Tag Archives: Cancer Strategy

What we’d like to see from the Cancer Strategy: one year on

It’s a big week for the All Party-Parliamentary Group on Cancer (APPGC). Ahead of today’s Britain Against Cancer conference and Thursday’s much-anticipated Backbench Business debate on cancer in Parliament, Ayesha Ahmed, Secretariat to the APPGC, reflects on the inquiry held by the group earlier this year into the progress of the 2015 Cancer Strategy in England.

Cancer services in England are at a crucial turning point. It is estimated that by 2030, 3.4 million people will be living with cancer in England and this figure continues to increase.  Transforming cancer services is no longer an option but a necessity, and is why implementation of the England Cancer Strategy is so important. This is an issue that Macmillan have been working on in our capacity as Secretariat to the All-Party Parliamentary Group on Cancer (APPGC), a position we have held for over seven years.

 

What is the APPGC?

The APPGC was founded in 1998 with the aim to keep cancer at the top of the parliamentary agenda, and to ensure that cancer policy remains evidence based and patient centred. The group consists of cross-party MPs and Peers, who monitor government initiatives, produce briefings for parliamentarians and campaign and debate on key issues in order to bring about improved cancer services for all those people affected by cancer.

appgc-inquiry-report

September’s inquiry report

In May this year, the APPGC held an inquiry looking into progress made since the publication of the report, Achieving World-Class Cancer Outcomes: A Strategy for England 2015-2020 (‘Cancer Strategy’) by the Independent Cancer Taskforce in July 2015, including a focus on the implementation plan published by NHS England in May 2016, Achieving World Class Outcomes: Taking the Strategy Forward (the Implementation Plan) which set out how the recommendations would be rolled out over the next five years.

The APPGC received written submissions from over 30 stakeholder organisations, from charities, pharmaceutical companies to Royal Colleges and patient representatives, and hosted oral evidence session to hear from key decision makers.

Having collated all the oral and written evidence, the APPGC published a report, Progress into the implementation of the England Cancer Strategy: one year on.

 

What needs to happen?

Whilst welcome progress has been made on delivering certain recommendations within the England Cancer Strategy since its publication, the APPGC’s inquiry highlighted concerns regarding the Implementation Plan and lack of visible progress made in other areas.

The APPGC therefore put forward three key recommendations to the Government and NHS England:

  • Firstly, the government needs to give further clarity over how it intends to fund the England Cancer Strategy each year, over the next four years.  Many contributors expressed their disappointment over the absence of detail on funding in the Implementation Plan, and sought specifics about how available funding would be used to deliver improvements across the entire cancer pathway.  Whilst some of this detail was set out in the Cancer Transformation Board’s one year on report, further clarity is still needed on how funding will be allocated to the six strategic areas outlined in the Strategy.
  • There needs to be further transparency regarding progress from NHS England and other Arms-length Bodies on how each of the recommendations as outlined in the England Cancer Strategy are being delivered. In addition, more detail is needed to explain how the Department of Health intend to hold these bodies to account and measure success of the delivery of the England Cancer Strategy by 2020.
  • Thirdly, the APPGC called on the National Cancer Transformation Board and the National Cancer Advisory Group to ensure greater involvement and collaboration with charities, other arms-length bodies and patients in the delivery of the England Cancer Strategy, locally and nationally.

 

What next?

The APPGC’s annual flagship event, Britain Against Cancer, is in its 18th year. As part of the conference today, we will be highlighting the Inquiry Report recommendations, calling on Government and NHS England to respond to the report and discussing how the cancer community can come together and work to ensure improved cancer outcomes. Follow the conference at #BritainAgainstCancer and Macmillan’s updates @MacmillanPA

The APPGC have also secured a Backbench Business debate on Thursday, titled Cancer Strategy: one year on, which also serves as a timely and welcome opportunity to discuss cancer services in the NHS today.  The debate will be a crucial opportunity for MPs to question the Minister on how the Strategy is progressing, and we look forward to monitoring the contributions on Thursday.

