The must-read stories and debate in health policy and leadership.

Cutting the cuts

This week, Public Health England held its annual conference, a week after the long-awaited government spending announcement by the chancellor. Serendipitously so, as the Treasury finally had some good news for public health professionals.

This time, there were none of the swinging cuts of the past decade. Instead, public health got a promise of a real terms funding increase.

At 1 per cent above inflation, it is not exactly a sum to write home about. It’s certainly not the £1bn a year the Health Foundation said was needed to correct the £850m docked since 2010.

But perhaps it is not to be sneezed at either. It takes public health back to 2018-19 funding levels and replaces the £85m taken out in 2019-20, the final round of cuts in the previous spending cycle.

Duncan Selbie told HSJ the increase was a “a powerful message, well understood by the secretary of state [for health and social care], that it’s time to stop the cuts to the public health services. That’s had its time.”

He was keen to reiterate that the public health grant is only part of the story. “Small increases can go a very long way, but I’m interested in the totality of the spend,” he explained.

“I’m interested in the totality of local government spend and the totality of NHS spend, and about how that’s working for local people. The public health grant of itself is not going to get clean air and it’s not going to solve the mental health dilemmas of young people, and so on.”

That being said, stemming the flow of cuts from the public health grant will certainly help.

Smoking outside the Asda on Old Mill Lane

Research putting the UK near the bottom of a table of rich nations for cancer outcomes made national headlines this week.

It is a little disingenuous of NHS England to respond to the work from the International Cancer Benchmarking Project by saying “outcomes have never been better”. While true, we are still behind other countries.

It is distinctly disingenuous of the national commissioner to say the ICBP study is outdated because it covers 1996 to 2014.

Asked where more recent data might be found, it points to Office for National Statistics data from, erm, 2016. This showed an increase in one-year survival from 2014 to 2016 of 1.3 per cent. And this data can’t be compared with the other six nations in the ICBP report.

So why are British outcomes worse?

A tacit admission of why can be seen in what NHS England is investing in (and what most people in the NHS have known for ages): early diagnosis.

Over the past week, HSJ has published two stories showing pretty stark regional variations in early diagnosis.

Data from the national cancer registry shows a 13 percentage point difference between Guildford and Mansfield in the proportion of patients whose cancer is picked up at the latest stage (stage four).

Why is this?

Whenever clinical commissioning groups get asked about late diagnosis, they tend to say they have an unusual population – deprived, disadvantaged or otherwise less inclined to get diagnosed and treated.

To be fair, NHS England is pumping £70m into mobile scanning units targeting this very population in supermarket car parks and elsewhere. Not an easy sell, though; trying to encourage people smoking outside an Asda to step inside a lorry and take a spur-of-the-moment test that might give them horrifying news.

What about people who do present with cancer symptoms?

The National Cancer Patient Experience Survey’s first question for cancer sufferers is about how many times they went to the GP with symptoms before being referred to hospital.

Patients might not always remember this accurately, but even so, the differences are stark.

Nationally, 6 per cent of patients reported five or more visits. In Herefordshire, the figure was 11 per cent. Why?

The CCG didn’t say but it did say the the patch’s sustainability and transformation partnership was laying on specific training for primary care on identifying cancer symptoms.

Hopefully the next ICBP study will show an even more dramatic improvement in outcomes as a result of the regional and national efforts.