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The NHS Cancer Plan - Making Progress
Everyone knows someone affected by cancer. One person in three will get cancer during their life and one in four will die of it. But we have not ensured that these thousands of people receive the best services. People have not had the support they need to help prevent cancer; patients have had to wait too long for diagnosis and treatment; they have not always received the quality of treatment, care and support they have a right to expect.
"Cancer patients want to be treated as a whole person - with a life, family and career, not just as a disease with a person attached. People do better if they are informed, supported and have active co-ownership of their disease. It's their body isn't it?"
- Sheila Keatley, Cancer Patient, Liverpool Cancer Support Centre
The NHS Cancer Plan sets out what we must do over the coming years to redress the years of under- funding and neglect. We need more nurses, more doctors, more radiographers and more equipment. Some of the vital equipment was old and needed replacing and we needed to ensure that new drugs were available to all who could benefit.
The NHS Cancer Plan sets out a comprehensive national strategy for cancer. It has four broad aims:
- to save more lives;
- to ensure people with cancer get the right professional support and care as well as the best treatments;
- to tackle the inequalities in health that mean unskilled workers are twice as likely to die from cancer as professionals;
- to build for the future through investment in the cancer workforce, through strong research and through preparation for the genetics revolution, so that the NHS never falls behind in cancer care again.
The Cancer Plan is being backed by the biggest ever increase in funding for cancer services. This year the NHS received an extra £280 million to improve cancer services. Next year there will be a further £127 million and by 2003/ 4 the NHS will be spending £570 million a year more on cancer services than it was in 2000/ 01 when we published the Cancer Plan - an increase of around 30%.
But the Cancer Plan is not just about extra money. This is a programme of investment and reform. The necessary changes will take time but we are making real progress. As we continue to implement the Cancer Plan, people will increasingly benefit from the services they want and expect.
Making progress: healthier lifestyles
"Although I had tried to quit many times before, I was able to kick the habit this time because I had the full support of the Quit Smoking Service as well as Heart Care and my GP. I took Nicotine Replacement Therapy for a total of 8 weeks and found it really helpful. I'd recommend the service to anyone who, like me, is really ready to stop smoking for good."
- Roland Parker, ex-smoker from Walsall.
A third of all cancers are directly linked to smoking. People know that smoking can kill them and 70% of smokers want to stop. After smoking, what people eat is the next biggest factor in the incidence of cancer.
- Services to help people stop smoking are now available across the country. Last year they helped nearly 62,000 smokers to quit and in the first quarter of 2001/02 they have already helped some 28,700 smokers which is over half the target of 50,000 quitters set for this year. At this rate they should comfortably exceed the target.
- Zyban, a new treatment to help smokers give up has been available on prescription from GPs from June 2000. Nicotine Replacement Therapy has been made available on prescription since April 2001 and on general sale from May 2001.
- The National School Fruit Scheme was launched last year. 80,000 children in 27 areas and over 500 schools now receive a free piece of fruit each school day. The scheme will be rolled out over the next two years to reach all school children aged between four and six years old.
Making progress: better screening
People want to be sure that cancer screening services are readily available to allow treatment when the cancer is most likely to be curable, or in some cases, even before it develops. This year we have taken some important first steps to widen the screening programmes and to make them more effective.
- An extra 50,000 women are already being invited for breast screening as we begin to extend the NHS breast screening programme to include women aged 65 to 70. We are also introducing improvements in the way mammography images are taken.
- Women want to be confident that their smear tests are as accurately reported as possible. So we have started trying out new cervical screening techniques to see if they are successful in improving the accuracy and quality of service provided.
- 470,000 people in Coventry and Warwickshire and Tayside and Fife are being invited to undertake bowel cancer screening as part of a pilot to see if we should introduce this new screening programme across the NHS.
Making progress: understanding screening
The public expects openness and honesty from the NHS. The Cancer Plan committed us to help people understand screening better.
- New leaflets giving women an informed choice on whether to undergo breast or cervical screening were introduced in October 2001. These give women honest, clear and balanced information about the benefits and limitations of breast and cervical screening.
- Women with learning disabilities often find it difficult to access services. Last year we published guidance, illustrated leaflets and picture books about breast and cervical screening for this group. The materials, simple and clearly laid out, were produced with the help of the women themselves and have been hugely popular with a wide range of people.
- Many men are anxious about prostate cancer and ask about testing. But in the past the NHS decided what was best for them. Now we have launched a new approach so that men are given full information to help them decide for themselves about whether or not to go ahead with testing. New information leaflets have been developed and we have a consultation exercise underway to assess what people think of them. They are available on the National electronic Library for Health website:
Making progress: faster treatment
Patients with cancer want to be sure that they will get the tests and treatment they need quickly. But too often, waiting times have been far too long. The Cancer Plan set new targets to cut waiting times. Staff across the NHS have made tremendous progress in starting to meet the targets and in streamlining service provision through the Cancer Services Collaborative.
