The Delay of Death? How NHS waiting times for cancer treatment got political
Raj Persaud and Peter Bruggen
It is widely reported that after inaccuracies were found in waiting times for cancer treatment at Colchester Hospital University NHS Foundation Trust, Essex Police are considering a criminal investigation.
Prof Sir Mike Richards, the chief inspector of hospitals is reported to have said that patients’ lives may have been put at risk so the Trust could give an impression it was meeting waiting list targets.
Staff are said to have told Care Quality Commission inspectors that they were “pressured or bullied” to change data, to make it seem as if people were being treated in line with national guidelines. As a result some patients may not have had the treatment they needed in time.
What the press did not report is how waiting times for Cancer treatment and subsequent deaths because of treatment delays, have become a political hot potato. Health and mortality are such explosive issues that pressure, in our experience, is routinely brought to bear on NHS staff to assist in a countrywide ‘cover up’.
A study entitled ‘What if cancer survival in Britain were the same as in Europe: how many deaths are avoidable?’ published in the ‘British Journal of Cancer’, set out to estimate how many cancer deaths could have been avoided here. This is if survival over the next five years among patients diagnosed in Great Britain, had been equivalent either to the average levels of survival, or to the highest survival, seen in other European countries.
In one five-year period the researchers analysed – for patients diagnosed during 1995–1999, cancer survival in Europe was higher than in Britain for all but one of 22 common cancers. In all, 57,119 deaths would have been avoided if 5-year survival in Britain had reached the highest levels observed in the 13 European comparison countries.
This represents 11,424 premature cancer deaths a year. This means if British patients suffering from cancer had the best treatment the rest of Europe had to offer, 11,424 more each year, would in all probability, still be alive five years later.
But what happens if the NHS is compared with, more modestly, just the European average?
Of the 1,020,786 cancer patients diagnosed during 1995–1999, about 34,841 of these excess deaths would have been avoided if the average European survival had been achieved. The authors of this study based at Cancer Research UK Cancer Survival Group at the London School of Hygiene and Tropical Medicine, the University of Khartoum, Sudan, the Scottish Public Health Observatory and the Finnish Cancer Registry, calculate this still represents 6968 cancer premature deaths a year in Britain.
The authors of the study Manar Abdel-Rahman, Diane Stockton, Barnard Rachet, Timo Hakulinen and Michel Coleman found that for some cancers, survival in Britain was in fact slightly higher than the average survival in Europe.
So in some cases being treated by the NHS meant you stood a better chance of survival from your cancer than if you had taken pot luck and obtained treatment from an ‘average’ centre somewhere in Europe. However, this represented some 110 – 180 premature deaths avoided each year during the period 1985 – 2003. In other words each year around 180 people who had cancer are walking around alive thanks specifically to the NHS, meanwhile, depending on which figures you pick, approximately 7000 people, each year, aren’t.
But these figures apply to averages across the UK – what happens if you are living in an area which is not doing very well?
In a study entitled ‘Primary care delays in diagnosing cancer: what is causing them and what can we do about them?’ Thomas Round, Liz Steed, Judith Shankleman, Liam Bourke and Liliana Risi point out that in Tower Hamlets in East London, one-year survival rates for cancer, a potential indicator of late diagnosis, are among the lowest in England. Of course, somewhere has to be the lowest.
For example, the paper published in the ‘Journal of the Royal Society of Medicine’ reports that one-year survival for colorectal cancer is 65.8%, compared to the England average of 74.8%, and the highest figure of 82.7%.
While the NHS continues to perform badly in comparison with other systems as illuminated by cancer deaths, those at the top continue to defend their impressive earnings.
In the same edition of the newspaper that reported the scandal in Colchester where staff may have been bullied to fiddle figures, The Daily Telegraph reports that Sir David Nicholson, outgoing chief executive of NHS England, defended pay levels of NHS managers, because they do “incredibly difficult jobs”.
Sir David, whose salary of £211,000 attracted criticism, was joined by Sir Bruce Keogh, Britain’s most senior doctor, whom the newspaper reported as declaring that NHS managers “deserve very significant salaries”. Sir Bruce apparently said that high wages are needed to bring managers of “the right calibre” into the health service.
The highest salary for an NHS chief executive is reported by The Daily Telegraph to be Sir Robert Naylor at University College Hospital London Foundation Trust, who was paid £260,000. The average Chief Executive salary is reported to be £164,000, while the newspaper also reports their earnings rose by 121 per cent between 1997 and 2010 – almost twice the rise given to nurses.
If these managers are of the ‘right calibre’, why are they not being seduced into some other industry – such as Chief Executive of a blue chip company? All the more surprising given how ‘difficult’ their jobs are, perhaps in comparison with running a train service, or a car factory. Generally speaking people don’t die as a consequence of poor management at factories or offices.
Yet there doesn’t appear to be a queue of companies involved in less ‘high stakes’ enterprises, wanting to recruit these marvellous NHS managers of the ‘right calibre’. It would be helpful if Sir David Nicholson and Prof Sir Mike Richards could produce a list of NHS managers who were recruited to work successfully in as lucrative jobs outside the NHS.
Then again, maybe elsewhere in Industry, there isn’t much appetite for bullies and fiddling figures.