Rapid Diagnostic Clinics proposal for 2020:

[SunshineAhead]

I have read and researched all the information I can on this NHS/NICE/Government proposed system to be incorporated in 2020 (being tested out and assessed right now).

Whilst I think this is a fantastic idea and support the intention, integrity and content of what is the ultimate goal to essentially have ALL suspected/potential cancer patients, examined, tested and diagnosed within 28 days, and thus removing the disparity up and down the UK, I really cannot see this succeeding for a long time to come.

As a cancer patient, I wish with all my heart that everybody throughout the UK could be diagnosed as quickly as possible with the prospect of more and more people surviving due to speedier diagnosis and appropriate treatment. However, when you read between the lines , it is clearly indicated that it is largely due to appropriate funding. In addition to this, NICE already have the two week referral clinic and the 62 day timeline for tests, diagnosis and treatment to commence yet we all know (and I've heard people on this forum confirm from personal experience), there are more NHS authorities who fail to comply with this by a very wide margin, and many patients are being failed and consequently options reduced as a result. The intention is to have 10 National regional centres for this purpose. Does anybody truly believe, that at least out the outset and foreseeable future, this balance of equality and fairness will occur? I do not see what will change. Areas that are not coping with the current timelines have reasons such as larger populace, covering a much wider area such as rural which in itself presents problems with patients attending appointments due to distance etc, and less experts in their relevant fields training, living and therefore working and practicing in some areas ie, London and Manchester being the preferred locations for these experts. This will not change. Those differentials will still remain and I can see nothing on how they intend to address this to make it effective.

I consider money would have been best spent better equipping every single individual current NHS region with sufficient funding dedicated to cancers only and thus not possible for those authorities to draw from the funding for any other purpose, as well as every area having an adequate team of surgeons, clinicians, specialist nurses, radiographers, dedicated laboratory technicians. Every region should also have adequate X-ray, CT and MRI scanners and every single NHS regional authority should have it's own PET scanner. Long term this would have cost less money, avoid the need for patients to travel in some cases, long distances, AND speed up referral and diagnostic timelines and thus subsequent commencement of treatment thus improvng outcomes everywhere!

I'm sorry to have got on my soapbox in this but I am so fed up of NHS reforms and millions of pounds being spent only for 5 years down the line proving it's made little or no difference and thus the spending and change circle starts all over again. Doesn't it make more sense with all the money this RDC initiative has cost to date, and will cost going forward, it would have been cheaper, simpler and more balanced and fair to have split that money per head count per NHS region for cancer purposes alone, to enable every single City and Town to have EASY access to the same standard! Cynically, private companies will make more money from this initiative as undoubtedly they will run the PET scans and the MRI scans (obviously for a profit) just like they do in most areas already!

[Elt79]

I too have been reading this and have to agree - my experience is patchy to say the least - getting a scan appointment takes longer than it should and then, for me the worst bit, the length of time you wait for results! I should have had a CT in May - no appointment arrived despite me continually chasing. Finally saw my actual consultant 3 weeks ago (2nd time in 9 months) - she arranged PET scan immediately but no results til next clinic which thankfully is tomorrow. I have just retired after 30 years in the NHS and have seen first hand how these targets are played out - funding withheld if not achieved! That’s helpful NOT! I believe NHS should be taken out of political arena and all should work together to make thing equal and fair. It should not be the case that your treatment depends on your postcode. I could go on but enough of my venting 😍

[JanetteR57]

There are so many variations in people's cancer experiences of treatment and support across UK and England and one way of trying to improve things is to impose targets to identify where areas are lacking/failing to follow up. As there are so many types of cancers and stages and many people with cancer have other conditions so it's not always as straight forward as believed. It will be extremely challenging for lung cancer to be detected for 'rule out' within 28 days due to the extensive tests including pathology required to determine precisely what the patient has (to provide optimum treatments). In other cancers it is not quite as complicated so as with current 31 day and 62 day wait targets (which themselves are not met in many Trusts) all cancers are amalgamated together for these results. In lung cancer, the national lung cancer optimum pathway was developed a few years ago by all clinical disciplines involved from across the country designed to shave off time in each part of the diagnostic and treatment pathway to enable results to be gained quicker for detection to start treatment. This is to try and raise our outcomes in line with other countries. In different parts of the country, this is providing much needed evidence for others to learn from. It's not always in the larger cancer centres where improvement gains are the greatest. It's a very complex area as are all NHS matters - having the right equipment at every centre isn't enough in itself, as the equipment needs suitably trained and experienced staff to manage this and as you rightly point out there are national shortages in areas that particularly affect lung cancer (pathology and radiology) but unless a national standard is applied, it's difficult to evidence how outcomes can be improved. In my own locality, we lost our chemotherapy services last year to a specialist Trust much further away - this was a political decision as our local trust was meeting its targets. It was nothing to do with local commissioners but NHS England took the decision supposedly on a temporary 12 month max basis but nothing has moved back and questions I ask are met with deafening silence. This happened despite local protest and a deprived population now having to take at least 3 transport modes each way or pay £20 uber fare average each way for chemotherapy. This is not a rural area so travel issues do not only affect long distances but also those where no direct routes exist. PET is usually run only in a few centres like other specialist procedures such as SABR/cyberknife but the reality is that most hospital buildings could not currently house some of the very large scanners/treatments (including proton beam). One of the many difficulties is that different geographic areas populations have different cancer types so with treatments varying, it's important that access is available for as many as possible within safe and quality limits. I'm on a number of committees for lung cancer and often remind members from larger centres to consider smaller centres/district general hospitals and patients like me who have to visit one centre for surgery, somewhere else for PET, somewhere else from these other two for chemo/radiotherapy and back to DGH for outpatient/respiratory follow up. I've been undergoing investigations since last Apr 2018 and one test due 31/7 has been postponed until November as the only specialist therapist has gone off on long term sick and the only other one is in Manchester! I'm in the Midlands. Personally I think there should be a national health workforce audit done as people's career choices have changed considerably from the current healthcare professionals. I learnt the other day that many clinical nurse specialists will retire at the same time so planning is essential if we are to avoid the crisis we have in primary care where it suddenly dawned on people that most GPs were recruited at the same time were due to retire together resulting in a crisis of provision. Without the suitably trained people in the right places including anaesthetists, phlebotomists, radiographers etc, equipment can lie idle (which happens already) so it is really a case of various government departments and those training (medical schools/universities etc) to try and identify candidates now and train more to meet what will only be a growing need in cancer services. I don't think realistically that politics will ever be removed from the NHS given the massive public funding it receives but believe areas like health, social care and education should be dealt with by cross party discussions/groupings to prevent one party undoing what another has done and wasting precious resources.