Monthly Archives: December 2015

Looking forward to 2016 – our influencing wish list for the next 12 months

Thinking about our Christmas wish lists is an exciting prospect, and here at Macmillan top of our list is improving the lives of people affected by cancer.

Following on from our blog about highlights in 2015 we’ve been busy writing a wish-list for 2016, focusing on what we think will could make a huge difference to people affected by cancer over the next 12 months.

  1. A fully funded Cancer Strategy

Achieving World Class Cancer Outcomes: A Strategy for England 2015 – 2020 is a very ambitious document which is helping to shape the future of cancer care in the NHS.

But to make sure it doesn’t just sit on the shelf, it needs to be fully funded.

Our recent report, Cancer Cash Crisis, shows that the NHS must spend now to avoid even greater costs later. The increasing number of people living with cancer and trying to cope with the physical and psychological effects of treatment is placing an intolerable strain on health and social care services. Unless we can support cancer survivors to live well, manage their own condition and stay out of hospital this is going to increase.

We believe that implementing the Cancer Strategy, in particular the following priority areas, will address these issues:

  • Ensuring that how well people are living, not just how long they are living after a cancer diagnosis, is measured and used to plan services
  • Patient experience should be accorded equal status with clinical outcomes
  • Ensuring every person with cancer in England has access to the cancer Recovery Package
  • The creation of new regional cancer specific organisations, known as Cancer Alliances, to develop local expertise and help integrate services

It provides a great call to action to introduce improvements for people living with cancer, but without the right funding these promises for positive change will go unfulfilled.

  1. True choice at end of life

Next on the list, we want choice at the end of life to remain a priority and the Choice Review’s recommendations to be fully implemented.

The challenge of delivering consistently good end of life care is growing, but, unfortunately, choice at the end of life is still too often unavailable. By 2035, around 550,000 people will die each year in England, compared to approximately 450,000 currently.[1]

The time to prioritise quality end of life care is now. We will continue to call on the government to implement the choice review, and realise their manifesto commitment on end of life care.

  1. Access to crucial financial support

Research we published earlier this month found that almost 170,000 people with cancer in Britain are unable to celebrate special family events such as Christmas and birthdays because of a lack of money.

We know that 83% of people living with cancer are £570 worse off per-month as a result of their diagnosis and it is an unfortunate reality that many people with cancer will feel cold and lonely this Christmas because of the financial impact of their disease. That’s why it’s essential that people affected by cancer continue to receive appropriate support through the welfare system.

We are therefore calling on the Government to urgently reverse plans in the Welfare Reform and Work Bill which would cut £125 a month from thousands of people who have been medically assessed as too ill to work, including those who have had a cancer diagnosis. You can find out more about the campaign and how to support it here.

2015 was a great year for innovative ideas about cancer care, with both the Choice Review and a new Cancer Strategy being published. But the work can’t stop here. A fully funded Cancer Strategy, quality care at the end of life and reform to welfare for people affected by cancer are our top strategic priorities, but we will also work to support people affected by cancer in many other ways, and on a range of other issues, over the next year. We look forward to continuing to be vocal for people affected by cancer into 2016 and beyond.

And finally, a very merry Christmas and a happy new year from everyone here at the Macmillan Policy team!

 

[1] Office for National Statistics. National Population Projections, 2012-based Statistical Bulletin. November 2013. Available at http://www.ons.gov.uk/ons/dcp171778_334975.pdf

Our influencing highlights from 2015…

With December in full swing, it’s beginning to look a lot like Christmas. Our advent calendars are open, there’s tinsel up in the Macmillan office and Christmas songs on the radio.

But while we’re all busy looking ahead to the festive season and what’s in store for next year, we’ve taken some time to reflect on 2015 and share our highlights from the last 12 months.

Cancer Strategy 2015

The opportunity to influence a national cancer strategy doesn’t come around every year, so we were thrilled when NHS England announced the creation of a new independent Cancer Taskforce to address cancer care over the next five years.

