Ten tests to ensure the cancer plan improves lives

A new national cancer plan is in development, due for publication shortly. It presents an early opportunity to translate the 10 Year Health Plan’s ambitions into a roadmap for delivery against a priority clinical condition.  

The cancer plan is also a test of whether we can turn those ambitions into real progress. If we can’t deliver change in cancer – a disease where we’ve already seen improvement – it doesn’t bode well for our ability to drive change at pace in other areas. 

I’ve been a close observer of the development and implementation of several national cancer strategies, including working directly to develop one. They have often provided a helpful set of priorities for the system to focus on, money and other resources for delivery, and – where they’ve worked best – charitable and life sciences endorsement.  

But in a cash constrained environment, balancing high demand for health care with large scale re-organisation and a goal to fundamentally shift models of care, what does success look like?  

Here's ten things to watch for – or ‘tests’ that I’ll be assessing the new plan against. 

1. Does it address the short-term performance issues in a credible way?

Speed of diagnosis and swift subsequent treatment is critical for good cancer outcomes, but day-to-day performance against national targets is not where it should be. Less than 70% of patients were treated within 62 days of referral against a goal of 85%, and this target hasn’t been met since 2015.

Behind every statistic is a real person, waiting in a state of stress and fear for the treatment that could improve or save their life. Routinely meeting the targets again requires a coordinated approach taking account of diagnostic and treatment capacity, the right workforce and good pathway design, to ensure patients get where they need to as quickly as possible. A commitment to get the fundamentals working is an important part of restoring confidence in the service. 

2. Will the plan reflect broader measures of patient satisfaction?

Having said there’s a need to adhere to existing treatment standards, there’s long been a desire to get better at measuring – and thus valuing – what matters most to patients. Time and again I’ve heard patients reflect they got effective cancer treatment but not wraparound care and support that felt appropriate to their needs.  

With the 10 Year Health Plan promising a digital revolution and power firmly in patients’ hands, cancer is an opportunity to test faster feedback loops and a single patient record that integrates across different parts of our health and care system. It’s also an opportunity to further roll-out Patient Reported Outcome Measures (PROMs) and secure the future of the cancer patient experience survey as a core measurement tool. 

3. Can the plan address the needs of an increasingly complex population?

70% of cancer patients live with at least one other long-term condition, and the thorny challenge of how you design services around people, rather than treating conditions in isolation, remains pressing. How do we join up care across disciplines and reduce the number of appointments that focus on single condition treatment? Care navigators, better digital systems – including an NHS app that allows us to manage our own appointments – and care delivered close to home are all part of the solution.  

4. What does a neighbourhood health service mean for cancer?

I’ve rarely heard so many different interpretations of neighbourhood health, or the shift from hospital to community, as in the months since the 10 Year Health Plan was published. Everyone wants a piece of neighbourhood health, partly because the concept of joining care up at local level and treating people in the most appropriate setting is a big prize. I am hopeful we can make further progress for those with cancer. A strong voluntary and community sector should be a huge asset here, helping to deliver tailored and local support. And with good progress made by the 165 community diagnostic centres now in operation, there are great examples of cancers being diagnosed more swiftly in the community. 

Several of the 43 pilot neighbourhood sites could be tasked with making further progress on integrated cancer treatment and care and working with non-NHS organisations to exemplify an approach that takes account of all partners in our communities. 

5. How does the plan deal with variation in performance and can we maximise the interventions that we know work?

We have good data in cancer and can identify variation in access to timely cancer services and best treatment. But moving from identifying variation to tackling it is another thing. A strong national cancer team, Cancer Alliances, and support programmes like the Getting It Right First Time (GIRFT) programme have helped in the past. The CQC will have a role to play here too, as it navigates its own transformation. The NHS England Chair, among others, has reinforced the need for a refocus on good commissioning as a driver of quality. The new plan should pull all the levers at its disposal to not only shine a spotlight on poor performers, but to provide the support and resources for improvement. 

