We are living in a time of great opportunity in cancer care. Scientific progress has transformed our ability to diagnose and treat cancer, enabling many people who receive a diagnosis to lead longer, healthier and more active lives, often being “cured” of the disease.
We will squander this opportunity, however, unless we ensure that cancer services have the capacity to deliver cancer care effectively to those who need it, when they need it. Cancer waiting times — a reasonable barometer of the capacity challenges facing services — have not been met for nearly a decade. With cancer outcomes in England already poorer than in other countries, the challenge is significant.
Despite fantastic technological advances, cancer care is — and will remain — a fundamentally a human endeavour. Any solution is going to require planning and investing in sufficient staff to meet current and future demands. Government commitments on workforce are welcome, but a fully-funded plan has been “coming soon” for a long time. The budget took us no closer.
Efforts to address workforce shortages will, in any case, take time. There is a risk that the timeframe, as well as the sheer scale of the challenge, leads to paralysis. Yes, there are big, long-term choices to be made on the NHS, but there are also practical steps that can and must be taken now to free up NHS capacity, reduce backlogs and improve and extend the lives of people in this country. This doesn’t mean expecting staff to work (even) harder, it is about services operating smarter.
I recently authored a report, Capacity to deliver: unlocking the resources required to improve cancer outcomes in England. Having spoken with experts, I made recommendations for policy change intended to support local action to unlock capacity, recover cancer performance and build a service equipped to deliver the best possible outcomes. These solutions fall into three areas:
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First, we need to streamline the cancer patient journey or “pathway”, which can be clunky and confusing, for staff as well as patients. By reducing the number of steps between referral, investigation and treatment, we can reduce anxiety, free-up staff time and minimise delays.
Second, we need to make better use of everyone who can contribute to better cancer care. This means enabling professionals such as nurses and pharmacists to play a greater role and making better use of the independent sector, particularly in rapidly scaling up the delivery of diagnostics in the community.
Finally, we need to recognise that cancer professionals are a precious and scarce resource, applying a “capacity premium” to the way in which we evaluate and purchase technologies which can help release staff time for other tasks. There are plenty of new technologies that offer efficiencies for the NHS — from robotic surgery and health apps to liquid biopsies and precision medicines — but adoption remains uneven.
There is no shortage of good ideas and there are examples of hospitals putting them into practice. But progress is slow and unequal. Action is required to accelerate implementation. Otherwise, some areas of the NHS risk being left behind.
This is a big year for the NHS, as hospitals grapple with backlogs, new organisations try to make their mark and the government tries to show it can be trusted to get health services back on track. Now is the time to inject urgency into efforts to free up capacity. Without it, efforts to improve cancer services will fail. However, if we get this right we will make the working lives of staff easier, improve the experience of patients and demonstrate that the NHS is capable of continuing to rise to the challenge of increasing health need.
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Mike Birtwistle is senior counsel at Evoke Incisive Health and an expert in cancer policy
