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

• 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.

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.