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The National Health Executive Podcast is the perfect place to garner insights from across all aspects of healthcare, as we get into the crucial ‘whys’ behind the stories and how they can impact all of us to improve our work, our lives and the care and services we provide as an industry.
Tune in, discover more about our diverse and talented health sector and it may well spark the solution to help you see a problem or challenge in a new light.
Episode 43 in FULL
National health executive podcast brings you views from leaders across the health sector
Dr. Penny Kechagioglu: There has been a, great effort and improvement. How do we strive for excellence? We need to learn from, you know, the things that we do well and the things that don't go well.
Presenter: This is the national health executive podcast bringing you views, insight and conversation from leaders across the health sector, presented by Louis Morris. Hello and welcome back. And today I'm very pleased to be joined by doctor Penny Kechagioglu, who is a consultant clinical oncologist at University hospitals, Coventry and Warwickshire NHS Trust. For those of you who don't know, and I'm sure many of you do, but for those who don't, Penny is a cancer expert and oncology specialist, and that's going to form the brunt of what we're going to be talking about today.
What do you make of the state of cancer care in the NHS
So, first question really, what do you make of the state of cancer care at the moment in the NHS? What is the status quo?
Dr. Penny Kechagioglu: Well, we know that we are facing certain challenges in terms of backlogs in the NHS in given what we went through in the pandemic. And there has been exceptional work to rectify those backlogs, whether it's surgery or diagnostics or cancer treatments. So we will start with that context. There has been a great effort and improvement, and we are seeing the improvement in performance. However, we are not quite nearly there when it comes to cancer. So we know the standards have changed, but we know that we need to diagnose cancers faster. We know we've got a faster diagnostic performance indicator, and sometimes we are not reaching that. We also know we need to treat patients following the referral within 62 days, and there are occasions where we are not reaching that. So there is a lot of work to do on, the background of a limited workforce, especially in oncology, but also in diagnostics. And as a result of that, clearly, you know, there are delays in treatment that we are looking at, and we know the patient experience is not always as we would hope it should be. And the important thing as clinicians, but also as leaders in the NHS, is, you know, to look at and focus, how can we improve those metrics, how can we deliver the best outcomes possible, and how do we ensure that patients get a good experience throughout their cancer journey?
What are the main opportunities to improve performance in the healthcare sector
Presenter: And you did mention the workforce right there, and we'll get onto that a little bit later. But you also mentioned diagnostics, and I believe I saw that the 28 day fatal diagnosis standard was exceeded for the first time a few weeks ago. So, with that being said, what are the main opportunities? Because, again, there is, improvements coming, there is a positive, there is a silver lining to all this because it can be quite drab, sometimes targets out being met goals, are underachieving. What are the main opportunities to improve, would you say?
Dr. Penny Kechagioglu: So, as I said, there has been tremendous efforts from organisations and systems to improve performance and then we are seeing those outcomes. With the advent of the community diagnostic centres, this is a huge opportunity to provide greater access to different diagnostic facilities for patients closer to home. I think that's really key. We are talking about not just access offer for certain people. By widening that access to a wider community, and hence why the CDC's are going to play a huge role, so that patients can have better access, quicker access to diagnosis in the community. I think it's important to say the workforce is how we optimise the workforce, in the sense that there are jobs that, for example, consultants can do, senior clinicians, but also there are roles where specialist nurses and pharmacists nowadays perform, such as prescribing and doing clinics. So I think it's important to work together as teams and optimise and look at the opportunities to expand the skillset of our workforce. And that goes hand in hand, really, with the CDC's.
Public health plans and m strategies feature in cancer care of the future
Presenter: I was going to ask, we heard the term what good looks like quite a lot banded around, but I want to go one step further and ask you what great looks like and does that feature, again, community diagnostic centres, does it feature striking further upstream? I remember the metaphor was put to me once, it's better to save somebody further upstream than fish them out downstream. So how much do public health plans and m strategies feature in cancer care of the future? We've got the smoke free generation plan. Is it more plans like that or is it CDC's?
Dr. Penny Kechagioglu: So, first of all, I really like what you say. How do we strive for excellence, not just, good. And I would say there are three points here. So looking upstream, there is a lot of work that is happening and needs to be consistent across primary care, but also secondary care when it comes to prevention. Prevention. We talk about primary prevention with lifestyle stop smoking programmes, alcohol control problems, etcetera, weight control, but also making sure that people come forward for the screening as secondary prevention. And that upstream strategy is key to keep our population healthy and prevent cancer. And we know that four in ten cancers are preventable with lifestyle changes alone. And then it comes when diagnosis happens. We talked about the CDC's, we talked about faster diagnosis, but what about when people get diagnosed? How do we get them, life saving treatments quicker, for example, radiotherapy. We know that the majority of cancers will need some radiotherapy treatment. And we know that delays in radiotherapy can increase mortality. Again, having access to those specialist technologies closer to home goes hand in hand with a faster diagnosis and is going to improve patient outcomes in the long term. And the third aspect is actually measuring those outcomes and looking at a holistic approach to patient care. So, for example, cancer patients go for surgery. How can we ensure, they are optimised physically and mentally before they go for an operation? We know that they stay in hospital less if we engage them in a rehabilitation programme, and the same comes after the surgery or after the chemotherapy or radiotherapy. Rehabilitation can really get the patients back on track, physically and mentally. And the final aspect is palliative care. Again, there is a shortage of palliative care clinicians and it's important that end of life care is given the attention as well, that, this part of the life journey deserves.
