Belfast Telegraph

Monday 22 December 2014

Scandal of urgent breast cancer referral delays

Targets missed for appointment with specialist

In March 2014 just over 50% of women with a 'red flag' referral by a GP were able to get an appointment with a specialist within 14 days
In March 2014 just over 50% of women with a 'red flag' referral by a GP were able to get an appointment with a specialist within 14 days

The number of urgent cases being seen by a breast cancer specialist within a two-week target in Northern Ireland has dropped by 20% in a month, shock figures have revealed.

Health Minister Edwin Poots has branded as "unacceptable" that in March 2014 just over 50% of women with a 'red flag' referral by a GP were able to get an appointment with a specialist within 14 days.

This was compared to 74.2% of women in February and 76.1% in January.

It means that more than 400 women were not seen by a specialist within the target time in a one-month period.

Staffing problems have been blamed for the situation, which was described as "very concerning" by a leading doctor.

The figures, published by the Department of Health, showed that within three months there were 211 fewer urgent referrals of women with suspected breast cancer seen within the Government timeframe.

And the figures reveal a huge variation between the east and west of Northern Ireland, with the Northern, South Eastern and Southern Trusts the worst performers. The Western Trust was able to treat 100% of 'red flag' patients in the last two months.

In February the Northern Trust was treating 88% of women in two weeks, but this fell to 22.9% within a four-week period.

And within three months the number of women who were treated in 14 days dropped by 58.1% in the South Eastern Trust.

In the Southern Trust it also fell by 38%, with just 15.5% of women regarded as urgent getting their first appointment in that timeframe.

The figures have led to calls for an explanation for the drop and for assurances that patients are getting treated as quickly as possible.

Dr John O' Kelly, chairman of the Royal College of General Practice in Northern Ireland, said: "We need clear answers as to why this is happening.

"If you have a woman coming into you with a breast lump that you are worried about, they are in a high state of anxiety. We would always refer them as a red flag immediately," he said.

"This is an extremely stressful, worrying time for women. I'm just surprised by this figure, that the number of women who we regard as urgent cases and need to be seen in two weeks have dropped by 20%."

Mr Poots said it was a "priority area" for his department and much of the delay had been caused by recruitment difficulties.

"The recent figures in relation to breast cancer performance are unacceptable," he said.

"My department has been assured by the Health and Social Care Board that escalated measures are in place to improve performance, particularly in the three worst performing trusts – the Northern, South Eastern and Southern Trusts."

Mr Poots added: "I am aware that much of the delay has been caused by recruitment difficulties and these are being addressed with a number of consultants having been recruited and it is expected that performance will improve in the coming months."

The minister said he had been assured that "considerable focus and effort" was taking place to ensure that women referred with suspected breast cancer receive the service they required.

Apologies little comfort when you need to see a consultant

Analysis by Victoria O'Hara

The figures in relation to breast cancer performance are unacceptable.” Those are the words used by the Minister of Health Edwin Poots to describe the position hundreds of women across Northern Ireland are in.

But the word “unacceptable” will be little comfort to the women in fear that they have breast cancer and have yet to see a specialist.

Ministerial guidelines require patients ‘red-flagged’ with suspected breast cancer to be seen for their first appointment within two weeks.

But at a time which can cause great anxiety and fear, hundreds of women caught up in a backlog are faced with waiting longer — not knowing if they have cancer.

 Doctors ‘red flag’ these cases for a reason — because there is something about a lump or other symptoms that concerns a GP. During March 2014, 454 of the 860 patients who were seen for the first time by a breast cancer specialist following an urgent referral for suspect breast cancer received their assessment within two weeks of referral — that’s just over 50%.

This left over 400 women still waiting. What is more concerning is that just four weeks before, 74.2% of patients were seen.

Staffing problems have been blamed for the situation, which was described as “very concerning” by a leading doctor.

A shortage of doctors has been an endemic problem across all areas of the health service in Northern Ireland—and Britain.

But what isn’t clear is why this staff shortage happened within a four-week period.

And what is more concerning is the geographical variation emerging.

Two women — for example one in Bangor the other in Strabane — could both be given an urgent referral at the same time.

But the woman from Bangor is unlikely to get her first appointment within two weeks — creating a postcode lottery.

However, it is important to highlight that Northern Ireland does have the highest survival rate for breast cancer in the UK.

And the minister said he has been assured by the Health and Social Care Board that “escalated” measures are in place for improvements.

But those words will be cold comfort for any woman caught up in a backlog.

The words those on a waiting list not knowing if they have breast cancer want to hear are “the doctor can see you now”.

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