Date of prep: December 2020
Prescribing information and
adverse events reporting
For healthcare professionals only
The head of a Scottish medical college has sounded a warning over the scale of the catch-up challenge facing diagnostic services.
Professor Michael Griffin, President of the Royal College of Surgeons of Edinburgh, says key tests to confirm or rule out serious illnesses such as cancer had been “forgotten about” while the focus was on cancelled elective procedures.
The collapse in diagnostic procedures could mean conditions are only detected at a later stage when they are more difficult to treat – or missed altogether.
More than 100,000 people in Scotland are waiting for eight key diagnostic tests as of September, the last month for which figures are available. Nearly half had been on the list for more than six weeks, compared to less than 20% in the same month in 2019.
It comes after the Scottish government unveiled a new plan to get cancer services back on track after disruption during the pandemic.
In an interview with healthandcare.scot, Professor Griffin said more diagnostic testing should be taking place at Glasgow’s NHS Louisa Jordan temporary field hospital, which was set up to deal with virus patients but has been used to support routine health service work.
The Newcastle-based surgeon said it was vital for the public to follow the guidelines ahead of a “very difficult” winter– as the vaccine will make “no difference” this year.
“We have to acknowledge the five-day period over Christmas where we can all get together is a very worrying time.
“I totally understand the reason for doing it but I do understand the Scottish government’s reluctance because it will come at a cost.
“As a result of those five days, there will be increased numbers of infections, increased numbers of admissions and increased numbers of deaths.
“What we have got to do is get the message over to the general public that just because they have been given this opportunity to get together, that it is not an instruction to get together it is a permission.
“So, it is a difficult winter for Scotland and the UK – but it will be a better Easter.”
Professor Griffin voiced concerns over the number of “hugely important” diagnostic tests that had not taken place because of the pandemic.
He welcomed the use of the Louisa Jordan to do scans but said “we need to increase those numbers” and extend to endoscopies and other tests.
Endoscopies – which involve using a flexible tube with a light and camera to examine the inside of the body – were paused for all but emergency and essential procedures at the start of the pandemic.
Services resumed in June, starting with potential cancer cases and screening for the disease.
Earlier this year healthandcare.scot reported a contract has been awarded to decommission the facility when virus levels are “under control”.
Between 2,500 and 3,000 patients were seen at the Louisa Jordan each month over September, October and November, with two new scanners based at the hospital.
Meanwhile, six roving MRI vans have been used to target areas with the longest waits, leading to more patients being seen within the six-week goal.
“UK-wide there have been huge cancellations of elective surgery and also a reduction in the number of diagnostic procedures that are done,” said Professor Griffin.
“Diagnostic meaning ultrasound scans, CT scans and MRI scans, but also endoscopies, colonoscopies and bronchoscopies, to rule out serious illnesses affecting those parts of the bodies but in particular to rule out cancer.
“A lot of them have been reduced all over the United Kingdom but it has been a particular problem in the second wave in Glasgow and Lanarkshire because they have been hit hardest by the second wave of covid.
“These diagnostic procedures are hugely important. Up to 10,000 avoidable deaths from cancer [across the UK] will happen over the next four or five years because of the delay in diagnosis in the first wave and the same will apply in the second wave.
“This is really worrying. We’ve been calling for other provision to maintain diagnostic services throughout this.
“One of the possibilities was to use the Louisa Jordan. It’s certainly being used to do CT scans and we could have increased that; we could have set up endoscopy units and do other ‘oscopies’, if you like.
“I’m afraid that hasn’t happened. One of the reasons has been workforce and the fact that a lot of the workforce, up to 25%, have been off self-isolating at any one time, hopefully with testing coming on stream in the next week or two that will help to maintain the workforce.”
A further challenge is staffing the Louisa Jordan:
“Of course staff have to come from somewhere, whereas the independent sector has their own staff – that’s the great attraction of the independent sector.
“For the Louisa Jordan we have to find the staff to do the extra work and that has delayed doing the endoscopy and colonoscopy list.
“We need to be more innovative about how we use returners – people who have volunteered to come back – to do these diagnostic lists.
“Returners to the health service, people who have recently retired, they haven’t been utilised to their full extent in the first wave and perhaps we can increase their contribution.
“In particular that contribution may be more significant if vaccination is coming into play because we’ve got a long road ahead to get over all of this.
“Doing routine elective surgery, non-cancer work like hip and knee replacements, cataract surgery, hernia repairs and all of that which has been completely paused, to get that back on track we are going to need extra workforce and extra facilities. That is going to go on for years as well.
“I want to emphasise the fact that the vaccine is on the way doesn’t mean that we should take our eye off the ball.
“Winter is going to be difficult and we need to get that message over; we’ve got to maintain our hand-washing, not touching our faces and social distancing. Even the five-day period over Christmas will have an effect and there will be a price to pay for that.
“If everybody’s sensible and behaves appropriately and public-spiritedly then we can get through this.”
By Henry Anderson
Pharmacy in Practice is a UK pharmacy publication with its roots in Scotland.