Health
Tackling variation in cancer treatment: can the National Cancer Plan deliver? – Cancer Research UK
In February 2026, the UK Government published its National Cancer Plan, the first dedicated cancer strategy for England in a decade. With a new administration now responsible for implementing it, we want to make sure the Plan remains a priority and its ambitions are delivered as quickly as possible. In this series, we’re examining several of the Plan’s key themes, and what needs to happen next to translate its commitments into genuine improvements for people affected by cancer.
In this article, Holly Norman, Head of Health Policy and Systems, explores the National Cancer Plan’s commitments towards reducing treatment variation and considers what further action is still needed.
After being diagnosed with cancer, nobody should have to worry about whether they’re being offered the best treatment options for them.
But, shockingly, evidence – from across England and internationally – suggests that this isn’t always the case. Some treatments aren’t used consistently around the country, and some treatments simply aren’t used as much here as in other countries.
This is a long-standing, well-recognised, but unacceptable situation. It needs to change urgently, especially if the Government is to realise its ambition, set out in the National Cancer Plan for England, that, by 2035, 3 in 4 people diagnosed with cancer will survive for at least five years.
The Plan is clear that it’s essential to tackle treatment variation: making sure everyone diagnosed with cancer gets the treatment that is best for them, regardless of where they live or receive their care. It proposes action on several fronts to do this.
But will these steps be enough to ensure everyone with cancer can benefit from the treatment that’s best for them?
Steps to address unwarranted variation
Research is delivering an astonishing array of ever-more sophisticated and effective treatments for cancer. So it’s good to see the Plan commit to specific measures that will help put key advances into practice more quickly. These include launching new robotic surgery training standards, faster genomic testing, and streamlining the way groundbreaking radiotherapy is approved.
But delivering better treatment outcomes isn’t only about the latest breakthroughs. A phenomenon known as ‘unwarranted variation’ also needs to be addressed.
There are many reasons why people with cancer may be offered, and receive, different treatments – ranging from the stage their cancer is diagnosed, other health conditions, or simply personal preference. Nonetheless, audits that measure care in the English NHS consistently suggest differences between hospitals in the proportion of cancer patients who receive best-practice treatments. Similarly, there’s evidence from international comparisons that patients in England are less likely to receive radiotherapy and chemotherapy than in other countries.
There’s still a lot to learn about what causes this variation, but many of us in the cancer community worry that it could mean that some people with cancer are missing out on the best treatment for them.
Encouragingly, the Cancer Plan promises many measures that could help – for example, quality improvement projects, and ongoing work to enhance the way cancer multi-disciplinary teams (MDTs) operate.
Particularly promising are proposed new ‘Cancer Manuals’, setting out standards of care for different cancer types – making it clear what good looks like for people with cancer.
These are positive, practical actions, and provide solid foundations from which to build.
But these are first steps. At Cancer Research UK, we think there’s an opportunity to develop them into a stronger strategic approach to reducing treatment variation.
Building a strategic approach to reducing variation
Building a robust strategic approach to reduce treatment variation won’t be completely straightforward. The causes of variation are complex, and there are many unanswered questions.
But there’s a lot we do know too. Data and other evidence about cancer treatments is improving. And there’s a substantial amount of insight and expertise across the health service, academia and the charity sector that could be drawn on.
Areas that need to be considered include further work to help clinicians assess what treatment options should be offered to which patients, and understanding why treatment differs across socio-economic groups. Crucially, work is needed to ensure that the NHS has enough investment in treatment capacity to cope with rising numbers of people with cancer, and increasing clinical complexity, whilst also reducing the gap in treatment rates between England and other similar countries.
Importantly, it would also help identify areas where solutions aren’t yet clear, and guide future work to explore these further.
For example, one area we think needs deeper exploration is the Plan’s promise to concentrate more treatment in specialist centres. This is important – outcomes are often better in hospitals that treat more cancer patients. But there are risks too. For example, not everyone lives near a specialised centre, making the availability of transport particularly important. In 2025, we convened a round table of experts who concluded that creative solutions – like making use of new technologies for remote care – are needed to help ensure that treatment services deliver the best care for everyone and don’t introduce further variation.
Setting up for success
As well as developing a more strategic approach to tackling variation, success will also depend on whether system itself is set up to deliver change – and there are some challenges on the horizon here too.
Changes to NHS Specialised Commissioning mean that, although national standards will still be set, future decisions on planning, configuring, and commissioning most cancer treatment services will be made locally or regionally by Integrated Care Boards (ICBs), instead of by the NHS nationally. This could introduce further variation if different ICBs adopt different priorities or approaches – not to mention the potential for disruptive organisational change to distract from focus on delivery.
Another factor is the role played by the newly refreshed National Quality Board (NQB) which the Plan says will oversee action on cancer treatment as part of its remit across the whole NHS.
It’s good that the NQB emphasises using data to drive improvement. For cancer, this will come from two key sources: regular Audits; and the National Disease Registration Service (NDRS). However, changes in the NHS mean that future plans for the NDRS are unclear – Government must address this at the earliest opportunity.
However, the NQB’s remit is enormous, overseeing a list of 163 separate ‘core quality metrics’ covering the whole NHS. While this does include some cancer metrics, we’re concerned that this approach might not drive the detailed focus on individual cancer types needed to improve treatment. We were also surprised not to see the Plan’s Cancer Manuals highlighted in NQB’s new strategy, as they could provide a basis for this work.
The vital role of Cancer Alliances
Both the National Cancer Plan and the National Quality Strategy emphasise the responsibility of individual NHS organisations to improve the care they each provide. This is important – but because people with cancer often receive treatment in multiple places, a wider focus is needed, beyond single organisations.
This is where Cancer Alliances have a crucial role to play.
In the past, the most effective efforts to improve cancer services have combined robust national leadership with dedicated networks that bring together clinicians, commissioners and providers at a more local level.
Cancer Alliances are the modern version of such networks. They create capacity to focus on cancer pathways and services, spotting and addressing variation, highlighting good practice, introducing innovation, and developing solutions that can work in real-world local contexts.
A long-term investment in Cancer Alliances is an essential step towards sustainably improving treatment quality and reducing variation.
Looking ahead
The National Cancer Plan sets out an ambition to transform cancer treatment across England. Making the most of this opportunity will mean addressing the unwarranted variation in treatment that exists throughout the country.
Government must deliver on its immediate commitments on MDTs, cancer manuals and local improvement support. But if it is serious about becoming a world leader in cancer survival, it needs to develop a more strategic approach that can drive improvement action over time.
It must also ensure that the system is set up to deliver change despite the potential distractions of NHS reorganisations and a stretched national quality improvement approach. And it must invest in critical enablers and infrastructure – cancer data, service capacity, and the national network of Cancer Alliances.
This won’t be easy – but as Government takes on this important challenge, Cancer Research UK will be right alongside them.
