Agenda item

The Acting Chief Operating Officer (ACOO) for Elective Care at BHRUT delivered a presentation on managing planned care at the Trust, which included the impact of Covid-19 on key planned care measures and actions taken to mitigate this, current service performance and future plans.

In response to questions from Members, the ACOO stated that:

• Inequalities between different populations had become much more manifest as a result of the Covid-19 pandemic. Whilst this topic was still fairly new, BHRUT had noted that there did not appear to be any trust level differences between different ethnic groups, or in different socio-economic groups in accessing care; however, this finding could change once BHRUT started to look at the data in more detail. There were also not currently any obvious differences in the waiting times between different socio-economic, ethnic, or age groups; however, much more work needed to be undertaken to understand the data and the questions to be asked.
• There were, however, differences in waiting times between different specialities. Surgical services tended to have longer waiting times than medical specialities, as they required patients to have a number of outpatient and diagnostic appointments, as well as to wait to come into theatre. About half of the waiting list was currently within six different specialities and BHRUT knew that it needed to focus on its surgical specialities, in particular certain paediatric services such as Ear Nose Throat (ENT), where it knew that there were longer waiting times than other areas.
• There were also some cancers that took longer to diagnose, such as colorectal cancers. These diagnostics were also stopped for a longer period during the pandemic, meaning that there was a greater need to catch-up on these diagnostics to reduce waiting times back to pre-covid levels. BHRUT was also dependent on tertiary providers for treatment in relation to more complex cancers. As these complex surgical services stopped during the initial phase of Covid-19 and as BHRUT was dependent on these providers, there was a lot of catch-up work and longer waiting times. Unmet need within the community was also unknown, in terms of patients not being referred into services.

The CM also highlighted that a higher proportion of the Borough’s residents presented to services when their cancers were already at stage three or four. One of the priorities at the North East London Integrated Care System (ICS) level, was to encourage individuals to come forward earlier, as the combined impact of long waiting times and presenting late, meant that outcomes for these individuals were poor. There were also issues around how different cultural groups perceived cancer, so the ICS had been working with faith and cultural leaders as to how this message could be relayed appropriately for each cultural group.

In response to further questions, the ACOO stated that:

• National awareness campaigns were taking place on a rolling programme, with a lung cancer campaign taking place in November 2021. Big increases in referrals were also experienced following the deaths of prominent public figures. Whilst there was limited capacity in secondary care, it was hoped that awareness campaigns would identify unmet need. Whilst awareness campaigns and increased investments in diagnostics were positive, the system needed to ensure that patients accessed services in the first place.
• In regards to patients waiting over 63 days from referral to treatment, the Trust had two measures, one of which was a ‘backlog’. Pre-covid, there were approximately 200 patients waiting over 63 days due to complex reasons, and currently this figure stood at 350 patients. BHRUT’s plan was to return to pre-covid levels by the end of the financial year.
• BHRUT was in a position to run more super clinics; however, it was less able to encourage patients to access care in the first place, as the first point of contact for patients was with GP practices. Work needed to be undertaken with primary care as to whether more could be done jointly to encourage patients to access care.
• There was an intention to invest in cancer diagnostic pathways with the investment that BHRUT was expecting from the Government, locating diagnostics within the community to make these easier to access, such as through Barking Community Hospital and the St. Georges Hub.
• BHRUT was focused on ensuring that it had a sufficient workforce to deliver services. During the pandemic it had moved staff treating patients in theatres, to critical care wards to manage a greater emergency demand. There was an additional challenge in that BHRUT was having to catch-up on work that could not be undertaken during Covid-19, alongside current demands, with the same workforce. Whilst technology, such as virtual appointments, could mitigate some issues, it would take a long time to catch-up on this work.
• There was ongoing work into potential missed cancers during the pandemic, and the Trust knew that it needed to run at around 120 percent of its pre-covid levels to undertake this work. The NEL Cancer Alliance was also exploring whether there was evidence of inequalities between particular communities in terms of missed cancers. The Trust received financial incentives to recover its lost work and had not received any penalties.

The Director of Commissioning and Performance (DCP) at BHR ICP and NEL CCG also confirmed that a large amount of work had been undertaken across Phlebotomy over the last six to twelve months, addressing the closure of services during the first pandemic. The backlog was now under control and residents could go online and book blood tests for the following day. BHRUT did not use the blood test tube bottles that had been impacted by the global shortage and was therefore not significantly affected.