Anguish as backlog forces cancer operations to be cancelled
SIX cancer patients have had their operations cancelled at Addenbrooke’s after the Cambridge hospital was ‘too full’ to take any more patients.
The patients were either waiting to have tumours removed, have “complex surgery” for reconstruction or undergo procedures to determine whether they indeed have cancer.
Dr Gareth Goodier, chief executive of Addenbrooke’s and the Rosie hospitals, told Cambridge First it was the first time the NHS trust had to cancel and rearrange cancer patients’ operations, however its hands were tied.
He said a combination of the number of delayed discharges – where a patient is deemed medically fit for discharge but there is not the NHS or social care in place for them to leave hospital – and the norovirus meant the hospital was full.
While the hospital is from time to time forced to cancel planned operations due to an influx of emergency patients, it is the first time Addenbrooke’s has resorted to cancelling cancer patients’ operations.
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Dr Goodier said: “When it gets to the point when you have to start postponing surgery for cancer patients it is a serious situation. We have an obligation to deliver services in a hospital and community services have an obligation to care for people in the community.
“We simply cannot have a backlog to the point where we have to cancel surgery for cancer patients.”
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Dr Goodier said despite the hospital having to make efficiency savings of �44 million during the current 2011-12 financial year, patient care at Addenbrooke’s had not deteriorated.
“I would have to say no, there has not been a reduction in quality of care except on January 26 when a combination of a large number of delayed transfers and the norovirus caused us, for the first time, to cancel operations for cancer patients,” he said.
It is believed the six cancer patients have since had their operations.
The problem of delayed transfers – otherwise known as bed blocking – has not, however, been resolved.
On Friday there were 81 patients in Addenbrooke’s – equivalent to four wards full – who were deemed by doctors to be fit enough to leave hospital but remained as inpatients as there was not a care package in place.
Dr Goodier said there are constant meetings between Cambridgeshire County Council’s social services department, Cambridgeshire Community Services, NHS Cambridgeshire and the hospital to address the problem but the situation never improves.
In fact it has got significantly worse over the past year.
From October to December 2010 Addenbrooke’s reported a total of 1,430 bed days lost to Cambridgeshire-based patients who were staying in the hospital unnecessarily.
This rose by 91 per cent for the period from October to December 2011 when there was a total of 2,735 bed days lost.
The hospital’s figures are disputed by NHS Cambridgeshire which says there were a total of 1,439 lost bed days to Cambridgeshire patients from October to December 2010 rising 76 per cent to 2,534 for the same period in 2011.
Of the 2011 figures 868 are ‘blamed’ on social services and 1,602 on NHS Cambridgeshire with the remaining 64 deemed the responsibility of ‘both’.
A spokesman for NHS Cambridgeshire said reasons for delayed discharges for which it is responsible are wide-ranging and include the ordering of equipment, transferring patients to care homes, nursing homes and hospices, waiting for mental health assessments and arranging community nursing.
The impact of the delayed transfers, however, for whatever reason, is reflected in the number of non-emergency operations cancelled at Addenbrooke’s.
From October to December 2010 the trust had to cancel and rearrange 93 procedures rising 94 per cent to 180 during the same period in 2011.
Dr Goodier said: “We have spent in the last four years more executive time talking about delayed transfers of care than any other issue in this economy.
“It might be domiciliary care or it might be residential care the patient needs but it is up to the primary care trust [NHS Cambridgeshire] and county council to provide enough funding to look after these patients in the community.”
Dr Goodier said the problem must be addressed sooner rather than later particularly with a boom in the number of pensioners predicted in Cambridgeshire during the next decade.
Co-ordinator for the Cambridge Cancer Help Centre, Ann Dingley, said: “I‘m sure everyone having cancer it is a great deal for them to have an operation cancelled.
“Everyone at the centre thinks very highly of Addenbrooke’s and if the hospital can’t do anything else I don’t know what the answer is to the problem.”
SHORTAGE OF SOCIAL CARE SERVICES NOT ONLY TO BLAME
A joint statement issued by Cambridgeshire County Council with Cambridgeshire Community Services (CCS) NHS Trust and NHS Cambridgeshire read:
‘Health and adult social care services in Cambridgeshire are under pressure and the demand increases during the winter months. This year the very cold weather arrived early making the situation more difficult. It was compounded by the norovirus outbreak at Addenbrooke’s which resulted in ward closures - reducing the number of beds available.
A delayed discharge can be for a variety of reasons, not only a shortage of social care - patients have a choice over the type and location of ongoing support or medial treatment they need and their wishes can sometime not immediately be met.
We work closely with our partners in the health sector and examples of new services being set up in Cambridgeshire to allow a smooth and rapid transition of patients from health to social care include GP out-of-hours services, GPs working with acute trusts in emergency departments, services staffed by nursing and social care teams, which work with private sector and voluntary organisations - a pivotal relationship to ensuring patients admitted to hospital only remain in beds for the time they require specialist acute care.’
Matthew Winn, chief executive of the CCS NHS Trust, said: “Our integrated discharge planning service based at the hospital saw a 19 per cent increase in January 2012 of cases requiring complex care packages in the community on discharge from hospital, compared to January 2011.
“We have redeployed staff from other services to help cope with the increasing complexity of care packages required. Recently introduced re-ablement and tele healthcare are helping to avoid hospital admissions or enabling earlier discharge.
“The reasons for delayed transfers of care are complex and hence solutions require the ongoing engagement of a range of NHS and non NHS partners.”
Cath Mitchell, director of integrated commissioning for NHS Cambridgeshire, said: “The whole system of health and social care partners are working together to support the movement of patients through an admission into hospital and back to their home. Our aim is to do this as soon as possible but also to ensure that the appropriate level of support is available.”