Cancer commissioning overhaul could save 30,000 lives

As part of a package of reforms, published today, the independent cancer taskforce also recommends a new target to increase early diagnosis and stronger public health programmes.

The taskforce has called for more cancer services to be commissioned above clinical commissioning group level, and for the budget for the entire cancer pathway to be devolved in at least one pilot area.

It is unclear how much of the £400m annual cost of delivering the taskforce’s strategy can be covered within existing financial projections for the NHS over the next five years.

NHS England established the independent cancer taskforce in January, chaired by Cancer Research UK chief executive Harpal Kumar, to develop a five year strategy for cancer services in England.

The strategy calls for an overhaul in how cancer services are commissioned and provided, with “most elements of treatment… commissioned at population levels greater than those served by CCGs”.

This should happen through a “lead CCG” taking responsibility for commissioning a range of cancer services for populations of 1 million to 4 million.

In a radical move, the taskforce recommends “the commissioning of the entire cancer pathway” in at least one pilot area through a fully devolved budget over many years.

NHS England chief executive Simon Stevens told HSJ that “different parts of the country” would be invited to work with NHS England to test the idea, which would involve a leading cancer hospital holding the population budget for cancer services to “drive improvement” across a “network of care”.

NHS England has accepted another recommendation, for reform of the cancer drugs fund, which the taskforce said was “no longer sustainable or desirable… in its current form”.

A new solution, which gives patients earlier access to innovative drugs while ensuring “cost-effectiveness is maintained”, will be published for consultation this summer and implemented from April 2016.

According to the strategy, if action is taken across the health service then by 2020,30,000 more patients a year could survive cancer for at least 10 years.

The strategy says 11,000 lives could be saved through earlier diagnosis.

NHS England has accepted a recommendation for a new four week waiting time target between a patient being referred for testing by a GP and getting definitive results, with the expectation that the target is achieved for 95 per of patients by 2020.

Once the new metric is embedded the existing two week urgent cancer referral target will be phased out.

Extra diagnostic capacity should be built, with all GPs having access to key tests. In parts of the country with poor GP coverage patients would able to self-refer for their first test.

The report said that with one in four cases of cancer preventable through lifestyle changes, public health needed a “radical upgrade” – including a tobacco control strategy to cut smoking.

Mr Kumar said he was “disappointed” by the government’s recent decision to cut £200m in-year from local authorities’ public health budgets.

The strategy also calls for “significant capital investment” to replace ageing radiotherapy machines and for action to fill deficits in the cancer workforce.

Mr Kumar said the new initiatives would cost about £400m a year by 2020, but that savings “substantially in excess” of that would begin to be accrued from 2018.

While some of the extra cost was covered by the financial assumptions laid out in the Five Year Forward View, he said it had not “been easy to tease out exactly how much is already in there”.

Mr Stevens said the plans could be achieved “without breaking the bank” and did not represent “an incremental spending proposition”.

“This was envisaged when we did the forward view,” he added.

In a statement health secretary Jeremy Hunt said: “Our ambition is for the NHS to become the best in the world for cancer care.

“Cancer is no longer the death sentence it once was, survival rates are at a record high but we know there is more work to do.

“I would like to thank Harpal Kumar and the Taskforce for their excellent recommendations, especially the focus on early diagnosis and how the NHS can be better at supporting people to live with and beyond cancer.”