Scotland’s cancer waiting times worst on record amid growing demand


One in 20 cancer patients in Scotland is waiting longer than 116 days to be diagnosed and start treatment, amid growing numbers of referrals.

The target stipulates that at least 95% of people diagnosed with cancer should wait no longer than 62 days between an urgent referral – for example by their GP, or due to a suspicious screening result – and the date they commence treatment.

One cancer patient waited more than 300 days from referral to treatment, amid growing demand for diagnostic testsSource: Public Health Scotland

However, the target has not been met nationally by NHS Scotland since 2012, and in the most recent quarter was achieved in only one health board area – NHS Borders.

Overall, one in 20 patients waited over 116 days, with one waiting 322 days.

Patients with prostate cancer or colorectal cancer detected as a result of bowel screening faced the longest delays, with only 51% and 35% respectively beginning treatment within 62 days of an urgent referral for diagnostic tests.

READ MORE: Can we really say the NHS is ‘in recovery’ from Covid? 

Kate Seymour, head of Advocacy for Macmillan Cancer Support in Scotland said waits for cancer treatment have “have drifted from bad, to worse, to dreadful” over the past three years.

She added: “Most health boards reported staffing and workforce issues as being the root cause of the delays.

“Scotland’s cancer strategy is set to be launched later next year, but cancer patients and over-stretched staff can’t wait that long. The crisis is already here and it needs to be resolved now, particularly as we approach winter when we’ll inevitably see even more pressure on the NHS.”

Health boards blamed a raft of issues for the delays, especially staff absences linked to Covid, sick leave and vacancies in radiology, theatre and pathology, as well as bed shortages. 

Demand on the system has also grown from pre-pandemic levels, with 4,072 eligible referrals in the three months covering April to June this year – up by 9.4% compared to the quarter ending December 2019.

One cancer patient waited more than 300 days from referral to treatment, amid growing demand for diagnostic testsAfter dipping during 2020, the number of people being referred and diagnosed with cancer is now exceeding pre-pandemic levels (Source: PHS)

Referrals fell during 2020 as screening programmes were paused and the numbers of people visiting GPs and A&E departments with symptoms declined, but have since rebounded – putting pressure on diagnostic pathways.

On average, NHS Scotland continues to meet the 31-day standard – that at least 95% of eligible patients should wait no longer than 31 days between a decision to treat and the start of treatment – indicating that the bottlenecks continue to be concentrated in the diagnostic stage.

However, four health boards – Grampian, Greater Glasgow and Clyde, Highland and Lothian – fell short, with Highland meeting the 31-day target for just 87% of patients.

NHSGGC said it is experiencing “Covid-related staffing issues across all specialties” and “significant pressure” due to an increase in cancer referrals from GPs compared to pre-pandemic levels. 

READ MORE: Prostate cancer hope as statins slow tumour growth in groundbreaking Glasgow study 

From tomorrow asymptomatic frontline healthcare staff will no longer be required to routinely test themselves for Covid once a week. 

The move is expected to alleviate NHS absences, but there are also concerns that it could lead to increased virus spread to patients in hospitals.

NHS Highland said a “lack of staffing availability” has impacted on breast cancer pathways, as well as on tumour types dependent on endoscopy for diagnosis.

NHS Lothian said Covid had “affected staffing across the board”, particularly in relation to theatre capacity but also diagnostics. 

Scottish Conservative Shadow Cabinet Secretary for Health Dr Sandesh Gulhane MSP, said Scotland was facing a “ticking timebomb” on cancer diagnoses delays.

He added: “We know that early diagnosis is crucial to patients’ survival chances, so it’s frightening and unacceptable that almost a quarter are not beginning treatment within 62 days of their first referral.

“The Health Secretary can’t hide behind the pandemic as an excuse for this failure because the target has not been met by the SNP in almost a decade.”

READ MORE: More than half of excess deaths in Scotland caused by non-Covid illnesses for first time since start of pandemic 

Scottish Labour Health spokeswoman Jackie Baillie said: “This is nothing short of catastrophic, but the SNP government are nowhere to be seen.

