The headlines today make for dispiriting reading for those of us interested in improving cancer outcomes. The BBC front page speaks of ‘The 20 years of failure on cancer’ and the HSJ reports that the early diagnosis rate has flatlined, with some areas actually reporting a decline in the proportion of patients diagnosed at stage one or two.
Having read these headlines, the Prime Minister might be forgiven for thinking that securing a win on the Meaningful Vote on Brexit is somewhat more achievable than delivering on her party conference commitment to improve cancer early diagnosis.
I was lucky enough to be asked to review the Health Foundation report in advance of publication and it is somewhat more optimistic than the BBC headline suggests. As the report’s lead author – Incisive Health’s Senior Counsel Sir Mike Richards – noted in The Times, “We have made great strides in cancer care but there is some distance to go.”
The report shows that a combination of developing clear guidance on what needs to change, empowering clinicians and patients to lead this change at a local level, ensuring effective national leadership and coordination and (of course) providing the necessary resources to create the capacity to deliver can all be powerful drivers of change.
Yet the report also points to significant barriers to change. The gate keeping model of primary care seems to present a double barrier. The system deters patients from seeking help when they have a sign or symptom of cancer, as well as GPs from taking a proactive approach to investigation. Both appear to be concerned about placing pressure on an overstretched system. Incisive Health research conducted this summer reinforces this point. One in five men and one in four women would avoid getting a potential symptom of cancer checked for fear of wasting a doctor’s time.
The desire not to waste scarce NHS resources is reinforced by the very real shortages in workforce and diagnostic capacity affecting cancer services. Changing public and clinical perceptions and behaviour will require more than just words. It will also require a different approach.
This is the challenge for the long-term plan. New approaches to primary care will be required, including direct access to diagnostics and the development of new rapid diagnosis centres. The NHS will also need to be bold in introducing new screening technologies and investing in approaches to rapidly expand diagnostic capacity, including the use of artificial intelligence and alternative providers.
The scale of improvement required means that cancer services cannot afford a prolonged period of consolidation and stabilisation before efforts to improve services kick in. Transformation will need to start immediately.
The good news is that the public will be strongly supportive of these efforts. Our research shows that cancer is the top disease priority for extra NHS investment, ahead of Alzheimer’s disease / dementia, heart disease and depression, and that – when it comes to improving cancer services – the public wants to prioritise increasing the number of tests for suspected cancer and ensuring the latest cancer treatments are available.
Make no mistake, diagnosing three quarters of cancer patients before their disease has spread within a decade is an extremely challenging ambition. The Prime Minister, of course, is unlikely to be in office for long enough to be held to account for the delivery of her pledge. However, if the NHS is to deliver, it needs to start now.