Following our data blog on cancer waiting times, Emer Sheehy of Macmillan Cancer Support looks at how these data fit into the bigger picture for cancer care in the UK.
2018 will be a pivotal year for the NHS. The health service marks its 70th birthday this July. While this is a cause for celebration, the latest winter crisis has brought the funding and workforce pressures facing the system into sharp relief. The scale of these pressures means that calls for a long-term funding settlement and a strategic rethink of how the NHS is funded and delivered cannot be delayed for much longer.
For many of the same reasons, this year is likely to prove critical for cancer services. An ageing population and the projected growth in the prevalence of cancer means that half of people born after 1960 are likely to be diagnosed in their lifetime. Improvements in diagnosis and treatment for cancer mean more of these people are surviving or living longer with the disease than in the past.
The Independent Cancer Taskforce’s Cancer Strategy set out a vision for how to meet the challenges of this growing and changing demand on cancer services. 2018 marks the half way point of the 5-year strategy, and the clock is ticking on the commitments made by the NHS and the Government to improve how people with cancer are diagnosed, treated, and cared for in England.
But can the system deliver this vision in the current climate of serious strain on the NHS’s resources?
What do the numbers tell us?
The most visible markers of a system struggling to cope with demand are waiting times. QualityWatch figures show a slow decline across many of the key cancer targets, indicating that cancer services are not immune to pressure on the wider system. But they also highlight where there are significant gaps in the system’s capacity to deliver.
The 62-day wait target – that patients should not wait longer than 2 months to start treatment after an urgent referral for suspected cancer – has not been met in all but one month in the last three years. Waiting to start treatment can be an extremely anxious and uncertain time, and the fact that this target now seems to be effectively unachievable for the NHS is deeply concerning.
The failure to deliver on the 62-day wait standard, in contrast to performance against other cancer targets which has been relatively good, suggests that there is a longer-term problem with the ability of the system to diagnose and treat cancer patients quickly. Earlier diagnosis is often key to ensuring effective treatment and increasing the possibility of long-term survival, but improving it is not straightforward. Gathering all the information on the extent and type of cancer, and potential treatment options – particularly with advances in targeted treatments – involves input from across the system.
NHS England’s commitment to begin introducing a 28-day faster diagnosis standard this year will help us to better understand and measure earlier diagnosis. But introducing new performance measures does not automatically ensure better performance. If we are to tackle waiting times we need to look at the long-term factors preventing the system from meeting these targets.
The long view
While the changing and growing demand on NHS services has been widely acknowledged, more work needs to be done to ensure that this is linked to long-term financial and workforce planning. Voices from across the sector have called for an independent body – modelled on the Office for Budget Responsibility – to identify the long-term staffing and funding needs of the NHS.
QualityWatch figures indicate consistent problems with meeting the six-week diagnostic waiting time target. It is therefore welcome that Health Education England’s Cancer Workforce Plan commits to addressing gaps in diagnostic manpower – with plans for increased capacity in clinical endoscopy and radiography.
Filling gaps in key professions is of course vital. But diagnosing people earlier and quicker is only one piece of the puzzle when we think about good cancer care. Earlier diagnosis has knock-on implications on the rest of the cancer pathway. These patients will require treatment, ongoing care, and support throughout their journey, all of which will need to be effectively planned for and resourced.
The promised long-term review of the cancer workforce needs to offer a strategic vision for how the NHS will deliver for a cancer population growing in size and complexity. With recent figures suggesting huge retention problems in the nursing workforce, we urgently need to shift away from short-term fixes to look at how the system will deliver care and support in the future.
The bigger picture
To do this, it’s helpful to try to look beyond the waiting time numbers at the patients they represent, and what we want the system to deliver for them. Each person who is urgently referred for suspected cancer by their GP deserves to see a consultant, receive a diagnosis, and begin treatment as quickly as possible.
But they also deserve to have ongoing care and support throughout their cancer journey. We need to look at the cancer pathway as a whole, to understand how to transform and improve services across these areas, and to ensure the cancer workforce has not just the capacity but also the right mix of skills to deliver this for patients.
Waiting time targets are helpful indicators of how the system is performing, but they only show one part of the picture. This year, on the back of recommendations in the Cancer Strategy, the NHS will begin piloting a metric to measure the long-term quality of life of cancer patients. Being able to measure not just how quickly someone is diagnosed and treated, but what impact their cancer has on their life should encourage and enable us to focus on the big picture.
Meeting waiting times is of course, vital for cancer patients. But they should also invite us to think about how the broader system is working, and what needs to be done to ensure it is delivering all the outcomes that matter for cancer patients – now and in the future.