Help us to stop bowel cancer

A quarter of England hospitals in breach of waiting time target for bowel cancer tests as services reach crisis point

Services to diagnose bowel cancer have reached a crisis point after our investigation reveals a serious backlog of patients waiting for crucial tests that can diagnose the disease. Across England, NHS and privately-run NHS hospitals for a third consecutive month this year are in breach of meeting the NHS standard of less than one per cent of patients waiting no more than six weeks for tests that could detect bowel cancer.

The waiting times published by NHS England today present a worrying picture for patients and demonstrate the urgent need for the next government to make addressing this crisis a national priority.

The two key tests to diagnose the disease are colonoscopy and flexible sigmoidoscopy. These tests are collectively known as endoscopy procedures.

In March 2017, 24% of hospitals in England were in breach of the NHS standard, with 1,121 patients waiting longer than six weeks for colonoscopy. In February 2017, 22% of hospitals were in breach with 1,288 patients and in January 2017 25% of hospitals with 2,253 patients.

In March 2017, 18% of hospitals in England were in breach of the NHS standard, with 452 patients waiting longer than six weeks for flexi-sigmoidoscopy. In February 2017, 17% of hospitals were in breach with 476 patients and in January 2017 22% of hospitals with 736 patients.

In some hospitals like Mid Yorkshire Hospitals NHS Trust more than a third of patients (38%) are waiting more than six weeks for a colonoscopy appointment and nearly half (49%) are waiting more than six weeks for flexible sigmoidoscopy appointment. 

Three hospitals have been consistently in the top ten worst performing waiting times for colonoscopy: Wye Valley NHS Trust, Central Manchester University Hospitals NHS Foundation Trust and Southend University Hospital NHS Foundation Trust

Today’s waiting times are further evidence that demand for endoscopy tests is outstripping capacity. Many hospitals are crippling under the pressure and are at breaking point because they simply do not have the capacity to meet the growing demand. A lack of funding, limited resources and a shortage of staff to carry out the number of procedures needed are contributing to this.

We need a long-term solution to finally deal with this long-standing crisis in diagnostic services for bowel cancer. Simply ignoring it won’t make it go away.

We are urging the next government to make this issue a priority and commit to increasing investment and developing a clear long-term plan to transform this vital service. If ignored, hospitals may buckle under the pressure and patient lives could be at risk.

These figures follow news of a further delay to the much needed action plan to address cancer workforce issues from Health Education England.  This action plan was promised as part of the delivery of the cancer strategy published in 2015, the publication of which has been delayed several times. NHS England’s commitment to recruit and train non-medical staff to carry out these tests in order to help plug the gap has already been down-graded from 200 to just 160. With the threat that leaving the EU poses on NHS staffing levels, urgent action is needed to ensure services have the workforce in place to carry out endoscopy procedures.

Deborah Alsina MBE, Chief Executive of Bowel Cancer UK, says: “We have been ringing the alarm bell for some time now and these unacceptable waiting times should serve as a wake-up call for the next UK Government.

“The failure to publish Health Education England’s action plans is a blow to hospitals that are currently struggling to deal with the increasing demand placed on the service and patients who continue not to be denied timely access to crucial diagnostic tests.

“We cannot continue to paper over the cracks with short-term initiatives. We need a long-term solution to finally deal with this long-standing crisis in diagnostic services for bowel cancer. Simply ignoring it won’t make it go away. 

“That’s why the next Government must commit to a national endoscopy strategy and training programme as well as finding ways of reducing demand, such as using a very sensitive Faecal Immunochemical test (FIT) to help triage people for endoscopy tests and reviewing surveillance criteria to ensure people aren’t given endoscopy tests unnecessarily .  These are the missing pieces in the puzzle to solving the significant capacity gap that currently exists in the system. Without these vital next steps, services will continue to struggle to provide timely and high quality care to all.”

The figures published today are for routine referrals for diagnostic tests. Patients who are referred via this route should be seen within six weeks of being referred. Under the NHS Constitution all patients have a right to be seen within maximum waiting time standards. Routine referrals are for patients who don’t quality for an urgent two-week wait referral and are not initially suspected of having cancer by their GP.

After waiting for 2 months, I had a call to say that it was pushed back another month. At that point I was bleeding when simply standing up so I called the doctor and insisted on an urgent appointment.

Research shows that around 50% of people who are diagnosed with bowel cancer do not present with the red flag symptoms that would qualify them for an urgent two-week wait referral. This is because the symptoms of bowel cancer can be vague and can also be symptoms of other less serious bowel conditions. Around 30% of people diagnosed with bowel cancer are referred via the two week wait. 

Professor Colin Rees, Vice President of British Society of Gastroenterology and Chair of Endoscopy Committee, says:  “Bowel cancer is a condition which can be both prevented and cured if treated early. By testing the right people at the right time we can save lives and stop people dying needlessly. Endoscopy is the key tool to achieving this. However a huge rise in demand over recent years has put major pressure on UK endoscopy services. It is imperative that we both expand endoscopy services and use current resources in the most effective way possible.”

Catherine Santamaria, 39 from Buckinghamshire, was diagnosed with stage 3 bowel cancer in February this year, says: “In 2014, I spotted bleeding and visited my GP but they dismissed it as nothing serious. In late 2016, the bleeding had become more frequent so I returned to the doctor – this time I saw a different GP and made the point that it felt more internal than external.  I was finally referred for a non-urgent appointment and was asked to wait three months.

“After waiting for 2 months, I had a call to say that it was pushed back another month. At that point I was bleeding when simply standing up so I called the doctor and insisted on an urgent appointment. After a 10 day wait I saw a specialist who confirmed the presence of haemorrhoids and suggested an endoscopy to check for anything else.  Just over a week later I had the procedure where, much to everyone’s astonishment, I was diagnosed with stage 3 cancer. I then had a number of scans and saw my surgeon for treatment options. Early in April I had surgery to remove the tumour, whilst recovering in hospital a few days later I had a haematoma and had to have further surgery to correct. 

“Since my diagnosis, I’ve had to stop work and as I can’t look after my children who are 1 and 6, my husband has had to take time off work too. I’m due to start chemotherapy in the next month.”