Breast cancer: Seven-week wait for some red flag patients

Some patients who have been red flagged for breast cancer assessments are waiting up to seven weeks to be seen in Northern Ireland.

The target set by Northern Ireland’s devolved Department of Health (DOH) – which oversees five health and social care trusts – is 14 days.

Judith Mullan, a nurse from Cookstown, who went private for an appointment said she was “frustrated” and “let down” by waiting times.

The DOH said work is ongoing with trusts to increase capacity through additional clinics and workforce planning.

BBC News NI understands that several breast cancer consultants are concerned that waiting times have spiralled since a new regional system for handling referrals was introduced.

The system was criticised for creating a postcode lottery network as, depending on a patient’s address, some were being seen more quickly than others.

Before its introduction, health trusts managed their own red flag referrals.

In May, all red flag referrals in the Western Trust were seen within 14 days, making it one of the better performing trusts at meeting its target.

However, within weeks of the regional system starting, some patients were waiting up to seven weeks, with the latest data showing 250 patients waited more than 14 days for a red flag breast clinic appointment.

More than 1,100 people across Northern Ireland are on a red flag list.

One health trust source told BBC News NI that the regional system was proving too complex to manage, with projections of waiting lists rising to 11 weeks by the end of September.

Judith Mullan, a nurse from Cookstown, said she visited a GP after discovering a lump in her breast.

“I have quite an extensive amount of breast cancer in my family,” said Judith.

Judith’s GP red-flagged her for an appointment, and told her it would be a minimum of an eight week wait.

“When my mum had breast cancer, there was a delay in her surgery for two weeks.

“Within that two week period, she went from needing a partial mastectomy to having a full mastectomy.”

Worried that the lump might be cancerous, Judith took out a loan to go private, eventually getting an appointment in Dublin.

“I tried to go private in Northern Ireland but the lists, even in the private clinics, were six to eight weeks.

“The hospital in Dublin gave me an appointment in three days.”

Judith said she feels “frustrated” and “let down” by the NHS wait times.

“This has had such a negative impact on my mental health. How many people have to die? How many people have to sit and suffer?

“Something needs to be done.”

Judith added: “My two daughters are going to be facing the same dilemmas as they grow up. I just don’t want them to have to go through the same turmoil that I have.”

The Northern Trust said: “We very much regret that anyone is waiting longer than the 14 day target for red flag breast assessment referrals.

“We recognise, however, that the overall waiting time for those awaiting assessment is too long, and acknowledge the stress and anxiety this can cause.”

Mary O’Hagan, from Maghera in County Londonderry, was red-flagged for a breast cancer assessment by her GP after discovering a hot red patch on her right breast.

When she was referred, Mary, who is still waiting for an appointment, was told the waiting time used to be two weeks but she could now expected to wait eight or nine weeks.

“When any woman finds a lump your stomach just drops”, she told BBC Radio Foyle’s North West Today programme.

“The first thing we think of is breast cancer, you think of everything that could be ahead of you, going home to tell your family and where you could be at in three months’ time or six months’ time.”

Mary, who swam an English channel relay in June, said that her current situation made her feel “stressed”.

“As soon as I finish one thing I book the next thing, I’m kind of in limbo at the minute for I don’t know where I am going to be at in three months’ time,” she said.

She said it was “shocking” that early detection was potentially being affected.”

“It’s obviously not working, maybe they need to get back around the table and have another look at this and get patients seen a lot sooner”.

The new red flag initiative was announced in May by Health Minister Mike Nesbitt in response to the “unacceptable” waiting times for breast cancer services in Northern Ireland.

The aim was to enable people from across all the health trusts to access the earliest appointment available to them, no matter where they live.

For instance, patients living in the South Eastern Health Trust have been offered referrals and screening appointments in the Western Health Trust including at the weekend.

Not all patients, however, are able to make that journey or a weekend appointment.

Nesbitt said that it was not acceptable for women in one trust area to have to wait significantly longer to be assessed than women in another trust area “so this will help address the disparities between the trusts”.

As the system has been operating for about three months, others have said it needs time to bed in and that summer leave among medics has also been an issue.

Sources have told the BBC some of the health trusts felt they were in a better position to manage the lists, but as some breast units were better staffed than others, this did not produce an equitable appointment system.

In a statement, the Department of Health (DOH) told BBC News NI while the regional approach aims to equalise waiting times and improve fairness, it does not in itself reduce the overall waiting time.

They added that it does not directly increase the number of appointments but significantly improves how existing capacity is utilised.

The DOH said they recognise that there is a core demand, amounting to almost 4 clinics per week.

To help address the demand, the DOH has secured £5m recurrent funding to increase HSCT’s core capacity.

The department said they will continue to monitor the situation closely and are committed to improving access to timely and appropriate care.