Agenda item - Cancer Diagnosis and Treatment

21.1    This item was presented by Nigel Kee, University Hospitals Sussex NHS Foundation Trust Chief Operating Officer, and by Stephen Peacock, NHS Sussex Deputy Director, Acute Services Commissioning and Transformation, Cancer & Diagnostics.

21.2    Mr Peacock told the committee that the post-Covid recovery programme for cancer treatment is progressing. Services are now meeting the 28 day target. There are still issues with the 62 day target, but this is also showing consistent improvement. Efforts are focused on the areas of most concern and on the greatest impact areas. Mr Kee added that lower GI treatment has now been consolidated on the Worthing site and services are performing well. There is still room to improve co-working across the Sussex Cancer Alliance.

21.3    Cllr Evans asked why the statistics show an increase in referrals but a flat rate for cancers detected. Mr Peacock responded that this is being evaluated. It may be that this just shows enthusiastic referral patterns from primary care.

21.4    Cllr Evans suggested that this may be linked to a de-skilling of NHS services with more workers who are not doctors now involved in assessing patients. Mr Peacock replied that this is an area under investigation. However, the NHS does need a broad skills-mix across its workforce. Mr Kee added that the majority of cancer referrals are made by GPs, with some from dentists also. GPs have ample guidance on making cancer referrals, and it may be that some of the increase in referrals is due to greater awareness of cancer symptoms across the general population.

21.5    Cllr Parrott asked about staff shortages. Mr Keen responded that some cancer posts are difficult to recruit to, including oncologists and radiographers. There have been some successful recruitment rounds recently plus retention has been good. Cllr Parrott noted that the 2024 system review of staff retention had identified aggressive behaviour by colleagues as a major factor in high turn-over. Mr Kee replied that this is monitored closely; the local rates for staff to staff aggression are low.

21.6    Cllr O’Quinn asked why the 62 day performance and national survival rates are so low. Mr Peacock replied that UK survival rates have long lagged behind other European countries, and particularly behind Scandinavia. There is a long term national improvement plan. Mr Kee added that cancer care is complex and is always evolving. Improving performance against different cancers may require quite different actions. We are seeing consistent improvement across cancer types, and the development of the new Sussex Cancer Centre will help cement this.

21.7    Geoffrey Bowden noted that 62% of local patients rated their experience of cancer services as good. However, there remain serious issues with access to diagnostics, for example in terms of breast and cervical cancer screening rates for older women. Mr Kee agreed that more needs to be done to help people access diagnostic services.

21.8    Cllr Mackey asked what the benefits of the performance oversight regime were. Mr Kee replied that there were many advantages in working with the Cancer Alliance, particularly in terms of learning from national best practice. Mr Peacock added that it is useful to be able to highlight issues to NHS England in a proactive way.

21.9    Bernadette Kemp asked why there were no equalities implications in the report. The scrutiny officer explained that report implications outline the implications of the report recommendations. Where a report recommendation is ‘to note’ there will not usually be any implications to capture. This does not mean that equalities issues are not of importance in terms of the diagnosis and treatment of cancer.

21.10  Cllr Hill asked about developing future workforce. Mr Peacock replied that work is ongoing with the University of Chichester to develop a diagnostics faculty. Mr Kee added that it is also important to share information with schools.

21.11  Cllr Hill asked about self-referral. Mr Peacock replied, noting that there had been a self-referral pilot in East Kent. Mr Kee added that being able to share information from this type of initiative was one of the benefits of working with the Cancer Alliance.

21.12  Cllr Hill asked for clarification on plans to phase-out endoscopy in ‘low-yield cases. Mr Peacock explained that this is about using less invasive alternatives to endoscopy for low risk bowel cancer patients. This works well, and includes the ability to refer those who test positive for further investigation via endoscopy.

21.13  The Chair asked about 62 day breaches. Mr Kee responded that when delays do occur, services examine what caused the delay and also conduct harm reviews.

21.14  Nora Mzoui (CVS representative) asked about delays in getting appointments for breast cancer screening due to capacity issues at the Park Centre. Mr Peacock agreed to provide a written response.

21.15  Members discussed whether to request a further update on cancer performance and agreed that one was required within the next 6 months. Members also agreed to hold a work-planning session.

21.6    RESOLVED – that the report be noted and an update on cancer performance be brought to a future committee meeting.