A range of services for screening, diagnosis and treatment of breast problems, including cancer. Currently these services are delivered in Lincoln, Pilgrim and Grantham Hospitals with a small number of patients seen in Louth Hospital. There is also a mobile breast screening mammography service that travels across the county. Lincolnshire’s is the third biggest cancer service in the UK.
Why we need to change?
Our hospitals are currently not able to deliver breast services as efficiently as they would like to because of the challenges in recruiting clinical staff, and this results in guidelines not always being achieved, and patients waiting longer for an appointment than they should. The care and treatment patients receive is good but patients are waiting too long to receive it.
There has been a significant increase in referrals recently and our breast surgeons have 700 new patient cases each year. For the 5,200 appointments we are able to offer each year, we currently have 6,100 people needing them. We have had to set up some weekend clinics at Lincoln and Pilgrim Hospitals to cope with demand. We cannot keep doing this in the long term, as our staff cannot continue to work extra hours.
We do not have enough breast radiologists and have tried to recruit for many years; we are competing with many hospitals in the country who are in the same position. We need 27 radiologists for the current service model and we only have half this number. We also need more clinical nurse specialists who are hard to recruit.
Our senior clinicians tell us that best practise is to provide diagnostic and surgical treatment in a ‘centre of excellence’, supported by local outpatient and follow up clinics. This model of care achieves best results for patients.
What are the ‘emerging options’ from our previous engagement?
We think that a centre of excellence approach would work well in Lincolnshire, and has already proven so in rural Cornwall. We think this will help us address the quality of care issues and shortage of specialist staff.
In practice this emerging option would mean that all follow-up outpatient appointments and routine breast mammography screening services would continue to be available across the county as they are now. These appointments are where most patients receive their care. First outpatient appointments and all surgery would be provided at the centre of excellence. This would enable specialist staff to fully cover rotas, see more patients and retain and develop their skills. Together, this means patients will be seen more quickly and receive a better standard of care.
Our emerging options indicate that this centre of excellence could be at Lincoln Hospital, or Grantham Hospital. The NHS’s current preferred emerging option is Lincoln Hospital for this centre of excellence as it requires the least amount of capital funding. If located at Grantham, any complex breast surgery required would be done at Lincoln.
The benefits of this could include:
- Reduced waiting time due to a better staffed service, meaning we can see more people more quickly
- Standardised models of care so that all patients get the same, high quality of service
- Improved ability to deliver to national guidelines (all diagnostic tests are done in the first outpatient appointment)
- Increasing staff numbers by improving recruitment and bringing together resources. Staff are attracted to working in specialist environments