Press release

New report: How to re-engage patients with cancer pathways

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Long-term funding plan for workforce and capital investment needed to rapidly scale-up cancer services in response to “calamitous” pandemic impact.

  • Cancer services must be rapidly scaled-up top meet post-Covid surges in referral rates
  • Strategies to transform diagnostic services proposed by Professor Sir Mike Richards must be implemented without delay, with a detailed delivery plan that includes capital investment and workforce funding
  • “Unacceptable” variations in regional performance must be addressed through targeted actions to address inequalities in cancer services currently described as a “postcode lottery”

A new report from Public Policy Projects (PPP) has called upon government and health providers to drastically scale-up and improve cancer services across England. The report comes in response to what it describes as a “calamitous” impact upon UK cancer treatment in the wake of Covid-19.

How to re-engage patients with cancer pathways

The report: How to re-engage patients with cancer pathways

How to re-engage patients with cancer pathways, published on Thursday 27 May in partnership with MSD, outlines a series of recommendations to not only improve oncology services in response to the pandemic, but to address longstanding issues, such as poor waiting times and sub-standard survival rates by international standards.

With cancer rates rising in line with the UK’s ageing population, demand for oncology services is only set to increase in future. The report states that NHS England’s “fine ambition” of diagnosing 75 per cent of cancers by 2028 is not on track to be delivered, with early diagnosis hovering at around 55 per cent for several years.

The reasons for this lack of progress are plentiful. The UK is currently “severely compromised” by a chronic shortage of diagnostic capacity, with much of the current equipment being obsolete. Further, the workforce must be significantly expanded and reshaped to meet current and future demand – the NHS still lacks a robust plan to meet current and future workforce requirements and the government has yet to commit the funds to deliver one.

The report also finds stark variations in regional performance across the country and describes the state of UK cancer care as a “postcode lottery.” Analysis of 2017/18 data by the National Audit Office of the percentage of patients treated within 62 days of a GP referral revealed that the performance of clinical commissioning groups varied from 59 per cent to 93 per cent, against a standard of 85 per cent. The report strongly recommends that integrated care systems (ICSs) be given greater responsibility for cancer services in their area.

The report hails the work of Professor Sir Mike Richards, particularly around his emphasis on moving diagnostic capacity into the community. To this end, PPP recommends the swift implementation of all of Professor Richards recommendations in his recent report.

Pandemic disruption has had a devastating impact upon already stretched cancer services across the UK. Lung cancer screenings effectively came to a halt, urgent referrals in primary care collapsed and, while there has been a significant recovery in urgent referrals, the drop-in service means that 350,000 fewer people have been referred urgently across the UK since the beginning of the pandemic compared with a normal year.

A key recommendation of the report is to ensure the NHS takes steps to restore public confidence on the safety of cancer services by publishing steps to ensure they are Covid-free. Concerns about catching Covid became intertwined with pressure to “protect the NHS” and fear of contracting Covid led many patients to postpone seeking help or to miss appointments. This issue was compounded a lack of trust in Government information, where mixed messages only served to add to the confusion.

In addition to diagnosis, cancer treatment has also been severely disrupted, with delays to surgery exacerbating the problems of late referral and diagnosis – as patients are presenting themselves with more advanced stages of cancer. The pandemic has also led to skyrocketing diagnostic wating times, domestic tests for suspected cancer were 10 times the length in August 2019. The plunge in diagnostic activity has also led to “some cancers progressing to a stage where they were no longer treatable,” the report says.

Marginal gains will not be enough to restore services to pre-pandemic level, the report says that “the aim must be to finally deliver world-class cancer care through service transformation”.

Among a host of key recommendations, the report calls for strengthening of the relationship with key cancer charities, many of which have suffered from heavy funding cuts over the past year, a close examination as to the benefits of remote cancer care, the immediate reopening of cancer treatment trials to deliver potentially lifesaving treatments to patients, and recommends that real-time data be harnessed to revolutionise service.

