Question – Do you have any suggestions for how to get more people diagnosed quicker?
The previously announced £10 billion investment in NHS Community Diagnostic Hubs is welcome and will increase access to faster diagnosis, but their potential will only be realised with a wholesale review of the entire cancer pathway. In short, earlier diagnosis will only improve patient outcomes if patients are also being treated earlier. This is simply not possible without parallel investment to increase treatment capacity. Currently, the Government is missing a valuable opportunity to integrate treatment options into these hubs. Radiotherapy machines, for example, could easily be placed into the new hubs so patients can be both diagnosed and treated quicker. This could be achieved for the relatively modest cost of £250m. We would urge the Government to consider that any new national cancer strategy needs high level Government direction, be it a dedicated cancer minister or cancer tzar, to look at the whole system and, with expert advice, reshape the future of cancer services with integration with these new Community Diagnostic Hubs.
We are pleased that the Government aims to get more people diagnosed quicker. An early cancer diagnosis can make the difference between life and death. But only if measures to diagnose more people earlier are matched with the capacity to treat them during this early stage. Even if a diagnosis is made early, if left untreated, unfortunately cancer will move from curable to incurable. More advanced cancers are more costly and complicated to treat. The main advantage of early diagnosis is only realised if the patient is treated quickly and with access to the best available treatments. Early diagnosis must be matched by increased treatment capacity.
The latest figures from NHS England paint a worrying picture for how long people are currently having to wait for cancer diagnoses. In January 2022, just 75% of people with suspected cancer were seen by a specialist within 2 weeks of being urgently referred, far below the Government’s target of 93%. Also, around 25% of patients are not diagnosed following urgent referrals, but via routine appointments. This is the lowest proportion on record. Cancer services are already running at max capacity. Indeed, they were at max capacity before the pandemic. COVID has had a devastating impact on cancer services causing widespread disruption resulting in a significant number of people waiting far too long for cancer diagnosis. It has created a backlog of missing cancer patients that the National Audit Office estimate at 60,000. New analysis carried out by the Institute of Cancer Policy and the Health Foundation estimates the cancer backlog is closer to 100,000. Any plan to increase diagnosis needs to be viewed in light of the expected 60,000-100,000 that are still to come through the COVID induced cancer backlog. There will be a double hit of demand for capacity: 1) the cancer backlog patients and 2) the patients diagnosed earlier through the new diagnostic hubs. This double hit means there is an even more urgent need for treatment capacity.
It must be re-iterated that investment in improving cancer diagnosis cannot be viewed in isolation but needs to have a corresponding investment in cancer treatments. Speeding up diagnosis but failing to speed up treatment will simply move the patient from a diagnosis waiting list to a treatment waiting list. It is the treatment that cures cancer patients. And yet there has been no new investment or a dedicated plan to increase the now critical lack of capacity in cancer treatment. Diagnosing cancer patients quicker is necessary but will not improve outcomes on its own. The Government’s new plan for cancer must take a more comprehensive approach that considers both diagnosis and treatment.
Question – Do you have any suggestions for how to improve access to and experiences of cancer treatment?
Cancer patients are currently waiting far too long for treatment, and for too many patients’ treatment options are limited by postcode. The Government’s new cancer plan must seek to address this as a priority or cancer outcomes will not improve. It is vital that the new cancer strategy increases treatment capacity. This will require ringfenced investment and a radical overhaul of policy at the very top. We must see acknowledgment that business as usual will not achieve the Government’s ambitions or improve the situation for cancer patients and a move towards embracing and adopting new technologies and smarter ways of working.
Even before the pandemic, the UK was at the bottom of the international cancer league tables and now the NHS faces a COVID-induced backlog of cancer patients of between 60,000-100,000. Of all the backlogs, cancer is one of the most deadly. International research shows that a 4-week delay in diagnosis and treatment can reduce survival by around 10%. With cancer waiting times currently the longest on record, the impact on patients cannot be overstated. A report by the Health and Social Care Committee expert panel found that the Government had made ‘inadequate’ progress against its targets. There is a collective frustration among frontline cancer professionals and a feeling that a new set of targets and ambitions are needed to improve cancer care. At the heart of this needs to be a focus on improving the whole cancer pathway and rebalancing the way key cancer treatments are funded, so that high potential technology-based treatments are no longer systematically overlooked. Only a truly radical change in Government and NHS policy will address the current backlog and continue to improve cancer outcomes in the future. The best way to improve cancer survival is to ensure all patients have the treatment they need to the agreed standard on time. Doing the basics right will have the biggest impact on cancer survival. Before COVID, the UK was at the bottom of the league of high income countries for cancer survival. This was because of the way cancer services were provided and accessed. The ambition must be to catch up with the backlog and be better than before.
