‘Catastrophic’ threat to cancer performance at England’s third largest hospital trust

In its latest board papers Mid and South Essex Foundation Trust rated “cancer performance” at its highest risk level of 25 — which based on their own risk-scoring key is “catastrophic”.

The board papers also rated “failure to deliver improvement national performance targets in the agreed trajectories and reset from covid-19” at risk level 25, stating the “risk remains high due to the latest risk of covid-19 resulting in the cancellation of cancer elective activity”.

The trust runs three general acute hospitals in the county. Its 2,000 plus beds make it the third largest trust in England after University Hospitals Birmingham FT and Leeds Teaching Hospitals.

The same board papers, dated 28 January, said cancer surgery at Southend University Hospital, one of three hospital sites run by the trust, “ceased on 24 December”. At a second hospital site, Mid Essex Hospital (also known as Broomfield) covid “hit hard just before Christmas” and elective work was “dramatically impacted with short period of life and limb only carried out on site”. This meant all P2 cancer surgery — which requires treatment in less than four weeks — did not take place. 

Both hospital sites said they hoped the independent sector could help them restart cancer surgeries this month with a focus on “long waiting and clinical urgent patients”. It is not clear how much capacity the sector has to work through waiting lists and the board papers said “some of this capacity may be reduced” because of recent changes to a new national contract for the independent sector.

Mid Essex said it was “currently embarked upon rapid scoping work to restart cancer surgery (P2) in an equitable way in conjunction with other sites, including fully exploiting the ISP capacity on offer”. Southend said it “now has access to independent sector hospitals to deliver some cancer surgery”.

The board paper said the situation had worsened due to a “lack of access to operating lists” because of staff redeployment to covid wards. It said harm reviews into those patients who had waited longer for treatment than recommended were “overdue” and may not be finished until “end of February 2021”.

It later told HSJ on 29 January that, as of that point, all its P1 cancer patients had dates for treatment, and that all its P2 patients “have plans for treatment either in our own hospitals, the independent sector or in neighbouring trusts”.

Last month, the hospital agreed “legal undertakings” with NHS England for breaches against its provider licence in five areas. Two of these include “delayed diagnosis and treatment of cancer patients” and “growth in elective backlog”.

Each individual hospital site, which operated as separate trusts until they merged into one single trust in April 2020, have had a history of poor performance in both these areas.

As of 18 January, the trust said its cancer waiting time backlog was 337 for 62-days and 320 for 104 days. It said both were showing a four-week consecutive increase since mid-December. Seventy-seven per cent of all patients waiting over 62 days are suffering from four types of tumour: lower GI (20.8 per cent), urology (24.9 per cent), skin (18.7 per cent), breast (4.7 per cent), and upper GI (7.7 per cent).

Its two-week cancer performance has also deteriorated due to breast service and endoscopy capacity at Mid Essex, head and neck service capacity at Southend and urology, skin and breast capacity at Basildon University Hospital (the trust’s third site). It said this is partly because cancer clinics were closed in January to help with the covid surge.

Clare Panniker, Mid and South Essex FT chief executive, said: “Coronavirus has clearly put significant pressure on NHS services, but any patients whose cancer treatment is urgent have received that care, and many patients — including 125 people this week — are getting their treatment through the independent sector instead, while those who have had their treatment postponed will get it the coming weeks and are being supported by clinicians.”

This story was updated at 14:35 on 29 January to make clear the trust board papers rated “cancer performance” and “failure to deliver improvement national performance targets in the agreed trajectories and reset from covid-19” at the highest risk level. An earlier version of this story stated “cancellation of cancer elective activity” was rated at 25. It was also updated later in the afternoon to remove a reference to part of the risk framework, and to reflect some information and a comment provided by the trust, which had not previously provided a statement.