Its report, Achieving World Class Cancer Outcomes: A Strategy for England 2015-2020, was published in July and showed real ambition and focus. Macmillan sat on the Taskforce and, together with many other members of the cancer community, helped to agree on an ambitious plan for world class cancer care. Crucially it acknowledges that the job of the NHS isn’t just to treat the disease but also to enable people to live healthy, fulfilling and productive lives after treatment.

More work is needed to ensure that the recommendations from the strategy can be translated into action, but with this strong blueprint in place we are confident that the next five years will bring positive changes for people with cancer.

The General Election

The 2015 general election seems like a long time ago now, but back when the outcome of May 7th was still uncertain Macmillan was busy campaigning across the political spectrum.

Our aim was to ensure that the interests of people affected by cancer were at the heart of every manifesto. By the time of the election, each main political party had committed to improving the lives of people affected by cancer in their manifestos.

The Conservative Party, who are now tasked with putting their election promises into practice, committed to deliver the new cancer strategy; offer safe and compassionate care where all people are treated with dignity and respect; and support commissioners to combine better health and social care services for the terminally ill so that more people are able to die in a place of their choice.

We look forward to holding government to account for the delivery of these promises over the course of this parliament, and helping MPs to continue to push for progress to improve cancer care.

Nationwide – Specialist Support Service

Macmillan have sought to address the financial implications of cancer for a long time, as we recognise that for some people affected money can be a big cause of concern.  In 2014 we published a policy report aimed at the banking industry called Counting on Your Support, which set out 9 key recommendations for how they could improve the service they provide to people affected by cancer. But we didn’t want to just show people how they could improve, we wanted to help ensure that these recommendations were put into practice. So this year teams across Macmillan, including Policy, have worked with Nationwide to do just that. The result is the Nationwide Specialist Support Service –which provides a bespoke case managed service for Nationwide customers affected by cancer, to help them manage their financial affairs based on their individual needs, ranging from immediate requests for support to the longer-term management of financial difficulties.

The Benefits System

As well as working with banking providers, Macmillan has also campaigned to ensure people with cancer get the support they need from the benefits system.

We’ve long been calling on the Government to reduce waiting times for the Personal Independence Payment (PIP) – a benefit many people with cancer rely on.  In January 2015 the Government heeded Macmillan’s calls to publish waiting times for the benefit – something they had previously refused to do – and in June published figures showing waiting times had been reduced to 11 weeks.

This represents significant progress from the situation in summer 2014, when waiting times where as high as 40 weeks – a huge delay which had a devastating impact on many people affected by cancer.  We continued to influence on welfare throughout the rest of 2015 and it is also an area of focus for 2016. You can find out more, and sign up to support our campaign, here.

Later this week we’ll be posting our wish list for 2016, and in particular what we will be focusing on over the next year – so look back soon for more details on our future priorities!

Urgent care services are overstretched – we need to fund the cancer strategy now


10 December, 2015
Juliet Bouverie, Director of Services & Influencing  |  @julietbou

This piece first appeared in the Health Service Journal

As the dust settles following last month’s spending review, the NHS has to get down to the nitty gritty of how the precious early investment of £3.8bn is spent.

One area in desperate need of attention is cancer care, which poses a series of stark challenges for the NHS, both now and in years to come, according to Cancer Cash Crisis, a new report out this week from Macmillan Cancer Support.

Let’s start with how money is currently spent. New figures in the report show we are spending more than £500m a year on inpatient emergency care for people diagnosed with the top four cancers alone. Of this, at least £130m is spent on care more than six months after a person’s diagnosis, when initial treatment would usually have finished, but before their last year of life.

After successful treatment, people should be looking forward to getting their life back on track. Instead, many find they bounce back into hospital because they aren’t given the right care and support.

Care beyond treatment

Future prospects are perhaps even more alarming. With more people than ever surviving years or even decades after a cancer diagnosis, the NHS will need enough funding to provide care and support far beyond initial treatment.

As the number of people living with cancer in England rises from 2 million in 2015 to 3.4 million by 2030, this demand will become ever more acute.

New figures in the report show that care beyond treatment for people living with cancer will rise to at least £1.4bn per year by 2020, with £1bn being spent on consequences of treatment, such as side effects from drugs, as well as long term after effects.

Over the next five years, the growth in care beyond treatment amounts to a cumulative increase of more than £600m.