6. Is the system ready for the innovation ahead – and will it support research as the engine for future progress?

The 10 Year Health Plan promises that by 2035, half of our interactions with the health service will be informed by genomics. A bold claim. Cancer has often led the way in offering up innovative treatments and personalised approaches to detect and determine therapy approaches. A perennial concern has been ‘system readiness’ to deliver innovative treatments. A good example is cancer genomics, where the service has had to catch up with the science, ensuring it can screen tumour biopsies for genetic mutations at a scale not previously envisaged. How can the plan increase the capacity of the NHS to deliver the most promising cancer innovations at pace and scale? And will the plan prioritise research to drive future progress? 

I’m often told we are living in a golden age of cancer research. We understand the complexity in the types of the disease and how it’s likely to progress based on a person’s genetic make-up like never before. A range of blood tests are in development that should allow us to detect cancers before symptoms become noticeable. Personalised cancer vaccines, new drug combinations, innovative radiotherapy, the use of AI to target cancers and more – all need to be supported through research. We are fortunate that we have a thriving cancer research infrastructure in the UK backed by public, private and charitable investment too. Making good on the 10 Year Health Plan’s commitment to work seamlessly across life sciences and the NHS is critical to future discoveries. And implementing the recommendations of numerous reviews including to support clinical research in the NHS should feature in the plan. 

7. Can the cancer plan model the sickness to prevention shift?

40% of cancers are preventable, so maximising efforts in this area presents a significant prize. The Tobacco and Vapes Bill, still working its way through parliament, offers the best chance to cut smoking for future generations and tackle the worrying uptick in youth vaping. But broader efforts to reduce the gap in healthy life expectancy between the most and least deprived have stalled.

The health mission is missing in action and there is no cross-government strategy to tackle our ailing population health. The cancer plan will need to show it is serious about prevention. That means raising awareness of how alcohol, obesity, physical inactivity, air pollution and excessive UV exposure can increase cancer risk – alongside the ongoing threat posed by tobacco. Setting tangible goals for reducing alcohol consumption, for example, would be a win for public health and cancer prevention that the 10 Year Health Plan dodged. The plan shouldn’t neglect secondary prevention either. 

8. Can it address health inequalities? 

Deep inequalities persist at every juncture of people’s cancer journeys. You are more likely to be diagnosed with, and die from, most cancers if you are poor (with a couple of notable exceptions). You are less likely to receive appropriate and tailored support if a member of certain community groups. And patients from minority ethnic backgrounds have poorer experiences on average. The cancer plan should recognise and commit to taking targeted action, such as boosting screening uptake, in areas of the country or community where inequalities are hampering progress. 

9. Will it provide the infrastructure needed to make change happen?

Cancer Alliances play an important role translating national strategy into tangible change on the ground. They bring together clinical and managerial leaders to prioritise, plan and deliver change in systems. Coupled with a workforce that feels equipped to deliver a plan, and enough diagnostic kit and treatment capacity to meet current and projected cancer cases, the ‘system glue’ that Alliances provide is helpful and should be sustained. 

10. Is it ambitious enough? 

More than anything, I’ll be looking for ambition. The last national cancer plan was published in 2015. We’ve made fantastic progress in cancer survival over the past 50 years: more than half of those now diagnosed survive for 10 years or more versus only a quarter in the 1970s. And we are getting better at recognising the need to treat the patient rather than the disease. But there is so much more to do. Early diagnosis is critical, and we should be sufficiently ambitious about our goals here.

Relatively new screening programmes such as the lung health check, with a huge potential to tackle health inequalities, are not yet fully rolled out, and we should double down on efforts to ensure that every patient gets excellent cancer treatment with good, holistic support. 

Cancer always feels personal. One in two of us will get it. We all know someone living with the disease, or who we’ve lost to it. The new national plan is an opportunity to bring the government’s vision for the NHS – and our broader health and care system – to life, and offer hope to us all. I hope it delivers.