 

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: RLeech@macmillan.org.uk or NKennedy@macmillan.org.uk

@MacmillanPA

 

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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One year on from the NHS Five Year Forward View: aspiration in the Cancer Strategy, desperation on the front line

Strategies and solutions to avoid further crises have been agreed – what we need now is action

30 October, 2015  |   James Shield, Senior Policy Analyst  |  View all posts  |  @jshield

Left to right: The NHS Five Year Forward View; the Cancer Strategy for England; headlines about missed cancer waiting time targets

The NHS Five Year Forward View (5YFV) – the ‘Stevens plan’ for the future of the NHS – is already a year old. What has the NHS achieved for people affected by cancer since its publication?

On the one hand, we were pleased to see that the 5YFV included a section on cancer, and were proud to be part of the independent taskforce behind a full Cancer Strategy for England, published in July. The whole cancer community came together to agree on an ambitious plan for world class cancer care which, crucially, 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. The report provides a compelling blueprint for change.

However, cancer services have faced an unprecedented struggle over the past year.

Cancer waiting time targets have now been missed for six quarters in a row with no sign of improvement in the near future. The official line from the Department of Health is that this is due to an unexpected increase in the number of people being referred by GPs for tests – but as we explained in March, the trend in referrals ought to have been fairly predictable. Perhaps, as the King’s Fund has suggested, the NHS simply faces an ‘impossible task’ given current constraints on spending and rising demand.

Whatever the cause, the result of this crisis is that people with cancer are having to wait too long for access to treatment and their lives are being put at risk. And  across the country, we know that NHS staff are under more pressure than ever, struggling to find the time they need to meet rising demands and deliver the best patient experience.

Time is clearly running out: by 2020, there will be half a million more people living with a cancer diagnosis in England than in 2015, and the Five Year Forward View is already the Four Year Forward View. The strategies and solutions to support this growing population and avoid further crises have been agreed – what we need now is action.

Macmillan’s priorities are clear. To solve the problem of fragmented responsibility and accountability for cancer care since the Health & Social Care Act was introduced, we need to set up Cancer Alliances. To make sure the NHS delivers what matters most to patients, we need to design new quality of life and patient experience metrics, start collecting the data and hold the system to account for its performance. To make sure the NHS has a cancer workforce fit for the challenges of today as well as the future, we need an urgent strategic review. And to ensure tailored, long-term support for the two million people living with a cancer diagnosis in England – half of whom may live more than 10 years after their diagnosis – we need a national Living With and Beyond Cancer programme.

If the NHS can deliver for cancer, it will position itself well to deliver for everything else. The same themes set out in the Five Year Forward View are also at the heart of the Cancer Strategy – whole-person care, a sustainable workforce model, taking early action to avoid costly care in the future, self-management – and as a rare area of political convergence, it should be possible to gather momentum behind improving cancer care as an early priority. Once these approaches have been implemented and evaluated, they can then be rolled out to release further efficiencies and join up long-term condition management.

If the NHS is to achieve this, and close the gap between the aspiration in our strategies and the desperation on the front line, the recommendations in the Strategy must now be fully funded. Ahead of George Osborne’s Comprehensive Spending Review next month, we are watching very carefully which parts of the Cancer Strategy have gained political and financial backing so far and which have not.

We welcomed Jeremy Hunt’s recent commitments to speed up diagnosis, ensure everyone gets access to a Recovery Package by 2020 and introduce a Quality of Life measure for people with cancer. But we need the government and the NHS to commit publicly – and financially – to initiatives such as the workforce review, Living With and Beyond Cancer programme, Cancer Alliances and accountability for improving patient experience that we know are so vital to improving England’s cancer care services.

We will only be able to say the government’s manifesto commitment to delivering the cancer strategy has been met when these cornerstone initiatives have been fully funded. And in order to deliver world class cancer care in the future, front line services must also be protected and properly funded today. The Department of Health’s settlement in the forthcoming Spending Review must be sufficient to tackle the increasing challenge that cancer care poses. A ‘technical appendix’ of the Five Year Forward View estimated that expenditure on cancer services will need to grow by about 9% a year, reaching £13 billion by 2020/21. The Cancer Strategy recommendations will help place NHS finances on a firmer footing – but its vision can only be realised if recent declines in performance are reversed and existing targets met through investment in the services people need today.

There is much left to do, then, in the remaining years of the 5YFV – and this parliament – to ensure that the 2.5 million people who will be living with a cancer diagnosis in England by 2020 get the best possible care and support. As NHS England’s strategy director has said, doing is harder than writing. We will continue to influence government and policy makers to make sure the 5YFV and the Cancer Strategy result in real improvements.

