NHS points scoring is hindering progress

When it comes to cancer survival rates, we continue to lag behind our European rivals. To tackle this problem, we need a health service focussed on long-term patient survival rather than party political points scoring, says John Baron MP.        

We need to have a health service based on patient outcomes rather than waiting lists. De-coupling funding and 62-day wait performance would be a good first step, but the best way forward would be to hold the NHS, both locally and nationally, accountable for outcomes.

When it comes to cancer care, it remains an inconvenient truth that, although there is recent evidence that we might be starting to narrow the 'survival gap' with some cancers, such as breast and rectal cancers, for most cancer types the figures show that survival in the UK and England continues to be lower than in other developed countries – our survival rates are improving, but then so are those of other healthcare systems, and we are not closing the gap. In 2009, the Department of Health estimated we could save an extra 10,000 lives each year if we matched European cancer survival rates.

The All-Party Parliamentary Group on Cancer's (APPGC) report in 2009 uncovered that the main reason our survival rates lag behind other countries is because the NHS tends to diagnose cancers at a late stage, when treatment is invariably less successful. Earlier diagnosis is truly the 'Magic Key' for cancer treatment, yet between 20 – 25% of cancers in England are first detected as the result of an emergency admission, such as at A&E, when it is often sadly too late for a good outcome.

Since 2009, the APPGC has accordingly campaigned to improve earlier diagnosis as a means of increasing survival rates, and thereby closing the 'survival gap' with other countries. This has included successes such as persuading Simon Stevens, the Chief Executive of NHS England, to place one-year survival rates in the various NHS frameworks which hold to account the Clinical Commissioning Groups (CCGs) running the NHS at a local level.

The APPGC was pleased when the five-year England Cancer Strategy, published in 2015, emphasised the importance of improving the NHS' performance at earlier diagnosis. As it approaches its half-way point this year, the APPGC conducted an inquiry into progress with the Strategy's implementation.

Extensive evidence was taken from across the NHS and cancer sector, with over 80 written submissions to our 'call for evidence' as well as two robust oral evidence sessions held in Parliament, during which APPGC members asked searching questions to both those at the 'front line' of cancer services and to those directing the Strategy at the top of NHS England, Health Education England and the Department of Health.

In brief, our resulting report, launched in front of the around 400 delegates at our 'Britain Against Cancer' conference earlier this month, concluded that the Strategy risks failure unless NHS England takes corrective action immediately. Several concerns emerged as key themes in our evidence.

First of all, the challenges facing the cancer workforce were raised as a significant threat to the Strategy's success. The implementation of many of its recommendations turn on having enough staff, with the right skills, in post to deliver services. We were dismayed to learn that a strategic review of the cancer workforce has been significantly delayed. It has only now been published, a year later than initially intended. It will require the necessary commitment and funding, and the APPGC will be watching this very closely.

We also heard that delays in data publication are causing further concerns. This is important because assessing improvements in patient outcomes is reliant upon timely and accurate data. Moreover, there is under-usage of data relating to rarer and less commons cancers, meaning that this information is not being taken into account in the NHS' various cancer metrics. Given that these cancers account for over half of all cancers, this must change in order for our survival rates to improve significantly.

Concerns also surfaced regarding the transparency and communication relating to the bidding process for extra funding. In January 2017, Cancer Alliances submitted their bids. However, they were subsequently required to demonstrate an improvement in the 62-day wait standard as a condition of accessing these funds. Yet we heard in evidence that 'Cancer Alliances were not originally set up with this 62-day target as their prime aim or task'.

As a consequence, in a number of areas of the country, the release of funding has been delayed, potentially preventing progress in improving cancer care and treatment. The report accordingly calls for the de-coupling of front-line funding from the 62-day target. Having raised this specific issue at Prime Minister's Questions, I look forward to my forthcoming discussion with the Prime Minister.

More broadly, we need to take the NHS out of party politics in order to encourage longer-term plans. Whilst 'process targets' like the 62-day wait have helped to improve survival rates, they can also be used to score political points when, in reality, outcomes are really what matter to patients. De-coupling funding and 62-day wait performance would be a good first step, but the best way forward would be to hold the NHS, both locally and nationally, accountable for outcomes. The APPGC will continue to raise this and other issues in the New Year.

John Baron MP has been Chairman of the All-Party Parliamentary Group on Cancer since 2009. The APPGC's latest report is available online at: http://www.macmillan.org.uk/appgc-on-the-cancer-strategy.