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.
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.
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.
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.