A new National Cancer Plan for England – does it deliver?

The government’s new 10-year National Cancer Plan for England aims to bring cancer care squarely into the 21^st century. The headline commitment is to improve 5-year survival and to achieve outcomes comparable with international peers. Full of promises to ‘end the treatment postcode lottery’ that too often means some but not all patients access the latest innovations, the key question is one of credibility. The plan is bold, but does the NHS have the resources to deliver the myriad commitments quickly, while fixing the basics?

In the autumn, I wrote about what I hoped to see in the forthcoming national cancer plan, and the urgent need for a step change. Lord Darzi’s 2024 investigation into the NHS underscored the gap between current policy and reality, showing how the NHS is not meeting the most important promises it makes; the core cancer waiting time standards have not been met across the country for over 10 years. I ended by reflecting that cancer always feels personal – after all 1 in 2 of us will get it, we all know someone living with or who we have lost to the disease – and how I hoped the plan delivers. With the plan now published, it is a good moment to re-visit the question.

The plan has been a long time in gestation. It is the first national cancer strategy published for ten years and has been informed by over 11,000 responses to a call for evidence, many received from patients and carers. This plan is deeply personal for the Parliamentary Under-Secretary, Ashley Dalton, who is living with cancer, the Secretary of State, who has spoken openly about his own cancer experience, and many other figures across government.

Innovation and early diagnosis – but is the NHS ready?

There’s much to like. This is an ambitious, long-term plan that seeks to model the 10 Year Health Plan’s three shifts through the lens of cancer. There is a major focus on implementing innovation and new treatment approaches at scale, including the expansion of genetic testing to find cancers earlier – for example via a specialist registry and increased screening for those at higher risk – the use of AI and robotic technology to spot hard-to-detect lung (and other) cancers earlier, and making use of NICE’s medtech mandate for promising cancer technologies, and much more. This should all help patients benefit from the latest scientific innovations.

There’s a lot of talk of the innovation ‘big bets’ that the 10 Year Health Plan outlined – data, AI, robotics, genomics and wearables – and their application to cancer detection and treatment over the next decade. As ever, alongside the science, NHS readiness remains a major factor that limits the pace of change. The plan acknowledges this, but whether there’s enough capacity to take advantage of new advances at the pace desired is questionable.

Tackling health inequalities and providing personalised care

There’s an ambition to tackle health inequalities in access to gold standard treatment and to deliver a more digital and personalised service. Commitments include attracting more cancer specialists to rural and coastal areas, increasing opportunities for patients to access clinical trials, including for rare cancers, and providing better access to information and research opportunities via the NHS app. A dedicated chapter on children and young people’s cancer recognises the particular challenges in diagnosing and treating cancer in the young, with commitments to boost specialist support around diagnosis, increase research efforts and improve the experience of children and their families.

Quality of life is an important and welcome theme too. As many who have experienced cancer reflect, they receive effective treatment but not always the holistic care that recognises what matters most to them. The promise of a personalised cancer plan for every patient, a neighbourhood health lead (to complement the cancer nurse specialist assigned to each patient) and an end of treatment summary (so people don’t feel they are falling off a cliff and ‘abandoned’ when their formal treatment ends) will be strongly welcomed by many patients.

These developments remind me just how far we’ve come in cancer policy, from recognising that great care is more than the surgical intervention, radiotherapy or chemo that may keep you alive, to actually investing in holistic planning and genuinely valuing patient feedback, for example via Patient Reported Outcomes Measures (PROMS – short questionnaires where patients share how their health, symptoms and quality of life are affected by their condition and treatment).

There’s also welcome recognition that pathways of care should change to suit patient preferences and be local and convenient. A focus on getting the 170 Community Diagnostic Centres operational 12 hours a day, 7 days a week aims to both boost diagnostic capacity and patient experience, delivering elements of care closer to home. Delivery of more oral chemotherapy in community settings or at home is promised too.

A missed opportunity on cancer prevention?

If the plan does a sound job on analogue to digital and hospital to community, it does less well on the sickness to prevention shift, a recurrent theme in government policy. A promise to consult on better enforcement of sunbed use restrictions is welcome but not game changing – and as someone who worked to support the 2010 Act, a reminder of the limitations of legislation to shift culture and behaviour, with many teenagers circumventing current rules. And there is welcome discussion of a shift to personalised prevention, for example by using the NHS app to provide more information about an individual’s risk of cancer and lifestyle advice to support changes to behaviour.

But there’s a missed opportunity in other areas. Around a third of cancers are preventable. This could have been the moment to go further on obesity prevention, alcohol harm reduction and boosting physical activity. As is often reflected, if physical activity was a drug, it would be an out and out blockbuster. Against the backdrop of the latest Health Survey for England findings, there’s much to do to improve the nation’s health. And as I’ve written about recently, when framed the right way, government taking a lead on creating a healthier environment is popular with the public. This administration is in danger of flooding us with NHS policy whilst failing to provide an ambitious enough health policy.

Making change happen

The plan recognises the levers needed to make change happen. It reaffirms commitment to the Cancer Alliances who help translate national policy commitments to on-the-ground improvements, alongside the need for a resilient workforce, the right kit and the capital shifts required to change cancer pathways. The importance of partnership is recognised. The cancer ecosystem is powerful and productive – a strong research base, passionate and well-resourced charity partners, creative public-private partnerships – and the plan reflects the need for all partners to contribute to make most progress.

The strategy also recognises the need to fix the basics, with a commitment to get back to meeting the constitutional standards by the end of this parliament. But that is only three and a half years away, and as we know, achieving progress against current long waiting lists is proving exceptionally challenging. Delivery of this plan will require a mammoth effort across the system. Money to support implementation will come from the existing Comprehensive Review Settlement except for a cash injection to fully roll out lung cancer screening by 2030. Commitments to be delivered in the outer years of the plan are dependent on future financial settlements and to some extent the broader economic outlook.

The real test: faster, fairer care for patients

The key question or ongoing test is one of delivery. Credibility will be built if we begin to see faster progress against waiting times and other fundamentals. It’s all very well launching new AI pilots, but they won’t have the desired impact if you can’t process basic histopathology and imaging tests swiftly. The current average performance for cancer pathway histopathology tests is 68% within 10 days against a target of 98%, so much progress is needed.

Stepping back, the cancer plan does a good job against many of my hopes from the autumn – 10 tests I hoped it would meet. It’s ambitious, forward looking, recognises the importance of treating the ‘whole person’, tackling unwarranted variation and the need to fix the basics. The biggest test is the first I outlined: does it address performance issues in a credible way? The plan says that the level of ambition signalled ‘cannot be delivered within the bounds of our existing care model.’ But can the NHS reinvent a new model quickly enough? We all know our health and care system doesn’t have the best track record on this front, so are the package of implementation measures sufficient to genuinely shift the dial?

Waiting for a cancer diagnosis or treatment is both extremely stressful and clinically significant. The success or otherwise of the plan will therefore rely on a relentless focus on delivery, not often politically sexy or headline grabbing, but at the heart of improving care and impacting hundreds of thousands of lives. And that’s a mission I can get behind.