Cancer Strategy ambitions

The six main ambitions in the Cancer Strategy for England

A Cancer Strategy for England: focus on living with and beyond cancer

Following on from Duleep Allirajah’s blog on the Cancer Strategy, we’re going to be publishing a series of posts looking in more detail at our priorities. This week, we’ll be looking at how to improve care for people living with and beyond cancer.

Half of people who are diagnosed with cancer will now survive for at least 10 years after their diagnosis[1].  This is, undoubtedly, a huge cause for celebration. But it is not the full story.

There is a common belief that people with cancer either pass away from the condition or are cured and enjoy a good quality of life. But while it is sadly true that many people still die from cancer, we also need to acknowledge for many others the end of treatment does not mean the end of ill health. Numerous needs can arise  from the physical, emotional, practical and financial impact of cancer: 53% of people living with cancer have one or more moderate or severe unmet needs, such as depression, anxiety or tiredness, six months after the end of treatment[2] and 1 in 4 people face poor long-term health or disability.[3]

Many of these needs could be tackled with the right follow-up care and treatment – but this is not available. Four in 10 (41%) cancer patients say they are not given all the  support from health and social services they needed after leaving hospital and 78% are not offered a care plan.[4] What’s more, failing to provide support for people with cancer doesn’t just impact the individual, it has consequences for the health service. People living with the consequences of cancer and its treatment are more likely to re-enter the health service, often requiring further treatment. But despite the evidence that improving the care for people living with cancer would have cost-saving benefits, there is still much more to be done to address the problems.

This could be about to change. Achieving World Class Cancer Outcomes: A Strategy for England 2015-2020, the hugely ambitious report published by the independent Cancer Taskforce last month, is seeking to improve quality of life for people living with and beyond cancer. This could be a watershed in the treatment of cancer. We hope that it will enable all people with cancer to access the support and care they need, and in turn reduce strain on the stretched health service.

So what does the report propose? One of its most radical recommendations is the introduction of a quality of life metric. This means not just measuring and holding CCGs to account for how long their patients survive cancer, but also how well they are living. It also recommends that all patients should have access to the cancer Recovery Package, designed to help people get back on their feet after treatment, and sorting patients into different follow up pathways based on needs.

This is a blueprint for improving the experiences and outcomes of people with cancer, but much more work is needed to turn these plans into a reality. The Strategy recognises this. It recommends a new living with and beyond cancer programme, led by the NHS and partners. This is really exciting, and we think a well resourced, fully funded 5 year programme will be crucial in transforming care.

Helping people to live well during and after treatment for cancer is something the NHS has struggled with for decades, but the new Cancer Strategy gives us an opportunity to change this. This is a huge ambition, and will require strong leadership and support from the health service.

We will be continuing to blog about implementing the strategy – check back soon for more thoughts on how our priorities can become reality.

[1] Cancer Research UK. One-, five- and ten-year survival for all cancers combined http://www.cancerresearchuk.org/health-professional/cancer-statistics/survival/all-cancers-combined#heading-Zero

[2] Armes J, Crowe M, Colbourne L, Morgan H, Murrells T, Oakley C, Palmer N, Ream E, Young A, and Richardson A. 2009. Patients’ supportive care needs beyond the end of treatment: A prospective, longitudinal survey. Journal of Clinical Oncology 27:36 6172-http://www.macmillan.org.uk/Documents/AboutUs/Newsroom/Consequences_of_Treatment_June2013.pdf

[3] Macmillan Cancer Support. Cured – but at what cost? Long-term consequences of cancer and its treatment. July 2013. http://www.macmillan.org.uk/Documents/AboutUs/Newsroom/Consequences_of_Treatment_June2013.pdf

[4] NHS England/Quality Health. National Cancer Patient Experience Survey 2014. September 2014. https://www.quality-health.co.uk/resources/surveys/national-cancer-experience-survey/2014-national-cancer-patient-experience-survey/2014-national-cancer-patient-experience-survey-national-reports/688-2013-national-cancer-patient-experience-survey-national-report-pdf/file.

