Plus ça change

Wednesday 28 October 2020

Unsurprisingly, for those pattern recognisers among us, the coronavirus pandemic is dominating news headlines around the world again …and not in a positive fashion. The rise in the number of documented infections, followed, with the now predicted lag, by hospitalisations and ITU occupancy demonstrate that we have not yet reached our new normal steady state, but that our understanding of the coronavirus is much deeper than it was six (short) months ago.

In an attempt to avoid a complete second national lockdown in the UK (I might cynically say until after 27 December – or 3 January, if I was being true to my Scottish heritage), our politicians across all four nations are increasing NPI and our recently refound freedoms are being curtailed. A grim prospect indeed as the days shorten. In England, we have been divided into three risk tiers (and somewhat demoralising that there is no low risk tier to aim for). Usually around now the work email traffic on “How do you want to manage chemotherapy clinics over the Christmas period?” starts. Patients begin to project forward their treatment schedule and negotiations open on how best to fit time with loved ones around ongoing therapy. Increasingly, the elephant in the room will be thoughts of Christmas spent without family and the emotional support that brings. The same, unfortunately, holds true for staff. Managing the mental wellbeing of the workforce through a second surge is one of the major challenges we face.

At the weekly briefings held by NHS England/Improvement (NHSE/I), the mood is both sombre and increasingly weary. Those for whom the second wave has arrived with a vengeance are recapitulating the responses (and problems) of March and April – crowding in ED (a major nosocomial risk), opening COVID-19 wards (again) and struggling to maintain some form of elective service, especially for those trapped in the void of the backlog. How big will the problem become? Numerous models abound but all agree collateral damage to non-COVID ill health is inevitable. For those of us watching waiting times lengthen no matter how much effort is put in, knowing there is true need out there, but being unable to identify and act on it, the collateral damage will be arriving in a clinic or on a PACs screen near you for a long time to come.

On a dreich (translation: dreary, bleak, damp) Monday morning, I joined a press panel briefing on the impact of ‘COVID on cancer’ hosted jointly by Cancer Research UK and the Science and Media Centre. A curiously flat experience given the importance of the topic – any event occurring on a day the Prime Minister is making a major announcement is never good and the message was, by no one’s terms, upbeat. Nonetheless, it served to highlight to journalists (and from there the public) the essential part imaging plays throughout the cancer pathway and how important it is to try to maintain cancer services through a second COVID-19 surge, despite the not insignificant challenges. The pre-COVID parlous state of the cancer workforce was highlighted and the case for expansion well made. This one event garnered coverage in many of the national news media as well as an invitation to be interviewed for ITV. An illustration of how a sense of flatness doesn’t always reflect the popular penetration of a good story and the value of putting the RCR out there.

To spite me personally (I am sure), NHSE/I released Sir Mike Richards’ (extremely) long-awaited review of diagnostic services the day after my last blog was published. Supporting the healthcare vision of the Long Term Plan (LTP), if the funding follows, the wait will be more than worth it. Sir Mike understands the diagnostic pathway better than most near the political centre of the NHS and has been an unceasing advocate for a properly resourced imaging service. He has long championed early cancer diagnosis as the only way to truly impact on cancer survival in the UK and sees that separating cancer from other imaging is an artificial divide. He makes the simple but compelling argument that to improve diagnostic capacity, shortages in workforce and kit need to be addressed in tandem. He recommends an expansion of the machine base as well as replacement of those scanners more than ten years old. The concept of a community diagnostic hub (CDH) – where a range of diagnostics could be delivered on a COVID-19 protected site remote from emergency pressures (a win-win for ED and secondary care) – are visionary (unless you are have been around as long as I have – there are no truly novel ideas). Who knew it was cheaper to install a CT on a new site than replace one on an acute site? For workforce, he recommends an expansion of 2,000 radiology consultants. Our RCR census calculations put the current shortfall at 1,876 WTE – we promise we did the work separately, miss! His view of diagnostics in the round and how to get the best bang for your buck is a tour de force.

Both these events, in different ways, prove the immeasurable value of our census data – I cannot emphasise how useful accurate, robust, granular workforce data is in supporting our case for workforce expansion. Census data collection is now underway in both faculties – feel free to encourage your CD to fill it in, in a socially responsible fashion of course! 

Dr Jeanette Dickson
RCR President


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