Commenting on the release of the report, Professor Sir Mike Richards said: “The Covid-19 pandemic has shone a major spotlight on cancer services both highlighting weaknesses in current service provision and demonstrating opportunities for improvement. The PPP report has identified 16 recommendations. It is now vital that we take these forward in order to bring cancer survival in this country up to the best in the world.”

Baroness Nicola Blackwood, Deputy Chair of Healthcare and Life Sciences at PPP, said: “The calamitous impact of the Covid-19 pandemic on UK cancer treatment has again highlighted the urgent need for an overhaul of every aspect of our cancer services. However, these profound impacts are as much a symptom of the underlying weaknesses of cancer care as a measure of the severity of the pandemic.

“We have known for years that our diagnostic equipment is scarce and obsolete, that the cancer workforce is too small to meet even current, let alone future, demand, that there are too few intensive care beds and that people are dying because treatment comes too late.”

David Long, Business Unit Director, Oncology, MSD, said: “The way that the health community has come together to combat the Covid-19 pandemic is tremendous. This was particularly demonstrated in cancer services through efforts to keep patient pathways open and flexible to the evolving situation. It continues to be demonstrated as everyone pulls together to recover those cancer services.

However, it is well recognised that the system was by no means perfect for clinicians or cancer patients before the pandemic. That is why we welcome the opportunity to support this initiative to examine the opportunities to come back from the pandemic with a system that is better than the one that went before it – and to continue the spirit of collaboration that has achieved such significant change in such a short period of time.”

View and download the report here.

Notes to editors

Recovery and transformation

The report makes several recommendations to restore and indeed improve UK cancer services:

  1. A long-term funding plan for capital investment and workforce for next CSR to facilitate major scale up of UK cancer service capacity.
  2. Strategy to transform diagnostic services proposed by Professor Sir Mike Richards must be implemented as quickly as possible.
  3. Unacceptable variations ion regional performance must be addressed through targeted measures and ICSs need clear responsibility for driving service improvements.
  4. Cancer services must be delivered at Covid safe hubs and public confidence should be restored in cancer service safety.
  5. The NHS needs to routinely collect cancer data based on deprivation and ethnicity.
  6. Care for people with incurable cancer must be improved.
  7. Cancer screening must be restored and expanded.
  8. Involvement of cancer charities must be maintained and strengthened.
  9. New pathways adopted during the pandemic should be adopted permanently where appropriate.
  10. Benefits of remote cancer services must be evaluated.
  11. The NHS must increase capacity for harnessing real-time data on cancer, so that data can be acted upon promptly.
  12. Cancer treatment trials must be fully reopening and expanded.
Press release

New report: Practical care for effective integrated care systems

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The Health and Care Bill must clarify its position on the statutory basis of the ICS Health and Care Partnership Board.

  • Joint working between the NHS and local government must reflect a genuine partnership of equals.
  • Those working in the social care sector need to be awarded with status and pay to match that of their NHS colleagues.
  • Report launched by Rt Hon Stephen Dorrell, former Secretary of State for Health, Phil Hope, former Minister of State for Care Services and other senior thought leaders including Patricia Hewitt, Independent Chair of Norfolk and Waveney ICS


As Parliament debates the Health and Care Bill, a new report from Public Policy Projects (PPP) has called upon Government to place the voice of local government and social care on an equal footing to the NHS. The report comes in response to the Government’s Integration and Innovation white paper and sets out a blueprint for how integrated care reform can be delivered in practice.

Effective integrated care systems

Practical action for effective integrated care systems, published on 13th July in partnership with DevoConnect, outlines a series of recommendations to achieve parity between local government and the NHS and address social care with the same vigour as acute care.

The report, co-chaired by Rt Hon Stephen Dorrell, former Secretary of State for Health and Phil Hope, former Minister of State for Care Services, consulted with a range of key stakeholders in Integrated Care Systems (ICSs), local government, public services and across political parties. Two key findings emerged from these evidence sessions: the white paper does not sufficiently prioritise the local government voice and fails to achieve parity of esteem between the NHS and social care.

