People waiting too long for skin cancer checks

Thursday 23 February 2023

Targets for how quickly people with suspected skin cancer are seen are being missed.

Key performance measures for the secondary healthcare contract have been published today and there has been a reduction from 82% to 52% in the percentage of patients seen within two weeks after a referral for suspected cancer, attributed entirely to potential skin cancer.

The UK’s National Institute for Health and Care Excellence recommends that all potential malignant melanomas are seen within two weeks, and they are the priority locally, but still 80% of urgent skin cancer cases in 2022 were seen within two weeks and 94% in 28 days.

In response, the number of dermatology sessions has been increased and safe pathways agreed with primary care for all skin cancers.

The annual KPIs report, published by Health & Social Care and the Medical Specialist Group, also show that around 20 beds in the PEH are constantly filled with patients who could be discharged because a nursing or care home bed is not available or because they need extra care at home.

That problem is getting worse.

It leads to surgery being postponed and waiting times increasing.

The 2022 result for this measure, known as delayed transfer of care days, is 629 days per month, up from 387 days in 2021 and against a target of fewer than 100.

“Delayed transfers of care have been an issue for several years, but they are on the increase. Following discussions with community colleagues and private care providers, it is clear that there is pressure for long-term care across all care sectors and it's not unique to Guernsey – it is reflected at a national level too,” said Dr Peter Rabey, HSC Medical Director.

Waiting time targets were missed.

A patient checking in at Emergency Department reception should either be admitted or discharged within four hours. The target is 95% and the result for 2022 was 89%.

It compares to 69% in the NHS.

“Patients in Guernsey are seen very quickly by a healthcare professional when they attend ED, but they may need to see a specialist Consultant before a decision can be made about how to progress or conclude that patient’s care,” the KPI report says.

“Guernsey does not employ Junior Doctors or have an Admissions Unit. If a Consultant is already undertaking surgery, is occupied with patients elsewhere or there is a delay in accessing diagnostics out of hours, there may be a delay in decision making. In addition, the Emergency Department may also be the first point of call for mental health patients who often require a longer assessment time than patients seeking assistance for physical issues.”

There is a 95% target for outpatient and inpatient contract waiting times. 61% of inpatients were seen within the contractual waiting times in 2022 and 71% of outpatients.

“Unfortunately, the third covid-19 wave at the beginning of the year resulted in staff shortages and subsequent further postponements of surgeries and provided a further setback to addressing the waiting list backlogs.” 

The specialities with the longest waiting times continue to be orthopaedics and gastroenterology. 

“The newly opened de Havilland Ward with ring-fenced orthopaedic beds is already making a large impact and prevents postponements of orthopaedic surgeries due to the unavailability of hospital beds. For the gastroenterology backlog, a dedicated waiting list initiative is currently being sourced with the intention to address the backlog over a number of additional weekend clinics starting by April 2023."

A radiology waiting list backlog reported in 2021 has now been addressed.

In 2022, 91% of patients were dealt with in times expected against a target of 95%.

Dr Rabey said that KPIs have been set to reflect high standards of practice and patient care.

“They are all about encouraging a culture of continual development, learning and improvement.

“Many of the quality indicators are positive but we are mindful of the impact of delays in waiting times for patients and their families who need surgery or are anxious for a diagnosis or treatment plan. Reducing the waiting list is our priority with waiting list initiatives in place for orthopaedics and gastroenterology which represent over half of the inpatient waiting list.”

He said that the introduction of the Electronic Patient Records solution at the end of 2023 and beginning of 2024 will further improve the KPIs in some areas by streamlining administrative processes.

Dr Steve Evans, MSG Chair, said that it was important that the MSG is held accountable for how it works in partnership with the HSC.

"We are determined to do all we can with HSC to reduce waiting lists and to get back to the position we were in before the pandemic. None of us want to see patients waiting longer.

“There are positives on the horizon, including the waiting list initiative which will significantly reduce waiting times for endoscopy patients from April onwards.

“And phase one of the hospital modernisation programme - the new Critical Care Unit and the post anaesthetic recovery unit - will make a tangible difference.

He said that it was very encouraging to see that while there was an increase in the number of patients cared for, there had been no adverse impact on the standards of care. 

“It’s very encouraging to see that while we continue to increase the number of patients we care for, there has been no adverse impact on the standards of care. The average length of stay for a patient is just three days (against a target of less than six days) yet our emergency readmission rate is as low as 6% (against a target of less than 10%) which means that we are not discharging patients before they are ready to go home.

“Recruiting specialists with the right experience and approach to patient care continues to be a top priority for the MSG and we’re developing new ways to reach out to consultants in the UK and internationally to promote the unique benefits of being a consultant in Guernsey.”