Category Archives: Policy

Can Cancer Alliances live up to expectations?

In our first look at the state of Cancer Alliances, Niamh Kelleher and Louisa Petchey ask how they can cope with the weight of responsibility that is being placed on their shoulders

24 November, 2016

Map of Cancer Alliances

16 Cancer Alliances have been set up across England to deliver the Cancer Strategy (Source: NHS England)

The UK’s population is getting bigger and it is getting older. That means more people than ever before are being diagnosed with cancer. But thanks to improvements in treatment, more people are surviving.

While this is obviously great news, it doesn’t mean the pressure on our health system is any less, it is just different — and potentially even greater and more expensive.

Eye on the prize

As set out in the Cancer Strategy for England in July 2015, we want our health system to deliver world class cancer outcomes by 2020, not just in terms of survival but quality of life. If this ambitious vision is to be met, there is much to do and it is not going to be straightforward.

There are now an array of ‘place-based’ policy initiatives — new models of care, vanguards, and Sustainability and Transformation Plans — all trying to find a way to improve care for their communities while often significantly reducing costs. It is important that during this challenging time we don’t allow ourselves to lose sight of or compromise the recommendations in the Cancer Strategy.

A long to-do list

That is where we are hoping Cancer Alliances will come in. Cancer Alliances have long been a priority for Macmillan. We view them as a vital for providing effective oversight and co-ordination of the whole cancer pathway at a local level. Among other things, they should:

  • drive the delivery of national strategies and priorities
  • ensure meaningful user involvement takes place
  • promote whole-system coordination
  • provide strategic support and leadership
  • facilitate alignment and support local providers
  • support cost efficiency within local systems

So we were pleased to see in their response to the Taskforce report that NHS England share this view and that Cancer Alliance “footprints” have now been announced.

Will Cancer Alliances deliver?

But how confident can we be that Cancer Alliances will live up to the weight of responsibility that is being placed on their shoulders to deliver the Cancer Strategy?

Their task is no easy one. They are being expected to come up with a plan for the future of cancer care tailored to the needs of their local population, involving local people while also coordinating day-to-day improvements in cancer care and support. This includes working with multiple commissioning bodies, potentially dozens of providers and, most difficult, ensuring the transformation of cancer care and support in their area’s Sustainability and Transformation Plans (STPs); a process that in itself has been fraught with controversy and difficulty. All of this is expected with limited resource or dedicated staff time.

Reasons to be cheerful

But there are several important reasons to be optimistic. For one thing, Cancer Alliances exist. So now at least we have a structure that can focus on driving improvements in cancer care in an ever-changing environment. And amid so much negative publicity about planning rounds with STPs and service transformation, Cancer Alliances now have a unique opportunity to lead the way in working collaboratively with their communities.

We also expect that NHS England will soon make money available to Cancer Alliances so they can make improvements to diagnostics and ongoing support for people beyond the end of active treatment. This will be the first time we get to see Cancer Alliances in action, spearheading the transformation of cancer care in line with the Cancer Strategy recommendations.

Big test

Cancer Alliances will soon need to face their first big test since their footprints were announced. No two Cancer Alliances will be facing the same challenges, from the differing needs of their local cancer population to the impact of STPs on their local area. We will be looking on with expectation and qualified optimism — and as ever, Macmillan will be working with the rest of the cancer community to help make a success of the Cancer Strategy.

Niamh Kelleher and Louisa Petchey are Policy Analyst and Senior Policy Analyst (respectively) at Macmillan Cancer Support

The NHS in England may be struggling to meet even relaxed cancer targets

18 November, 2016
James Shield, Senior Policy Analyst  |  @jshield

The NHS in England has now failed to meet a vital cancer target in all but one of the past 29 months — and on the latest evidence, it is struggling to meet even the relaxed targets set by NHS Improvement this July.

Recognising the problem in hitting the national target to treat 85% of patients within 62 days of an urgent GP referral, NHS Improvement put the previous system of fines on hold. Instead, most trusts now have an ‘improvement trajectory’ to meet, tied to a bit of extra money from a ‘sustainability and transformation fund’. Out with the stick, in with the carrot.

