What can we achieve by 2020?

It’s been a while since we have had a new cancer plan, so it’s great that NHS England recently announced a new independent taskforce to develop a five-year action plan for cancer services, to improve survival rates and save thousands of lives. A plan might not sound that exciting, but they are vital for driving where the NHS and beyond need to change in order to improve outcomes for people affected by cancer. A new plan can only be great news for the 2 million people currently living with cancer in England[i] and the 1.5 million people who we estimate will be diagnosed over the next five years[ii].

So what does history tell us we can expect from this plan? The very first cancer plan was in 2000, overseen by the then cancer tsar Prof Mike Richards, and in response to England’s dire cancer survival rates and poor patient care. It is believed to have succeeded in ensuring the specialisation of cancer services improving patient care, as well as bringing down waiting times. A 2007 strategy introduced the concept of survivorship, and recognised the importance of supporting people after treatment had finished, initiating another shift in cancer care, with the result that there is now greater awareness of people’s needs post-treatment, and a growing range of support for them. The last edition, in 2011, well before the most recent changes to the NHS in England had taken place, placed the improvement of outcomes for people with cancer as its priority. Now the NHS has been reorganised, and more and more people are living longer with cancer, and rapid changes in technology are changing treatments, it is time that we have a new, ambitious plan that sets out the direction of travel for cancer services, with patients at the centre.

We hope this strategy or plan (call it what you wish) will strongly reflect the vision NHS England, Monitor, Public Health England  and others set out in the NHS Five Year Forward View, published last autumn. In that document Simon Stevens set out a vision of the NHS as a movement, where care is personalised and centred around the patient. Anyone who wants patients to be at the centre of the NHS couldn’t fail to be heartened by that document which seems to have been universally well received; the cancer plan is a chance to turn the NHS Five Year Forward View into action for people with cancer and their carers.

This new cancer strategy is being lead by a taskforce, chaired by Harpal Kumar, Chief Executive of Cancer Research UK. Juliet Bouverie, Director of Services and Influencing at Macmillan, also sits on the taskforce, along with a myriad of senior NHS figures and a patient representative. There is a tight timeframe to produce the strategy; a statement of intent will be published in March and the final document should be published in the summer. There is currently a call for evidence, open until the end of February, (go here to let the taskforce know your views) and the taskforce will also oversee a programme of workshops to inform an action plan, seeking views from people with cancer, carers, clinicians, industry, nurses, commissioners, and allied health professionals as well as charities.

Macmillan will be submitting views to the taskforce, and seeking views of people with cancer as we develop our ideas. We hope that the intentions of the NHS Five Year Forward View will be realised by the plan. It is obviously really important that the plan has people with cancer at its centre and ensures that all aspects of the patient pathway are covered, from prevention and early diagnosis, through treatment and post treatment support, to end of life and supporting carers. We’d also like to see a commitment to matching the best survival rates in Europe – given that England lags so poorly behind other countries this must certainly be a priority. Increasing incidence and survival will mean more people living longer with cancer so there also must be a focus on ensuring that people are supported post treatment and helped with getting their life back, be that going back to work, help with managing the long-term consequences of treatment or supported emotionally. The strategy should also ensure that older people are treated appropriately and not dismissed on account of their age. To make all this happen, the strategy also needs to set out how cancer services will be measured and held to account, and how we can use data to improve and evolve services.

If the cancer plan can put into reality the aspiration of the NHS Five Year Forward View to integrate services around  the patient, as well as taking steps to save 8000 lives as Stevens promised in the press release, that would mean cancer care has made huge steps since the first cancer plan in 2000. It would show that when the NHS comes together across organisational boundaries to create a strategic plan, significant changes to people’s outcomes and experiences can be made within a generation.

Laura Thomas – Policy Manager, Macmillan Cancer Support

[i] Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107: 1195-1202.  (Projections scenario 1), and Macmillan analysis based on extrapolation of 2010 and 2020 projections and distribution across the nations taken from Maddams J., Thames Cancer Registry, personal communication. See also Maddams J, et al. Cancer prevalence in the United Kingdom: estimates for 2008. British Journal of Cancer. 2009. 101: 541-547.

[ii] Incidence predictions are based on the assumption that age specific all cancer incidence rates remain constant at 2012 rates for the next few years (Mistry et al. 2011 state “there is projected to be almost no change in the overall incidence rates of cancer (for all cancers combined) in the 23-year period 2007–2030”). Predictions based on applying the UK 2012 incidence rates for 5 year age groups from:

to the ONS’s UK population projections (2012-based projections – Principal projection for the UK – Population by five year age groups and sex http://www.ons.gov.uk/ons/rel/npp/national-population-projections/2012-based-projections/rft-table-a2-1-principal-projection—uk-population-in-age-groups.xls).


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