Agenda item

Consideration was given to an update on the continuing developments in relation to Tees Valley Breast Care Services.  Following a brief introduction by the North East and North Cumbria Integrated Care Board (NENC ICB) Director of Place-Based Delivery, the North Tees and Hartlepool NHS Foundation Trust (NTHFT) Acting Chief Operating Officer, supported by managerial and clinical colleagues from both NTHFT and South Tees Hospitals NHS Foundation Trust (STHFT), gave a presentation (circulated in advance) which focused on the following:

 Breast Services Clinical Services Strategy

 Current screening population

 Current breast screening provision

 Current breast symptomatic service provision

 Recap on work undertaken pre-pandemic

 Post-COVID recovery

 The challenges to delivery

 Current progress

During the presentation, officers emphasised the importance of understanding the difference between ‘screening’ and ‘symptomatic’ services.  In terms of the Tees Valley, the screening service had a catchment population of 55,000 per annum and was provided by NTHFT via mobile vans or static sites.  50- to 70-year-olds were invited to a screening every three years and were asked to attend specific sites based upon their GP registration.

For symptomatic patients, treatment diagnostic and treatment was provided in Darlington (Memorial Hospital), Hartlepool (University Hospital) and Stockton (University Hospital of North Tees), with the latter two involving longstanding close clinical collaboration with STHFT.  Required surgery following diagnosis was mostly provided at the patients’ local hospital Trust sites.

Whilst breast screening was suspended nationally from June 2020 due to the emergence of COVID-19, the Tees Valley offer was the first in the North East to recommence its services (in July 2021), and the second to fully recover the backlog.  Current waiting lists were now at pre-COVID levels.

As with many areas of health and care, workforce challenges within breast services remained prominent, and there had been a reliance on retire-and-return Consultant Radiologists.  Consultant Radiographer practitioners were in place and there were a number of trainee practitioners continuing their qualification journey, but this ultimately takes time (five years training) before it can assist in relieving pressure on services.  The current radiology workforce gap was outlined, as were the estate / equipment needs to provide one-stop provision at some spoke sites.

Several strands demonstrating progress in the development of services were outlined, including the introduction of a breast pain pathway which reduced reliance on the radiology workforce and could be delivered at pace without additional specialist equipment (anticipated 15% of future referrals could follow this pathway).  The direction of travel through training is for future Consultant Breast Surgeons to no longer take part in emergency surgery on-call rota and thereby increase capacity for breast surgery.  The commencement of planning for the procurement of a mammography machine for the James Cook University Hospital to support the re-introduction of surveillance mammograms on this site, as well as improved access for patients who can be offered immediate breast reconstruction free-flap surgery (specialist procedures undertaken at a tertiary site), was also noted.

The Committee queried how many men were invited to the screening service as breast cancer was known to affect males as well as females.  Clinical representatives present stated that breast cancer was around 100 times less common in men than women, and that a screening programme for males could not be justified due to these very low rates.  However, assurance was given that men could be referred into the symptomatic service and would be treated in the same way as women were.

Referencing delays in diagnosis as a result of the COVID-19 pandemic, the Committee asked if this had had an impact on the severity of cases being seen within breast services.  Officers felt that more time would be required to understand the effect of the pandemic as evidence would be determined to a large extent by survival times across a longer period (e.g. 5 years, 10 years, etc.).  It was, however, acknowledged that services did have to prioritise during this period and that some individuals were put on medication to slow disease.

In relation to the stated workforce gaps, Members questioned if there was anything more that could be done / considered to help with staffing resources, and were informed that a business case had recently been approved to boost recruitment (including from overseas).

AGREED that the Tees Valley Breast Care Services update be noted.