Analysis

Staff and funding shortages cause delay in cancer strategy implementation

While the vision for ‘world-class’ cancer services was well received, a recent report by MPs and peers questions whether staff and funding shortages will hinder its implementation
Lack of progress

While the vision for world-class cancer services was well received, a recent report by MPs and peers questions whether staff and funding shortages will hinder its implementation

In 2015 the government set out its 5-year vision for world-class cancer services and earlier this year a road map was published on making the strategy a reality.

While the strategy and implementation plan (see Timeline) were widely applauded, a recent report by a cross-party group of MPs and peers raises questions about progress to date.

30,000

Projected increase in the number of people with cancer in England surviving for 10 years once government strategy is in place

The All-Party Parliamentary Group on Cancers (APPGC) 20-page report calls for greater clarity around funding, more transparency on progress, and

...

While the vision for ‘world-class’ cancer services was well received, a recent report by MPs and peers questions whether staff and funding shortages will hinder its implementation

Lack of progress
MPs are concerned over slow progress in implementing England's cancer strategy. Picture: Getty Images

In 2015 the government set out its 5-year vision for ‘world-class’ cancer services and earlier this year a road map was published on making the strategy a reality.

While the strategy and implementation plan (see Timeline) were widely applauded, a recent report by a cross-party group of MPs and peers raises questions about progress to date.

30,000

Projected increase in the number of people with cancer in England surviving for 10 years once government strategy is in place

The All-Party Parliamentary Group on Cancer’s (APPGC) 20-page report calls for greater clarity around funding, more transparency on progress, and assurances that organisations and patients are involved in the strategy’s roll out (see Recommendations).

'Significant disconnect'

On workforce, the report highlights ‘lack of visible progress’ on staffing and suggests that timescales for addressing shortages are already behind. The implementation plan, for example, included a commitment to increase access to clinical nurse specialists and for Health Education England (HEE) to review the cancer workforce by March 2017.

UK Oncology Nursing Society (UKONS) president elect Richard Henry agrees with the APPGC’s recommendations and says that while the cancer plans are well-intentioned, there is a ‘significant disconnect’ between them and what is happening on the ground.

‘While you cannot disagree with plans to increase access to clinical nurses, to improve early diagnosis and prevention, there is a significant disconnect between these pronouncements and what nurses see every day,’ he says.

‘All nurses see in their workplace is more cuts, more struggles, more job losses and fewer colleagues being replaced when they leave. Some areas are working better than others, but in some areas it is dire.’

Shortages reported

Peers and MPs took written submissions from more than 30 cancer organisations and the report states ‘many’ covered workforce shortages. Prostate Cancer UK also told the APPGC that ‘given the imminent challenges to the future workforce it is essential that this is addressed with urgency’.

280,000

People diagnosed with cancer each year in England with half surviving for at least 10 years

In oral evidence sessions, Sir Harpal Kumar, chair of the Independent National Cancer Advisory Group (NCAG), agreed challenges around the cancer workforce remain ‘significant and severe’.

According to the APPGC report, HEE was due to release data on the current cancer workforce by June this year. The data have not yet been published and the APPGC report questions a lack of clarity on who is responsible for addressing such delays.  

‘It is not clear who is responsible for holding bodies to account when deadlines are missed; whether it is the National England Cancer Strategy Advisory Board, Department of Health (DH) or even the government,’ the report warns.  

'No plans to publish' workforce data

When questioned by Cancer Nursing Practice on when the data will be published, an HEE spokesperson revealed there are now ‘no plans’ to publish data on the current cancer workforce and that the data have been shared only with the Cancer Task Force Board and NCAG.

‘There are no plans to publish this document. The data has been collected and shared. This will be further refreshed as we get more information from Sustainability and Transformation Plans in terms of their response to the cancer challenge and subsequent workforce requirements,’ the spokesperson added.

Mr Henry, lecturer in cancer nursing at Queen’s University Belfast, says data on the current workforce are needed and may highlight nursing shortages in particular disease groups or pathways.

He also points out that delays in releasing the data undermine nurses’ confidence in the cancer strategy and implementation plan.

‘If the implementation plan is to be delivered, then nurses will have a big role to play in it. But they need to feel confident in the plans.’  

Within 28 days

Patients should be given a definitive cancer diagnosis, or the all clear, after being referred by a GP from 2020 

The APPGC, set up in 1998 to keep cancer at the top of the political agenda, also calls for organisations to be involved in delivery of the cancer strategy and implementation plan. Mr Henry agrees and says while UKONS would like to have input, there has been none to date.

‘Nurses will underpin these plans and play a key role in delivering this and we would like to see more nursing input. A lot of positions have yet to be appointed to the oversight groups, but as far as I know, the NCAG has one nurse and there are none on the Cancer Transformation Board.’ 

An NHS England spokesperson said it will shortly publish its own report into progress on cancer care. ‘Work is well underway to deliver the ambitions of the Cancer Taskforce. This includes the development of cancer alliances to improve local collaboration and high-impact initiatives like the National Diagnostics Fund to drive earlier diagnosis and save lives.’

Timeline

July 2015 – The Independent Cancer Taskforce publishes its vision for ‘world-class’ cancer services, Achieving World-Class Cancer Outcomes: A Strategy for England 2015-2020. The 5-year England Cancer Strategy includes 96 recommendations.

APPGC inquiry report

May 2016 – NHS England publishes Achieving World-Class Cancer Outcomes: Taking the Strategy Forward, setting out how it will be rolled out. Included are six work streams: prevention, early diagnosis, patient experience, living with and beyond cancer, high-quality services and commissioning, provision and accountability. 

May 2016 – The All-Party Parliamentary Group on Cancer (APPGC), made up of MPs and peers from across the political spectrum, launches an inquiry into progress made since the strategy’s publication.  

September 2016 – The APPGC publishes its report Progress into the Implementation of the England Cancer Strategy: One Year On after reviewing submissions from more than 30 groups and taking oral evidence from those leading its implementation.

 

All-Party Parliamentary Group on Cancer recommendations

The government must clearly set out in a progress report by the end of this year what funding will be available for the England cancer strategy every year over the next 4 years to make the vision a reality.

This should include how much funding has been allocated to each of the six work streams outlined in the strategy.

NHS England and the government must detail what progress is being made on each of the 96 recommendations in the cancer strategy and set out how these fit with wider NHS changes.

The DH should also explain how it is holding NHS England and other arm’s-length bodies such as clinical commissioning groups to account for delivering the cancer strategy and how it will measure success by 2020.

The National Cancer Transformation Board and the National Cancer Advisory Group, who are leading the roll out of the cancer strategy, should set out how they will work with interested organisations.

The board should also detail how it will ensure patients, particularly those with rarer cancers, are involved in the delivery of the cancer plan, at a national and local level, over the next 4 years.

 


Tamsin Newton-Snow is a freelance writer

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