Analysis

Evaluating the progress of England's national cancer strategy

NHS England has reached the halfway mark since it published its five-year cancer strategy in 2015. Shining a light on recent events, how far has the NHS come and is the strategy still on track?

In 2015, NHS England published a five-year strategy for cancer care, which pledged commitments to improve early diagnosis and boost survival rates. Shining a light on recent events, how far has the NHS come and is the strategy still on track?

The NHS in England is halfway through delivering on the strategy. There was much fanfare when it was published in summer 2015, with NHS England chief executive Simon Stevens promising there would be a ‘world class’ service by 2020.


Picture: Getty Images

So how is the NHS doing? Certainly there has been much progress and an update published in late 2017 by NHS England claimed it was ‘on track’.

Nineteen cancer alliances are now up and running and have been armed with a £200 million fund to coordinate the strategy on the ground.

They are closely monitoring the evidence emerging from NHS England’s cancer vanguard on everything from patient self-referral to digital pathology.


Cally Palmer

The programme actually predates the strategy and is led jointly by The Christie NHS Foundation Trust, The Royal Marsden NHS Foundation Trust and University College London Hospitals NHS Foundation Trust across three large geographical areas covering more than ten million people.

There is also a £130 million investment in new or upgraded linear accelerator radiotherapy machines across more than 50 hospitals, which is close to being completed.

Meanwhile, a network of multidisciplinary rapid diagnostic and assessment centres have started looking at whether the initiative, which gives patients access to a range of different specialist and same-day test results, is an effective way of achieving quicker diagnosis.

Concerns

NHS England national director for cancer Cally Palmer describes these steps as ‘significant’ and believes they have left the system ‘in a good position’ to transform services.

73%

of 2,500 healthcare professionals say staff shortages are a barrier to providing good care

(Source: Cancer Research UK)

But others argue there is simply too much left to do.

The major concern relates to workforce planning. Health Education England (HEE) only published its cancer workforce plan in December – one year later than originally expected.

It promised greater emphasis on equipping the cancer workforce with skills and an extension of the programmes to increase the numbers of consultants, endoscopists and radiographers.

But there were no recommendations for nurses; these are due in the spring once a census of the specialist nursing workforce has been completed.

Too little, too late?

UK Oncology Nursing Society interim president Helen Roe says this has come too late.


Helen Roe

‘Clinical nurse specialists and other senior cancer nursing roles are a bit of an anomaly as there are no agreed requirements in terms of job title, post-registration qualifications and experience.’

She says, given this and the time frame set out in the cancer strategy, ‘strategic planning should already be well under way’.

She is also concerned about the retirement time bomb. ‘There are more younger faces appearing, but not as many as we would like. Ultimately this could cause real problems and leave a hole in the workforce.’

John Barron, chair of the All-Party Parliamentary Group on Cancer, agrees. He says the challenges facing the workforce are a ‘significant threat to the success of the strategy’.

Coinciding with when HEE unveiled its plan, his group published the report Progress of the England Cancer Strategy: Delivering Outcomes by 2020?

'The release of funding has been delayed, potentially preventing progress'

John Barron

It was scathing of the approach to funding. There is no dedicated investment to increase staff numbers, while money for the cancer alliances to push ahead with the strategy more generally is being tied to improvement against the 62-day cancer target, which is currently being missed.

‘As a consequence, in a number of areas of the country, the release of funding has been delayed, potentially preventing progress,’ Mr Barron adds.

THE TO-DO LIST

1. Set out plan for nursing workforce

Health Education England is due to publish a nursing update to its 2017 workforce plan in the spring. This will be informed by a census being carried out by Macmillan Cancer Support. It is expected to include a pledge to increase the numbers of clinical nurse specialists to ensure all patients get access to one.

2. Introduce the new bowel screening test

The bowel screening programme will introduce a new improved home test kit for screening from April following the lead of Scotland, which already uses it. The test is called a faecal immunochemical test (FIT) and requires fewer samples and is more accurate and effective than the current test.

3. Evaluate the rapid diagnostic and assessment centres

By March, there will be a network of ten multidisciplinary rapid diagnostic and assessment centres. The concept, which allows patients to see a range of specialists and undergo a variety of tests in one place, has been borrowed from Denmark where it has proved effective at speeding up diagnosis.

4. Introduce the 28-day target for diagnosis

The target is already being piloted across six cancer pathways – gynaecology, urology, head and neck, lung, lower and upper gastrointestinal – at five NHS trusts ahead of its full launch in April 2020.

5. Measure outcomes not just processes

The world’s first cancer quality of life metric is due to be introduced in 2019. Five cancer alliances are piloting the initiative by getting patients who are post-treatment to fill out questionnaires on everything from how well they can keep up with their daily life to their psychological well-being.

6. Give patients a recovery package by 2020

Patients will be entitled to a holistic needs assessment, regularly updated care plans, a treatment summary at the end of each acute phase and a review with a GP or nurse to identify what support they need to maintain their quality of life. Group health and well-being events will also be organised to help patients manage their own health.

 

6,000

nurses are coded to oncology

(Source: HEE)

Further concerns have been highlighted by Cancer Research UK. It too published a report in December, called Full team ahead: understanding the UK non-surgical cancer treatment workforce.

The report says that due to incomplete workforce data, particularly in regards to nurses, it was impossible to get a true picture of the scale of the challenge facing the NHS. But it adds that with the information available it is clear that rises in demand were outstripping any increases in the workforce.

‘Without developing and supporting the workforce, we will not achieve what we are aiming to’

Sue Cruickshank

Further evidence was provided by a survey of 2,500 front-line staff. Nearly three quarters identified staff shortages as a barrier to providing efficient care.

RCN Cancer and Breast Care Forum chair Sue Cruickshank says this should not come as a surprise as such problems are ‘endemic’ across nursing.

19

cancer alliances up and running to coordinate the cancer strategy on the ground

Moving forward, she fears there is too much emphasis on the specialist cancer nurses.

‘Non-cancer specialists – like the nurse on the surgical ward – see a lot of cancer patients. We mustn’t forget that. They also need training and support. We need to go back to pre-registration and ensure cancer gets a profile commensurate with incidence.’

She says the career and education framework for cancer nursing produced by the RCN could provide a good starting point for the NHS.

‘The workforce is key – without developing and supporting the workforce, we will not achieve what we are aiming to.’


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