“Humza Yousaf’s dangerous incompetence has broken yet another grim record, despite the tireless efforts of dedicated NHS staff.”

A Scottish Government spokesman said: “The 31-day standard has been consistently met throughout the Covid-19 pandemic with a median wait of five days.

“Despite treating more patients on a 62-day pathway compared to pre-Covid this quarter, and with a median wait of 47 days, performance remains challenged overall and we must do more.

“Cancer remains a priority for NHS Scotland, but Covid has not gone away – pressures remain in diagnostic and treatment pathways. In August we released an additional £10 million of funding to boards to support recovery and redesign of cancer services focusing on the most challenged pathways and to reduce backlogs.”





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The great middle class shift to Aldi will end food snobbery



IT’S really time to reassess your priorities when the thought of being sprung anywhere but Waitrose is enough to have you shunned from your usual social circles.

Aldi arrived in the UK in 1990 and Lidl appeared in 1994, yet even as recently as 2014 it was being treated as a curiosity rather than a bona fide location to do your weekly shop.

That is, for certain sections of society. For some folk it was merely their local supermarket, for others it was a foible of the middle classes, a bit of a naughty secret among friends.

It looks like posh shoppers are going to have to look again at their attitudes for the economy’s loss is Aldi’s gain.

The supermarket has announced that customers are coming to them in “droves” looking for cut price deals to see them through the cost of living crisis.

Its chief executive said the chain has enticed more than 1.5 million additional shoppers in 12 weeks – an increase of 19 per cent – thanks to an “unprecedented” change in consumer behaviour, the most dramatic since the last recession of 2008.

Low price Lidl is also scooping up worried consumers from Tesco, Asda and Morrisons as shoppers “prioritise value”.

In response, the BBC reports, the established supermarkets have made their value ranges more competitive. The new Asda basics range, Just Essentials, was so popular the supermarket had to put a temporary cap on the number of items shoppers could buy in order to keep up with demand.

Asda’s rebranding of its own brand items caused some light pearl clutching when it was first unveiled. It comes in bright yellow packaging, which commentators feared would stand out alarmingly in trolleys and baskets, alerting those nearby that here was someone who couldn’t afford branded items.

Now, as the majority are cutting their cloth in a cost of living crisis, it’s surely, finally the time to address this weird food snobbery.

For a long time Aldi and Lidl crept along quietly, doing what they do – purveying their vittles.

Then came a particularly snobbish phase, coinciding with the 2008 financial crash, of newspapers sending restaurant critics and gourmands-about-town to sample the wares and see how they compared to mainstream supermarket brands.

These usually expressed shock and awe that any of the food was in any way acceptable.

Rarely was the result that the Lidl foodstuff was better than the full price supermarket version – let’s not get carried away with ourselves – but it was often found to be surprisingly good, the writer taken aback at the quality of something that didn’t come from Waitrose.

Maidstone mums

A favourite of this genre was wine and from thence sprung a glut of stories about middle class shoppers buying the bulk of their foodstuffs in their usual supermarket but skulking off to Aldi for cut-price Champagne.

In 2014 there was a marked increase in ABC1 shoppers heading to Aldi and Lidl, a trend dubbed the “Maidstone mums”. Women from whom it would, apparently, have been the aforementioned social suicide to be seen doing your big shop outwith Waitrose.

What hard lives, to be so concerned by appearance, to be fearful of shunning for buying a cheaper brie.

As sarcasm is the lowest form of wit, food snobbery is the lowest form of pretension. It’s how we’ve ended up with internet-famous self-described food experts who scaremonger about carrageenan and make up nonsense about rapeseed oil.

Perfectly safe and unalarming foodstuffs are all slowly poisoning us, if you listen to them. And people are willing to listen thanks to an obsession with clean eating and wellness.

We think of this as a modern phenomenon but the only modern part of it is how extreme it’s become. A New York Times article talks of premium prices being paid for farm fresh milk in glass bottles and grass-fed beef raised on chemical-free grazing land.