The report welcomes the commitment of NHS leadership to ensure that NHS services are joined up with other local services. However, there are strong cultural and institutional constraints to this potentially transformational development, the report warns, which needs to be addressed in a sustain way.

It is regretteble that the current draft of the legislation does not provide a statutory basis for the ICS Partnership Board. The former Secretary of State for Health stated that his objective was to strengthen national political control of NHS services. The report recommends that his successor amends the health and care bill to provide a statutory basis for the Health and Care Partnership Board and a statutory framework for partnership budgets which addresses the priorities agreed by the Partnership Board.

The Covid-19 pandemic has raise dramatically the status and value of social care in the public eye. The report recommends that the bill is amended to provide a new framework for social care which includes a commitment to increase funding for social care and arrangements for a Social Care People Plan to match the NHS People Plan.


The report identifies a series of key recommendations:

  • The decisions of the ICS NHS Board should be compliant with the aims and priorities of the ICS partnership board. Further guidance should be produced on how the ICS NHS board should have due regard to the ICS health and care partnership board health and wellbeing plan, and there should be a statutory duty on the NHS and local government to collaborate.
  • The ICS partnership board should be placed on a statutory footing with a duty to plan and deliver a comprehensive health and wellbeing strategy, built on local place-based strategies, to improve population health and reduce health inequalities within its health geography.
  • Action by the Government to support parity of esteem between health and social care in general, and parity of earnings in particular, is essential for ICSs to plan and manage their ICS workforce based on the requirements of the local population’s health, social care and public health needs.
  • A key step towards integration of the planning and management of local health and social care workforces by ICSs is for the Government to publish a social care people plan that mirrors the NHS People Plan. A further step would be to merge these into a single health and social care people plan to underpin local plans developed by ICSs.

Phil Hope, co-chair of the PPP report, said: “The Health and Care Bill presented to Parliament for debate provides a unique opportunity to build back a fairer health and social care system after the pandemic. But the legislation must create a genuine partnership of equals between the NHS and Local Government to deliver better health and social care services, and reduce health inequalities within our communities.

Failure to do so could lead to a more centralised NHS focused yet again on acute care in hospitals rather than on building local integrated systems which provide better care closer to home and tackle the causes of ill-health in the population.

Our report makes 31 recommendations for developing effective integrated care systems concerning their governance, collaborative working between service providers, system performance and incentives, funding flows, the workforce, digital health and the public estate. Some of these concern changes to the Bill whilst others are suggestions for good practice that every integrated care system could consider in this vital year of their development.

And it will be essential that proposals to reform and fully fund our social care services are brought forward without delay. Those who need social care, and those who provide it, deserve a fair deal and parity of esteem with our health services if we are to create an integrated health and social care system we can all be proud of.”

Commenting on the release of the report, Naomi Eisenstadt, Independent Chair of Northamptonshire ICS said: “The Government’s plans for integrating health and social care are ambitious and should be welcomed. Achieving the core aims of improving health and reducing inequalities in health outcomes is challenging. Making progress will be much more likely if the recommendations in this report are implemented. I am convinced we can improve health by public bodies and the voluntary and independent sector all working together. This wise report should help us in that task.”

Patricia Hewitt, Independent Chair of Norfolk and Waveney ICS said: “With the NHS Bill published last week, this timely report will make a valuable contribution to the debate about how each ICS should take advantage of the great opportunities presented by becoming a statutory system from April 2022.”

Also commenting on the release of the report, Matthew Stickland, Director of Strategy and Communications at TPP said: “Integrated Care Systems have the ability to enable cross-organisation working and new forms of collaboration between the NHS, local governments, and the third sector. This report highlights a number of key practical considerations to help achieve genuinely integrated care across a region.

From a digital health perspective, the recommendations outline the importance of clear digital leadership on the ICS board. In my view, careful consideration is needed when it comes to ICS board representation, in order to move toward a collective responsibility for digital maturity across the whole system.

