Widespread service suspensions will have ‘lasting impact’

The disruption or suspension of services has caused concern among patients, while cancer charities have told HSJ health leaders should move quickly to reinstate screening programmes where possible.

Current NHS England policy suggests screening programmes are supposed to be continuing, though whether to pause them officially is under review. However, HSJ understands disruption to screening is widespread across England.

In late March, London’s public health commissioner wrote to providers and commissioners in the capital to say the national adult screening services for cancer and other diseases were unable to provide screening to meet quality standards.

The threat from covid-19 infection and the national policies on social distancing meant “the benefits from maintaining screening through these programmes are outweighed by the risk posed to the NHS and the population,” the letter added.

However, on 21 April, NHSE’s national director of public health commissioning and operation sent an email to the NHS regions, seen by HSJ, under the subject “recovery of adult screening programmes”.

It said: “Service restoration will need to be undertaken as safely as possible and it needs to be undertaken in a methodical, planned and consistent way in order to minimise any risk to individuals receiving these services.”

Each screening programme has a national task and finish group that will “coordinate and ensure the necessary consistent systematic approach to maintaining these national population-based programmes and we will only achieve that by working on this collectively please,” the email added.

The screening programmes rely on the routine testing of sections of the population for the presence of cancer to catch the disease as early as possible. Delays caused by pausing the programmes now risks causing problems for years to come, HSJ has been told.

Genevieve Edwards, chief executive of Bowel Cancer UK, said: “The undeniable truth is that any decisions taken during this crisis regarding bowel cancer screening, either at a national or local level, will undoubtedly have a lasting impact. Those of screening age, 60-74, whose bowel cancer goes undiagnosed may suffer worse outcomes as a result of a later diagnosis.

“It’s vital that NHS England [has] clear, outlined plans in place to ensure any backlog in delivering bowel cancer screening; and the subsequent colonoscopies required for people with a positive screening test, can be cleared as soon as it is safe.”

Rob Music, chief executive of cervical cancer charity Jo’s Cancer Trust, said: “Data from our services show a high level of fear and confusion around cervical screening and colposcopy with many worried about the impact of delays on their health.

“Workforce across primary and secondary care will be an ongoing issue as greater numbers are accessing tests and receiving diagnoses.”

Baroness Delyth Morgan, chief executive of Breast Cancer Now, said: “We now need clear plans to be put in place to recover breast screening services once the crisis has passed, and to ensure catch-up appointments are offered to all those who have been affected.”

An NHS England and NHS Improvement spokeswoman said: “In areas where local providers have taken the decision to postpone screening due to the risk of coronavirus, they must now put plans in place to resume services for patients as quickly and as safely as possible.

“Patients are strongly encouraged to seek help from their GP if they have symptoms, as always.”