As summer progresses, interest is rising as to the content of the soon-to-be-published National Cancer Plan. Specifically, how it will approach a widening survival gap between those who have benefited from sequential advances and those who have been left behind?
Targets are the watchword
[…] where progress has been slow to the point of static. Change here would not be marginal but almost magical in impact.
Certainly, when it comes to rebooting the NHS, the Secretary of State for Health and Social Care, Wes Streeting MP, has made it clear that his preference will be to use targets and measures to track delivery, drive progress and judge success. So much so there have been hints around withholding pay rises from NHS senior management if key targets go unmet.
Though with the National Cancer Plan still to be published, the question remains as to whether reliance on metrics will focus attention sufficiently on the less survivable cancers. In short, will a National Cancer Plan be the ambitious vehicle for change we are hoping to see? A plan which does more than simply describe a widening survivable gap but takes active steps to overcome years of selective inattention, which have left so many people – particularly those with brain tumours – repeatedly overlooked and desperately far behind?
We don’t have a lot of detail around the National Cancer Plan, but the expectation is that it will mirror the duration of the 10 Year Health Plan and contain elements of the 2019 NHS Long Term Plan, including specific targets to drive faster cancer diagnosis in stageable disease groups, which was 75% of people with cancer will be diagnosed at an early stage (one or two) by 2028.
We know also that there will be an emphasis on using innovation, AI and new technologies to prevent, diagnose and treat all cancers. Pulled together, the potential for progress is almost unimaginable. More so in groups where progress has been slow to the point of static. Change here would not be marginal but almost magical in impact.
Encouraging focus…or not?
But how encouraged should we be to hear the Cancer Plan will merely focus on the rare and less survivable cancers? Certainly, a focus is good. No doubt an element of the Plan which has come about in response to the tireless work by communities, charities and collaborative groups like Cancer52 and the Less Survivable Cancers Taskforce.
However, without a specific measurable focus on less survivable cancers, where 5-year survival outcomes remain desperately low at less than 20%, the risk is that potential is realised once again almost exclusively elsewhere. Efforts may be unintentionally diverted because there isn’t a clear target against which healthcare delivery must report and be held accountable.
This is not about diverting resources away from some cancer groups in favour of another. No-one wants that. There is no ‘good’ cancer diagnosis where we’re all satisfied enough has been done. Every single person with that diagnosis must face into the terrible consequences it has the potential to bring.
No, this is about not learning from the past. Recognising that without a clear target, our NHS might be (re)arranged in ways that allows less survivable cancers to once again fall through gaps in the roll out of these game-changing initiatives. For those affected it won’t be just about seeing the benefits of technological advances land elsewhere, missing them out yet again, but robbing them of the only way to flag that the hoped-for, much-needed progress has not been made. It risks rendering them voiceless at a policy level – again.
It’s worth mentioning at this point that my background in clinical medicine means I am at times a bit of a target sceptic. Too often I’ve witnessed the requirement to meet a national target using local services drive some very mixed results for patients and staff alike. Unforeseen (but perhaps, foreseeable) adverse outcomes or an explosion of workarounds so that managers can report ‘success’ and in so doing avoid punitive actions against organisations for non-delivery have, in my view, contributed to staff conflict, blame culture, large variations in care across the country and patient distrust. Much of this eclipsing any benefit the original target may have had. The 4-hour wait in A&E is just such a cautionary tale.
What kind of health service do we want?
National targets say something profound about our culture. About our desire to ensure that when we adopt a National Cancer Plan, it is rolled out in a way that benefits everyone who has – or will be given – a cancer diagnosis.
The key inflection point is where national policy meets local delivery. This is where a target to double survival in the less survivable cancers could have huge impact; the requirement to attend to (and report on) this group driving genuine consideration for how proposed Neighbourhood Health Services will be designed. A national target to double survival in this particular group of cancers, including brain tumours, would mean being included into key initiatives processes which are critical to their care and survivorship, such as access to early diagnostics or innovation just because of rarity or complexity at the local level.
What now?
No government has ever looked at less survivable cancers in this light before. But as we stand on the cusp of huge technological advances in medicine, we must ask ourselves what meaning these improvements will have if they are so inequitably applied that some groups are simply left out?
A new National Cancer Plan is a chance to make good the oversights of the past. To do more than just acknowledge the widening survival gap or offer a plan with a focus on these outcomes. To show just how serious the government is about achieving that much-needed survival change, the Cancer Plan must go further. It must drive progress through setting a target to double survival in this group
Yes, caution is needed. But wouldn’t we all prefer to take the risk on something this important than know we accepted a Cancer Plan that didn’t try just that bit harder?