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As NHS hospitals in England contend with covid and winter illnesses, many are trying to free up capacity by clearing beds of patients who are fit for discharge. Matthew Limb looks at the challenges they face

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Diagnoses of early stage cancer in England fell by 33% in the first wave of the covid-19 pandemic in 2020, figures show.Experts warned that many people who "missed" a diagnosis could have an early stage cancer but that it might not be identified until later on, potentially affecting their chances of survival.Steven McIntosh, executive director of advocacy and communications for the charity Macmillan Cancer Support, said that although SARS-CoV-2 infection rates were now falling and lockdown was easing the pandemic's knock-on effects on the care of patients with cancer "cannot be overstated." He said, "We are likely to be dealing with covid's long shadow for many years to come, and so we need action now to address the chronic undersupply of cancer staff in the NHS."The charity's analysis of figures from Public Health England's National Cancer Registration and Analysis Service 1 showed that the number of people who had their cancer diagnosed at stage I fell from 18 400 in March to June 2019 to 12 400 in March to June 2020, the first months of the pandemic, a drop of around 1500 people a month.The first wave of covid-19 saw major disruption to NHS services and fewer people visiting GPs and hospitals for conditions unrelated to covid.The number of people given a diagnosis of stage IV cancer fell by 15%, from 10 900 in March to June 2019 to 9200 in the same months in 2020, a drop of around 400 a month.Decreases were seen in all types of cancer, with prostate cancer showing the biggest fall from previous levels.The picture improved after this period as diagnosis numbers moved closer to normal levels. The figures show that, for June 2020 onwards, in all cancer groups the estimated number of new diagnoses rose from their lowest levels. By September 2020 the estimated number of diagnoses had reached 95% of pre-pandemic activity in all malignant cancer groups except for non-melanoma skin cancer.But Macmillan Cancer Support warned that cancer care continued to face severe problems, compounded by critical shortages of specialist staff. These included lengthening waits for treatment, diagnosis backlogs, and high levels of anxiety among patients about their circumstances.The charity said that the number of people having cancer surgery was 11% lower in February 2021 than in February 2020. Official data on waiting times indicated that the "recovery of cancer services (both in diagnosing new cancers and treating those already in the system) struggled during the first two months of 2021," it said.McIntosh said, "There is still an immense backlog in cancer care, with delays and disruption having a profound impact on people's lives."Our analysis estimates the NHS in England would need to work at 110% capacity for almost a year and a half to catch up on missing cancer diagnoses and for 15 months to clear the cancer treatment backlog." 1 National Cancer Registration and Analysis Service. Covid-19 rapid cancer registration and treatment data. https://www.cancerdata.nhs.uk/covid-19/rcrd. This article is made freely available for use in a...