It is easy to see why cancer is the first clinical strategy of this parliament. The question is to what extent the government will fund and act on its recommendations
The work of the cancer taskforce has been widely (and rightly in my view) praised but - rather like the NHS Five Year Forward View it seeks to translate - it will be the start of the conversation and not the final word.
Cancer remains the condition that the public say they would most prioritise for investment. It is also a condition where, despite the NHS strong performance on other indicators, our outcomes stubbornly lag behind those of other countries.
‘People diagnosed with cancer in England less likely to survive five years than people in Sweden, Canada or Australia’
Services in England have got considerably better, but this does not appear to have been sufficient to bridge the gap with other countries.
Put simply, people diagnosed with cancer in England are still much less likely to survive five years than people diagnosed in countries such as Sweden, Canada or Australia.
Cancer is also a condition that embodies many of the challenges facing modern health services. It is easier (and cheaper) to treat if diagnosed at an early stage, but spotting the signs and symptoms (which may very well not be cancer) is tricky for the public or for primary care services under immense pressure.
Thanks to brilliant research, we know more about how to treat cancer and to reduce the consequences of treatment, but these treatments often come at a great cost. And the people who develop cancer are increasingly older and often also develop other conditions; juggling the management of different conditions, as well as the consequences of aging, is not a simple task.
It is therefore easy to see why cancer is the first clinical strategy of this parliament. There is a political imperative to act, but this is underpinned by the health need and the health service opportunity; get it right for cancer and we can get it right for any condition.
There are three distinct themes within the strategy, each of which is worthy of consideration. The first is continuity but acceleration in the direction of travel. The major focus on earlier diagnosis and improving support for people after treatment builds on evidence generated as a result of previous cancer strategies. The ambition to improve outcomes for older people builds on a personal priority of the national cancer director. These are the areas where the NHS can save and improve lives, as well as make much better use of public money.
The acceleration comes from the proposed step change in the use of diagnostics (with a new headline target to replace the two week wait measure to encourage action), as well as a promised new measure of quality of life to encourage better support for people living with and beyond cancer.
‘The taskforce recommends subtly recreating some of the infrastructure torn down by the 2012 reforms’
The second theme is more of a reversion to type. The taskforce recommends subtly recreating some of the infrastructure torn down by the 2012 reforms, proposing a new national cancer team to coordinate delivery across the arm’s length bodies, as well as the establishment of cancer alliances (local coordinating groups that will cover similar geographies to the old cancer networks and fulfil similar functions to some of the more effective networks).
The third theme is a significant challenge to the government. There is little doubt that the taskforce has attempted to answer the question about how to deliver “world leading” cancer services, which was the commitment made in the Conservative manifesto. However, the taskforce is clear that doing so will involve initial costs, some of which fall outside the projection made as part of the forward view costings. Although improvements in quality will help fill the efficiency gap, they will take upfront investment to realise.
Waiting for the spending review
NHS England has already welcomed the taskforce’s recommendations and stated that it “broadly agrees with the cost-estimates the taskforce has made”. However, an implementation plan will only be published after the spending review, presumably when a view has been taken about affordability within the context of the settlement the NHS receives. When the £8bn kicks in, and whether further targeted investments are made on issues such as diagnostics and equipment, will help determine how much progress can be made on cancer.
The cancer strategy is a prototype for a new generation of clinical strategies. A similar process is underway for mental health. The benefits, in terms of alignment across the system and stakeholder buy-in, are already being seen. However this approach presumably also makes it harder (or at least more embarrassing) for the system to ignore or fail to fund the strategy’s recommendations. Many contributors to the process are also likely to take a dim view of any attempt to pick and choose from the 96 recommendations.
‘Contributors will take a dim view of any attempt to pick and choose from the recommendations’
When the taskforce was commissioned, NHS England may not have anticipated the speed with which the government would agree to, at least in headline terms, provide the funding identified in the forward view. Nonetheless, discussions with the Treasury on the spending review have yet to begin in earnest and the recommendations will no doubt now become an important point of discussion.
Cancer is one of a few important manifesto commitments on the NHS, which, if delivered, will go some way beyond the ‘stand still’ position of the forward view. The question is the extent to which it will be a funded commitment.
If the consensus view is that world leading cancer outcomes will cost more than the funding already committed on health, then will the Treasury find a way to pay for the strategy to be put into action? And will any settlement require that the national bodies implement the recommendations which have been made?
Mike Birtwistle is a founding partner at Incisive Health, a specialist health policy and communications consultancy.