Hi Iain, I am a GP and feel the Labour are misrepresenting the situation regarding the ‘right to see a cancer specialist within two weeks’. As you say, the inference of their campaign is that patients will be disadvantaged should this target be removed and that their health could suffer. In the PPB tonight, it had an anxious patient saying: “But I don’t have time!”, the inference being that he may be beyond helping if he waits more than two weeks. This gives a very inaccurate representation of the facts – indeed I wonder if the ASA could be asked to investigate the message behind this PPB and the campaign leaflets which give the same inference?
The truth is, the effects of this target have been analysed and found to have achieved the opposite effect. Various medical journals have researched the impact of the 2 week wait and have shown it to be counterproductive. This is for the following reasons:
• The majority of people eventually diagnosed with cancer do not meet the strict referral criteria for the 2 week wait – and they are having to wait even longer because of the 2 week waiters taking priority.
• In addition, the wait for results of diagnostics, scans etc and the clinic appointments to discuss them and the start of treatment are also waiting because of the priority for the 2 week wait.
• The main delays in cancer treatment occur at the following stages: 1/ delay between getting symptoms and deciding to go to the GP; 2/ delay between the initial 2 week appointment and the commencement of treatment. The time between the GP referring and the patient being seen are much much less than these times.
Other problems, directly due to Labour government interference are: 1/ the 2 week wait doesn’t allow sufficient flexibility to refer to the consultant of the patient’s choice; indeed because of this new pressure on referrals sometimes the patient is seen by a lesser qualified nurse-practitioner and doesn’t get to see a consultant at all – it is too soon yet to know if this is fully safe. 2/ the constraints on prescribing cancer medications for patients who are incurable or resistant to other treatments (imposed by NICE).
As GP I can tell you that cancer care is an important issue to people and it is true that the 2 week wait is popular as patients understandably worry if the GP refers them because of a risk of cancer. However, more needs to be made that Labour’s populist approach to this very small aspect of the patient experience is not the key thing in what matters: ie getting the patient swiftly treated with a high chance of cure.
Like the present conservative thinking, I feel a greater emphasis needs to be on OUTCOMES (and this applies to all public services), rather than just shovelling money and the unevidenced targets which might well be populist, but ultimately ineffective.
Hope you find the links below useful. And do keep blogging!
Telegraph: Women with signs of breast cancer wait months as Labour breaks manifesto pledge.
And THIS which starts with: “Women with suspected breast cancer are being failed by the Government's waiting time target and it should be scrapped, doctors report today.”
Some relevant studies can be found in: the BMJ.
“The ‘two-week wait rule’ is failing breast cancer patients” “the researchers found the percentage of patients diagnosed with cancer in the 2-week wait group decreased from 12.8% to 7.7% whilst the number of cancers detected in the ‘routine’ group increased from 2.5% to 5.3% over the same time period. In 2005 more than 1 in 4 (27%) patients ultimately diagnosed with cancer in 2005 was referred non-urgently. Dr Potter describes the increase in cancers diagnosed from the routine population as “alarming” and says: “These patients are also potentially being disadvantaged by longer clinic waits and delays in diagnosis as waiting times for routine referrals have increased in the face of increasing service demands from the dramatically increased number of patients referred under the two week rule, over 90% of whom have benign disease.”
And another from the BMJ
- showing only a tiny minority of gastric cancers are picked up by 2 week wait – the majority are found at ‘routine’ endoscopies. (implies the target not helping those most at need)
And yet another from the BMJ
- the conclusion in this paper includes: “The two week standard clinics did not shorten the overall time to treatment or improve the stage of disease because the time lags before referral and after the outpatient appointment are the major causes of delay in the bowel cancer patient’s journey”.
A review in the BMJ of the same paper noted: “Although patients referred to the two week clinics were seen more quickly than patients referred elsewhere, they were not treated any more quickly, nor was their disease caught earlier, the audit showed. Furthermore, referral to a two week clinic had little impact on the length of time patients had to wait for treatment, nor was their disease caught at an earlier stage. This was because the time lags before referral by the family doctor and after the outpatient appointment, which are the major causes of delay in bowel cancer treatment, remained the same. The government should not be deterred from stumping up more money to ensure that all patients with bowel symptoms can be seen promptly, say the authors. But the two week urgent referral is being let down by delays elsewhere in the system. “Ultimately the value of the two week standard is small in the context of a process of care that is slow both before referral and after being seen in outpatients,” they comment.
“resources may be more effectively targeted at reducing the waiting times from diagnosis to treatment than on reducing the time from referral by a general practitioner to diagnosis”.
And finally from the BMJ.
I don't think any comment from me is necessary.