Minutes:
The chair welcomed the following colleagues from the Guy’s and St Thomas’ Trust (GSTT) and Partnership Southwark:
• Dr Kate Haire, Clinical Director South East London (SEL) Accountable Cancer Network (ACN)
• Anne Rigg (medical director Guys St Thomas Trust (GSTT) and consultant oncologist
• Christopher Sivell, lead nurse Rapid Diagnostic Centre (RDC)
• Nikki Macfarlane, Partnership Southwark cancer clinical lead)
• Darren Summers, Strategic Director Integrated Health and Care/Southwark Place Executive Lead.
A presentation was provided and then members were invited to ask questions.
The following points were made:
· A member asked GSTT colleagues how the long term national ambition of detecting 75% of cancers at an early stage can be reached, given the present local performance ranging between 58% and 53.3% in 2023/24. Clinicians responded that this is the biggest challenge and can be best tackled by ensuring that health services are able to reach the whole population, that there is good access to Primary Care and ensuring patients symptoms are listened to and understood by Primary Care. There is also work to be done to de-stigmatise cancer. Granular engagement shows that for some people health is not a priority as the focus is on trying to exist and survive – for example people on zero-hour contracts and low pay. The wider deterrents of health are very relevant here.
· A member commented that there are people who would find it difficult to access Primary Care as may not be able to not ring in for a GP appointment at 8am. Members asked if there is engagement with corporations employing people on zero hours contracts. The Strategic Director commented that GSTT are primarily commissioned to work with people come forward with symptoms, however GSTT do support people who are struggling to attend appointments and have benefit problems.
· A member commented that people on zero-hour contracts /low paid are often also recent immigrants and there may also be language barriers; the member therefore suggested outreach and leaflets in different languages. The member added that Latin American community associations see people with cancers, such as breast cancer, seeking treatment abroad because of an inability to access care or a perception that care is not available.
· Clinicians said that there is a project working with Latin American community looking how to improve engagement and access to healthcare services. In addition, that is a cervical screening project in Lambeth working with the Latin American community.
· There was a discussion on improving translation services and ensuring that speakers with Spanish from the right country are allocated to patients. Clinicians acknowledged the importance of good quality translation and reported that there are Latin American leaflets available.
· The Rapid Diagnostic Centre confirmed that will it pick up on cancers such as Non-Hodgkin Lymphoma, which can be hard to detect early and present with symptoms such as weight loss.
· There was a covid backlog to overcome after the pandemic, and also people were more reluctant to take up invitations to attend hospitals. More work is ongoing here with communities.
· Members asked about drop-in clinics to assist people who find appointments harder to make. Members commented that these used to be common for cervical cancer screening and Sexually Transmitted Diseases; unfortunately, now an appointment is required. The clinicians strongly agreed with the need for flexibility. They did however flag up that this can be difficult with a national programme that often requires appointments, whilst agreeing making appointments can be difficult and a barrier, and the benefits of drop in provision.
· Members suggested more outreach for prostate cancer, such as a community bus offering information and perhaps even testing, as well as visits to places such as Southwark Pensioners Centre. Clinicians said that they have been working with men with prostate cancer to provide better information, such as reassurance that diagnosis is non- invasive.
· Clinicians explained that GPs are skilled up through training packages, including one by Macmillan Cancer Support and Red Whale cancer referral guidelines. They explained diagnosis can be difficult as people with non-traditional cancer symptoms are only present a few times each year.
· Members commented that there is an ongoing concern with difficulties accessing GPs, and this was acknowledged. Clinicians reported that there is work to improve Primary Care access. This work will be the subject of a report to the next meeting of the Commission.
· Clinicians said that private providers are only used in unusual circumstances, but this may occasionally happen e.g. if a scanner broke down or to buy theatre time for operations that are required, if there is a backlog that urgently needs addressing.
· Members asked clinicians for recommendations to improve performance and the following were suggested:
A) improvements to the system and partnership working
B) engagement with communities to drive change
C) Improved data quality, including that hospital and Primary Care record Protected Characteristics, plus post code and socio-economic status.
It was noted that there have been some issues with data from Epic, the newly introduced patient record system.
Rapid Diagnostic item