Uphill battle

It’s too early to say whether that approach will work in the medium term. But what we do know is that NHS Improvement appears to have a bigger challenge on its hands than it might have thought.

Here at Macmillan, we’ve been comparing actual performance against this target with the ‘improvement trajectories’ for the first quarter of this new system — July 2016 to September 2016 (the most recent stats available).

Waiting times chart - for twitter.png

The actual picture differs in two important ways from what NHS Improvement wanted to happen by this point:

  • Many more trusts failed to meet the national target than NHS Improvement expected. By this point, just over 20% of trusts were expected to be missing the national target, leading into a period of recovery over the winter. Instead, it was more like half in July, August and September.
  • We may be seeing a divergence among trusts, between those persistently missing the target by a wide margin, and those meeting it by a comfortable margin. Such a wide divergence has implications for the way improvement funds are allocated.
Waiting times table - for twitter.png

Phantom carrot

Previously, trusts were fined for missing these targets. But since July, each individual trust can be rewarded for staying on their improvement trajectory with a pay-out from the £1.8bn Sustainability & Transformation Fund. 5% of that fund (or about £90m) is linked to this cancer target.

The idea is that rather than taking money away from struggling trusts, they should be helped to get back on track — a carrot rather than a stick — and between July 2016 and March 2017, much of the country is supposed to have recovered.

But according to our analysis, more than half of trusts (56%) could be at risk of missing out on this money, at least for the most recent quarter.

The rules go like this: in Q2 of 2016/17 (July to September), trusts need to be within one percentage point of their trajectory to get the pay-out. This then ratchets up to half a percentage point in Q3, until the ‘tolerance’ disappears entirely in Q4.

However, fewer than half (44%) of trusts were near enough to their improvement trajectories from July to September to qualify. Our estimate of the amount of money that might be withheld from these trusts during Q2 puts the figure at around £12.7m, though it’s hard to know for sure.

Reality check

It is too early to say whether this picture will improve as we move further into the winter. Early signs appear to be that the NHS is struggling even to meet relaxed targets. And perhaps more worrying is that these targets are being missed by so wide a margin that many trusts could continue to miss out on the money they need to improve, trapping them in a cycle of missed targets.

Macmillan will continue to speak out on behalf of the thousands of people who continue to wait too long to start treatment. We’d encourage NHS Improvement to keep a close eye not only on the targets, but also on whether its system for supporting trusts to get back on track is working.

With thanks to Samuel Jones in Macmillan’s Evidence department for help with data analysis

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1) Not all trusts have ‘performance trajectories’ in NHS Improvement’s new system. According to a document published by NHS Improvement in July 2016, trusts that had not accepted a financial ‘control total’ were excluded, and at the time of the document’s publication trajectories were subject to change due while they waited for regional sign-off. So for the purposes of this post, and its charts and tables, we only looked at the 133 trusts that had trajectories set for this period.

2) A couple of points on our estimate of the money that might be withheld from trusts: firstly, we only included trusts that had performance trajectories in place and saw at least 5 patients in any given month. Secondly, we estimated the withheld funds as follows: 5% of the Sustainability and Transformation Fund is linked to the performance trajectories for the 62-day cancer target. 5% of £1.8bn = £90m. Assuming this money is spread equally over the four quarters of the year, the amount linked to this target between July-September = £22.5m. We estimate that 56.4% of trusts missed their trajectories by >1% for the most recently reported quarter. 56.4% of £22.5m = £12.7m. If you think we’ve estimated this incorrectly, please do let us know.

Why we can’t be daunted by the workforce challenge

The NHS employs around 1.5 million people (around 1.2 million of these in England), putting it in the unlikely company of McDonalds, the US Department of Defence and the Chinese People’s Liberation Army as one of the largest employers in the world.  It’s perhaps no wonder then that workforce has always been one of the hardest questions for the NHS to tackle – how best to use 1.5 million people to deliver healthcare to a population of 64 million?  With the NHS seeming to constantly lurch from one crisis to another on workforce, is the question just too difficult to answer?  At Macmillan, we think it can’t be, and that starting with the cancer workforce could be a way to start unlocking some of the trickier questions around how to manage one of the world’s five largest workforces.

