Patients rushed to hospital with suspected cancer are having their treatment delayed so that managers can meet Government targets, an NHS investigation has found.
By Laura Donnelly, Health Correspondent
Published: 8:45AM BST 07 Jun 2009
People arriving at Accident and Emergency departments with symptoms which could indicate the aggressive spread of the disease are waiting weeks for diagnosis and treatment while “routine” cases are prioritised.
Hospital managers told researchers that treating desperately sick patients more quickly would “reflect badly” on their performance against Government cancer targets which only cover those referred to specialists by GPs.
Doctors, patients groups and politicians were appalled by what one described as a “breathtaking admission” which confirmed their “very worst fears” about how far the NHS target culture has gone in distorting clinical priorities.
Although most people with suspected cancer are referred to hospitals by their GPs, more than 30,000 people diagnosed with the disease each year are first alerted to tumours by violent symptoms, such as seizures, vomiting and jaundice, which cause such alarm that patients go straight to their local A&E departments.
The report by the NHS Institute for Innovation and Improvement, an official health service agency which issues advice to hospital managers, says that many of these emergency patients waited six weeks or longer for basic tests.
It said they were “often” not given the same priority as patients who had been referred by GPs, who were covered by two targets, ensuring that they see a specialist within two weeks, and start treatment, following diagnostic tests, within two months.
“As a result, they can end up with a very poor experience before finally receiving a diagnosis and the right care,” it warns.
The report, due to be published tomorrow added: “Many trusts recognised the need to get some patients in this group onto the same pathway as people on the cancer two week wait [target] but were concerned this would reflect badly on their cancer figures”.
Some A&E departments failed to recognise the risk of cancer in seriously ill patients. In cases where the disease was suspected, patients were sent home to wait six weeks or longer for diagnostic tests. Others waited weeks on wards before seeing a specialist or having scans, the report, which is endorsed by the Government’s cancer tsar, found.
Nigel Beasley, the NHS Institute’s lead for cancer, and head and neck surgeon from Nottingham University Hospitals said: “Targets are very effective, but they do have side-effects. The risk is that these patients are not being prioritised because of the focus on the two-week target for patients referred by GPs.”
He said anxious patients admitted as an emergency were often trapped in hospital for weeks waiting for scans, and to see a specialist, and should learn from good hospitals, who carried out investigations quickly, often using outpatients appointments.
Mr Beasley said: “Patients can be stuck in hospital for a long time, waiting for scans, and other diagnostic tests. Once they are in hospital, they can end up waiting two, three, or even four weeks before there is a diagnosis and any decision to treat.”
The admission about the effect Government targets were having on emergency cancer patients horrified clinicians and patients groups.
Shadow health secretary Andrew Lansley described it as “one of the clearest examples yet of how Labour’s tick-box targets are failing NHS patients”.
He said decisions about which patients should be seen first must be taken by doctors, based on the patient’s clinical needs, not by managers following Government diktats.
Katherine Murphy, from the Patients Association, said the report provided “breathtaking” evidence of a confidence trick being played on the public, repeatedly told that waiting times for patients with suspected cancer are falling, while desperate cases were forced to the back of the queue.
She said: “This confirms our very worst fears, and exposes the scandal of what pernicious targets are doing to patients. We have seen other targets being used in ways that damage patient care, but of everything we have seen, this really is the cruellest of the cruel”.
Leading cancer specialist Prof Karol Sikora said: “I think it is absolutely horrifying that hospital managers are playing around with targets that can delay treatment for people who may well be at an advanced stage of the disease.”
“I know of many cases where people who have been admitted to NHS hospitals as an emergency have languished for weeks before even seeing an oncologist,” added Prof Sikora, Medical Director of independent company CancerPartnersUK.
The British Medical Association said many trusts were bullying doctors into delaying urgent referrals.
Dr Jonathan Fielden, chairman of the BMA’s consultants committee, said: “A number of our members have already expressed fears about the two-week cancer target, because it means all the cases referred by GPs are given the same priority, regardless of whether they are expected to be benign or high risk. When this same target is delaying patients who have been admitted as an emergency that is an even greater cause for concern”.
Several oncologists said they supported two-week waiting time targets for cancer patients referred by GPs, but called for the target to be widened to include all patients.
Ian Beaumont, from charity Bowel Cancer UK said it “beggared belief” that anyone would value statistics over efforts to save lives.
Dr Jane Maher, chief medial officer at Macmillan Cancer Relief described the revelation in the report as worrying, but said the biggest obstacle to getting the right care for patients admitted to hospitals as an emergency was getting the right diagnosis, as cases were often complex, meaning cancer could be mistaken for other conditions.
Among those who have experienced the problem is Melissa Matthews was 28 when she went to the Accident and Emergency department of her local hospital.
For several days, she had been suffering abdominal pain which had left her feeling so uncomfortable that she was unable to eat. She told her family doctor, who advised her not to worry, unless she began vomiting, in which case she should go immediately to A&E.
When she began being sick, her partner took her to the casualty unit of Norfolk and Norwich Hospital. The couple mentioned concerns about bowel cancer, having recently watched a programme about its symptoms, but the doctor reassured her: “You are far too young to have bowel cancer; when the blood tests come back they will show that”.
The tests did not indicate a problem; Miss Matthews was sent home to Norwich and told she was probably suffering from irritable bowel syndrome.
But the pain and vomiting continued. A week later, when she was unable to even swallow water, she returned to A&E, and was admitted to a ward for five days, but sent home once more.
One week later, after she collapsed in agony at home, she was admitted to hospital again. This time, X-rays revealed a blockage. During an eight-hour operation, surgeons found a tumour so large they were forced to remove her womb and 36 inches of her bowel.
The blood tests which Miss Matthews had undergone in A&E, she later found out, were not a clear indicator of bowel cancer, or its absence after all.
Six months of chemotherapy followed Miss Matthews’ operation, after which she was given the all-clear. However, since then the cancer has returned. On Tuesday, Miss Matthews, now 30, will undergo a second operation to remove a tumour.
The mother of two girls, aged 11 and 13, says her focus now is on survival.
“I don’t feel angry about this any more, my concern is about what happens next, but I did feel very frustrated, and frightened. I thought going to A&E was the safest place to be, but I was just fobbed off”.
A hospital spokesman said patients were encouraged to complain if they were not satisfied with their care, and added that bowel cancer was rare in patients of Miss Matthews’ age.
More than 4,900 people have backed The Sunday Telegraph’s Heal Our Hospitals campaign, which is calling for a review of hospital targets to make sure they work to improve quality of care.
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