With some cancer treatment still on hold as the NHS focuses on tackling the Covid-19 outbreak, fears are growing over the impact on patient outcomes. Maria Davies talks to Check4Cancer founder, CEO and CMO Professor Gordon Wishart about the need to maintain essential diagnostics and treatment in a time of crisis
It was just days into the dawning reality of lockdown that I first met Professor Gordon Wishart over Skype, and he was already warning that cancer treatment and diagnostics could fast become an unseen victim of the Covid-19 outbreak. Weeks later, as life moves from the surreal to an unsettling new normality, the founder, CMO and CEO of cancer screening and diagnostics company Check4Cancer is starting to see his fears play out.
Much routine cancer surgery and chemotherapy has been put on hold, both to protect high-risk patients and the NHS, and guidelines for suspected cancer referrals have been relaxed. In Wishart’s own specialty of breast cancer, many NHS trusts are no longer including symptomatic women aged under 25 in the urgent two- week wait pathway. Women under 35 years of age present- ing with breast pain and men under 50 with any breast symptoms are also being excluded and, in some instances, he says, diagnostic investigations will have to be delayed until resources are reinstated.
‘As a medicolegal expert on delay in diagnosis of breast cancer, I know only too well that delays in breast cancer diagnosis can lead to patients ultimately requiring more treatment and having a worse prognosis and in certain cases, losing their chance of survival. Therefore, the longer that the coronavirus is allowed to reduce access to timely breast cancer diagnosis and treatment, the greater the negative impact on patient outcomes. It is likely that this scenario will be similar for other common cancer types and many other acute healthcare interventions that are currently being rationed or cancelled,’ he says.
Last month, he wrote to Health Secretary Matt Hancock urging the government to set up a ‘Coronavirus-free’ network of private hospitals for the diagnosis and treatment of cancer and other acute conditions, as well as establish a cross-disciplinary group of scientific and clinical advisors to help devise an ‘all-patient’ approach to the crisis.
‘While the collaboration between the NHS and private sector was well received in the media to help tackle the corona- virus pandemic, I would have preferred public/private partnership that established a network of private hospitals that could continue to provide diagnostics and treatment for many different time critical diseases and conditions during the crisis,’ he says.
At the end of March, Check4Cancer announced it was opening a new ‘OneStop Breast Clinic’ for younger patients who may face delays in diagnostics because of the new guidelines on the two-week cancer pathway.
The Harley Street centre will provide access to consultant-led diagnostic investigations including examination, ultrasound and biopsy. However, Wishart acknowledges that the company may be forced to temporarily reduce services in other parts of the country.
‘We are working closely with hospitals and insurers to try and maintain a diagnostic service for our pathways, excepting that a number of private hospitals are effectively being requisitioned by the NHS,’ he tells HM.
‘We may not be able to run all of our existing clinics in those private hospitals at present but we are looking at alternatives – clinics and cancer facilities that will not be taken over by the NHS – and will try to redeploy some of our clinics and staff to other locations. I think it’s fair to say what we are trying to do is to run and maintain a level of network capability that is per- haps lower than it would normally be, but can still help patients access some of the services that they would expect.’
Coronavirus had not been on the agenda when I requested an interview with Wishart at the beginning of February. Back then, it seemed a dim and distant threat: unnamed and far away.
A far more pressing issue for the private healthcare sector was the Paterson Inquiry and, more importantly, its potential to transform the way services are delivered.
Wishart completed his medical and surgical training in Scotland with an MD in oncology before moving to Cambridge in 1998 where he was instrumental in the modernisation of the breast unit at Addenbrooke’s Hospital. As well as being professor of cancer surgery at Anglia Ruskin School of Medicine, he led the team of clinicians and scientists that developed the PREDICT breast cancer treatment and survival model in 2010, which is now used worldwide.
However, it was working as an expert witness for the Ian Paterson cases that gave Wishart the idea to set up Check- 4Cancer in 2014. The company provides screening tests for breast, bowel, cervical, lung, prostate and skin cancers and works with a network of consultant breast surgeons and urologists to deliver full service diagnostic pathways for breast and prostate cancer. In addition, it has a team of specialist nurses who deliver skin cancer diagnostic pathways from dedicated clinics.
‘I began acting as an expert witness
in the Paterson cases in 2011 and the more and more cases I reported on and the more and more women that I met that had been damaged by him, I thought it would be quite straightforward to set up
a network of breast surgeons who fulfilled certain criteria which would go a long way to prevent something like the Ian Paterson scandal happening again,’ says Wishart. The criteria include membership of
the professional body, the Association of Breast Surgery – of which Paterson was never a member – and operating with a breast radiologist present at the time of examination.
Crucially, members of the network also have to perform all the necessary investigations as part of a ‘one stop shop’ and their activity is subject to detailed audit.
