Exclusive: Cancer diagnosis cash not ‘reaching frontline’ in some areas

Increased central funding for cancer tests is “being diverted to plug gaps” in finances in some areas, according to concerns in new research shared with HSJ.

Cancer Research UK interviewed and collected information from clinical commissioning groups about funding, investment and waiting times for leading diagnostic tests for cancer.

The charity’s report, exclusively shared with HSJ, found wide variation between CCGs in approaches to funding the tests, and in their spend per head.

Of 25 CCGs which provided detailed spending information, seven CCGs said they were cutting funding for three of the most common tests in 2016-17, despite most CCGs having a “clear increase” in patient need. One of the CCGs reduced the budget by £1.6 m year-on-year.

Spend per head of population varied widely, from £19 to £61. There were also variable year-to-year swings, with one CCG allocating 69 per cent more in 2016-17, and another 18 per cent less.

The CRUK report recognised variations may be clinically appropriate for varying populations, but said reductions in budgets were “very concerning at a time when activity is meant to be increasing”.

It said that in interviews with commissioners, concerns were raised that “money from the increased baseline allocation was being diverted to plug gaps in NHS finances leaving them unable to invest in improving pathways or capacity due to funding constraints”.

There were also concerns about a hospital department asking commissioners to reduce referrals because it wasn’t receiving additional income despite performing additional tests.

Both government and NHS England have prioritised cancer diagnosis and 2016-17 CCG allocations were based on an assumed 7 per cent annual increase in diagnostic activity, according to CRUK. Government committed in 2015 to spend “up to £300m more on diagnostics every year” by 2020.

CRUK’s policy manager and lead author of the report Sara Bainbridge said: “It is concerning that we can’t be sure that investment is reaching the frontline and we aren’t sure how CCGs are grappling with current levels of diagnostic capacity.”

NHS planning guidance said CCGs must close gaps in diagnostic capacity, but CRUK said 26 CCGs told it they had “no plans to increase capacity in 2017-18”, in research carried out last year.

Ms Bainbridge said the report should act as a “warning sign” that the chance to speed up diagnoses may be “missed”.

The report analysed waiting times for various diagnostic tests and found some CCGs were repeatedly among the lowest performers.

Ms Bainbridge told HSJ that lack of diagnostic capacity played a part in the NHS not achieving the 62 day wait cancer standard – in which 85 per cent of patients should start treatment within two months of an urgent GP referral – for more than two years.

CRUK called for additional cancer diagnostic funding to be “ring-fenced” and for more “scrutiny of how additional resources are being deployed”.