Budget burden

This is a significant chunk out of tight NHS budgets. Unless action is taken now, we will continue to see money being spent inefficiently and we will see the burden on an already overstretched emergency care services grow further.

Our health system cannot continue to assume that the needs of people living with cancer finish when initial treatment does – this is bad for the individual and a false economy for the NHS.

We must place as great an emphasis on supporting people to live well as we do on early detection and survival.

People’s needs are more complex now than ever before. As well as those living with the long term consequences of cancer and its treatment, increasing numbers of people will live with incurable but treatable cancer for several years.

Add in the fact that we currently have an estimated 1.4 million people with cancer in England who have at least one other long term condition, and suddenly providing care and support for this growing number of people starts to look like an almost insurmountable challenge.

Pressing strategy

What is the solution? Early diagnosis is certainly a key component, but it is by no means a magic bullet. For example, new figures released this week reveal that for the 40,000 women diagnosed with early stage breast cancer each year, the cost of inpatient care during diagnosis and initial treatment (£155m) is dwarfed by the £250m spent on inpatient hospital care after their initial cancer treatment ends.

This challenges the notion that patients’ outcomes, as well as the costs of care, can be improved through early diagnosis alone.

If the NHS is to get a grip on this dramatic collision of public spending and public need, the cancer strategy for England must be fully funded and implemented at the earliest possible opportunity.

Recommendations in the strategy, such as the rolling out of a recovery package, including a holistic needs assessment and other key interventions, such as a treatment summary and cancer care review, are vital steps that need to be taken if we are to help people live well beyond a cancer diagnosis.

Wise investment

When delivered together, these interventions can help to contain the rising tide of costs and significantly improve coordination of care and patient outcomes, including better and earlier identification of consequences of treatment, better management of co-morbidities, help with staying at or returning to work, and support with healthy lifestyles.

Funding the cancer strategy for England’s recommendations will not be cheap – it will cost an estimated £400m a year between now and 2020. But it will be a wise investment.

Investing early, followed by delivery of the savings identified by the strategy’s recommendations, would result in a £420m lower cumulative spend by the NHS over the next five years than failing to fund it at all. Worse still, delayed funding and late implementation of the strategy would actually cost about £100m more by the end of this parliament than doing nothing at all.

The cancer story will continue to shift with time and new solutions will constantly have to be found. Through the cancer strategy, the NHS has a chance to shape this story for the near future.

The health service has to be brave and invest now, so that we can improve lives and make every penny count.

George Osborne

Five thoughts on what the Chancellor’s spending review means for people affected by cancer


1 December, 2015
James Shield, Senior Policy Analyst  |  @jshield
Victoria Woods, Senior Public Affairs Officer  |  @vgwoods

It was widely reported last week that George Osborne has committed billions of pounds of ‘extra’ money for the NHS over the next five years as part of his Comprehensive Spending Review. But what is the bigger picture for healthcare, social care and welfare, and what will the announcements mean for people affected by cancer?

1. Extra funding for the NHS is welcome – but it needs to be spent wisely

It is good to hear the government is investing in the NHS’s plan for the next five years, and that £3.8bn extra will go into the NHS next year; our creaking health service badly needs this money now.

But three quarters of England’s hospitals are now running a deficit, which by the end of the year is expected to hit £2bn. We have seen the impact of this pressure on frontline cancer services: cancer waiting time targets have now been missed for seven quarters in a row. In the short term, the extra money will help to plug the black hole in NHS balance sheets, which we hope will mean getting back on track with meeting existing targets.

It is now crucial that the government spends wisely and fully funds and implements the cancer strategy for England which will be transformational for cancer care. Although the cancer strategy was mentioned in the Spending Review, this was only to reiterate a commitment to implement the previously announced recommendations on a new 4-week target for diagnosis and improved diagnostic capacity through £300m in funding.

As we said in October, time is running out: by 2020, there will be half a million more people living with a cancer diagnosis in England than in 2015. The strategies and solutions to support this growing population and avoid further crises have been agreed – what we need now is action. Macmillan will continue to push for the cancer strategy to be implemented in full.

