bear fruit – saying that it was “a fair question to ask”.
However, Mr. Gizzi said that while it would be possible to talk “ad nauseum” about the challenges facing the NHS in the region, “we all know what they are”.
Noting that the elective recovery programme was being delivered at a pan-Lancashire – rather than a Central Lancashire – level, he added: “We are nowhere near out of [the pandemic] – and things are going to take quite some time to settle. There are some slow signs of recovery – but it’s not a performance issue, it’s not like people are working slow [and] we’ve got to go and crack the whip, that’s not the case at all. We’ve got the biggest backlog in 60 years.
“The programme is the programme, the backlog is the backlog [and] the change management arrangements that are put in place have started to have some effect – but it’s going to be a long haul,” Mr. Gizzi said.
CCGs are due to be wound down this summer as part of new local NHS structural arrangements which are set to be established nationwide.
‘Hospitals need to keep Covid under control’
The boss of the Royal Preston and Chorley and South Ribble hospitals says that while Covid precautions have become a matter of personal responsibility in the community, it is vital that they remain as standard on hospital premises.
Kevin McGee told a board meeting of the trust that runs the two facilities that there were “large numbers” of Covid outbreaks occurring within the wards of hospitals across the country. He added that the number of patients in hospital with Covid continued to have a knock-on effect on how services can function – noting that the over 120 Covid-positive patients being treated by Lancashire Teaching Hospitals as of late last week was the equivalent of more than five wards full and put a “considerable strain on capacity”.
“We still have very strict infection control and prevention procedures throughout the organisation – so anybody entering…any hospital premises will have to wear a mask and will have to abide by social distancing and hand washing. [Covid] has implications about how we actually run the hospital and manage the hospital – and the processes and the capacity that we have.”
Professor Mohammed Munavvar, a Covid specialist and respiratory physician at the Royal Preston, last week said that although just over 50 percent of current Covid patients at LTH had been hospitalised for reasons other than the virus, high numbers of Covid inpatients nevertheless affected the running of the hospital, including its capacity to carry out operations.
790 – number of Preston and Chorley hospital patients waiting over two years for treatment (as at the end of March 2022)
7,047 – number of Preston and Chorley hospital patients waiting over 12 months for treatment (as at the end of January 2022)
0 – number of Preston and Chorley hospital patients waiting over 12 months for treatment (as at the end of February 2020)
56,412 – number of patients on the Preston and Chorley hospitals waiting list (as at end of January 2022)
22,415 – increase in number of patients on the Preston and Chorley hospitals waiting list since February 2020
50.1 percent – proportion of patients on the Preston and Chorley hospitals waiting list who have been there for longer than the NHS standard of 18 weeks (as at end of January 2022)