Aspiration in the Cancer Strategy, desperation on the front line

This piece first appeared on Macmillan Cancer Support’s ‘Evidence and Influence’ blog in October 2015

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.

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