Cancer services attract bold election promises as politicians know what the public wants to hear, but how many of these pledges can really be delivered?
The government have set a goal to save 55,000 lives a year through early detection of cancer and improved treatments, first announced by Theresa May and relaunched it in the new 10-year plan for the NHS.
In reality, the NHS is so overworked that the existing government target for patients to start cancer treatment within 62 days of a GP visit has not been met for over three years.
Before the election campaign, Boris Johnson’s government announced a £200m investment in NHS diagnostics to upgrade and replace older mammography and diagnostic imaging equipment.
Welcome but insufficient was the conclusion of health economists, declaring that the new money is ‘below what is needed to bring the UK up to an acceptable level’.
“we will save 55,000 lives through better cancer detection”
“I want to see the way we fight cancer in the NHS transformed, so we can confront this cruel disease with the best facilities to give our family, friends and colleagues the greatest chance.”
Matt Hancock, health secretary
International comparisons show how far the NHS has fallen behind on basic capacity – in staffing and equipment.
Among EU15 and G7 countries, the UK currently has the lowest number of both CT and MRI scanners per capita, according to the Health Foundation, with less than a third of that in Germany. They calculate that bringing the UK up to the average number of scanners would require around £1.5bn in extra capital spending.
Cancer UK reminds us of the size of the challenge – reporting that every year around 115,000 cancer patients in England are diagnosed too late to have the best chance at survival.
The weight of evidence says that identifying cancer early provides a much better chance of successful treatment, but progress with some cancers has been slower – for lung cancer almost half of people in the UK (48%) are diagnosed when their cancer is already at an advanced stage.
Cancer Research UK blame the government for not making progress in raising capacity, pointing to the critical areas like diagnosis where 1 in 10 of these NHS posts are currently unfilled.
“there’s no plan to increase the number of NHS staff to cope with demand now or the growing numbers in the future,” says Emma Greenwood, Cancer Research UK’s director of policy.”
NHS England published its interim NHS workforce plan in June, but this was not backed with any significant money to fund new education and training places.
Last year the government pledged to catch 75% of stage 1 and 11 cancers by 2028.
It would require a big step up in activity – diagnosing an extra 100,000 patients early each year, but how realistic is this when currently cancer services are struggling to tread water?
Hospitals are continuing to miss their targets to start treatment quickly according to the latest NHS data for cancer waiting times. The current commitment is a maximum wait of 62 days from the time of referral by a GP, in fact nearly a quarter of patients wait longer.
Only 38% of NHS trusts meet the 62-day waiting times standard for referral to treatment for cancer patients.
“For 41 months in a row the target for the time it takes people to start cancer treatment following an urgent referral from their GP has been breached. It has been the worst financial year on record (2018/19) for cancer waiting times with almost 34,000 people waiting too long for treatment”
Dr Moira Fraser-Pearce, Director of Policy and Campaigns at Macmillan Cancer Support.
A dossier of evidence collected by the Hospital Consultants and Specialists Association (HCSA) confirms the problems with understaffing. A consultant radiologist reported that “Scan report turnaround time has gone from one week to over a month. Unexpected and critical findings are going unreported for weeks. We are now just firefighting.”
The HCSA state that delays of five to six weeks for scans are common and that patients are turning up to outpatient appointments but having to leave without their results because scans are not available.
A new study from the UK Lung Cancer Coalition (UKLCC), confirmed that there aren’t enough scanners or staff to operate them, “putting the NHS far behind other European countries, including France, Germany and Spain.”
In the UK, there are only seven radiologists per 100,000 people, which is “significantly below” the EU average of 12, the report said.
The Clinical Oncology UK Workforce Census Report 2018, warned that the workforce in clinical oncology is 18% understaffed and says that the UK needs to train double the number of oncology trainees to close the gap, but even then the gap would not be closed until 2029.
The NHS has fewer of nearly all types of staff than its counterparts overseas, relative to the number of patients.
Despite record underfunding and a shortage of over 100,000 staff across the NHS is working much harder.
The number of patients referred for elective care has increased by 17% since 2013-14 and the number of patients referred for suspected cancer has almost doubled since 2010-11.
In the face of huge understaffing the NHS long-term plan, launched at the start of the year included a list of steps to improve cancer survival. It emphasises earlier diagnosis, and sets out plans to “lower the threshold of referral”.
However the NHS cannot expect to achieve the best cancer survival rates in Europe, or even to work in a safe and sustainable way until it solves its basic capacity problem – more staff and beds are needed in both hospital and community settings.
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