Britain’s top surgeon admits ‘we’ve never had to deal with anything like this’ with NHS waiting list

A surgeon has warned the NHS could ‘easily’ win war with Covid-19, but at the cost of losing the battle with cancer.

Ben Challacombe, a consultant urological surgeon at Guy’s and St Thomas’, said a ‘surge’ of cancer cases will come in the wake of the pandemic.

But he fears a lot of them will be diagnosed in the late stages of disease due to a drop in the number of people coming forward with symptoms. 

Experts have said patients are reluctant to see a doctor with symptoms because they do not want to be a burden on the NHS during the coronavirus crisis, in which ministers’ top priority was to protect the health service from being overwhelmed.

Another top surgeon in Britain today admitted ‘we’ve never had to deal with anything like this’, in regards to the record-high waiting list for surgery. 

Professor Derek Alderson, former president of the Royal College of Surgeons, said the 2.15million people who had waited more than 18 weeks for routine treatment was ‘unprecedented’. It is the worst figure since records began in 2007. 

He told a virtual briefing today that Britain ‘cannot allow the waiting list to worsen’ moving into a potential ‘second wave’, with worrying data showing Covid-19 hospital admissions have begun to creep up once again. 

It comes as Matt Hancock today pledged £2.7billion to support the NHS during the winter months and help tackle the growing backlog.

The Health Secretary said that extra funding for the NHS would help it to operate safely in a ‘world where Covid is still at large’. 

Mr Challacombe, who works at the hospital that treated Prime Minister Boris Johnson for Covid-19 in April, spoke at a Royal Society of Medicine virtual conference discussing the backlog of surgeries in the UK.

He revealed the hospital was seeing a spike in the numbers of people being given a late diagnosis as an indirect result of the coronavirus pandemic while urging people to get checked if they have any concerning symptoms. 

He said: ‘We could easily try and eventually win a battle with Covid and lose the war with cancer big time. I think we need to encourage everybody to go and checked. Because these secondary surges of cancer will come unfortunately.

‘The more aggressive cancers are likely to be the ones that show the stage migration the earliest. We are seeing that in testes [cancer].   

‘Young men who metaphorically sat on things for a few months and then presented with metastasis disease at rates we’ve not seen before.

‘My worry is that it’ll come through in other cancers, like kidney and bladder. 

‘I think we all need to be part of a national campaign. If you have a symptom that could be serious, go and see a doctor. 

‘We have not go a problem with diagnoses, biopsies or scans. We have not got a backlog for those at all. We are there as the NHS to try and look after these people whatever their problems are, and they may be at higher risk of them than covid. Even though we are going through a second pandemic.’ 

Mr Challacombe gave an insight into the sheer impact of Covid-19 on elective surgery in his speciality of urology, revealing: ‘We did essentially no elective surgery for April and May.

‘We pretty much put prostate cancer on hold for two months and carried on with kidney and bladder cancer in my speciality.’

Clinicians would have to make difficult decisions about which patients were of higher priority every week, choosing between those who needed bowel reconstructions or kidney tumours removed, for example. 

Mr Challacombe, who specialises in the treatment of kidney and prostatic disease using robotic surgery, said: ‘There are lots of men with catheters certainly I know of in south London waiting around desperately waiting for an operation.

‘One of the big things we are going to look at is if the second wave becomes a major factor, it’s trying keep going, keep many more things going this time round than we did last time.’

Professor Alderson, an emeritus professor of surgery at Birmingham University, also spoke at the briefing and gave some sobering comments about the dire NHS waiting list.

He said: ‘The sad fact is we’ve got more than two million people waiting now waiting more than 18 weeks which is the government target to get people treated in. 

‘We are at a level which is unprecedented, it’s worse than it has been ever since we started keeping records on that basis.

‘The harsh reality of course, is that many patients will have worse outcomes than they should have had, had we not had this crisis and not had this delay.

‘Enormous numbers of people with orthopeadic problems – which [surgery for] just about stopped in parts of the country – are in pain, unable to work [and have] lost their jobs…

‘The scale of the problem and the broadness of it is in unprecedented. We’ve never had to deal with anything like this.’ 

Thousands of hip and knee replacements and other straight-forward operations were cancelled from March, as well as cancer procedures deemed non-urgent, in a desperate attempt to make space for Covid-19 patients who ministers feared would overwhelm over-stretched NHS hospitals.

And there have been obstacles in restoring services to levels seen before Covid-19 due to social distancing in hospitals and a lack of routine testing of NHS staff.

As a result, hundreds of thousands of patients are feared to have been left in agony, in some cases causing them to have lost their job, according to Professor Alderson.

