A one-year survival from diagnosis metric is an essential component in driving up NHS cancer survival rates, says John Baron MP
My time as a Shadow Health Minister, and as the Chairman of the All-Party Parliamentary Group on Cancer for nearly ten years, gave me a good vantage point to follow our cancer policy over the last decade or so. One constant over this period has been that our cancer survival rates have continued to lag behind those in other countries with comparable healthcare systems. One of the first reports of my APPG chairmanship in 2009 showed that the NHS, by and large, was just as good as other countries’ healthcare services at treating cancer once detected, but was (and remains) much less good at diagnosing it in the first place.
For cancer, early diagnosis is the ‘magic key’, because the earlier the condition is detected, the greater the chances of successful treatment. In addition, early intervention tends to be less invasive, less onerous on the patient, and less expensive overall to the health service. These are all important considerations from the standpoints of patient welfare, quality of life, and survival, as well as to the economics of running a health service for tens of millions of people at a time of scarcity.
Between 20-25% of cancers in England are first detected as an emergency procedure, when the disease is usually in its advanced stages and the chances of successful treatment are accordingly much reduced. Other countries are significantly better at catching cancers earlier. As such, in England average cancer survival one year from initial diagnosis lies at around 72%, whereas in Sweden it is around 82%. According to the Department of Health’s figures released in 2009, around 10,000 lives each year in England could be saved if we matched average European cancer survival rates, and this probably remains unchanged.
The mantra of NHS officials and Government Ministers alike is that our cancer survival rates have never been better. This is factually true – and is to be welcomed – but the inconvenient truth is that international average survival rates have also risen over this time, and there is little evidence we are materially closing the gap. Good progress on some types of cancer can also sadly mask the situation with other cancer types – survival rates for pancreatic cancer, for example, have barely moved in 40 years.
To be fair to the NHS and the Government, there have been well-intentioned attempts to improve this situation. In recent decades NHS cancer services, as with other disease areas, have been subjected to a number of process targets. These measure performance against certain benchmarks, such as waiting times, rather than the success of treatment. The House of Commons Library last year identified nine such process targets applying to cancer. These need to be reduced in number.
In her speech to the Conservative Party conference last October, the Prime Minister made the welcome commitment to ensuring that 75% of cancer patients are diagnosed at stages I or II. I suggest the best way of meeting this is to focus on outcomes, homing in on what is fundamentally most important to patients and their families. If outcomes are good, it follows that processes are also good and treatment both timely and safe.
Such an approach also allows health professionals – rather than politicians – the flexibility to design services and pathways without the ‘straitjacket’ imposed by blunt process targets. Outcome measures additionally retain the focus on accountability which, quite rightly, governs our health service. As the Department of Health and Social Care considers the next iteration of cancer services, I urge Ministers and officials to move away from process targets and embrace measuring outcomes.
A one-year survival from diagnosis metric would encourage the NHS to really focus on introducing initiatives to encourage earlier diagnosis. This would be preferable to the five-year data as it would be available much sooner, because it is a better measure of early or late diagnosis, and because better one-year figures will be correspondingly reflected in better five-year figures. Given the extent of staff changes within the NHS, the one-year metric would also help improve continuity.
The one-year metric could finally provide the great improvement in survival rates we have all waited so long to see, and I hope the Government will take this bold and necessary step.