While the NHS has adapted and rallied to cope with the pandemic, another health crisis has sprung up in Covid’s wake. Missed diagnoses, spiralling waiting times and reduced safeguarding opportunities are just some of what non-Covid patients have had to contend with since the country’s healthcare system was forced into battle with a brand new virus. Health chiefs are now warning that these non-Covid patients have become the “collateral damage” of the pandemic.
Since the start of lockdown, the figure for unnecessary cancer deaths is estimated to be in the tens of thousands and the British Heart Foundation warned in November that almost 5,000 more people had died from heart problems than would have been expected. As of September, almost 140,000 patients in England had been waiting more than a year for surgery — 100 times the number in 2019.
With lengthening waiting times and many illnesses going undiagnosed, the problem is only likely to worsen. Breast Cancer Now estimates that up to 10,000 UK women could be living with the disease undetected and consultants have warned of a surge in oral cancer cases caused by delays to dental care. Meanwhile, cancer research charity Eve Appeal recently found that six per cent of women invited for a cervical screening in the past 12 months had been refused an appointment. The programme is estimated to save 4,000 lives a year.
Purvis’s operation, due to take place at the Royal Marsden in Chelsea two days after the first lockdown announcement, was cancelled at the last minute. Two months later she was told the cancer had spread to her brain. It is now incurable.
Among the spiralling figures there are also widening disparities between those receiving and not receiving care. More than half of the UK’s 102 million GP appointments took place over the phone or video between March and July last year, but digital maturity — the ability to access appointments virtually — between patients and surgeries varies significantly. Even if patients can access online appointments, many abuse victims don’t feel safe opening up from home.
There are geographical disparities, too. Deborah James, a bowel cancer patient and presenter on the BBC’s You, Me and The Big-C podcast, recently warned of a “postcode lottery” of cancer care, with treatment going ahead in some hospitals and not others. Meanwhile an investigation by The Observer recently discovered disparities in waiting times for NHS mental health services of up to 14 weeks between council areas, meaning those at risk of suicide are slipping through the net. The gap is likely to only get wider, with the chief executive of NHS Providers warning that “very large numbers” of staff are expected to go on long-term sick leave or quit in the coming months.
For some patients, the warnings come too late. “It was like starting the treatment again,” says Kris Chadwick, 44, whose breast cancer treatment was delayed by 12 weeks, forcing her to shield at home in Tooting alone – she lost her husband, Matt, to brain cancer in 2013 and has set up a blog, Chadders Cancer Club, to create a sense of community for others.
“Not being able to see [family and friends] in person has been cripplingly sad,” agrees bowel cancer patient Bobby Bertoli, 28, who says that Covid delays added “three or four angsty months” to his painful wait for a colonoscopy. By the time the museum officer was diagnosed with stage four cancer last year, the disease had spread to his neck, liver and lungs.
Chadwick and Bertoli’s ordeals have been common since March, but he still considers himself one of the “lucky” ones. At appointments he has met patients forced to travel to London from Cornwall for critical cancer surgery and a recent report found that 100,000 patients may have missed out on life-saving care due to the pandemic.
Katherine Goodes, 35, says she worries she’s been “forgotten” — she’s still waiting to hear from St George’s in Tooting about a growth in her jaw that flared up in September. Medics originally suggested an “urgent” biopsy that same day but when she had to postpone due to childcare issues, she never heard back. “Their sense of urgency made me feel anxious and now I’m worried I’ve fallen off the list,” she says.
Kim Page, 50, from Luton, agrees the waiting times can be frightening. She has now been waiting three months for a muscular-skeletal investigation, with the numbness in her arms leaving her unable to complete everyday tasks. “At what point do you accept you can’t get dressed and stop calling?” she asks. “They’re so overwhelmed I feel guilty even phoning and it makes me think: how many patients must be in front of me in the queue?”
In her job working with clinicians, Page has experienced these “heartbreaking” delays from the other side, too. Doctors are often left with difficult toss-ups between delaying patients’ treatment or risking them catching Covid, says Jane Murphy, a clinical nurse specialist at Breast Cancer Now. Psychotherapist Rose Stephenson says she’s worried about the knock-on effects of Covid anxiety on patients who are already ill. “Many of [my cancer patients] are so anxious they’re not sleeping, which will impact their recovery,” she says.
Safeguarding is also a concern, with the reduction in face-to-face appointments reducing GPs’ ability to spot signs of poor mental health or abuse. The charity SOS Silence of Suicide says helpline call volumes spiked by 670 per cent in December, with UK male suicides at their highest level in 20 years. An inquest for one victim, Craig Murray, 41, ruled that the sales executive’s lack of face-to-face contact with experts was a “missed opportunity” in the events before his death last May.
There are similar concerns for domestic abuse victims, says Amy Glover from Solace Women’s Aid. Over the first lockdown, her helpline experienced a period of “deathly silence” but there was a “massive surge in referrals” when restrictions eased. July was their busiest month to date.
Referrals from the NSPCC helpline to agencies in London about children living with domestic abuse have also risen by more than 40 per cent in the pandemic, with signs no longer able to be picked up by schools, GPs, youth groups and grandparents. In the more visible of these cases, abuse is now being reported by neighbours, postmen and even Deliveroo drivers, says Denise Ellis, an NSPCC helpline volunteer. But many are not. Ellie*, an Oxford graduate who experienced domestic abuse as a child, says “things could have gone very seriously wrong” if she’d been growing up during the school closures. She and her brother endured physical and mental abuse, which was eventually picked up by teachers.
Glover points to alternative reporting services such as asking for “ANI” (Action Needed Immediately) in participating pharmacies, and organisations like Crisis Text Line, Sign Health and YoungMinds have texting helplines for those who don’t feel safe to phone.
For those at risk of other health issues such as cancer or heart disease, the message is simple: keep contacting your GP, says Labour MP and A&E doctor Rosena Allin-Khan, who is campaigning for the public to keep accessing services in lockdown. Patients must not be deterred by potential waiting times or concerns of overloading staff, she insists. “Our doors are always open.”
Anyone in need of cancer support can call the Macmillan Support Line on 0808808 00 00, which is open 7 days a week, 8am-8pm, or visit Macmillan’s Online Community. Those who are experiencing cancer symptoms should contact their GP as a matter of urgency.