What the pausing of shielding means for people living with cancer
Macmillan’s view on how to ensure people with cancer get the support they need in the coming months.
The new restrictions on gatherings in parts of northern England and the pause in the easing of lockdown come just as the shielding programme draws to an end. Those who are clinically extremely vulnerable, including around 240 000 people with cancer¹, have been advised to stay at home and keep interactions outside to a minimum since March. But the programme will be paused from August 1st in Scotland, England and Northern Ireland and August 16th in Wales.
The level of coronavirus in the community has fallen and we have far more nuanced information about what the risks are for different types and treatments of cancer than we did at the beginning of lockdown. Nevertheless, some people with certain types of cancer are still being advised by their doctors to reduce social contact as much as possible and new local restrictions will cause great concern to people whether they were advised to shield or not. Research carried out in June this year for Macmillan found that 90,0000 people with cancer said they wouldn’t feel safe enough to leave the house until a vaccine or effective treatment is available regardless of changes to government guidance².
Macmillan have recently highlighted the very real fears around people with cancer feeling that they will be forced to choose between their health and their livelihood as they are no longer protected by the shielding programme, and today we signed a joint letter to the Chancellor calling for an extension to the furlough scheme for people who can’t return to work safely.
We also know, and people with cancer have told us, that guidance on shielding has been inadequate:
‘I’m supposed to be shielding. The advice was completely impossible to follow, it’s utterly meaningless and it’s caused an enormous amount of distress’.
- Macmillan campaigner, Daloni Carlisle, to the Health and Social Care Select Committee in June
The pandemic is far from over and it is vital that from now people with cancer both understand what the pausing of the shielding programme means for them and have access to the support they need. Macmillan Cancer Support has developed five clear tests that we will be monitoring over the next few months so that we can be sure that people living with cancer are as supported and safe as possible.
Test one: I can make an informed decision about shielding
People with cancer should have a named care coordinator or team with whom they can have a meaningful conversation to assess their level of risk and what actions they should take.
Test two: People are supported to make informed decisions about shielding
Charities and health bodies will be included in the development of updated guidance for people who have been shielding if there are future outbreaks of coronavirus and clinicians have the tools they need to give the best possible advice and guidance to people who have been shielding
Test three: I don’t need to choose between making ends meet and my health
People who have been shielding should be supported to return to work safely and, where this is not possible, should be protected from losing their income and employment security through the Job Retention Scheme, or an equivalent scheme.
Test four: I am not struggling to get the food, medicine, or healthcare I need
Supermarkets should continue to offer priority delivery slots to those who need them for as long as necessary and people who have been dependent on now discontinued food boxes from local authorities are still able to access food through local volunteering services or other means.
Governments across the UK should communicate clearly the measures they have taken to ensure that care can be delivered in Covid free environments so that patients feel safe and confident to return to NHS services.
People undergoing treatment for cancer should have a care coordinator and personalised care and support plans to keep them updated on their treatment, facilitating access to hospital, primary and community services and helping to meet any additional needs that they may have.
Test five: I know what would be involved if the risk of infection increases where I live
Governments must communicate a clear plan for what steps will be taken to reactivate shielding measures if the incidence of Coronavirus increases. This should include proactive contact with people who were previously shielding and the resumption of local support for those who need it.
We will be monitoring these five tests over the coming months with insight from people living with cancer and the health care professionals that we work with. People with cancer must have continued access to the right support and have clear and timely information they need to make the decisions that are right for them.
Sarah Gregory is a Senior Policy Adviser at Macmillan Cancer Support. Find out more about our Policy and Campaigning work here.
References
- NHS England and NHS Improvement estimated in mid-March that 200,000 people with cancer needed to be contacted about shielding because they were deemed to fall into the ‘clinically extremely vulnerable’ classification in England, which Macmillan estimates if a similar ratio to incidence in 2017 applied across the UK, it could equate to around 240,000 ‘clinically extremely vulnerable’ people in the UK. Since this estimate was made additional people living with cancer may have been identified as ‘clinically extremely vulnerable
- Macmillan Cancer Support/YouGov survey of 2,202 adults with a previous cancer diagnosis. Fieldwork was undertaken between 2nd — 15th June 2020. The survey was carried out online. The figures have been weighted and are representative of all UK adults 18+ who are living with cancer according to age, gender, cancer type, and UK nation.
