Written evidence submitted by Macmillan (DEL0079)
Addressing the immediate concerns of people with cancer during the pandemic
- Treatment delays - We’ve been told that thousands of cancer treatments have been changed, delayed or cancelled. Some of this delay may be clinically appropriate for that patient but is important that this is well communicated. It may be that some health services in England deprioritised elements of cancer care based on system capacity rather than individual patient circumstances: though we cannot be sure about the level where these inappropriate blanket decisions were made. Macmillan are concerned about the immediate and long-term effects that delayed cancer treatment and care will have.
Q) What steps are being put in place to ensure that any change, delay or cancelled cancer treatment is due to clinical and not COVID-19 response capacity considerations?
Q) Has NHS England cancer programme had to take any remedial action, following reminding trusts about their responsibility to continuing to provide urgent cancer care?
- No patient forgotten – Macmillan are concerned that suitable follow up is undertaken wherever patient treatment has been changed, delayed or cancelled. Additional resources may be required to address treatment backlogs caused by the COVID-19 response. Macmillan would like to see the publication of a COVID-19 recovery/catch up cancer plan to ensure that services and treatment return to normal as quickly as possible after the pandemic with all patients receiving suitable follow up.
Q) What additional resources will be made available to ensure that no cancer patient is disadvantaged from a delay or cancellation of their treatment?
Q) What “recovery plan” will occur to address how the NHS will catch up with a potential surge in cancer cases, due to the drop in GP referrals and suspension of cancer screening?
- COVID-free cancer Hubs – It is essential to implement solutions for maintaining continuity of cancer care within the response to the pandemic, like establishing clean hubs with the required equipment, testing and staff. Macmillan is aware of 7 in 21 cancer alliances that have established cancer hubs. We welcome this new innovation but remain concerned that such practices are not yet uniform across the country with some alliances potentially requiring more support to establish these hubs.
Q) To what extent is the hub model operational and to what scale are they operating? What underpinning ‘enablers’ are in place for this to continue – such as PPE or testing for staff or patients?
Q) What “system preparedness” do you need in place to make sure cancer services can continue if there was another pandemic, or surge in cases later in the year?
- Effect on 3rd sector cancer workforce – Macmillan nurses, who normally deliver cancer care and treatment have been redeployed towards the NHS frontline in order to boost the ability to respond to COVID-19. This is despite an estimated reduction in fundraising for Macmillan this year of up to 50%. In other instances, due to this significant funding shortfall, NHS professionals have been furloughed as their host charity can no longer afford to pay their salaries and support cancer care within the NHS.
Q) What analysis has been undertaken to understand the impact on the cancer workforce due to the current significant reduction in charity funding?
- Effect on wellbeing – Calls to the Macmillan Support line about COVID-19 has increased by 1600% in March. Cancer treatment and concerns about work were the overriding issues raised. In a Macmillan survey, it showed high levels of emotional need and anxiety resulting from delayed treatment; high levels of concern around money due to furloughing, lack of work for self-employed, difficulties claiming benefits, needing to access food banks.
Q) Will the additional negative impact on emotional wellbeing for those waiting for diagnosis, treatment or care caused by COVID-19 response be addressed?
Ensuring system change continues
- NHS People Plan – Due to concerns with the current levels of NHS staffing, ensuring that cancer services had a sufficiently fully trained, and sustainable workforce to deliver 21st century cancer care was a large requirement within delivering the NHS People Plan. Macmillan would not wish this work to be lost within need to respond to the pandemic.
Q) What plans will be put in place to ensure that the NHS People Plan will be published with the additional resources to increase the cancer workforce needed?
- Delivering NHS Long Term Plan – The NHS Long Term Plan included some very welcome commitments on improving psychological support for people with cancer and personalised care and holistic needs assessments.
Q) What assessment has been made on the impact that the response on COVID-19 will have on these commitments within the NHS Long Term plan?