Blogs

Cancer: the big issues for 2018

Anna Reilly, Catrin Hughes and Michael Cousins

With one in two people in the UK being diagnosed with some form of cancer during their life, it is no surprise that the disease was the UK’s most googled health issue in 2017.  But what is actually being done to tackle this big killer?

It has been two years since the publication of NHS England’s National Cancer Strategy, Achieving world-class cancer outcomes – A strategy for England 2015-2020. So why did over 90 per cent of delegates at the Britain Against Cancer last year vote ‘no’ to the question of whether the Strategy could be delivered by 2020?

For one thing, the UK still trails behind its European counterparts in survival rates and there is still vast variation in standards of care. A disparity exists between those developing changes to the system and those actually delivering services, in working out solutions to these problems.

So what has 2017 meant for the cancer landscape and what challenges still face the NHS to improve its cancer care in 2018 and beyond? With World Cancer Day taking place yesterday, we have used this opportunity to take a look at a few of the biggest challenges across the cancer landscape over the upcoming year.

62-day wait target and transformation funding

In January 2017, cancer alliances submitted bids for transformation funding, but were subsequently asked to demonstrate an improvement in the 62-day wait target – the maximum time for patients to start treatment following an urgent GP referral for cancer – as a condition to access funds.

Despite wide recognition of the importance of this target, this move has been described as a distraction to enabling alliances to deliver more strategic and transformational work, which they were initially asked to undertake.

Jeremy Hunt MP, the Secretary of State for Health and Social Care, has been less than engaged with the argument to ‘de-couple’ the target with access to funding, suggesting alliances either hit the target, or they don’t. For now, alliances are currently left trying to improve patient outcomes – potentially without the money to do so.

Data

Data is an increasingly important tool to help measure and improve the outcomes for cancer patients across the country. However, it is widely acknowledged that there are limitations with the national cancer dashboard. Firstly, in providing data sets on specific cancers – the dashboard only provides site-specific data for the four most common cancers – significantly reducing its value.

Secondly, data sets are several years behind with alliances working to improve services. With some services being updated based on data from 2014, before the Strategy was even written, there is a risk that meaningful data is being lost while inefficient practice continues.

NHS England’s National Cancer Director, Cally Palmer, has stated that work with the cancer vanguard is ongoing to develop detailed data for each alliance which will look at all cancers, within the next twelve months, but there is still a long way to go to improving the quality of data the NHS has access to in order to support service transformation and improve patient outcomes.

Workforce

The implementation of many recommendations within the Strategy rely on a sustainable and skilled workforce. Health Education England (HEE), the body responsible for delivering this, published its Cancer Workforce Plan in December which presents a “pragmatic and focused” look at the immediate actions needed to support the cancer workforce.

The plan clearly outlines that unless action is taken now, there will not be enough staff to deliver the commitments set out in the Strategy.

It identifies that there can be 5,000 extra staff by 2021 through training existing staff to do more. But is this achievable?

It sets a high ambition but with the different pressures facing the NHS in cancer care, transforming the workforce could fall to the ‘bottom of the pile’ on the list of priorities.

New technology and innovations in cancer, such as precision genomic medicine and immunotherapy, also offer a potentially ‘transformative’ impact on the way we diagnosis and treat the disease, but the health service is ill-prepared for the significant implications this will have on the training and roles across the cancer workforce. How will it support the workforce to adapt these advancements? Are we now hiring staff to fill the gap of the immediate workforce shortages, but will shortly be asking them to do a different job for which they are not trained for?

So, what does this mean for the future of cancer care? Without a strong workforce, the NHS will fail to adapt in order to provide new, innovative technologies. With access to crucial funding blocked, alliances will struggle to meet the needs of patients. And in the absence of efficient data collection and application, there is a serious risk that outcomes will stagnate.