North Central London Cancer Alliance

We developed a detailed recovery plan that enabled the partnership to hit this goal four weeks ahead of target. We also shaped a longer-term programme to guide the development of innovative, more efficient and sustainable endoscopy services for the future. Prompt access to diagnosis and earlier treatment will result in better outcomes for thousands of patients. NCLCA is also now in a better position to recover these services from the effects of subsequent lockdowns.

Key successes

• Designed the recovery plan to reduce waiting list for cancer diagnosis to pre-pandemic levels at pace and in line with national targets
• Deployed programme management expertise to hit goal four weeks ahead of target
• Brought innovative thinking to a vision for more efficient, sustainable endoscopy services for the future
• Delivered flexible support and coached management to enable client team to continue to drive improvements

Driving down post-pandemic waiting lists

North Central London Cancer Alliance (NCLCA) is a partnership of NHS organisations that brings together partners to improve cancer outcomes and patient experience. One of its key cancer diagnostic tools is endoscopy, a procedure which lets medical professionals examine internal organs using a tiny camera on the end of a flexible tube. In the UK, around 2 million endoscopies are performed each year. However, the coronavirus pandemic had had a serious impact on waiting lists. As lockdown lifted, there were over 8,500 patients in North Central London waiting for endoscopies, including some with suspected cancer.

Even after services reopened following the first lockdown, the waiting list continued to grow. Infection control measures between appointments and the need for social distancing in waiting rooms meant fewer people could be seen. Meanwhile burn-out, illness or the requirement to self-isolate among staff meant there were fewer skilled people available to conduct the work. In addition, patients, anxious about coming into hospital, were not turning up for appointments. All these factors were having a knock-on impact on waiting list numbers. PA was asked to work with the Alliance and the member Trusts to develop an approach and plan to reduce waiting lists to pre-COVID levels.

Building back better

Throughout the COVID-19 pandemic we’ve been supporting healthcare organisations globally respond to the extreme pressures they’ve faced – from matching clinicians with hospitals in need in New York, to creating a COVID-19 rehab centre from scratch in Surrey, England. We were uniquely positioned to support NCLCA.

Bringing waiting lists back to pre-COVID levels was the Alliance’s most urgent priority, but we recognised this challenge as an opportunity to think bigger. The pandemic had created an environment in which it was possible to reshape endoscopy services and increase screening capacity by making better use of resources.

We quickly assembled a team of experts in healthcare, operating model design, workforce planning and programme management to work with their team to shape and deliver a recovery plan. Our team included people with on-the-ground experience of transforming NHS endoscopy services.

Exploring innovation

Working in a hybrid team with NCLCA, we capitalised on our mix of expertise and insights into healthcare delivery to start uncovering opportunities to run endoscopy services more efficiently. Could a shared waiting list help ensure that capacity at the various hospitals was used more effectively? Could more virtual working among partners improve communication and speed up the allocation of referrals?

We also looked for opportunities to find more capital and estates. This included seeking out unused spaces that could be requisitioned to create new endoscopy suites, identifying the equipment needed to fit them out and exploring options to secure funding to procure this.

Our flexible team, which started small and scaled quickly, began identifying the challenges and focus areas. Working alongside the Trusts, we reviewed their approach at a local level and compared it to the wider healthcare system. We then drew on the expertise of our own team to develop the insights needed to achieve longer-term endoscopy sustainability.

Workforce shortages emerged as a major challenge. Even before the pandemic, the partnership’s hospitals had been unable to employ enough endoscopists and had been relying on agency staff – an expensive option. Post-pandemic, illness and burn-out were depleting the workforce. In the short term, we proposed drafting in existing staff with the right skills to support the recovery plan. Longer term, we worked with the alliance on plans to release more staff. This included considering how training should be organised to minimise impact on staffing in other areas.

With PA’s extensive insight into uncovering patient preferences and behaviours, we knew it was important to improve the patient experience. We considered how better communication with patients could improve efficiency – from providing a clear map of the hospital site in advance so patients didn’t need to contact endoscopy units to check where to go, to communicating more on the infection control procedures in place to reassure patients and make them more likely to attend. For the longer-term, we identified the potential benefits of clinical innovations. Introducing capsule endoscopy (where patients swallow a minute camera in a pill) had the potential drive down DNA (did not attend) rates by improving the patient experience dramatically.

Delivering the recovery

Such innovative thinking was put at the heart of the recovery plan and helped to develop a longer-term programme for ensuring more sustainable and efficient services in the future. For the recovery phase, we drew up a delivery programme, identifying priority activities and setting up a programme management office (PMO) to steer and monitor progress. The PMO produced weekly reports showing where the plan was on track and where more support was required. We focused our expertise on these areas as they emerged, flexing our support to supplement our client’s capabilities as required.

Getting results

The impact of the recovery phase was immediate. We hit the goal of reducing endoscopy waiting lists to pre-COVID levels four weeks ahead of the national target and enabled 174 more patients a week to access life-saving endoscopies. In addition, NCLCA endoscopy services are far better prepared for the subsequent waves of the pandemic. Elsewhere, we worked with seven London NHS trusts to apply learnings from this assignment to reduce waiting lists for imaging tests such as CT and MRI scans.

Longer term, our work will make an important impact on the quality of cancer diagnosis and care NCLCA can offer. We left the partnership with a clear set of recommendations for developing innovative and efficient endoscopy services, and a clear programme for implementation.

We also undertook a comprehensive handover, providing coaching to the NCLCA and local teams to ensure they can continue to drive the change. They are now in a position to realise the NHS Long Term Plan goal of introducing a new, faster diagnosis standard which will ensure patients receive a definitive diagnosis within 28 days. It will also help them reach the target by 2028 of an extra 55,000 people each year surviving for five years or more following a cancer diagnosis.

For patients across north and central London, shorter waiting lists for endoscopy services could be the difference between life and death.