2. We often hear that to have a strong NHS we need a strong economy – but despite extra funding, the NHS is not receiving its fair share of the proceeds of growth

The Government has often said that we need a strong economy to have a strong NHS. The reverse is just as true – we need a strong NHS and a healthy population to have a strong economy. As the economy returns to growth, we should invest in the long-term health of the nation. But on the evidence we saw in the Spending Review, it looks as though health and social care funding are going in the opposite direction.

Billions of pounds of extra money is a big investment, but as the population ages, more treatments become available and more people survive diseases such as cancer, the demand for healthcare could still outpace funding. Even with the additional money, we are now mid-way through the longest decline in NHS funding as a percentage of GDP since the war:

What does this mean for cancer services? The picture is unclear: we don’t yet know how the NHS will use its funding allocation, and will find out more when NHS England’s plans are published in early 2016.

What we do know is that between 2010-2013 spending per cancer patient had already fallen by between 4-10% (the latest figures available).

It can be difficult to know whether healthcare funding necessarily leads to a healthier society, and not all high-spend health services get value for money, but there comes a point where it is clear that more could be done with additional funding, and this is true of cancer.

In comparison with the rest of the world, both our level of healthcare spending and our cancer survival rates fall short. Last week’s announcement means that over the next five years, the share of GDP the UK spends on the NHS will fall even further below European and OECD averages:

3. Cuts to public health and bursaries for nurses are counterproductive

We understand much of the extra £3.8bn for the NHS next year is in fact sourced from a 25% cut to the Department of Health’s non-NHS budget.

It is counterproductive that ‘extra’ NHS money is being sourced from cuts to public health (which includes cancer screening and smoking cessation clinics) and bursaries for student nurses. This precious investment should be used to drive genuine progress – instead, it is being used to paper over the existing cracks.

Local authorities’ public health budgets will also fall by an average of 3.8% in real terms each year. The public health ring-fence will be ‘maintained until 2017/18’, which implies it might not continue afterwards.

This means the Spending Review has failed to meet one of the ‘five tests’ set by the head of the NHS, Simon Stevens, for the Spending Review – to “make good on the public health opportunity”.

4. We’re still concerned about social care funding

Funding the health service is just one side of the coin. The needs of people living with cancer are often life-long, and many require non-medical support to get by.

We are concerned that continuing pressure on social care budgets means that extra funding given to the NHS could end up being spent propping up a cash strapped social care system.

George Osborne announced a new optional levy on council tax of up to 2% per year, which is to be ring-fenced to fund adult social care. But commentators are suggesting that even if this is implemented by every council each year there will still be a substantial funding gap.

Perhaps even more problematic is the risk that access to social care could become more of a postcode lottery and exacerbates health inequalities by disadvantaging councils with weaker tax bases. According to the Institute for Fiscal Studies, councils such as Manchester, Hackney, Liverpool, Newcastle and Birmingham could only raise an extra 4%, while Richmond and Windsor could raise 17-18%. Meanwhile the King’s Fund warned the measures “are not a substitute for sustainable funding”.

No other advanced economy is reducing the share of national income spent on social care, as the UK is doing. We know that during the first few years of the last parliament’s social care cuts, over 360,000 fewer older people received social care than before. It is difficult to be optimistic about the future of social care against this background.

5. The welfare situation has changed less than the headlines suggest – and we will do all we can to be there for people affected by cancer

One of the big headlines after the Spending Review was the government’s supposed u-turn on its controversial proposals to cut Tax Credits. While we welcome this change because we know many people with cancer use this financial support, this is only a short-term gain, as the same cuts will continue to apply to Universal Credit, which is already being phased in.

Despite talk of u-turns, the impact of tax and social security changes over the next four financial years will be the same as first estimated after the July Budget statement (the poorest 20% will still be around 7% worse off). The Chancellor also reiterated his commitment to implement £12bn of savings, part of which is the already announced cut to ESA WRAG, which we are campaigning to stop.

Macmillan believes it is vital people affected by cancer get the support they need through the social security system, so monitoring and responding to the introduction of Universal Credit will continue to be an important part of our work.

What do you think about the impact of the Spending Review? Let us know in the comments below.

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