Despite progress, the UK’s cancer survival rates still lag behind those of our European neighbours, writes John Baron MP.
As Chairman of the All-Party Parliamentary Group on Cancer (APPGC), I have closely followed the twists and turns in the Government’s cancer policies in recent years. During this time, my fellow Officers and I have constantly campaigned, both inside and outside Parliament, on behalf of cancer patients and their families.
In 2009, the APPGC published its major report into cancer inequalities, which also found that those NHS cancer patients reaching the one-year survival mark stood as much chance of reaching the five-year mark as any other patient in Europe. However, where the NHS falls down badly is in getting patients to the one-year mark in the first place. In other words, the NHS is as good as any other health system at treating cancer, but is well behind when it comes to detecting it. This is why European and international survival rates are considerably ahead of ours.
The figures are stark: we could save an additional 5,000 lives a year if we matched European survival rate averages, whilst the OECD believes as many as 10,000 lives could be saved if we matched international averages. One in five cancers are first diagnosed as late as A&E, when treatment options are more limited. To put these figures into context, on average around 70% of cancer patients in England survive one year after diagnosis – in Sweden, the figure is 82%.
As a result, the APPGC, together with the wider cancer community, campaigned for the inclusion of one-year cancer survival rates into the NHS Outcomes Framework and the Clinical Commissioning Group Outcomes Indicator Set (CCG OIS). The logic is simple. As late diagnosis makes for poor survival rates, putting the one-year figures up in lights at a CCG level should encourage the local NHS to adopt initiatives promoting earlier diagnosis, tailored to the requirements of their populations. These initiatives could include better screening, better awareness campaigns, further GP training or increased referral rates – to name but a few.
NHS England agreed to include the one-year survival rates into the NHS Outcomes Framework and CCG OIS at the beginning of 2013, with the first CCG figures coming on-stream in 2014. However, the cancer community was understandably dismayed when, out of the blue, NHS England introduced a fresh tier of accountability above the CCG OIS in the form of the ‘Delivery Dashboard’ of the Assurance Framework. Feedback to the APPGC from CCG leaderships was that they were paying more attention to the Dashboard than to the CCG OIS, principally because it, unlike the latter, has ‘teeth’ if performance does not meet its strictures.
My fellow APPGC Officers and I raised this issue in Parliament, both in Health Questions and during back bench and Westminster Hall debates, and followed this up with meetings with NHS officials. Consequently, the announcement by the Chief Executive of NHS England at our 2014 ‘Britain Against Cancer’ conference that the one-year figures would be included in the Dashboard from April 2015 was met with spontaneous applause from the 500 delegates. The decision to include survival rates should be transformational in terms of improving cancer survival, and will help many families avoid the anguish of losing a much-loved relative before their time.
The work continues. Now that the survival rates have been in the Dashboard for slightly over a year, it is incumbent upon all of us to use the ‘tools in the toolbox’ and ensure that our CCGs are held to account by Parliamentarians, the cancer community and the general public. To this end, the APPGC has made all MPs aware of their local figures, and have provided them with a pack of materials for them to draw upon when they meet their CCG leadership.
In addition, at its annual Summer Reception on 6th July, the APPGC invited the leaderships of the 23 CCGs which according to the ONS had most improved their one-year survival rates over the last twelve months, and recognised their achievement by awarding them with a certificate. A large number of CCGs sent representatives, and the APGGC was grateful to the Cancer Minister, Jane Ellison MP, as well as Dr Vivek Varakantam, from the East Leicestershire and Rutland CCG, who spoke at the event, as well as to the many MPs and Peers who joined us.
Cancer policy continues to evolve. The Delivery Dashboard is due to be replaced by an ‘OFSTED -style’ rating system, although NHS England has assured us in our conversations that the focus on the one-year figures will be retained.
There is also the ongoing implementation of the recommendations of the England Cancer Strategy, published last year by the Independent Cancer Taskforce chaired by Sir Harpal Kumar. The APPGC held a useful public inquiry session with Sir Harpal, Cally Palmer [NHS England National Cancer Director], Professor Chris Harrison [National Clinical Director for Cancer] and Jane Ellison MP as ‘witnesses’ earlier this month, and will shortly be producing its report.
The APPGC will also continue to press the Government and NHS England to do more on rarer and less common cancers. Despite their name, taken together they account for roughly half of all cancers in England, and more than the ‘Big Four’ combined. We will not significantly increase our survival rates until we address the rarer forms of the disease, and this will remain one of the APPGC’s areas of interest.
The Government and NHS England is working on cancer on many fronts, and overall I remain optimistic that the situation for patients continues to improve. There is still much to do, particularly when it comes to catching up with the performance of our international counterparts, but as long as we all pull our weight, I am sure we can make a real difference.