NHS targets for early diagnosis of cancer in England will not be met and urgent action is needed to prevent further deterioration, warns a new report on cancer services from the House of Commons Health and Social Care Committee.
Cancer outcomes in England lagged behind those of comparable countries even before the COVID-19 pandemic – which itself continues to have a profoundly detrimental effect on cancer diagnosis and care. The Committee inquiry found that patients are less likely to seek primary care appointments about potential cancer symptoms; investigations and diagnosis of cancer is occurring later, and treatments for diagnosed cancers are being delayed.
Critical challenges to improving cancer care
The 2019 NHS Long Term Plan included a target to diagnose three quarters of all cancers at stage 1 or 2 (ie. in the early stages when more responsive to treatment) by 2028. The new report warns that this target will certainly not be met without prompt intervention. It makes specific recommendations for remedial actions to improve both early diagnosis and patient outcomes.
The report emphasises the need to address gaps in the cancer workforce, noting the inquiry found ‘little evidence of a serious effort to do this’ and highlighting the apparent absence of any detailed plan to address current shortages in oncology, pathology, radiology and specialist cancer nursing.
Other policy issues noted include the need to reduce variation in the standard of cancer care ‘across the country and between cancer types’ by developing strategies to counter the impact social and economic deprivation has on outcomes; creating an action plan for improving survival for the less survivable and less common cancers; and embedding cancer leads within the new Integrated Care Systems (ICSs) to work with local Cancer Alliances to improve adoption of best practice in cancer care.
Accelerating progress from research into practice
These recommendations are in line with the new Cancer Research UK (CRUK) strategy released last month, which similarly notes that improvements in cancer outcomes are ‘still unacceptably slow’. It calls for an acceleration in the implementation of innovations in healthcare, to deliver the benefits of research to patients in terms of improved prevention, diagnosis and treatment. The strategy focuses on all forms of cancer research excellence, and on the effective translation from research into clinical practice.
CRUK proposes to ‘support UK health systems to transform into learning systems, with greater integration of research and clinical practice, and greater ability to adopt and implement innovation more quickly and equitably’. It also stresses the importance of making the most of the UK’s strengths in terms of health system, data assets, and academic and commercial research and development (not least that funded by CRUK) to ‘lead the world in pioneering new tools and technologies that help us beat cancer’. To achieve this, the charity says it will address three critical stages in translation from research into practice and improved care, focusing particularly on those areas of lower commercial potential:
- Innovation gaps – supporting collaborative and high-risk research into potential diagnostics and treatments
- Adoption gaps – encouraging the rapid adoption of proven treatments, diagnostics and other interventions into the NHS, including care pathways and screening programmes
- Implementation gaps – working with health system to support consistent, equitable uptake of best practice
These are long-standing gaps in translation, as the PHG Foundation has pointed out many times over the last twenty five years. The potential value of (and wider political appetite to fund) high risk, high reward research is arguably growing, as evidenced by the announcement of plans for the wide-ranging Advanced Research and Innovation Agency last year. There has also been some progress towards faster uptake of healthcare innovations, with the introduction of promising new cancer treatments and diagnostic tools via the Accelerated Access Collaborative, strategic developments at NICE and plans to support personalised cancer care through the National Genomic Healthcare Strategy and commitments.
The third implementation gap is perhaps the hardest to address, despite previous policy initiatives. Could the move to new ICSs provide, as suggested by the new Health and Social Care Committee, a fresh opportunity to bridge this gap? Or will the fact that there are 42 separate ICSs only increase the challenges to consistent, nationwide uptake of best practice?
Towards a new Cancer Plan
The Department of Health and Social Care is currently consulting on a new ten-year cancer plan, which seeks to not only recover from the pandemic’s adverse impact on cancer services but to go further, creating a ‘new vision for how we will lead the world in cancer care’. The aim is to look at life sciences innovations arising from research and development – along with lessons from successful collaborations and accelerated ways of working from the pandemic – and to consider how to deliver and build on previous ambitions to improve cancer outcomes for patients across the UK. Specifically, the intention is to:
- Improve cancer risk assessment and prevention
- Provide earlier diagnosis, including delivery of equitable diagnosis
- Provide diagnostic and treatment capacity to meet rising demand
- Deliver high quality personalised care for every patient
- Build a ‘world class cancer workforce’
- Harness data, science and technology in pursuit of these ambitions
It seems that there is strong agreement on the unmet needs for cancer care in the UK. There is also consensus as to the policy priorities to address these needs, focused on making the best use of data, science and technology; offering more consistent best practice care for all patients irrespective of their personal circumstances or cancers; and addressing workforce issues. However, the operational challenges to delivery are greater than ever, thanks to the impact of the pandemic, wider economic pressures, and workforce issues, combined with the further distractions of the health system switch to ICSs.
Much will depend on the forthcoming cancer plan, as stakeholders look for realistic, practical – and this means, appropriately resourced – government commitments to action. The call for evidence on the new Cancer Plan does specifically seek to learn from the COVID-19 pandemic where there have been many examples of what can be achieved when the NHS, industry, charities and patient groups, government and academia work together in pursuit of common and urgent goals. Clearly, where there’s sufficient will, there’s a way.
The UK needs a better way forward for cancer, and, in cancer, we are well-placed to show the way to a research-driven, patient-centred, prevention-focused learning health system future. Now is the time for policy to truly make science work for health. The new Cancer Plan, alongside other policy initiatives, is a critical opportunity – but to work, it cannot shy away from difficult – and expensive – longer-term fixes.