Surgical Cancer Hubs FAQ

There are multiple reasons for ‘backlogs’, but these have occurred because people have understandably been reluctant to go to their GP or hospital for investigations and also as there has been a suspension of elective or planned care - so that the NHS could better cope with ensuring that urgent and ‘time critical’ treatments could still continue alongside managing those patients admitted with COVID-19. This applies to all conditions – not only cancer.

What is elective care? Elective care is all non-emergency work, of which cancer is always prioritised. These tend to be less time-critical and will not cause harm if delayed. Examples may be hip replacements, hysterectomies and hernia repairs and in effect any surgery that will cause no harm if the date is pushed back and these too will have been paused.

Surgical hubs will prioritise all time-critical urgent surgery – this might be for cancer or non-cancer conditions.

It is estimated that cancer referrals have dropped by about 70%. A survey by NHS England of 1,000 people found a third were worried about seeking help from their GP.

The top reasons for this included fear of catching coronavirus, giving it to family members, and being a burden on the health service.

Prof Peter Johnson, NHS England's clinical director for cancer, said waiting to get help could have "serious consequences" for patients - and ultimately put a greater burden on the NHS,

Given that the covid situation is likely to persist for some time, rather than asking patients to wait or patients choosing to stay away, we will ensure that we provide ‘safe’ care through ring-fenced facilities and reconfigured care pathways. Online consultations mean people do not necessarily need to go to GP surgeries for check-ups.

That message now needs to be heard by the public; that we can create a safe environment for both staff and patients now that testing efforts are escalating quickly. Staff in hospitals around the country are working extremely hard and with more testing of staff and patients – with and without symptoms – we will have hospitals and centres relatively free from COVID-19 where patients can be treated safely.

We all need to spread this message to our friends and colleagues.

It is a mixed picture across the UK, with many hospitals and centres working innovatively to ensure as many people with cancer as possible are safely treated. Within the East of England, in the first instance, cancer treatments and diagnostics will remain within your locality. Specialist treatments will as always take place be at your nearest larger ’tertiary referral’ hospital.

Across the region we are discussing the option of a ‘virtual’ hub. If this model was put in place, it would mean that there would be regional oversight so that if your treatment could not take place at your local NHS trust, we could look to other NHS provider or partnered private hospital within your area.

Some trusts will also be in partnership with a local private hospital as part of their ‘covid free’ estate.

Hospitals can arrange for travel.

In order to reduce foot fall and to keep hospitals ‘covid free’ hospitals ask that patients come into the hospital unaccompanied. If there are extenuating circumstances, please discuss this with your treatment team.

If your surgery or treatment means that travel is uncomfortable for you please discuss with your treatment team.

They will do all they can to give you the right medication to ensure a safe journey – in this case you will need someone to pick you up.

Absolutely, this would remain the same as pre COVID-19. If you were to have any aspect of your care elsewhere then this would be ‘shared care’ and the centers/clinicians would communicate with each other. Any support services offered will still be accessible to you.

If we established a virtual hub then your clinical team from your hospital trust would remain the same and they’re be focus would be on ensuring that you still receive the same high-quality treatment as near to your home as possible. If you needed to have surgery at a hospital out of your area you would be transferred back to your local treatment team once you had recovered from the surgical procedure and follow up would be back with your local treatment team.

Patients will prioritised for treatment based on clinical need, and the level of risk. Patients will be fully involved in reaching this decision.

Essentially decisions will be made with patients, according to their individual needs for care and treatment, and their vulnerability to coronavirus.

A great deal of consultation amongst clinical experts has produced a Categorisation of urgency. This will be used by all clinicians across all hospitals.

This prioritises patients who need an operation:

1. Within 24 hours to save their life
2. Urgent within 72 hours.
3. Elective with the expectation of cure needed within 4 weeks to save life/stop progression (taking into account symptoms and potential complications from lack of treatment and;
4. Elective surgery that can be delayed for 10-12 weeks and will have no predicted negative outcome

This prioritisation applies to all surgery no matter which cancer type.

Yes – it would still be classified as an extension of your cancer surgery but may not be prioritised as urgent.

The surgical team within the hospitals covid ‘free’ zone will not routinely operate in areas outside of that covid ‘free’ / green zone. There will be separate theatres in the ‘red’ zone that will have their own surgical teams for patients who are known to be covid positive. However, do note that even within those ‘green’ zones full protective measures will remain in place even though patients have shielded and been tested as negative.

In some models’ surgeons from the referring trust might go with their patient to operate on them at another site.

In the first instance we are developing the principle of covid free treatment pathways in the normal hospital estate – creating a whole hospital solution is logistically more challenging because of the need to relocate all its existing services and staff.

Yes, robotic / laparoscopic machines will be moved into these ‘clean/green’ areas.