Since the announcement of the Independent Cancer Taskforce last January and the subsequent publication of the Cancer Strategy for England in July last year, the cancer community has been working hard to decide what cancer care should look like in the future.  We know that the number of people living with cancer is growing and that their complex and changing needs have to be addressed.  We know that care needs to be more personalised, and that improvements need to be made to patient experience right across the pathway.  But we also know that none of this can be achieved without the right workforce with the right skills in the right place.

At Macmillan, we understand just how important the workforce is to someone with a cancer diagnosis.  Workforce planning and its associated focus on capacity, skills-mix and retention, may sound fairly dry but the stories we hear from patients about the crucial role played by both the salaried and unsalaried workforce – from the consultant who diagnosed them, to the Clinical Nurse Specialist who supported them through treatment, to the volunteer who provided them with information and support – remind us why this is such a crucial part of delivering the ambitions set out in the Cancer Strategy for England.

But it also reminds us of why it is such a huge challenge.  The needs of the 2 million people currently living with or beyond cancer in England are complex and varied, and whilst many people with cancer have a positive experience of their care, too many people do not have the support they need.  Data shows us that there are gaps in key professions including Clinical Nurse Specialists and General Practitioners, and professionals across the health service are still hampered by organisational boundaries and silos.  Add into this mix the unprecedented financial challenges facing the NHS, the need to deliver the changes set out in the Five Year Forward View, and uncertainty around what impact the EU referendum result may have on the NHS workforce, and the challenge of developing a sustainable cancer workforce that is fit for purpose can seem a daunting prospect.

It is vital however that we don’t shy away from this challenge.  The Cancer Strategy for England recognised how integral workforce is, and included a number of recommendations, with the key one being that Health Education England should work with NHS England and other bodies to conduct a strategic review of the cancer workforce.  We believe that this is one of the most important recommendations in the strategy and offers a huge opportunity to think differently about what the cancer workforce needs to look like in the future.

The scope of this recommendation means that it will require the support of the whole cancer community to deliver.  That’s why earlier this year we worked in partnership with Cancer Research UK to bring together around 30 organisations including charities, professional bodies, Royal Colleges and Health Education England themselves, to discuss what the strategic review should look at.

The output of this event is a set of eight principles which those organisations, along with Macmillan and CRUK, believe should underpin the workforce review.  For example, principle one states that the review should look both at the current and future cancer workforce, whilst principle four states that the review needs to demonstrate how the workforce can be educated and supported to develop the right skills, training and behaviours to deliver high quality and compassionate care.  We believe that all of them are equally important, and all need to be considered if the review is to set out a meaningful vision for what the cancer workforce of the future should look like.  However, they should be just the start of the conversation and we’d like you to get in touch and tell us what you think – is there anything else that should be prioritised?

What ultimately underpins these principles is a shared consensus that there is an urgent need for change. We must be ambitious when thinking about when, where and by whom care is delivered.  It is no longer possible to plan for the future workforce by thinking soley about numbers of current professionals. We need to start with the needs of the patient and decide how the workforce can best meet the challenge, not just of a rising population but of a changing demographic with more and more people living with cancer as a long term condition (something which we highlighted in our report released earlier this month on how cancer care has changed over the last few decades).

Importantly, we also need to think about how strategic workforce planning should work in future.  A number of think tanks have highlighted the challenges around workforce planning in the NHS more widely, with data gaps and a lack of clear roles and responsibility in relation to workforce strategy being two key issues.  These challenges are all borne out in the current challenges facing the cancer workforce, and as cancer involves a wide variety of professions, specialisms and settings we believe it can be an effective test bed, with lessons that can be applied across the NHS.

At Macmillan, we’re excited about the opportunity to start tackling some of these big questions, and we’re inspired by the drive, commitment and consensus of the cancer community on this important issue.  If the Cancer Strategy is to make a real difference to the experience of individual patients by 2020, it is important that this momentum is retained and that workforce is at the heart of the Cancer Strategy implementation.  Over the next few months, we’ll be continuing to think about what the future workforce should look like, so why not get in touch and tell us what you think.

Rebecca Leech, Senior Public Affairs Officer

Contact: or



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

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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