Trusts told to create ‘covid-free hubs’ for cancer patients

In a letter from national leaders, all NHS trusts have been told cancer surgery should be consolidated on a “clean” covid-19-free site within the local system. This could include independent sector provision.

The letter said: “Given the covid situation is likely to persist for some time, rather than deferring cancer care, continuing to provide it through ringfenced facilities and reconfigured care pathways is generally more appropriate.”

Some providers, including Barking, Havering and Redbridge University Hospitals Trust and University Hospitals of Birmingham Foundation Trust, have cancelled most non-urgent cancer surgery. HSJ also understands Walsall Healthcare Trust is using a local private hospital for all its cancer surgeries and its own main acute site for coronavirus cases.

However, Karol Sikora, chief medical officer at independent provider Rutherford Health, told HSJ he was not sure how “workable” the clean site plan was. He said: “You just need to admit one covid patient or allow one staff member who has the virus to work there, and that’s it, you’re done”.

Despite the ongoing national shortage of coronavirus tests, the letter from NHS England and NHS Improvement said all potential admissions must also be tested for the virus “48-hours before surgery”.

Those patients who test positive will be “considered alongside other urgent surgery within a hospital treating covid-19 patients”.

It said it had based this decision on experiences in Italy and in London, where the Royal Marsden is now the main hub for cancer care in the capital.

HSJ has previously reported cancer patients are to be prioritised based on how urgent their surgery is or if their chemotherapy or radiotherapy is curative.

The new letter goes further, saying all cancer patients needing treatment must be referred to a clinically-led “central triage point” that should be set up at regional level or within a single cancer alliance.

It said this will then “prioritise patients for surgery on the basis of clinical need, and the level of risk, both patient-and service-related, and match patients with appropriate surgical specialisms and capacity across the cancer system”.

The letter also clarified that those people who have had their diagnosis or treatment deferred because of coronavirus should be kept on a provider’s “patient tracking list (PTL) to ensure they can be appropriately followed up. Patients should be fully involved in reaching this decision [on deferral] and given advice on how to report worsening or new symptoms.”

The letter was signed by Dame Cally Palmer, Peter Johnson, and Steve Powis, national cancer director, national clinical cancer director and national medical director respectively.

Steven McIntosh, director of policy, campaigns and influence at the Macmillan Cancer charity, said: “We know this is a very anxious time for people living with cancer and those awaiting treatment.

“Even in a time of crisis, it is vital that decisions must be made with cancer patients, according to their individual needs for care and treatment, and their vulnerability to coronavirus”.