John Baron is the Member of Parliament for Basildon and Billericay, and a former Shadow Health Minister. He is the Chairman of the All-Party Parliamentary Group on Cancer.
The Coalition is laudably committed to preventing the deaths of an extra 5,000 cancer patients by 2015. Though this would only bring us up to the European average, it is an ambitious and achievable aim. However, a decision taken in the next few weeks may throw this into doubt, and risks cancer treatment taking a step backwards.
In 2009, the All-Party Parliamentary Group on Cancer (APPGC) produced a report which showed that the NHS stood as much chance as any health service in Europe at getting cancer patients who had survived for one year from diagnosis to the five-year point. Where the NHS fell down, however, was getting patients to the one-year point: this suggests the NHS treats patients as well as any other health service once cancer is detected, but is poor at detecting it in the first place.
The best way of improving one-year survival figures is to encourage earlier diagnosis. This can rightly be called the "magic key" for cancer treatment, since the chances of successful treatment are greatly magnified by catching the disease in its early stages. As a consequence, the APPGC has been campaigning hard to get the NHS to introduce one- and five-year cancer survival indicators at both a national and local level.
The thinking is simple. Late diagnosis makes for poor survival figures. Therefore, getting the NHS to focus on these one- and five-year indicators would force it to do more to encourage earlier diagnosis. By putting the one- and five-year measures up in lights, the local NHS would have to introduce local initiatives tailored to the needs of local populations to detect cancer earlier – whether they be screening, diagnostics, awareness, prevention &c.
The Government listened. We were delighted that one of the most important "big ideas" in the Government’s NHS reforms is the new focus on outcomes. Almost for the first time, the NHS will measure the success of treatment, rather than just its volume. This new focus on "output" (rather than "throughput") should lead to the raising of standards across many conditions, including cancer.
In order to maintain and enforce this focus, the NHS reforms will create various "Outcomes Frameworks", which will hold the different levels of the health service to account. As of next April, Clinical Commissioning Groups (CCGs), which will operate at the local level and are set to replace the existing Primary Care Trusts, will be answerable to the Commissioning Outcomes Framework (COF). The contents of the COF will set the priorities of the local NHS.
In order to improve earlier diagnosis, the APPGC has lobbied for one- and five-year survival rate indicators for all forms of cancer to be included in the first edition of the COF. These indicators will reveal how good an individual CCG is at detecting cancer early, since good survival rates are a marker of timely diagnosis. Our hope is that a CCG with poor survival rates will take it upon itself to redouble its initiatives to promote early diagnosis.
The APPGC was therefore deeply disappointed by the COF Advisory Committee’s decision in July not to recommend one- and five-year survival rates in the first edition of the COF. There is little doubt the inclusion of these indicators is the best way to encourage CCGs to prioritise the early diagnosis of cancer, and their exclusion would be a real step backwards in cancer care.
The final decision of what to include in the COF now lies with the Commissioning Board, which has overall responsibility for outcomes across the NHS. The APPGC has had constructive meetings with its Chief Executive, Sir David Nicholson, and Anna Soubry MP, the Minister in charge of cancer, highlighting that one- and five-year survival rate indicators are already in the NHS Outcomes Framework (which holds the Commissioning Board to account). We have also raised the issue in the Commons on numerous occasions, and with the Secretary of State. We now await the outcome of the Commissioning Board’s deliberations.
The APPGC, cancer charities and others all believe that not to include one- and five-year survival rates would be a grave mistake. It would pass up a golden opportunity to ensure the local NHS knuckled down on early diagnosis, and will endanger the Government’s commitment to saving an extra 5,000 lives by 2014. This should not be allowed to happen. I urge the Commissioning Board to make the right decision, and the Department of Health to give it a prod.