A local vehicle for improvement will fill the gap in a fragmented system that lacks a single body with oversight of the whole pathway and also act as a crucial enabler to reach ambitions of the new cancer strategy, writes Fran Woodard

There are two million people living with cancer in England and this number is growing every day. In fact, over 280,000 people a year receive a cancer diagnosis.

Fran Woodard

Fran Woodard

We also know too many of these people are struggling with the devastating impact of cancer and are unable to access the type and quality of support they need. People are living longer than ever before with the disease, and the NHS is under increasing resource pressures so there is a greater need than ever for the systems which design and deliver care to address the changing cancer story.

Cancer pathways are complex, and the responsibility for commissioning them can be split between NHS England and local commissioners. Transitions between care settings further complicate matters, and there is a need to better integrate across health and social care.

The need for integrated care

Without an organisation able to look along patient pathways and support the design and delivery of joined up services, people will not experience care that is integrated. There is a lack of coordination across local cancer systems, a deficiency in overall accountability, and no single quality assurance mechanism for cancer.

The challenge of a fragmented system – lacking in a single body with oversight of the whole cancer pathway – would be significant enough if we only wanted to maintain the status quo. But standing still isn’t good enough.

England is already lagging behind the rest of Europe in terms of outcomes – not even meeting the average in some cases. There is an urgent need to improve on this and keep up with the changing needs, and increasing numbers, of people living with and beyond cancer.

‘Better diagnostic pathways will improve outcomes for cancer patients’

That is why the ambitions and recommendations set by the new Cancer Strategy for England are so important. We know that better diagnostic pathways and earlier diagnosis will improve outcomes for cancer patients.

We also know that the Recovery Package, a series of interventions to support self-management, presents an opportunity to provide the kind of care and support people living with and beyond cancer need. Jeremy Hunt’s recent announcement that everyone will receive a tailored recovery package is an important first step, but we want to see this commitment across all the recommendations set out in the strategy.

This includes developing and implementing a quality of life metric, and creating a greater emphasis on patient experience overall.

However, we need to accept that currently, local systems won’t be able to deliver against these recommendations or ambitions at the pace required. Many clinical commissioning groups are telling us that they don’t have the cancer specific expertise or the time to adequately commission complex and holistic cancer services as things are, let alone drive the implementation of the strategy in the future.

Further, at present there is not the crucial local improvement architecture in place that will ensure the successful delivery of the strategy, there is an absence of a single body with the right form, function and remit to take responsibility locally for the essential tasks presented by the new Cancer Strategy.


That is why Macmillan sees recommendation 78, calling on NHS England to establish Cancer Alliances as the local vehicle for improvement, as a crucial enabler for the rest of the strategy. While we should learn from Cancer Networks and build on the success of strategic clinical networks, we need to view alliances as a new solution to a gap in the new world.

Over the next five years, at the least, we will need dedicated local resource to provide cancer expertise, engage patients, harness local data, and pull all relevant local and statutory organisations together to deliver the ambitions set by the Cancer Strategy at pace. Unless there is investment in alliances, we can’t expect to see a fully implemented strategy and the required improvement in patient outcomes by 2020.

By this point 2.4 million people in England will be living with cancer, so it is imperative we take steps now.  

‘We need to view alliances as a new solution to a gap in the new world’

There are already some inspiring examples of good practice, for example in London or Manchester. We should build on these systems and align them with a coherent national direction towards the same ambitions and goals for cancer. 

We know that the specific form of Cancer Alliances will need to vary from place to place. While we need absolute clarity on what their role should be and a clear central commitment to empower them to carry this role out properly, it is equally important local areas coproduce what their Alliance should look like. We should not seek to impose a uniform organisational form and structure.

There can’t be a one size fits all model, and we will only see alliances which add value if they are designed flexibly in partnership with local areas.

We have a golden opportunity to make further strides in cancer, and pull England closer to achieving the best possible outcomes for people; but we need to get the right enablers in place first. We need the whole system to come together and commit to developing Cancer Alliances as one of these enablers – recognising that they will underpin the improvement of outcomes between now and 2020.

NHS England, the arm’s length bodies, charities, and local stakeholders now need to build on the momentum created by the strategy and as a cancer community define what we need alliances to do, and how they will be empowered to do it.  

Dr Fran Woodard is executive director of policy and impact for Macmillan Cancer Support