It is widely recognised that technology can play an important role in facilitating integrated care, providing a better experience for patients, improving outcomes, and supporting the workforce. We need digital systems that genuinely assist staff and facilitate high quality care across an entire ICS. These systems need to interoperate, so that vital data is always available at the point of care. They also need to support data flows for population health and for improved planning. Any systems deployed must be cost effective and leave enough room in the IT budget for investment in people. This is key to ensuring the success of ICSs.”

This programme of work has been written in partnership with DevoConnect. Sponsorship for this report has provided by TPP and Cerner. Public Policy Projects have retained full editorial control.

View and download the report here.

Press release

PPP report proposes ‘Personal Asset Protection guarantee’ to fix social care crisis

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Personal asset protection

LONDON, July 19, 2021 – Public Policy Projects (PPP), the global policy institute, has today published a report that unveils realistic and transformative solutions in four key areas of social care policy: integration, innovation, infrastructure, and funding.

PPP report proposes ‘Personal Asset Protection guarantee’ to fix social care crisis


  • Puts forward recommendations for a nationally funded, but locally delivered model as an alternative to national Dilnot proposals or local council tax
  • Damian Green MP welcomes the conclusions


A succession of Governments have promised reform over the past 25 years, but they have not been able to reach a solution that is backed by Parliament and the electorate. ‘The Future of Social Care: Turning Rhetoric into Reality’ aims to fix that dilemma for the new Health & Social Care Secretary.

The proposed model for state funding is based on analysis of the Dilnot Commission, but with a different funding mechanism. This is because the Commission’s proposals were too complex, had an inherent geographical bias and required constant review of the asset and cap limits. Moreover, their implementation would have rendered the business model of many care providers obsolete by reducing the number of self-funding private payers who are a necessary part of a sustainable model.

The mechanism proposed is called the Personal Asset Protection (PAP) guarantee: when an individual has spent a certain percentage of their assets, they qualify for local authority support in the ordinary way if they meet the eligibility criteria. The authority will pay for a person’s long-term care costs once the person has spent that defined percentage of their assets on care.

The modelling on this report is based on a person being eligible for state-funded care when they have spent 30% of their assets on their care. At this level, the total net cost to the British taxpayer would be an increase in spending of just over £2 billion per annum, and the rate could be flexed depending on the will of the Government and on political agreement.

The advantages of the PAP system are that it is easy to understand and mitigates some of the inequities inherent in the Dilnot Commission’s proposals. This £2 billion is the minimum extra funding required, and many commentators think that the figure of £7-8 billion is a more reasonable figure to re-establish the level of access to state-funded services compared with before the financial crisis of 2008, to ensure appropriate remuneration for care staff and embed sustainability in the system.

The former First Secretary of State and Minister for the Cabinet Office – who at the time had responsibility for the Government’s social care policy – now Chair of the All-Party Parliamentary Group on Adult Social Care and Deputy Chair of PPP, the Rt Hon Damian Green MP, said:

“This report comes after 15 months of lockdown, during which many people have been deprived of the community support that would normally be available to them. As restrictions are eased from tomorrow, carers in the community and in residential facilities will be expected to ratchet up their levels of care to help people return to their normal lives.

“The proposals put forward in this paper are aimed at setting up a care system that is resilient and adaptable, supported by a funding system based on fairness and equity. I hope my Right Honorable Friend, Sajid Javid MP, reads, considers, and accepts PPP’s recommendations in full as he writes both the white paper and the plan for social care that is due to be published by the end of this year.”

Notes to Editors

The report draws on existing literature and pilot programmes as well as two PPP roundtables and a symposium on international models of care funding, where representatives from Japan, Denmark and the Republic of Ireland presented alternative systems of social care.

Participants in the roundtables came from local authorities, care providers, community innovators, technology companies and, importantly, users with lived experience of caring. The 21 case studies in this report were also sourced from the roundtable participants.

The report was produced in partnership with Casson Consulting and Care England. It is sponsored by Anchor Hanover, Hammond Care and Nourish Care; however, PPP doesn’t advocate on behalf of any organisation.