EAST Cheshire faces a serious issue with head and neck cancer, with missed target times and inefficient practices leading to worsening outcomes for patients.

That’s prompted officials from the NHS Cheshire Clinical Commissioning Group (CCG) to come up with a plan of action to tackle the problem — but as Cheshire East councillors heard this week, it’s hit a snag.

What’s the issue?

Since 2014, the East Cheshire NHS Trust and Manchester Foundational Trust (MFT) have co-delivered the head and neck cancer pathway.

One important point to note is that the East Cheshire Trust does not cover the same geographical area as Cheshire East Council.

In effect, this means that patients are seen by staff at Macclesfield Hospital for diagnostic tests — and if malignant cells are detected, then the patient will be referred on to Wythenshawe for surgery or, if sadly needed, East Cheshire’s own palliative care team for supportive care.

In a presentation to CEC’s health scrutiny committee, the CCG said just 10 percent of patients in the borough were seen at Macclesfield within the 62-day target time in Q3 of 2019/20 — against a desired level of 85 percent.

Additionally, this issue is ‘compounded by insufficient consultant cover and a four week average wait’ for some procedures like collecting biopsies.

Simon Goff, chief operating officer of East Cheshire NHS Trust, told the committee: “There is no one stop service - which is where a patient gets diagnostics all on the same day.

“Biopsies are not always up to the standards required so patients need to have it again. This is a key weakness in the existing service.”

The lack of a ‘one stop service’ means there are no on-site pathology services — so samples are taken off-site for testing, and with biopsies needing to be analysed within 24 hours of collection, it results in 39 percent of all patients having to undergo the procedure again.

So what are they going to do about it?

The first step was to launch a consultation, with 64 former patients out of roughly 300 eligible providing feedback to the Trust over the summer.

The ‘robust’ consultation, saw patients express their desire to ‘know what is going on as soon as possible’, with the ‘issue of travel being outweighed by [the desire for] a quick diagnosis’.

Fortunately for health chiefs in Cheshire, there are ‘outstanding’ hospitals surrounding the county — with the Care Quality Commission giving top marks to hospitals in Salford, St Helens, and The Christie in Didsbury.

So with East Cheshire’s patients happy to travel a distance in order to gain a quick and accurate diagnosis, and the existing partnership with Manchester’s trust, officials are proposing moving some patients experiencing positive diagnoses and ‘bad news’ cases to MFT sites, such as The Christie or Wythenshawe Hospital.

The idea is that ‘neck lump’ patients will be immediately sent to Wythenshawe, with all other patients undergoing initial tests in Macclesfield first before being either sent home with the all clear, or referred on.

Biopsies will be done in Wythenshawe, as will ‘breaking bad news’ appointments — where patients are told of a positive cancer diagnosis.

Officials say this solution ‘would start to address some of the clinical and performance concerns’ by cutting the average diagnosis wait time from four weeks down to one, reducing the amount of appointments patients need to attend, and allowing for continuity of care throughout treatment.

It’s also worth noting that the proposals only relates to the diagnostic phase of the pathway, not treatment.

What’s the problem with the solution?

In short, Manchester’s services are in too high demand. There are fears that a new surge of patients from East Cheshire being directly fed into the mancunian hospitals will add to the ‘significant pressure across the region around the recovery of cancer and elective services’, according to Simon Goff.

He added: “The position the Manchester Foundation Trust find themselves in at the moment is having one of the largest cancer waiting lists in the country. That’s the reticence.”

Undeterred, CCG officials have met with regulators — who they say is ‘100 percent supportive’ of the strategy — and have a further meeting planned with MFT chiefs in order to ‘sit down and find a solution to this’.

One proposal is to phase in the Cheshire patients, beginning with neck level and bad news cases before extending it to everyone who is eligible.

Whilst it’s unclear how those meetings will conclude, Clare Watson, Cheshire CCG’s Accountable Officer, said: Patient safety is our priority. We will continue to work closely with Manchester NHS Foundation Trust to identify a sustainable solution for patients with suspected head and neck cancer.

“In the meantime, patient safety will not be compromised and those affected can be assured of continued care on their treatment pathways.”