A piecemeal approach to transform cancer care won't work

The beginning of 2018 bears a particular significance for all those with an interest in improving cancer care in England. We are now over halfway through the five year cancer strategy that was launched in July 2015 – so how has the NHS in England fared at the midway mark?

Is the health service on track to make this ambitious plan for improving cancer care, a much vaunted priority, a reality?

It is a very mixed picture.

Positives

Let’s start with the notable positives. It has been great to see important investment made in updating crucial radiotherapy equipment.

This new equipment will mean that future patients will have more accurate treatment, and will hopefully live with fewer of the often debilitating consequences of treatment associated with less sophisticated equipment. There has also been welcome progress in terms of early diagnosis, with innovative approaches being tested.

We are also pleased to see cancer alliances being established so that improvements can be driven at a local level, and at Macmillan we’ll closely work with alliances to ensure they make the progress they are tasked with. Increased numbers of clinical endoscopists and radiologists will also do much to help pressures in those particular areas.

We are also pleased to see cancer alliances being established so that improvements can be driven at a local level

The obstacles to delivering the world class cancer care that the strategy aims to achieve are, however, significant. There is a disconnect between the extraordinary innovation seen in some aspects of cancer care, while fundamental gaps in patient care persist elsewhere – you need look no further than consistently missed cancer waiting time targets.

Workforce

Workforce is one fundamental in cancer care that is badly in need of further attention. Having enough staff with the right skills to deliver cancer care underpins progress in almost every area of the strategy. But worrying recent estimates from the Nursing and Midwifery Council, and others, that suggest 2017 saw yet more growth in the number of nurses leaving the profession shows that much work remains in this area.

Last month, Health Education England published the first part of its long awaited strategy for the cancer workforce – a key recommendation in the cancer strategy – but little has been done over the past two and a half years to address immediate workforce gaps.

In recent years long term planning to deal with increased future demand has not been undertaken with the level of application and foresight that was needed

Meanwhile, pressures have mounted: a Macmillan report published last September found that nurses are now reporting that pressures are beginning to affect the quality of care cancer patients are receiving. Recent reports in the media of proposals to reduce access to chemotherapy for some groups of patients at a leading hospital because of workforce shortages show just how far reaching an impact this issue can have.

What has become clear is that – as is the case with the wider NHS workforce – in recent years long term planning to deal with increased future demand has not been undertaken with the level of application and foresight that was needed.

It is essential now that these recently published plans are now urgently acted on. In a sense, we have a cancer workforce designed to tackle yesterday’s challenges, and is scarcely keeping up with current demographic demands.

Future planning and funding

There is also a need for the government to start thinking seriously and imaginatively about post-2021 planning. We need plans that focus beyond diagnostic and surgical staff, which also look at the role nurses and support and care workers play, and what kind of skill mix is in place to care for patients.

There is also a need for the government to start thinking seriously and imaginatively about post-2021 planning

Another source of concern is that, for a variety of possible reasons in different parts of the country, transformation funding is not making it to cancer alliances. This puts in jeopardy a key target that by 2020 every cancer patient must have access to a personalised “recovery package” of support, which assesses individual needs via interventions such as a holistic needs assessment and a treatment summary.

New rules are being applied restricting cancer alliances’ access to this funding. A crude measure has been introduced that sees cancer alliances not meeting targets on 62 day waiting times from referral to treatment effectively penalised so they cannot deliver plans to modernise services and support for patients on another part of the pathway.

Meeting needs

The needs of people after cancer treatment are considerable, whether it is profound, enduring consequences of treatment such as incontinence and lymphoedema, or depression and anxiety. As the population ages, an increasing number will not only be living with cancer, but also a range of long term health conditions, adding a further layer of complexity to cancer treatment.

As with the significant challenges we see in workforce, if the needs of people after cancer treatment remain unaddressed it will only cause further complications for cancer care in the NHS. The government and NHS England must press ahead with plans to roll out the recovery package, so that everybody gets that crucial level of support from the moment they are diagnosed onwards.

If one or two aspects of the patient pathway are improved, but others remain unaddressed, then this only shifts pressure and poor patient experience elsewhere in the system

The whole purpose of this strategy is to ensure that the health service in England changes to meet the constantly expanding and increasingly complex needs of people diagnosed with cancer. This is not achieved by withholding funding for improvements needed in key aspects of cancer care.

All aspects of the cancer strategy must be addressed. If one or two aspects of the patient pathway are improved, but others after treatment remain unaddressed, then this only shifts pressure and poor patient experience elsewhere in the system. This is neither fair on people with cancer, nor on the staff and healthcare system who care for them.