 

 

A Cancer Strategy for England: turning ambitions into reality

Cancer is changing. The old ‘die or cure’ paradigm no longer holds. There is an increasingly sizeable section of the population who have survived cancer but who are still unwell. Until now the NHS hasn’t been good at supporting cancer survivors to live well after treatment. But all this could change with the publication last month of the Independent Cancer Strategy Taskforce’s blueprint for achieving ‘world class cancer outcomes’. In future the outcomes which the NHS will be aiming to achieve will include quality of life as well as length of survival.

Achieving World Class Cancer Outcomes: A Strategy for England 2015-2020 is a hugely ambitious document which has prompted some critics to question whether, in the current economic climate, the NHS can afford the cost of implementation. A better question would be: ‘Can we afford to do nothing?’ The answer is an unequivocal ‘no’. It’s a scandal that survival rates in the UK continue to lag behind the best performing European nations. It’s also a false economy. If cancers are diagnosed later not only are outcomes likely to be poorer but treatment costs are generally higher. There’s also a powerful economic rationale for improving aftercare. There are 2 million people living with cancer in England, one in four of whom will have treatment-related long-term effects and 70% have one or more long-term health conditions. The increasing numbers of people living with cancer and trying to cope with the physical and psychological effects of cancer treatment will place 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.

The report proposes a series of measures aimed at preventing cancer and diagnosing patients earlier. These include reducing smoking prevalence to less than 13% by 2020, ensuring that 95% of patients are diagnosed within 4 weeks of GP referral. The new 4-week target is massively ambitious and, in order to realise this ambition, the report calls for an increase in diagnostic capacity, direct GP access to key diagnostic tests and the trialling of new models – such as multidisciplinary testing centres – which can facilitate earlier diagnosis. These measures will require significant investment, as will the proposed replacement of over 100 linear accelerators with new, state-of-the-art equipment.

Inevitably, the headlines have focused on the ambition to save more lives – the report estimates that by 2020 up to 30,000 additional people could survive for 10 years or longer each year if its recommendations are implemented and ambitions met. However, while saving lives is an absolute imperative, what’s really radical about the proposed strategy is the recognition that people with cancer must be enabled, not just to live longer, but to live well after treatment. One of the potentially game-changing proposals in the report is the development of a new ‘quality of life’ metric for cancer. At present the NHS primarily measures the length of survival, not the quality of a person’s life. Why is a quality of life metric important? Firstly, it is a very significant statement of intent; it signals 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. This isn’t just good news for patients, it makes good economic sense. If people with cancer are equipped to live well and manage their condition, it should reduce downstream costs to the system and provide economic benefits to wider society.

Secondly, a quality of life metric should serve to incentivise the radical overhaul of ‘follow-up’ and the development of new aftercare services envisaged in the report. It is proposed that the NHS rolls-out the ‘Recovery Package’ and ‘risk stratified pathways’ across the country. What this means in practice is that, in future, patients won’t just be abandoned at the end of curative treatment and left to cope on their own. It means that all patients will have a post-treatment care plan; they will be supported to manage the potentially debilitating effects of treatment, such as chronic fatigue or breathlessness, they will be remotely monitored and they have rapid re-entry back into acute care if symptoms reappear. There is strong evidence that this approach delivers better health and well being outcomes without additional cost.

Another strategic priority that will be transformational is the proposal that patient experience should be accorded equal status with clinical outcomes and safety. Why does this matter? One of five patients, surveyed in 2014, said they felt treated like a set of symptoms rather than a person. This is simply not acceptable. The scandal at Mid Staffordshire NHS Trust starkly illustrates the dire consequences of allowing a culture of compassionate care to erode. The report proposes a set of measures to ensure that patient experience is hardwired into the culture of the NHS. This means that the Cancer Patient Experience Survey (CPES), a tried-and-tested improvement tool, will be conducted on an annual basis, and that the survey data will be supplemented by a broader set of patient experience metrics designed to drive continuous improvement.

