CLINICIANS at Scotland's flagship cancer centre have considered cutting back on treatment as a "last resort" to relieve pressure on the service, according to leaked emails.

Internal communications between senior staff at the Beatson West of Scotland Cancer Centre, shared with the journal Lancet Oncology, are said to expose a system that is "stretched to the limits of endurance", our sister title The Herald reports.

The journal reports that the emails include discussions about potentially reintroducing pandemic-style national prioritisation levels as a contingency plan to relieve demand, although this is facing pushback from the clinical team who oppose any reduction in services "unless these are evidence-based and the details made publicly available".

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The journal reports that one communication mentions a decision taken to discontinue the offer of a cold cap - a 'hat' worn during chemotherapy which helps to protect the scalp and reduce hair loss.

This was said to be "partly motivated by the hope that affected patients might start to raise complaints and, in doing so, highlight the problems at the Beatson".

The emails are also said to include discussions on altering patients' cancer drug regimens as a means to reduce pressure on the Beatson "including intermittent dosing instead of maintenance dosing for some chemotherapy drugs, longer dosing intervals for both maintenance and palliative regimens, and stopping maintenance regimens early."

Glasgow Times: The Beatson West of Scotland Cancer Centre The Beatson West of Scotland Cancer Centre

The journal states: "In one email, a consultant writes that measures to reduce demands on the day bed unit without compromising efficiency or availability of treatment have largely been exhausted, and measures that will limit access to treatment have to be considered."

The journal said the email exchange "gives the impression of a system that is stretched to the limits of endurance", adding: "CT scanning, nursing, pharmacy, and the day bed unit are specifically mentioned as being under extreme strain.

"Matters seem to have been brought to a head by the need to replace ageing and poorly functioning equipment in the aseptic unit.

"One respondent to the chain of emails, understood to be the clinical director of the Beatson, describes the situation as approaching a crisis point."

It adds: "The communications make it clear that the situation has been deteriorating for months. Staff shortages and Covid-19 physical distancing precautions, which are still in place, have further reduced capacity."

The Beatson serves a population of 2.8 million people.

Glasgow Times:

One unnamed Beatson staff member is quoted by the journal saying the centre is now running out of options, stating: “We either have to expand capacity or think about what we are not going to do.”

In a statement, NHS Greater Glasgow and Clyde said “any suggestions that could be detrimental to patients were immediately discounted and rejected by clinical teams”.

It added: "No treatment schedule would be changed without evidence to support it, so there are no plans to increase schedule length, stop treatments early or interrupt schedules.

"Likewise, any adjustments would only be adopted following discussion and approval at a national level."

The situation is said to have been exacerbated by pandemic backlogs, but is rooted in rising demand from an ageing population against a long-term backdrop of growing staff shortages.

A recent report by the Royal College of Radiologists forecast that Scotland faces a 30% shortfall of radiologists by 2026, and a 21% shortfall in oncologists.

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Other cancer centres in Scotland are also described as being "at breaking point", and unlikely to be able to take on extra workload from the Beatson.

Speaking to Lancet Oncology, David Cameron, professor of oncology at Edinburgh University and chair of Scotland’s National SACT (systemic anti-cancer therapy) Programme, said: "We have seen this coming, but we have not acted quickly enough. The system is under significant strain.

"Demand is increasing and there are staff shortages at all levels, from consultants to pharmacy technicians.

"We need a very serious discussion about how we can continue to expand what we deliver in medicines and surgery.”

Beatson insiders are also said to be concerned that the crisis is leading to exhaustion and low morale among staff which could lead some to quit the service, and make recruitment difficult.

Alastair Munro, a retired clinical oncologist and emeritus professor of radiation oncology at Dundee University, criticised a long-term lack of workforce planning for the NHS in both Scotland and England.

He said: “Even if a hospital has unfilled vacancies for consultants, chemotherapy nurses, and pharmacists, and it does not have enough money, and its equipment does not work properly, it can still get by for quite some time.

"What tends to happen is a gradual decline, leading to the moment when no more adaptation is possible, and then there is a sudden and precipitous fall.

“The Beatson may be at a point where it is clear that if they do not take action, they will reach the stage at which things escalate out of control.”

David Kerr, professor of cancer medicine at Oxford University and author of the 2005 Kerr Report on Scotland’s national health service, described the situation as "extraordinary" and said it needed to be "looked at very carefully".

He added: "There would appear to be a breakdown of leadership and planning at a local, or possibly national, level.

"The Scottish Government needs to take a long hard look at itself and how it is delivering health care to the citizens of Scotland.”

Scottish Labour Health spokeswoman and MSP for Dumbarton, Jackie Baillie, described the email exchanges as “truly terrifying”, adding that they “lay bare the existential crisis facing our NHS”.

Scottish Conservative Shadow Health Secretary Dr Sandesh Gulhane, a GP, said the situation was “utterly appalling”. 

A spokesman for the Scottish Government said it is investing £10 million in the SACT and Acute Oncology workforce “in order to keep up with the growing demand”. 

He said the Scottish Government accepts NICE guidelines on the prioritisation of Systemic Anti-Cancer Therapy in circumstances where services are disrupted “such that they can no longer be delivered”, but added: “They provide guidance to ensure patients are treated in order of clinical priority consistently across NHS Scotland. 

“It stipulates that it should only be implemented when all other options have been exhausted and duration should be no longer than is required. No board has yet implemented the framework.”