Presenter: You touched on, I guess, getting patients prepared for radiotherapy treatment, I guess.
How much does education factor into prevention and empowering the patient
Speaking more back on prevention, how much does education factor into this and empowering the patient? We hear about shared decision making. Is it, about. I mean, it might sound obvious that, you know, smoking is bad, but how much of it is just driving awareness about cancer and cancer diagnosis?
Dr. Penny Kechagioglu: You say that it's obvious that smoking is bad, but believe me, a lot of people, they don't know and they don't know, for example, what smoking does. They don't know the effects of the alcohol on the body or even, you know, the use of, ultra processed foods. So education is key, and for me, it needs to happen in every setting, you know, every opportunity, whether it's schools, whether it's colleges, universities, workplaces, the hospital, the GP clinic. The more education we do, the more we're going to gain from people's knowledge and, you know, doing the right thing, making the right changes in their lives and being compliant with the programmes that are out there, because that's the other thing. If we don't tell people what is available, how can they access it?
There is a 15% shortage of clinical oncologists in the UK
Presenter: Moving slightly onto the workforce, auditing spoke about patients. How well is the oncology workforce equipped to drive all these improvements? I'm going to throw out a few stats here. There is a 15% shortage of clinical oncologists in the UK, which I believe that was from 2022, so three years ago, and that was projected to jump to 25% in the next three years. So next year. And then there are ten times fewer oncologists in north and west Wales than in London. As we hear the word or phrase, postcard, lottery, a lot. What are you hearing from your colleagues in that regard?
Dr. Penny Kechagioglu: Those statistics are real and clinically on the front line. They are also felt, you know, the pressure in seeing more patients is there and we know that the demand has gone up. So imagine, you know, more patients are coming through, which is good. We want to treat patients with less staff. That makes it really challenging. And a couple of ways to deal with that disparity is, as I mentioned before, using every role in a more optimised way. So, for example, training, non medical prescribers and being able to see patients who are not complex using digital technology and digital means. When I do an online clinic, I can see more patients than I could see in a face to face mode. And how do we use technology, for example, to maybe do the radiotherapy planning remotely, if there are not enough staff within an organisation, collaborate between organisations that could offer that facility to help with radiotherapy planning, for example, endosymmetry, there are ways to do it, but we need a really good strategy and collaboration across organisations.
Presenter: So would you say it's about doing, I guess, more with less? Obviously, there is a need for an expansion of the workforce, but it's not necessarily about an expansion, more of an optimization and collaboration and partnership?
Dr. Penny Kechagioglu: Yeah, I think both need to happen together. We are not going to expand the workforce overnight. Certainly the workforce needs to expand to account for the high demand for cancer services and for the complexity of cancer. But until we get to that level, we need to use the resources we have more effectively and our digital means more effectively.
Half of all consultant clinical oncologists are burnt out, study finds
Presenter: We've spoken slightly on recruitment, but just to switch it to retention again, I saw that half of all consultant clinical oncologists like yourself are burnt out. So what would you say that, NHSE, the DHSS, need to do for, your peers and your colleagues to retain them and just make them more happy?
Dr. Penny Kechagioglu: I guess that's a really, really good question. And first of all, we need to understand what the sources of burnout are, and I think we need to look at a whole system change here. And I think the burnout comes when we know that patients need to be seen quicker and we cannot see them quick enough. So it's that moral dilemma that plays with clinicians, that they know what the right thing to do is, but, it's not in their hand to do it. So everything that we just discussed, you know, driving the faster diagnosis, opening more community diagnostic centres, expanding the workforce and also using the resources effectively. And our, digital means are the things that are going to make a change and we're going to see improvement in getting the patients through the system quicker. When it comes to the personal level, I think we all need to look after our health and wellbeing because that's how we're going to look after our patients as well. And when I talk about rehabilitation for patients and rehabilitation, I think it's important that applies to staff and we are mindful and we are mindful with our colleagues how they're feeling and make sure that they're well supported throughout, their work, and if they need any support externally to be able to offer that. And many organisations, including ours at the moment, we are opening more health and wellbeing programmes for our staff so that they feel, you know, the organisations value their work because it's an extremely valuable work and, an extremely rewarding specialty, oncology.
Presenter: I mean, how important is that mental health support? I guess it hit the headlines with NHS practitioner health. It was decided that secondary care, staff weren't going to be renewed and then obviously there was a bit of a U turn. How important is that mental health aspect, caring for yourself as well? Because we always think about the patients. But again, in a sense that staff are patients as well.