As I said, the vision is massively ambitious. That’s why there need to be strong ‘enablers’ in place to ensure the strategy is more than just a set of warm words but capable of delivering real change. It’s therefore very encouraging that workforce features prominently in the Taskforce’s six strategic priorities. The current cancer workforce is ill equipped to cope with today’s challenges, let alone tomorrow’s. The Taskforce proposes a more strategic approach to workforce development – something that has been sorely missing in recent years. This means addressing the workforce deficits, for example the shortage of radiologists and clinical nurse specialists (CNS). It means getting the skill mix right and developing new roles, such as 1-2-1 support workers, who can coordinate care and can free up valuable CNS time. And it means equipping the workforce with the skills to work in new ways, i.e. to facilitate shared decision-making and support patients to self-manage.

Another key enabler is boosting local NHS improvement capability. It’s obvious that Strategic Clinical Networks, established in the 2013 NHS restructure, simply haven’t been equipped with the right resources to deliver large scale change programmes, such as pathway redesign care or integration of health and social care. The Taskforce report proposes the creation of new regional ‘Cancer Alliances’ which are ‘properly resourced’ to drive change and ensure local integration of services.

The Taskforce has produced an exciting and ambitious strategic vision which addresses ‘what’ cancer care in England ought to look like as well as ‘how’ we can deliver the key recommendations. The report provides the blueprint for change. Now we must hold the NHS to account to deliver.

A Cancer Strategy for England: turning ambitions into reality’ was authored by Duleep Allirajah, Head of Policy at Macmillan Cancer Support.

The Cancer Strategy – an historic opportunity

By Duleep Allirajah – Head of Policy

The cancer story is changing. More people are being diagnosed with cancer than ever and, as treatment has improved, more are surviving the disease and living longer with it. There are currently 2.5 million people in the UK living with cancer; this number is set to rise to 4 million by 2030. But improved survival rates don’t mean that every person with cancer is ‘cured’, nor does it mean that the issue of cancer is ‘fixed’.

The changing cancer story presents huge challenges for a health and social care system which, after a five-year public spending squeeze, is already under tremendous strain. So, how should the NHS tackle these challenges? This is the question which the independent cancer taskforce, assigned by NHS England to develop a new cancer strategy for England by this summer, is currently trying to answer. It’s an historic opportunity to shape the cancer agenda for the next five years and, here at Macmillan, we’re working to determine how the strategy could be truly transformational for people affected by cancer.

Firstly, it’s vital that the new strategy articulates an ambitious vision for cancer care. Fifteen years on from the publication of the NHS Cancer Plan for England, it’s a scandal that despite being better than ever, our survival rates still lag dangerously behind the best in Europe. If we are serious about closing the outcomes gap we will need to boost diagnostic capacity, reduce the proportion of patients diagnosed in A&E and reduce ‘system delays’ from GP referral to treatment. We also need to tackle the survival rates for patients aged 75 and over which still lag behind the best European countries. If you’re aged 75 or over and get diagnosed with lung, stomach, kidney or ovarian cancer in England, your chances of surviving at least five years are lower than in any region of Europe, including Eastern Europe[i].

But as more people survive, more support is needed to help them get their lives back after treatment. This means preparatory rehabilitation and ensuring that patients have access to treatments which have less debilitating consequences. It also means addressing the lack of aftercare services.  Two in five cancer patients who need support from health and social care services after they leave hospital say they are not given enough[ii] and at least one in four people suffer ill health or disability after treatment[iii]. The health system needs to help people manage the long-term physical and psychological after-effects of treatment.  It needs to support them to get back to work and to make the lifestyle changes – such as becoming more physically active – that we know can reduce the risk of recurrence or ill health.

These changes require big shifts in clinical practice and care pathways. They require the roll-out of a set of interventions – the ‘Recovery Package’ – to ensure that people with cancer aren’t abandoned when curative treatment finishes. This means reforming cancer follow-up by replacing the old  medical-only follow-up with a more ‘whole person’ approach, which combines remote monitoring, support for people to self-manage and rapid re-entry if symptoms recur.  In order to incentivise these shifts, Macmillan is advocating the development of new high level ‘quality of life’ outcome measures. Because we know what good cancer care looks like: good cancer care is having the best possible chance of survival as well as the best possible quality of life.

