Sajid Javid has announced a series of bold initiatives to improve the UK’s record on cancer, but he will have to overcome several obstacles if he is to succeed
"Winning a war on cancer takes more than good intentions or even large quantities of money." Greg Allen, CEO, FCC
When we consider the future health and care system, often strategy and planning is focused on the health and care system itself. For example, do we have the right services? How efficient are they? What are the outcomes? Do we have sufficient funding and capacity?
But a fit for purpose health and care system (and, by implication, better outcomes) will not be achieved by focusing on health and care alone. Tackling major health and care issues cuts across many different agencies, sectors and areas of society. Take cancer, for example.
Last week the government announced a 10-year strategy for improving cancer care in England.
The ambitious nature of the plan is underlined by Sajid Javid’s decision to refer to it as a “war on cancer”. This was the phrase popularly used to describe the US’s 1971 National Cancer Act, which poured money into cancer research. It was thought by President Richard Nixon and others that a cure for cancer could be found within five years. Fifty years on, 600,000 Americans (and 166,000 British people) still die of the disease every year. Winning a war on cancer takes more than good intentions or even large quantities of money.
Early diagnosis is crucial
The government plans to tackle cancer on three fronts: prevention, diagnosis and treatment.
Prevention will focus on reducing the major risk factors, such as tobacco, alcohol and obesity. Javid aims to make England “smoke-free” by 2030, halve childhood obesity by the same year and introduce specialist alcohol care teams to hospitals. We need to know the finer detail of these plans, but if they are to succeed, they will need to be part of a much bigger strategy – beyond health and care policy alone. Javid himself acknowledges that smoking, alcohol consumption and obesity are closely linked to poverty, yet we know that one in five of the population survives on a low income. The combination of rising inflation and rising energy bills could see far more thrown into poverty.
Early diagnosis of cancer is crucial to improving patients’ chances of survival. Although there has been some improvement in recent years, England ‘s survival rate still lags behind that of other OECD countries. One of the reasons for this is late diagnosis, caused in part by a shortage of diagnostic staff, and in part, research suggests, by a reluctance of patients to bother their GP. Other research has found GPs failing to urgently refer patients with cancer symptoms to a specialist. The UK’s system of primary care thus acts as a block to patients receiving the treatment they need. The situation has been made worse by the pandemic, with patients facing severe delays in referrals: Javid has this week reinstated an earlier promise to reduce waiting times for a cancer diagnosis to 28 days.
The health secretary’s decision to bypass primary care by setting up community diagnostic centres where patients can have the necessary tests and scans is welcome – but its success largely depends on finding doctors and nurses who can staff them. A workforce plan is promised, but the stark truth at the moment is that NHS England is short of 50,000 doctors.
Finally, treatment. Javid has promised more investment into cutting-edge research using technologies such as artificial intelligence, genomics and a cancer vaccine (used for treatment rather than prevention) based on the mRNA technology deployed so successfully during the pandemic. There is real hope that new scientific breakthroughs will be found to treat cancer.
Yet putting money into research is in some ways the easiest part of the strategy to carry out. Bringing people out of poverty and helping them break habits such as smoking, consuming alcohol and overeating is far more challenging – as is meeting the staffing shortfall at a time when overworked doctors and nurses are leaving the NHS in droves.
We welcome the good intentions behind the government’s plan. But it has several hurdles to overcome if it is going to turn those good intentions into outcomes. We suspect it may be a long time before we can call victory in the war on cancer.