In December 2022, Michelle Mitchell, the CEO of Cancer Research UK, asked: “Is Improving Cancer Survival still a Priority of this Government?” She went on to point out that in February 2022 Sajid Javid, then Secretary of State for Health and Social Care, had “declared a war on cancer”, committing to publish a 10-year cancer plan which would focus on research and innovation, boost the workforce and tackle inequalities. She asked: “Where is that plan?”
As if in reply, in January 2023 Stephen Barclay, now the Secretary of State (two governments later), announced there would be no cancer plan. Instead he would be developing a 5-year Major Conditions Strategy (MCS). The announcement went largely unnoticed by the national press.
The MCS will cover six major conditions: cancer, cardiovascular disease, chronic respiratory disease, dementia, mental ill-health and musculoskeletal disorders. Despite their many differences we are told that they are being lumped together in the interest of achieving better all-round health. Government has pointed out that many patients with cancer have other conditions, many with musculoskeletal conditions have heart problems or respiratory disease.
A strategy designed to fail
Mitchell returned to her blog in February to look at the proposals, which have so far not been detailed in any way. She expressed the concern of many that by bundling cancer alongside other conditions in a short-term strategy “will fail to give cancer the due care and attention it requires”.
Each of the six major conditions merits its own strategy to address detail without distraction and which allows NHS commissioners and managers to focus on meeting clinical needs. Mitchell points out that cancer is “an umbrella term “ for hundreds of different diseases. One specialist clinician I spoke to commented that if he failed to recognise and allow for co-morbidities in an individual patient he would be negligent, and no politician was going to make that kind of decision-making quicker, easier or better through a national strategy.
A significant concern is that the strategy will define revised cancer targets which will be less sensitive than the current ones. Although the complexities of developing a Major Conditions Strategy will take time to resolve, the apparent plan is for publication early next year (2024). Cancer charities fear a superficial plan but are reassured that planning for cancer care will not slip into a policy vacuum.
But because the Government does not want a lengthy document, the strategy will not provide, or delve into, detail. Behind a cloak of words which will be vague at best, it will divert resources and take time reconciling differences and determining priorities. Put simply, the MCS, if it survives, will kill people with cancer.
The Lesson of History
In February 2023 the National Cancer Director Dame Cally Palmer and the National Clinical Director for Cancer Professor Peter Johnson were interviewed by the Commons Health Select Committee. Asked about the MCS, they avoided the question, which was repeated. Their response indicated a less than ringing endorsement.
Both cancer directors have been around long enough to remember the 1995 report of the then Chief Medical Officers for England and Wales, Professor Sir Kenneth Calman and Dame Deirdre Hine. They worked with a small team of specialists to review UK cancer care and identify a route forward. They found that cancer was a disease treated by generalists with occasional specialist intervention, and that UK performance in terms of speed of diagnosis, treatment standards and patient survival were poor when compared with other countries of a similar size, population and wealth.
They proposed a specialist cancer service, giving each major grouping of cancers its own treatment structures, priorities and clinical specialisms. Soon after their report was published, governments changed and Tony Blair became prime minister. Cancer was the UK’s biggest single cause of death. It leapt to the top of the health agenda: a National Cancer Director was appointed and a National Cancer Plan developed for England, with similar plans forthcoming in Wales and Scotland.
A National Cancer Research Network was created and a series of ‘Improving Outcomes Guidance’ was developed addressing the needs of different cancers. An Action Team within the Department of Health was charged with creating local networks to speed up change, encourage collaboration and develop local expertise. Ten years of dynamic development followed with a growing and increasingly skilled oncology workforce, supported by strategic improvements in gathering data, better drug regulation, access to innovative treatments and involving patients in the decision processes.
A change of direction
The coalition government from 2010 onwards heaved on the brakes. The NHS was re-organised with a ‘bonfire’ of NHS bodies. Among the first to go were the Cancer Networks and the Cancer Action Team. Without their co-ordination local hospitals stopped sharing resources and ideas to focus on themselves. The successful and admired National Cancer Director was moved into another role. It took pressure from patients and doctors to keep the cancer performance targets in place.
In 2015 a new 10-year Cancer Plan for England was published. It has largely failed. Our cancer survival has improved but we have not made up the gap with other comparable countries. Targets established in the early 2000s and supported by successive governments are consistently missed. An independent international bench-marking project shows England’s performance running behind seven similar nations.
Going against the evidence
The World Health Organisation (WHO) suggests that having a cancer plan is vital in today’s management of healthcare. Sajid Javeed’s “war on cancer” can be regarded as rhetorical – he is after all from the same political family as Stephen Barclay – but the intention was pragmatic and the plan was relevant to the challenge the disease presents.
The approach being adopted is not. It is potentially damaging and the people who will suffer the most will be the growing number of those who are diagnosed late, cannot access specialist care, are denied modern treatments and whose disease becomes advanced because of that. Highly specialised treatment in university hospitals will get a lot of publicity but will be available to few.
The hidden story will be poorer cancer survival, already among the worst in the western world. The European Union has just published its Beating Cancer plan which sets out a map for the member countries to address. Increasingly England can be seen slipping further behind, although Scotland and Wales have Cancer Plans in preparation.
By ignoring the weight of evidence supporting a new National Cancer Plan the Secretary of State is going against the mainstream of healthcare thinking. If you live in England, the chances of beating cancer, already among the worst in the western world, will be poorer.
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