Dr. Penny Kechagioglu: It's absolutely hugely important and it can be driven, you know, by your personal resilience and your personal network. But it's important as a professional network within an organisation. We support each other and we work closely. We have this psychological safety culture to say, you know, concerns without feeling that we're going to be blamed. And again, an open dialogue between clinicians on the front line and executive team is really important, so that leaders are, understanding of the challenges and they are supporting frontline staff. And that feeling of acknowledgement of the difficult and rewarding work that's going on is really, really important. And you can see people doing more and going a step further if they feel well supported by their employer.
You talked about not losing the humanity of the NHS under pressure
Presenter: With that being said and everything we spoke about today, I think it links quite nicely with a piece you're going to do for the National Health Executive magazine that's coming out next month. It's about the charter for Oncology. Can you tell us a little bit about that? and what it includes, what it's about, really.
Dr. Penny Kechagioglu: So the charter of oncology is started from a group of people who support patients, in a charity. So lots of people, including clinicians, patients, patient advocates and people with lived experience, came together to understand how we can make the NHS more empathetic and more compassionate and at the end of the day, how do we offer patient centred care and a holistic approach to care? And oncology, is a very good example, because patients probably face one of the most vulnerable time in their lives, and we, as clinicians, should be able to address their needs and their preferences and get at the level where they are and support them, not paternalistically, but as you said before, with shared decision making. How do we optimise that? How do we have respectful dialogues? How do we ensure that we listen to patients and their families, or what matters most to them? This is what the charter for Oncology care is about, is ensuring that within those difficult and challenging times, we don't lose the humanity in the NHS and we ensure that our patients are empowered to make decisions for their care.
Presenter: I mean, this may be a bit of a leading question, though, but you talked about not losing the humanity of the NHS. Do you feel like sometimes it is lost a little bit, a slight bit? With all the pressure and the targets and the backlog, people forget it's. Again, it's people we're speaking through, not.
Dr. Penny Kechagioglu: It's natural, isn't it? Sometimes when you focus on performance metrics, you forget to step back and say, actually, these are the people, there are people behind those metrics who are going to deliver them. And also there are people at the end who are going to receive the outcomes of whatever we do with those metrics. And we cannot just pick numbers. Numbers are important because we can track them. But what about the people who are doing the work? We talked about the workforce well being and also the end user on the other side? How can we engage with our people better with our patients, with our citizens, give them the right information, make sure they have the right communication tools before they come to see us in clinic and afterwards, so they can make decisions for themselves. And, you know, sometimes those are tough decisions, but we have to respect that people are able to make them and they have the right to make them.
You started a role at the World Health Organisation recently
Presenter: I'm m going to go on a slight segue here because it's a question for me, really, rather than our listeners, but I believe you started a role at the World Health Organisation recently. Can you tell us a little bit about that?
Dr. Penny Kechagioglu: Yes, I've started as an advisor, on the lifelong learning group for health. And really I have applied for this a few months ago because I'm really interested in the learning aspect in healthcare. You probably know, I've written a book around learning, from organisation experience and improving our innovation and our leadership. And that is really important. We need to learn from the things that we do well and the things that don't go well. And how do we transmit that learning to the next generation? We talk about training and learning around lifestyle, for example, how do we instil that into our populations and into our workforce? So learning is key for development and learning is key for quality improvement and the who opportunity, I'm hugely honoured to be part of. It's a multidisciplinary team, really, from all over the world, trying to put those frameworks together and expand learning in health.
Presenter: Absolutely. And to be fair, Penny, we've gone from pillar to post today on this podcast, and I think we're about to wrap up.
National Health Executive podcast focuses on cancer prevention and improving access to care
What are your three main talking points, your three main takeaways for our listeners that you want to hammer home? What should they learn from this podcast? Basically, what should they take away?
Dr. Penny Kechagioglu: I would like to leave our listeners with hope, really. I would say there's a tremendous piece of work happening nationally around cancer and improving access to care, which is commendable. But I would like my listeners, whether they are professionals or patients, to voice their concerns and have open dialogues between each other. I really enjoy listening to my patients and what matters to them in clinic. And unless we do so, we cannot learn from them and, we cannot learn how to improve our services. So I think these are my two main points, and the third one is basically urging to look more upstream as, systems, I guess, and looking at the prevention element and the education element. Our population is getting sicker, is not getting healthier, and that is what's causing cancers going up as well. So it is imperative that we all make an effort individually as communities to exercise more, to eat better, to cut down on alcohol and smoking. And by doing so, it will improve our lives considerably and it will prevent chronic illnesses, including cancer.
Presenter: I think that's as good as point as ever to leave us with. Thank you so much, Penny. It's been a great pleasure to have you on, and that has been the National Health Executive podcast. Thank you so much for listening and we'll see you next time.