Agenda item

Update on Changes to Cancer Services and Breast Cancer Screening

Report of NHS England

Minutes:

The Committee received a report of NHS England and welcomed Siobhan Harper from the City and Hackney CCG, and Kathie Binysh and Sarah Galbraith, representatives from NHS England to the meeting. The Committee was given an overview of cancer services and breast cancer screening in the City of London. All CCGs were monitored on cancer standards and rated by the Integrated Assessment Framework (IAF) on key indicators such as waiting times, survival rates, patient experience and staging.

 

Siobhan Harper informed the Committee that City and Hackney CCG was underperforming by these standards. There was a need for improvement in cancer services, and this was a high-profile focus of the CCG. There were some issues specific to the area, but performance in City and Hackney had been poor in the last year, with particular issues in the delivery of 62-day referrals for cancer screening. However, performance had been encouraging with regards to survival rates where the CCG was improving significantly. The Committee was informed that there was a lot of work ongoing to learn from methods in other European countries where cancer services were better. A Member expressed concern that the cancer unit at St. Bartholomew’s was not delivering what had been expected when it had opened.

 

Members noted that the CCG’s level of 65.4% for urgent referrals within 62 days was well below neighbouring CCGs and was a significant cause for concern, as the shortfall was greater than in other places. Members expressed the urgent need to work past difficulties and barriers, and made suggestions for increasing referral numbers, such as making screening locations more convenient, and increasing engagement with patients to understand any reasons that might cause barriers to screening. Siobhan Harper told the Committee that there had been some discussion about introducing mobile CT scans, and a GP endorsement service had been commissioned. As Homerton Hospital had very small numbers of patients being referred, each person had a bigger influence on the data. The NHS Trust was a diagnostic centre which sometimes caused bureaucratic delays, as there was a need to refer patients to other places for treatment. The CCG had met its targets in this area in December and was close to the target in January and so far in February, indicating some improvement.

 

Members suggested that any structural issues also needed to be analysed. As there was a clear shortcoming, the issue needed to be looked at closely to gain a fuller understanding and identify as many possible routes to improvement. Members suggested that a report be brought back to a future meeting to examine the CCG’s progress in this area.

 

Kathie Binysh then gave the Committee an overview of breast screening in the City of London and Hackney. Breast screening coverage in London as a whole was the lowest in England, although this was a long-standing issue. The data for City and Hackney was encouraging, as coverage had increased by 2.9% over the last year and was the third-highest for Central and East London. The Committee noted that the Neaman Practice coverage, at 65.6% was higher than the average for City and Hackney CCG GP practices.

 

Coverage was an ongoing concern, as it was vital for as many women as possible to take up the offer of breast screening. There were a number of reasons women did not take up the offer, and so efforts were made to influence these factors where possible. Whilst there had been recent challenges like workforce capacity, overall uptake was increasing in City and Hackney and Central and East London. There were a number of initiatives being actioned to improve uptake such as second timed appointments, pre-appointment reminder texts, commissioning Community Links to contact women who DNA screening appointments and marketing strategies. NHS England London would continue to work with a variety of partners to implement and roll out interventions that have been shown to improve uptake and coverage.

 

The Committee noted that whilst the City of London had relatively high population turnover, this was likely to be caused predominantly by younger patients and should not have a significant impact on screening numbers. The Director of Community and Children’s Services expressed some concern that the statistics for the City of London had been grouped in with Hackney, as there were City-specific figures available from other sources. The report had not provided some data that would have been helpful to the Committee, and some of the data that had been provided was confusing or poorly presented.

 

In response to queries from the Director of Community and Children’s Services, Sarah Galbraith told the Committee that the Community Link service had been piloted in Hackney (but not the City of London), and that wider rollout was slow and dependent on capacity within the service. A serious incident communicated by St. Bartholomew’s in 2016 had been caused by a major IT issue which affected the breast screening service, causing the service to cease screening for four weeks. The investigation and subsequent recovery process was still ongoing, and a clinical harm review had been undertaken. Sarah Galbraith told the Committee that the data used in the graphs had come from the national team rather than the City and Hackney CCG, but that they would look at improving the graphs and data available.

 

The Committee thanked Sarah Galbraith, Kathie Binysh and Siobhan Harper for attending and for their contributions to the meeting, and asked to be kept informed about cancer services at St. Bartholomew’s and breast cancer screening in the City of London.

 

RESOLVED – That the report and briefing papers be noted.

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