Health
Can the National Cancer Plan deliver faster care and better outcomes? – Cancer Research UK
At the same time, demand for cancer services has been growing, and that’s only going to continue. The number of people diagnosed each year in the UK has now passed 400,000 and is expected to pass half a million by 2040, driven largely by a growing and aging population who will increasingly be living with multiple health conditions and require more complex care.
On top of this, advances in research and innovation are expanding treatment options and creating new opportunities to improve outcomes for patients, but they are also increasing the complexity of service delivery.
These trends mean the job of improving operational performance is only getting harder.
And this is our worry: the Government must deliver the National Cancer Plan’s central ambition to drive up survival through action right across the breadth of the cancer pathway at the same time as improving cancer waits.
This creates two key challenges.
The first challenge: meeting waiting time targets by 2029
More people requiring cancer care, coupled with stretching goals on improving operational performance, mean capacity across the cancer pathway will need to expand.
The Plan places considerable emphasis on improving productivity, through improved pathway management, technology and innovation. The Government is right to pursue this and make better use of existing resources, but it’s risky to place too much expectation here.
The long standing barriers to improving NHS productivity are well understood, and there is not a linear relationship between productivity improvements and falling waiting times. The Health Foundation has compellingly argued that recent improvements in waits for hospital care have already exhausted the ‘quick fixes’ to improve productivity, and longer-term improvement will need sustained investment alongside productivity gains.
It’s also welcome that the Plan recognises and gives extra weight to the work Cancer Alliances do to provide intelligence-led intensive support to challenged Trusts. The support Cancer Alliances provide will be invaluable to improving performance. But again, this support is not a substitute for a properly resourced system.
On new capacity, the Plan points to investment for more Community Diagnostic Centres, funding for new radiotherapy machines, new aseptic medicines production and digital diagnostics.
Undoubtedly this is all welcome. However, wider NHS pressures mean there will be significant competing demands on that additional resource, particularly in areas like diagnostics where capacity is shared. Government has to grapple with the challenge of either ensuring new capacity reaches cancer pathways or investing further to expand capacity.
The second challenge: faster care and better outcomes
Compared with other important markers of progress, like survival or stage of diagnosis, waiting times are easier to measure, are highly visible to patients and the public, and offer a quicker indication of whether performance is improving. So it’s understandable that they often take centre stage in conversations about how well the NHS is doing on cancer.
But beyond waiting time improvement, getting to a place where 75% of patients survive their cancer for five years or more by 2035 will require reducing late-stage cancer diagnoses, tackling treatment variation and addressing inequalities, to name but a few areas.
This means that action on waiting times needs to be accompanied by an equal focus on other areas. Timeliness is a critical part of high-quality cancer care, but so are access, equity, and experience. Government needs to prioritise action across the piece to make good on the promise of faster care and better outcomes.
The dual challenge
To illustrate the dual challenge, let’s take the example of tackling variation in access to best-practice treatment.
Research has shown that, in the UK, people with cancer receive chemotherapy and radiotherapy less often than in comparable countries. Although the underlying reasons aren’t fully understood, this probably indicates that some people are missing out on treatments that they might receive if they were treated in other countries. This suggests the NHS needs to not only improve treatment waits, but do this alongside planning for the extra activity needed to close the treatment gap.
There aren’t quick or easy solutions to reduce demand in cancer pathways either. For example, the steep rise in urgent suspected cancer (USC) referrals is putting huge demand on NHS services, particularly in diagnostics. However, with a few limited exceptions, there aren’t currently good approaches to reducing USC referrals without the (clearly unacceptable) risk of missing more cancers.