We need a radical new cancer plan which includes:
- Recognition of the existence and scale of the issues in cancer care especially the COVID induced cancer backlog, the disruption to the whole of the cancer pathway and the exhaustion of staff.
- Ringfenced investment for cancer infrastructure. Investment should look to increase capacity in both diagnostics and treatments.
- Immediate funding for short term solutions to assist the workforce crisis and at least the 20% increase in the professionals needed to run the service.
- Commitment to listen directly to frontline staff and implement “oven ready” technology solutions, data intelligence and cast away needless bureaucracy.
In May 2021, the #CatchUpWithCancer Campaign supported the publication of a report from the Chairs of the All-Party Parliamentary Group for Radiotherapy and the All-Party Parliamentary Health Group. Many of the report’s recommendations are still, unfortunately, hugely relevant and should be considered in the context of the Government’s 10 Year Cancer Plan.
The report recommended, for example, that the Government and NHS recognise the true scale of the cancer backlog in both diagnosis and treatment and the impact of this backlog on patients and the workforce. Similarly, the Public Account Committee warned in their report published in March 2022 that officials are “too optimistic” about the NHS’ ability to deal with the current pressures. The Government must, therefore, start by acknowledging the significant issues in cancer care if they are to effectively address them. To demonstrate the significance of the task ahead, we would also like to see the Government appoint a dedicated Minister with the responsibility to lead and oversee the implementation of this new plan. Centralising decision-making, particularly within the context of cancer treatments, will also go some way to reducing the postcode lottery and regional inequalities in access to treatments.
In parallel with the Government’s welcome commitment to improve diagnostics, there must be a corresponding investment to boost treatment capacity, including investment in new equipment, IT and digitalisation, and workforce. This is paramount to achieving the Government’s ambitions.
The three main pillars of cancer treatment are radiotherapy, surgery and chemotherapy and they need to work together in harmony to improve cancer outcomes. Investment is needed across the board but radiotherapy, which has been systemically underfunded receiving just 5% of the cancer budget, needs particular attention. As well as a substantial funding boost of £850M over three years, radiotherapy needs more innovative and radical thinking and an overhaul in commissioning to ensure patients are not missing out on this life-saving treatment.
Treatment is what cures cancer patients and should therefore be at the very heart of the new strategy. Efforts to catch up with the cancer backlog have, up until now, focused largely on reducing wait times in diagnosis. This is important but equally important is ensuring these patients have swift access to appropriate and effective treatments once diagnosed. This must be reflected in Government policy going forward.
Background to this submission
About Radiotherapy UK and Radiotherapy4Life
Radiotherapy UK is the only charity dedicated to improving radiotherapy treatment throughout the UK. We believe that everyone in the country – no matter who they are or where they live – should have access to the best radiotherapy treatment available.
Radiotherapy4Life is a campaign run by Radiotherapy UK to stop people dying and suffering needlessly by developing a world-class patient-first radiotherapy service in the UK to help boost the UK’s cancer survival rates to be the best in the developed world, rather than among the worst.
About #CatchUpWithCancer
The #CatchupWithCancerCampaign was founded in July 2020 by Radiotherapy UK’s Radiotherapy4Life campaign in response to the grave concerns of patients and the public about the Covid-induced disruption to cancer services. It has been a focus of public and media discussions providing real time information and insight into the causes, scale, and effects of the disruption to cancer services in response to the Covid pandemic. The campaign has had the backing and support of a number of cancer charities, has nearly 400,000 engaged supporters with high profile celebrity support and the backing of over 100 parliamentarians. The campaign has been working with the All-Party Parliamentary Group (APPG) for Radiotherapy which in turn has been working with the APPG for Health and other APPGs related to cancer. In May 2021 the campaign supported these APPG produce a report following a cancer summit attended by APPG chairs, Royal Colleges, charities, and clinicians. The Catch Up With Cancer Way Ahead Document was contributed to by over 70 organisations from the cancer space.
