Collaborative approach to cancer inequalities

Inequalities in cancer care contribute to Britain's relatively poor standing in comparisons for survival rates with much of the developed world. The key to this issue is getting more people from disadvantaged groups and areas to present earlier with symptoms of ill health so they can benefit from early treatment and enjoy better survival prospects.

Late presentation is linked to low expectations of health and a fatalistic acceptance of disability and early death. People in spearhead areas often think of 50 as old. These low expectations need to be challenged and people's expectations raised.

The Healthy Communities Collaborative was originally part of the work of the National Primary Care Development Team, with various projects, such as healthy diets and ways to address the problem of elderly people falling. Two years ago, the team metamorphosed into the Improvement Foundation.

Survival rates

The foundation's chief executive Ruth Kennedy explains how it is now using the collaborative for early presentation for cancer. "The early presentation programme is about promoting early attendance among people with breast, lung and bowel cancers. We're working with 20 spearhead primary care trust sites, having started in July 2007 with 10. We also run a programme on early presentation of cardiovascular disease. Both are being supported by the Department of Health and run through the Improvement Foundation."

The programme is based on the idea that UK survival rates, once patients are in hospital for these cancers, are comparable with other European countries. However, as Ms Kennedy says, "the real concern is that we are not good at the fast-tracking of cancer patients and we are not sure whether that's about delay in getting into the secondary care system or about delay from patients in terms of presenting. The main emphasis on getting people to present early involves running workshops, exposing community members to people talking about social marketing techniques and giving access to real experts on some conditions."

The collaborative's model has been developed since 2002, and its original work proved very successful in deprived communities in Northampton, Easington and Gateshead. Ms Kennedy notes that its success was "about engaging community members and statutory and non-statutory agencies".

The cancer work is, she emphasises, "very new, and I believe of international importance. Observers like the US Institute for Health Innovation and Kaiser Permanente have expressed interest in learning about our approach.

"This is about joint engagement of clinicians and community members to work on one specific clinical issue, which makes it quite radical. It is both about encouraging early presentation with symptoms and about specialist trainers educating and empowering patients to request onward referrals from their GPs. This is against the culture, and working with GPs and clinicians on it can be quite challenging".

Uncovering talent

Collaborative clinical lead David Lyon emphasises that while part of the project is working with GPs in deprived areas to encourage more referrals, many may only see around eight cases a year of genuine cancer.

Dr Lyon adds that the project is about empowering people in deprived communities to take charge of their own lives. "Many accept they'll be dead by 50 through coronary heart disease or cancer - they think that's normal. In Anfield, 40-year-olds can be seen as decrepit and near death, by themselves and by their peers. We've got to change attitudes in the community. The people know their area much better than PCTs or strategic health authorities do, so when we teach them the 'plan-do-study-act' cycle methodology for improvement, they soon see how it can chime with health.

"The overall aim is to reduce mortality from cancers. Our way of working with the community unleashes their creativity. It gives them the confidence to get up and speak at our project meetings, which few have at first. By the third workshop, they can get up and tell their stories with real pride."

Dr Lyon says that in deprived areas only 30 per cent of people presenting with cancer get fast-tracked in two weeks as per the national target. But the talent and creativity that the collaborative has uncovered in the deprived communities is "incredible".

"When their expectations are raised, they have as much desire to improve their health and that of their community as anyone."