• East Midlands and Yorkshire have nine of the 10 worst performing CCGs for stage four cancer diagnosis
  • Mansfield and Ashfield CCG has worst performance in the country, while Guildford and Waveney CCG has best
  • Across England, 27 per cent of cancer cases were diagnosed at stage four

Just two regions account for nine of the 10 worst performing clinical commissioning groups for late detection of cancer, according to official data.

Analysis by HSJ of Public Health England data on the stage cancer patients were at when they were diagnosed suggests the East Midlands and Yorkshire house most of the worst performing CCGs in England. 

Mansfield and Ashfield CCG, which is in the East Midlands, had the worst performance in the country, according to the data for 2017, which is the latest available.

Guildford and Waveney CCG in Surrey had the best performance with only 21 per cent of its cancer patients diagnosed at stage four. South Cheshire CCG and Bromley CCG, a London suburb, were the next best performing at 22 per cent.

The PHE data revealed 27.1 per cent of diagnoses nationally were at stage four, and a further 19.2 per cent were at stage three. By stage three, the cancer has grown and may have spread to other organs. By stage four, it has moved to another organ.

These figures are excluding “unstaged” diagnoses where it was not possible to include patients in the one to four stage system. Nearly 20 per cent of the 305,000 diagnoses in 2017 fell into this category.

Worst performing CCGs

CCG nameRegion Percentage of cancers diagnosed at stage four
Mansfield and Ashfield CCG East Midlands 34%
Nottingham North and East CCG East Midlands 33%
Hull CCG Yorkshire 33%
Newark and Sherwood CCG East Midlands 32%
Salford CCG North West 32% 
Leicester City CCG East Midlands 32%
Barnsley CCG Yorkshire 32%
Bassetlaw CCG Yorkshire 32% 
North Kirklees CCG Yorkshire 31%
Doncaster CCG Yorkshire 31%

Best performing CCGs

CCG nameRegionPercentage of cancers diagnosed at stage four
Guildford CCG South East      21%
South Cheshire CCG North West 22%
Bromley CCG London 22%
Surrey Downs CCG South East 22%
Horsham and Mid Sussex CCG   South East 22%
City and Hackney CCG London 22% 
Brighton and Hove CCG South East 22%
Fylde and Wyre CCG North West 23%
Darlington CCG North East 23%
Croydon CCG London 23%

Source: PHE cancer data

A spokeswoman for NHS England and Improvement said: ”It will be important for hospitals, CCGs and cancer alliances in areas with higher proportions of delayed diagnoses now to take a hard look at how they can improve further so as to cut health inequalities. The NHS nationally is also helping support areas with the biggest challenges – including four of those mentioned in this research – by rolling out new initiatives like lung cancer screening trucks in supermarket car parks, which can help save hundreds of lives.”

However, the East Midlands CCGs said the issue was more likely to be a data problem than a service provision issue.

Joint accountable officer Amanda Sullivan said: “These figures provide a useful comparison between CCG areas but it’s very difficult to attribute specific causes to these results, which offer a snapshot of data that does not match all our survival rates.

“We know that underreporting of staging data affects the figures significantly. This has no impact on patients. But it does mean that cancers that are often diagnosed earlier are sometimes not included in the results.

“Nevertheless, our integrated care system has a robust action plan to address late diagnosis of cancer, and we expect to see clear improvements in the 2020-21 data.

“This includes working to address rates of late presentation, which can often lead to diagnosis in the advanced stages of cancer. Parts of Nottingham and Nottinghamshire have higher levels of deprivation than the national average, which has historically been a cause of poor cancer outcomes.”

Mansfield and Ashfield is one of 10 CCGs to be targeted by a £70m NHS England scanning programme, focussed on lung cancer. Several other CCGs with the worst performance are taking part in this scheme, due to start later this year.

A spokeswoman for Doncaster CCG, which is getting £7m in investment from the scanning programme, said the area had high levels of deprivation. She added it was specifically targeting smokers, young people, people with a BME background and traveller communities, while recent activities included working with Healthwatch Doncaster and BeCancerSafe and going out to Doncaster “using a local health bus”.

A spokeswoman for Hull CCG, the third-worst performing CCG, said the city had “higher than average levels of deprivation and health inequalities”.

She added: “The CCG is committed to identifying patients at an earlier stage of cancer to increase the likelihood of a more positive outcome and does this by supporting national cancer campaigns and actively promoting screening programmes locally.”

Last year, the government set a target for 75 per cent of cancers to be caught at stages one or two by 2028. In the 2017 data, 43.8 per cent of patients were diagnosed at this stage. In nearly a fifth of diagnoses, the stage was not known.

Cancer Research UK’s policy manager Matt Case said: “Staff shortages will make this target unachievable unless action is taken. The government must now invest in NHS staff to ensure it can meet its target.

“When people are diagnosed with cancer at a late stage, they have fewer treatment options, and ultimately their chances of survival are worse than if their cancer was detected earlier.”

The other CCGs and NHS England were asked for comment but have not yet responded.

HSJ National Cancer Forum

The HSJ National Cancer Forum takes place on 18 March 2020 at the Park Plaza Victoria in London. Taking place over one day, the forum will bring together the cancer community to discuss national policy and how to deliver the long-term plan at a local level. The event is free to attend for the relevant audience from the NHS. By attending you will gain clarity on and hear analysis of national policy from those responsible for shaping it, and understand how to implement it in your area. You will also explore the future of cancer care, and the innovations along the whole pathway.

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