A record total of 2.15million people – triple the figure for the same time last year – are having to wait more than 18 weeks to start hospital treatment in England, figures revealed this month show.

It’s the highest number for any calendar month since current records began in August 2007.

The number waiting longer than 52 weeks was also at the highest level for more than a decade, the NHS England statistics show. In July, some 83,203 were waiting more than that length of time – equivalent to one in 50 and the highest number for any month since November 2008.

Doctors have said the NHS is facing ‘worrying times’ in response to waiting list figures, while the Labour Party said there are ‘undoubtedly’ people who desperately need medical help but can’t get it as a result of the coronavirus crisis. 

In March, all routine surgery was postponed for at least three months to free up 30,000 beds for Covid-19 patients who were expected to flood hospitals.  

Joint replacements, cataract removals and hernia repairs were all among the elective surgery postponed in order to free up beds. 

In May, health leaders set out a series of measures to help hospitals get back to normal activity levels. But patients would be prioritised depending on how urgent their medical condition was, leaving millions who are not in seious need — but still possibly in pain — waiting. 

Meanwhile, surgeons are only working at around 50 per cent capacity, claimed Professor Neil Mortensen, current president of the Royal College of Surgeons.

He told The Telegraph last month that surgeons ‘didn’t have much to do’ during the lockdown, as routine operations were cancelled to make room for an expected swarm of Covid-19 patients. 

The Health Secretary today announced a huge cash injection into the NHS in order to get the ball rolling in cutting through the dreaded waiting list. 

Mr Hancock said in the Commons this morning: ‘I can tell the house we have allocated a further £2.7billion to the NHS to support it during winter months. 

‘This funding, in addition to the extra funding for PPE and testing, will help the NHS with the vital task of operating safely in a world where Covid is still at large – the task, which is critical, of working through the backlog of elective work that was inevitably caused by the first peak.’

Mr Hancock also announced the Government would be investing to expand capacity in urgent and emergency care so ‘hospitals can continue treating patients safely in the coming months’. 

He said: ‘In august, we confirmed £300million for emergency upgrades across 117 trusts. And today I can go further and announce £150million to expand 25 more emergency departments including some of the most constrained in the country like Worcester and the Royal Shrewsbury.’ 

This extra funding will ‘put us in the strongest possible position’ this winter and ‘boost the crucial work to accelerate non-covid care’, Mr Hancock said. 

Asked what he envisioned in surgery care moving forward, Professor Alderson said it may be possible to sustain the current level of work if Covid-19 is contained in outbreaks. 

He said: ‘I’d like to think that we have isolated outbreaks that we are able to control through testing and tracing in an adequate way and that we are able to maintain reasonable surgical services throughout this winter.

‘I think we are going to have to look as imaginatively as the profession can at ways in which we can sustain or surgical services, maintain Covid light sites, in order to try and at least do the complex surgery. 

‘If we can do our very best, we can at least prevent the situation as far as waiting lists go, from worsening significantly this winter. Because we cannot allow things to worsen because of knock-on consequences.’

Hannah Warren, a junior doctor and specialist registrar, King’s College Hospital NHS Foundation Trust, said operation slots were ‘very precious’.

But there were still barriers even for patients planned to have their surgery due to the strict social isolation rules. 

She said: ‘Until now any patient who has been waiting for an operation, the deal has for them to have their elective operation, both them and their households have to self-isolate for two weeks, at least in my trust that’s been the policy.

‘And if they turn up on the day, and they haven’t been doing that then they would be cancelled. Those operation slots of course are very precious given everything going on.

‘Particularly in my area in south London, it is quite a poor are. Lots of people work in hospitality which has obviously seen a crisis in employment. And people are terrified about people keeping their jobs. 

‘It is a big ask to ask someone to self-isolate for two weeks for someone to be able to have an operation.’

Experts fear 10million people may be waiting for treatment by Christmas as hospitals grapple with the resume of non-urgent care while maintaining social distancing. 

And cancer charities have warned of a ticking time-bomb of the disease because so many appointments and procedures had to be cancelled by the NHS so hospitals could make way for an expected deluge of coronavirus patients. 

However, it is also estimated one million Covid-19 patients could have died had there not been efforts to protect the NHS, according to reports. 

A potential second wave in the autumn and winter, coinciding with the flu season, will cause even more chaos in the NHS, experts fear. 

Hospital admissions in England are starting to rise again after coronavirus cases have soared in the past two weeks. 

Another 172 newly-infected patients needed NHS treatment on Monday, with the figure being above 100 for almost a week. For comparison, the average number of admissions dropped to just 45 at the end of August. 

Mr Hancock warned today the number of patients on mechanical ventilation beds has risen above 100 since the first time since July.