‘We knew there were a few people like Paterson but thankfully they are rare. However, there are private consultants who choose to spread out a series of tests over three consultations so they can charge for three consultations even though best practice dictates that you do all the tests on the same day,’ says Wishart.
‘That’s what we try to do in the NHS and we should be trying to do that in the private sector too because we know it’s better for patients than having multiple visits. This theme really goes through all of the cancer pathways we’ve developed – it’s finding and defining what is best practice for patients and if you do that and set up a rapid access streamlined pathway to deliver that best practice it will almost certainly save money too because it is more efficient. It is good for patients, good for the insurance companies and good for self-payors and that is a great way forward.’
The company currently works with 52 consultants operating out of 67 clinics throughout England, Scotland and Northern Ireland. And, according to Wishart, it has had an overwhelmingly positive response from insurers. It now has agreements with most of the major PMI providers, including AXA PPP healthcare, Vitality Health and Cigna.
According to Wishart, insurers benefit in a number of ways, including assurance that their members are receiving best practice, a small cost saving in the diagnostic pathway and potential cost savings in the whole treatment pathway. However, he says the company’s ability to audit consultant activity and share that data with insurers has been integral to its success.
‘There are 500 breast surgeons in the UK, most doing something different, and the insurance companies have very little data on this. We can provide them with the reassurance that if they work with us, our consultants are working to a protocol and best practice. I think we are the only company managing and auditing cancer pathways in the insured sector and providing insurers with data which they would otherwise have no visibility of,’ says Wishart.
Skin cancer schemes
It is not just in breast cancer diagnosis that Wishart and his team are delivering cost savings for insurers. The skin cancer service was set up to tackle two issues in the private sector: long waiting times of up to ten weeks to see a dermatologist or plastic surgeon and high biopsy rates. Using a sophisticated nurse led service, patients are seen quickly and biopsy rates have reduced from around 60% to less than 10%, resulting in significant cost benefits for insurance companies and patients.
At the moment, the company audit only goes up to the point of diagnosis but Wishart says there is anecdotal evidence that its best practice pathways are also leading to reduced treatment costs.
‘One of the insurance companies that we have worked with has looked at our network of about 50 breast surgeons and compared them to all the other breast surgeons they work with.
‘They’ve looked at the average treatment cost for a breast cancer episode and what this shows is that with our group of surgeons, the average cost of cancer treatments is much lower,’ he says.
Although Wishart does not foresee a time when the company gets involved in the delivery of cancer treatment, he would like to extend its audit right through the cancer pathway, including multidisciplinary team decisions, outcomes, survival and local recurrence.
‘That kind of information would be invaluable for insurance companies planning for the future, and would really make sure that they are getting the best deal for their money,’ he tells HM.
‘I think what we will see over the next three to four years is that rather than insurance companies working with every single private breast surgeon there is, they are going to shrink it down and work with groups of surgeons who operate to defined standards for diagnostics and treatment to make sure that their members get best practice delivered in the most efficient way possible and avoid any unnecessary treatment and unnecessary costs.’
Wishart also has plans for the company to expand into new cancer pathways on the diagnostics side of the business and promote the benefits of screening to both its corporate and insurance customers.
‘There is a real push now to get involved in cancer prevention and early cancer detection so looking at risk and trying to reduce risk will become a key part of what we do.
‘Traditionally, PMI companies in the UK have stayed away from cancer screening and focused on diagnostics but we have worked closely with Cigna and Vitality to help them introduce cancer screening for their insured members and now other PMIs are considering how they might do that. We are building a number of tools with a team of health actuaries which will help us explain the potential return on investment if they invest in screening for their members,’ he says.
For the moment, however, Wishart recognises that interest in cancer screening
is likely to dip as companies turn their attention to the social and medical implications of the Covid-19 outbreak.
‘What happens to screening services over the coming months is uncertain. I wouldn’t be surprised if the Covid-19 outbreak drags out that they might suspend screening services for a period of time because there will be nowhere for those patients to go for further investigations,’ he tells HM.
‘But we will help where we can, whether that’s the provision of private cancer screening and diagnostic services for patients who cannot access these on the NHS or supporting the government’s efforts to contain and control the virus.
‘Check4Cancer has experience of collecting finger-prick blood tests for cancer screening, and we are keen to work with laboratories that have a validated anti- body test to ensure that this test is distributed as widely as possible, on a not-for- profit basis, throughout the UK private workforce through our partnerships and collaboration with insured and corporate sectors, as well as multiple brokers and intermediaries that work with UK PLC.
‘We would also be able to collect information from those tested on their geographic location, as well as whether they had been exposed to the virus or had any symptoms, to help better understand how it has spread throughout the UK.’