And there is still some way to go in ensuring that people with cancer have this quality of life through a positive experience of the care they receive. Sadly, one in five cancer patients say that they felt treated like a set of symptoms rather than being recognised as a personiii while half of NHS staff have received no training on how to deliver good patient experience[iv]. In order to foster a culture of compassionate care, we need to establish feedback loops to make sure that patients are routinely asked to rate their experience of and that clinical staff have dedicated time to reflect on that feedback. In the interests of transparency, we’d also like to see the publication of how each hospital trust performs on patient experience. The National Cancer Patient Experience Survey has been an invaluable improvement tool for driving service improvement, but it needs to evolve. Currently, for example, the survey only measures the experience of inpatients but, as most people receive treatment as outpatients or day cases, we’d like to see it focus on how patients are being supported out of hospital, as well as at key transition points, for example, at the time of hospital discharge or at the end of treatment.

While we want the cancer strategy to focus on improving survival and helping people lead healthy and fulfilling lives after treatment, we shouldn’t forget that over 145,000 people die of cancer every year in England and Wales[v]. It’s still the case that the preferences of people with cancer for how and where they receive care at the end of life are not being met. We know that 73 per cent of people with cancer would prefer to die at home[vi], but only 30 per cent are currently able to do so[vii] because they don’t have the support to make this happen and there is only patchy provision of round-the-clock community services. Having people die in hospital against their wishes is not only morally wrong but it represents a waste of NHS resources. We estimate that the NHS spent £137 million on hospital care at the end of life for cancer patients who wanted to die at home in 2012, whereas the equivalent cost of a community palliative care package – including social care – would be £68.1 million[viii]. We’d like to see the new strategy address how to roll out new models of care, such as Macmillan’s Specialist Care at Home model, which provide integrated 24/7 support to enable people with cancer to die in their own homes if that is their preference.

If this strategy is to really make a difference to people’s lives, it must be strong on delivery mechanisms. There is a real opportunity here for the strategy to be a trailblazer for the radical vision set out in the NHS Five Year Forward View and we don’t want this opportunity missed. This means a radical shift from commissioning by activity, for example procuring chemotherapy or diagnostic services, to commissioning for better outcomes across a whole population. This, in turn, means developing the right outcome metrics, capturing the right data and looking at how financial levers can become enablers of, rather than obstacles to, change.

Finally, it means having the right system leadership – both at a national and regional level – to oversee and drive implementation and ensure that the workforce is fit to deliver the ambitions set out in the strategy.

Achieving these shifts won’t be easy and will cost money. But, if we want to saves more lives and support people to live well and longer after treatment, doing nothing is not an option.

[i] De Angelis, Sant M, Coleman MP et al. Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5–a population-based study. Lancet Oncology 2013;  http://dx.doi.org/10.1016/S1470-2045(13)70546-1

[ii] NHS England/Quality Health. National Cancer Patient Experience Survey 2014. September 2014. https://www.quality-health.co.uk/resources/surveys/national-cancer-experience-survey/2014-national-cancer-patient-experience-survey/2014-national-cancer-patient-experience-survey-national-reports/688-2013-national-cancer-patient-experience-survey-national-report-pdf/file. Of those patients who said they needed it, 59% said they were definitely given enough care and help from health or social services after leaving hospital; 23% said they were to some extent; 18% said they did not get enough care and help.

[iii] Macmillan Cancer Support. Cured – but at what cost? Long-term consequences of cancer and its treatment. July 2013. http://www.macmillan.org.uk/Documents/AboutUs/Newsroom/Consequences_of_Treatment_June2013.pdf

[iv] NHS England/Picker Institute. NHS Staff Survey 2014. http://www.nhsstaffsurveys.com/Caches/Files/NHS%20staff%20survey_nationalbriefing_Final%2024022015%20UNCLASSIFIED.pdf

[v] Office for National Statistics. Deaths registered in England and Wales, 2013. July 2014. http://www.ons.gov.uk/ons/rel/vsob1/death-reg-sum-tables/2013/rft-deaths-summary-tables-2013.xls

[vi] Macmillan Cancer Support. February 2010 online survey of 1,019 UK adults living with cancer. Seventy-three percent of people with cancer said they would prefer to die at home if all their concerns about dying at home (such as access to pain relief, round the clock care, and support for their family and carers) were addressed.

[vii] Office for National Statistics. Place of death for cancer patients 2012, England and Wales – personal communication.

[viii] Macmillan Cancer Support. Can we live with how we’re dying? Advancing the case for free social care at the end of life. June 2014. http://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/Endoflife/EndofLifereport-June2014.pdf