In my previous blog, I wrote about some of the ‘early priorities’ from the Independent Cancer Taskforce report that NHS England has committed to acting on immediately. Now I want to highlight the work we’re already doing towards a new referral to diagnosis standard.
The taskforce recommended a new standard to ensure patients either receive a diagnosis, or have cancer ruled out within four weeks of their initial referral. I see this new standard as having three aims:
- Developing a much more patient-focussed performance standard for the beginning of the patient pathway.
- Creating a new standard covering the whole first part of the patient pathway, all the way to diagnosis. The start of this pathway will remain the start of the 62-day pathway, ensuring patients do not ‘fall through the cracks.’
- Incentivising the system to minimise the time patients spend uncertain whether or not they have cancer.
Although the taskforce have given us a strong framework to work with, there are still significant details to be looked at. Input from across the service is vitally important to help us develop our plans for rollout, pinpoint the key areas which are crucial for success, identify potential problems and mitigate the inevitable risks.
Input from patients will also be essential – the taskforce consulted extensively with patients, who have set us this challenge. We will need to continue to get patients’ input as we develop our plans and begin to roll the new standard out.
To get the ball rolling on these discussions, we invited around 40 NHS colleagues from across the country, both clinical and non-clinical, to a workshop in London to begin shaping the new standard. We aimed to explore three questions – how we define the new standard; what the challenges, risks and unforeseen consequences might be; and how we begin to overcome those challenges and take some positive next steps.
It was great to see so much energy and animated discussion in the room, and a great focus on the potential of the new standard to improve care for patients. As you might expect, the discussions ranged far and wide over the course of the whole day, with some great ideas and useful insights. By the end of the day, however, three core themes had emerged.
The first of these was the importance of the increased patient focus. This was welcomed by all, and it is vital that as we get into the more technical details of the standard, we don’t lose sight of this powerful principle.
The second key theme that ran through all of our discussions was a familiar one – the critical importance of communication. In many ways, the first and most important requirement of the new standard is to improve the conversations we as clinicians have with patients during the first 28 days we are concerned about their symptoms, whether or not they are diagnosed with cancer.
Communication will also be crucial between providers, to successfully coordinate a rapid pathway to diagnosis between primary, secondary and tertiary care. Many recognised the critical role some of the NHS’ often unsung heroes will play in making sure this happens – people like Multi-Disciplinary Team coordinators, who can ensure that patients receive everything they need to get a diagnosis as quickly as possible.
The third key theme is a simple one, but is no less important for that – the definitions and rules for the standard must be clearly laid out if it is to achieve the goals we have set for ourselves.
Of course, we all know the context within which this work is taking place, and the current pressures on diagnostic services. None of the recommendations of the taskforce exist in isolation, and we fully acknowledge that for the new standard to be a success, it will need to link closely with the rest of our work. Widening the access GPs have to diagnostics, ensuring sufficient diagnostic capacity is available, in the right places, and thinking critically about the path to diagnosis taken by patients all remain of critical importance.
Over the coming weeks, we will be taking the feedback we have had from the day and feeding it in to the development of a more comprehensive plan.
I’d like to thank once more everyone who came along and contributed to what was a really useful day of discussion for us, and we hope also a good opportunity for those who came along to help shape a major new national policy direction.
We know that it will be challenging to achieve our goals. However, we are convinced it is the right thing to do for patients, and the clear message we can take away is that with the right support in place, our aims are achievable. I look forward to continuing the conversation as our plans take shape.
Sean Duffy is the National Clinical Director for Cancer. Professor Duffy is also a clinical academic gynaecologist based at the University of Leeds with his clinical practice at the city’s St James’s Hospital. His medical expertise is in endometrial cancer and he has an international reputation in the field of endoscopy surgery and training. He has had senior academic experience in laboratory and health services research and has had national and regional responsibilities for undergraduate and postgraduate education in obstetrics and gynaecology with senior roles in the Royal College of Obstetrics and Gynaecology and the University of Leeds. For the eight years before he was appointed National Clinical Director for Cancer, he was leading the Yorkshire Cancer Network as medical director and over the last four as director as well.