“Today, such so-called ”pure” foods, victims of advanced agricultural technology, are so scarce they command premium prices,” it reads. “Once eaten by rich and poor alike, simple, unadulterated foods have become status symbols, affordable only by the affluent.”

That could have been written yesterday but its premise – that housewives are doing all the shopping – reveals the fact it’s from 1986.

Elites have always taken steps to distinguish themselves from the masses and food is one easy way to signal class and status. From the days of spices being exotic, rare and expensive signifiers of social rank to water lily seeds and kombucha today, the upwardly mobile want to be seen to be eating the “right” things.

A forced shift to Aldi could be just what we need to finally democratise food – or at least attitudes towards it.


Read more by Catriona Stewart:

Meghan Markle or the Little Mermaid – why the hate for Black princesses

Why did mourners wait so long to see the Queen’s coffin?






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Statins ‘slow prostate cancer growth’, finds Glasgow study



DRUGS commonly used to lower cholesterol have been shown to slow tumour growth in prostate cancer patients for the first time.

Scientists at the Beatson West of Scotland Cancer Centre in Glasgow gave atorvastatin – a form of statin – to 12 patients whose prostate cancer had stopped responding to hormone treatment.

Over a six to eight week period, 11 of the 12 participants experienced a decline in their levels of prostate specific antigen (PSA) – a key marker used to estimate tumour growth.

Larger and longer clinical trials are now planned to investigate whether statins should be given in combination with androgen deprivation therapy (ADT) – the standard hormone treatment for prostate cancer – to make it more effective.

READ MORE: Teen survivor of breakthrough leukaemia trial ‘wants to give back to NHS’

Professor Hing Leung, who led the research in Glasgow, said: “Our study is the first of its kind to show statins having a detectable effect on prostate cancer growth in patients.

“We think statins could stop prostate cancer from making androgens from cholesterol, cutting off a route for cancer to resist androgen deprivation therapy.

“Castration-resistant prostate cancer, when cancer becomes resistant to hormone therapy, is currently very difficult to treat.

“If further trials are successful, we could use these already-approved medicines very quickly to offer patients better options for treatment.”

Prostate cancer needs androgens, like testosterone, to grow. Current treatments work by reducing androgen levels but, in some cases, the cancer eventually stops responding.

Previous observations, at a population level, indicated that patients who were taking statins during treatment for prostate cancer were at a lower risk of dying from the disease, but scientists wanted to see whether statins could actively reduce prostate cancer growth.

The findings, published in the journal BJU International, were welcomed by 64-year-old John Culling, who was diagnosed with the disease in 2019.

His first indication was needing to use the toilet in the night on a skiing trip – something he had never needed to do before.

He put it down to age, but when it happened again on a trip as an army hill walking instructor a medic with the group suggested he ask his GP to check his prostate.

READ MORE: Never had Covid? Why the secret might lie in your genes 

Mr Culling, who lives with wife Margaret in Broughty Ferry near Dundee, was subsequently diagnosed with an aggressive form of prostate cancer.

He said: “The diagnosis came a shock. I was 60 but I had been in the army all my life so was fit.”

The grandfather and father-of-two has successfully undergone chemotherapy, radiotherapy and hormone treatment and is now being monitored.

He said: “The aggressiveness of the prostate cancer I have means there is a high chance it could come back, so it’s a case of waiting and watching.”

Mr Culling, who is originally from Jedburgh in the Borders, added that studies currently funded by Cancer Research UK “give me hope both for myself and for future generations”.

Around 3,800 men a year in Scotland are diagnosed with prostate cancer.

The findings on statins come as the Scottish Medicines Consortium accepted the prostate cancer drug, apalutamide, for prescription on the NHS – in combination with ADT – as an option for patients with metastatic hormone-sensitive prostate cancer.

These patients account for around 15-30 per cent of all prostate cancer diagnoses, but have a poorer prognosis.

Apalutamide, a pill which blocks the androgen signalling pathway, has been shown to improve both progression-free and overall survival.

