John Baron is MP for Basildon and Billericay, and is Chairman of the All-Party Parliamentary Group on Cancer.
At our annual ‘Britain Against Cancer’ conference today – one of the largest one-day conferences of its type in the UK, with around 400 delegates – the All-Party Parliamentary Group on Cancer (APPGC) is launching its new report into progress half-way through the five-year England Cancer Strategy (2015-2020). In brief, the report concludes that the strategy risks failure unless NHS England takes corrective action immediately.
The importance of getting this strategy right cannot be overstated. Over 20 per cent of cancers are first diagnosed as an emergency procedure, which is often far too late. This late diagnosis is the main reason we struggle to close the gap with international survival rates – the last Government analysis suggesting an extra 10,000 lives could be saved each year if we did so.
The report is the result of extensive evidence taken from across the NHS and cancer sector. We were very pleased to receive such a strong response from the cancer community at the front line to our inquiry’s ‘call for evidence’. We received over 80 written submissions, including from Cancer Alliances, Clinical Commissioning Groups, Foundation Trusts, Sustainability & Transformation Partnerships, patient representative groups and cancer charities – far more than we had expected.
In addition, this wide range of evidence was further built upon by two robust oral evidence sessions, held in Parliament in September and October, during which APPGC members were able to ask searching questions both to those at the ‘front-line’ of cancer services, and to those directing the strategy at the top of NHS England, Health Education England, and Department of Health. The APPGC would like to extend its thanks to all those who took the time to submit evidence to our inquiry.
Several concerns emerged as key themes in our evidence. First of all, the challenges facing the cancer workforce were raised as a significant threat to the strategy’s success. The implementation of many of its recommendations turn on having enough staff, with the right skills, in post to deliver services. We were dismayed to learn that a strategic review of the cancer workforce has been significantly delayed. It is only now being published, a year later than initially intended. It will require the necessary commitment and funding, and the APPGC will be watching this very closely.
The APPGC also heard that delays in data publication are causing further concerns. This is important because assessing improvements in patient outcomes is reliant upon timely and accurate data. Moreover, there is under-usage of data relating to rarer and less commons cancers, meaning that this information is not being taken into account in the NHS’ various cancer metrics. Given that these cancers account for over half of all cancers, this must change in order for our survival rates to improve significantly – such cancers have been the poor cousins of the cancer community for too long.
Concerns also surfaced regarding the transparency and communication relating to the bidding process for transformation funding. In January 2017, Cancer Alliances submitted their bids. However, they were subsequently required to demonstrate an improvement in the 62-day wait standard as a condition of accessing these funds. Yet we heard that ‘Cancer Alliances were not originally set up with this 62-day target as their prime aim or task’. As a consequence, in a number of areas of the country, the release of funding has been delayed, potentially preventing progress in improving cancer care and treatment. The APPGC is accordingly calling for the de-coupling of front-line funding from the 62-day target.
More broadly, it remains an inconvenient truth that, although there is recent evidence that we might be starting to narrow the survival gap for a few cancers such as breast and rectal, this is not the case for most cancers – we are still not meaningfully catching up with international averages. A 2013 report from the Organisation for Economic Co-operation and Development placed the UK only above Ireland and Poland out of 27 nations when it came to certain cancer survival rates. This is despite the application of many process targets over the last 20 years, of which the 62-day wait is a good example.
Yes, survival rates in this country are at their highest ever level, but then so are international survival rates. Our real challenge is to close the gap with averages – let alone the best.
We are wedded to process targets in this country, such as the 62 day wait, but they do not come without a price. They can distort clinical priorities and resources. In part this is because they focus attention on just part of the care pathway, when in reality a more ‘holistic’ approach is required. The delay in the release of transformation funding to front-line services, courtesy of the 62 day wait target, is but one example.
At least equal importance should be attached to ‘outcome’ measures – such as one-year survival rates. There is really only one way to significantly improve survival rates from first diagnosis, and that is to diagnose earlier. This more balanced approach would allow the medical professionals at the front line greater freedom to introduce initiatives and methods which better met patient requirements – be they initiatives encouraging better awareness campaigns, higher screening participation, more diagnostics at primary care, speedier referral routes (whatever the best combination to suit local populations).
In adopting this more balanced approach, we would slowly remove the NHS from party politics – and so encourage longer-term planning. Both parties have been well-intentioned in their pursuit of process targets (the 14, 31 and 62 day targets) but then sadly fall into the trap of using them to score political points – which then further intensifies their apparent importance. Yet outcomes are really what matter to patients. De-coupling funding and 62-day wait performance would be a good first step.
Though the report may make for difficult reading, it is a representative picture of where we find ourselves at this stage. We hope NHS England will heed the report’s findings and accepts the feedback from front-line cancer services, and look forward to a positive conversation with the Government and NHS England both at ‘Britain Against Cancer’ today and afterwards.
The APPGC’s latest report is available here.