It is expected to benefit over 800 eligible patients in the first year, rising to over 3,200 within five years.

READ MORE: Non-Covid illnesses cause majority of Scotland’s excess deaths for first time since start of pandemic 

Rob Jones, an oncologist and professor of clinical cancer research at Glasgow University, said there remains “significant unmet need” for men whose cancer had spread beyond the prostate and in whom existing hormonal therapies may not be appropriate.

He added: “The acceptance of apalutamide for use in NHS Scotland adds another effective and generally well-tolerated treatment option for men in Scotland with one of the most common of male cancers.

“It is also important to acknowledge the contribution made by Scottish patients who took part in the trial which showed this new treatment to be effective.”





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Thrombectomy service in Scotland has ‘long way to go’ says charity


A stroke charity has echoed a doctor’s concerns that Scotland lags behind England in providing access to a “game changing” treatment that catches potentially deadly clots.

Dr Maria Corretge, a consultant in geriatric medicine at NHS Lothian, said thrombectomy was now available “across most of England” but was “not fully established” north of the border.

In an interview with the Herald on Sunday she said the procedure had “great outcomes” and went as far as to say that she always advised people in the Borders to “go south” if they suffer a stroke.

Dr Corretge, who is part of an NHS campaign group called EveryDoctor, said Scotland’s aim to roll out treatment  had been slowed by shortages of radiologists.

She blamed a decision by Nicola Sturgeon to cut places in medical schools when she was health minster, describing this as “very poor workforce planning.”

HeraldScotland: NewsquestNewsquest

The Scottish Government said in response that it was committed to continued improvement in stroke care but acknowledged that some areas had “proven challenging”.

The Stroke Association said it welcomed progress made in establishing three centres that offer the treatment but said Scotland “has a long way to go”.

Ischaemic strokes can often be treated using injections of a medicine called alteplase, which dissolves blood clots and restores blood flow to the brain.

A small number of severe ischaemic strokes can be treated by an emergency procedure called a thrombectomy.

It  involves inserting a long tube into an artery in the leg, which is then fed through the body to reach the blood clot in the brain. The blood clot is then captured in a mesh and pulled out.

READ MORE: Neil Mackay’s Big Read:The NHS is collapsing but are the SNP to blame?

The removal of the clot allows blood flow to resume and oxygen to reach the brain, halting the damaging effects of the stroke.

In Scotland, three pilot services have been introduced in Edinburgh, Dundee and Glasgow. 

It is hoped that they will pave the way to a national service able to treat 600 to 800 patients a year.

NHS England started commissioning the service nationally in 2017 with St George’s University Hospital becoming the first hospital in the UK to have a fully staffed 24/7 service.

There are currently 24 tertiary neuroscience centres in the UK that can provide the treatment.

Angela MacLeod, Communications Officer for the Stroke Association in Scotland said: “Thrombectomy is a fantastic medical treatment that can show great outcomes for patients and, because it reduces ongoing support needs, means significant savings to health and social care budgets down the line

READ MORE: Tayside stroke patients home in a week after pioneering treatment 

“We welcome the progress that has been made towards the Scottish Government commitment to a 24/7 thrombectomy service for everyone in Scotland, but there is a long way to go and they need to sustain the good work and investment until we get there.”

A report released by the charity last month found that NHS England missed its original target of making thrombectomy available to all patients for whom it could provide benefit, only delivering the procedure to 28% of all suitable patients by December 2021.

It found that just 25% of thrombectomy-capable centres operate 24/7 services.

A Scottish Government spokesperson said:“We recognise that there are areas within stroke care that have proven particularly challenging and we are committed to continued improvement. 

“We expect health boards to identify aspects of their stroke services which do not meet the Scottish Standards and to work to improve standards of care locally.

“We are also committed to introducing a high quality and clinically safe thrombectomy service in Scotland and we are making important progress against this commitment. 

“Patients are already benefitting from the provision of thrombectomy at hub centres in NHS Tayside, NHS Lothian and NHS Greater Glasgow & Clyde.”

 

 





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