- 92.4% of people (60,458) with suspected cancer were seen by a specialist within two weeks of being referred urgently by their GP in the first three months of this year (April to June 2001).
- By next month (December 2001) all patients with acute leukaemia, testicular or children's cancers will be treated within one month of being referred urgently by their GP
- By next month (December 2001) all patients diagnosed with breast cancer will wait a maximum of one month for treatment
Streamlining care: the Cancer Services Collaborative
In North Hampshire Hospitals NHS Trust patients had to wait between 7 to 49 days (with an average of 20 days) for a CT scan after attending their outpatient appointment. The hospital introduced a system of pre- booked CT scan slots for lung cancer and patients now take their X- rays to the CT department and book their appointment. The length of time the patient has to wait between an outpatient appointment and a CT scan has been reduced to 2 days.
In Avon, Somerset and Wiltshire Cancer Network urgent suspected prostate cancer patients now wait 25 days from referral to treatment compared to 56 days. This has been achieved by introducing a weekly rapid access clinic with protected slots, prebooked diagnosis and a co- ordinated care programme.
Making progress: fairer, better treatment
It is unacceptable that patients' chances of getting effective treatment and drugs have depended on where they live rather than their clinical need. Clinicians and cancer service providers also need to know the evidence for best quality services.
- We are ending the 'postcode prescribing lottery' for new anti-cancer drugs once and for all by ensuring up to date guidance is available from the National Institute for Clinical Excellence. Patients need no longer worry that they might be unfairly prevented from receiving new chemotherapy drugs to treat ovarian, brain, pancreatic, lung and breast cancers as well as leukaemia. Around 19,000 patients each year should now be benefiting from these chemotherapy treatments.
- We are producing evidence- based guidance, which sets out for clinicians and managers the evidence of good practice and greatest benefits in treatment, including the need for specialist multi- disciplinary teams. This year we have published guidance on stomach cancers. Early next year guidance on urological cancers, including prostate cancer, will be published.
- Earlier this year we published the first ever Manual of Cancer Services Standards which are drawn from the evidence based guidance. The cancer services provided by every NHS hospital in England have now been reviewed against these standards by teams of clinicians visiting their peers, and have developed action plans as a result.
Making progress: more clinicians shaping services
Patients with cancer often need to be treated by many different health professionals working in different hospitals and locations. They should be able to expect all those involved in their care to work together to provide high quality seamless care, regardless of which hospital they are in.
- Thirty- four cancer networks have now been established to work together to deliver cancer services. All these networks have now reviewed their current service provision and identified where they need to develop and invest for the future.
- Nearly 300 lead clinicians in primary care have been appointed, with dedicated time to co- ordinate and improve the provision of services in the community for cancer patients.
- New clinical datasets have been developed so that clinicians can track the quality of treatment they provide and monitor the outcomes. A new programme to improve the quality of cancer registration is underway so that we have more up to date, accurate information about the impact of cancer.
Making progress: more staff, more training
Patients want to be able to be seen quickly by their specialists and have enough time to discuss their illness. The key to both lies in getting more specialists and training staff to make best use of their skills and potential.
- By the end of 2001/02 we expect to increase the number of cancer consultants by 428 (compared with 1999). This means we are on track to hit the target set out in the Cancer Plan of nearly 1000 extra cancer consultants by 2006, (in addition to extra surgeons, urologists, gastro- enterologists and other specialists involved in cancer care).
- New initiatives are underway to train staff in skills and areas traditionally carried out by other specialists. These include training in endoscopy, therapy radiography, breast screening, cytoscreening and histopathology.
Making progress: better information and support
Cancer patients need to be confident that their views will be listened to. We need to know what patients think about the care and treatment they receive and what needs to be changed to improve services both locally and at a national level.
- We have been working closely with the national charity Cancerlink to enable cancer patients to play an active role in cancer networks. Every cancer network is now establishing a patient partnership group to involve patients and their carers in decisions around shaping services for cancer treatment.
- We have also commissioned the largest ever national survey of cancer patients to ask them about the care they have received. 65,000 patients have responded and their views will help us shape and revise cancer services at national, network and local level. The survey will be published in full in spring next year.
- We have established a Cancer Information Advisory Group to oversee the development, content and availability of cancer information for patients about the diagnosis and information about their disease.
- We are funding new information sources including substantial funding towards DIPEx (Database of Individual Patient's Experience of illness). DIPEx aims to link patients' experience with evidence based information and is available via internet access and or CD-ROM. Watching, listening or reading the experience of others helps patients and carers to make some of the difficult decisions they need to take about their care.
Making progress: better palliative care
When asked, most people with advanced cancer want to stay at home with their family for as long as possible. In practice only about a quarter actually die at home. In addition access to high quality specialist palliative care, such as that provided by hospices, is variable.
- Over 10,000 district nurses (one in four of all district nurses) are receiving training over the next three years to help them support people with cancer at home for as long as possible during their illness.
- The New Opportunities Fund is investing a total of £45 million in initiatives to improve access to adult palliative care, particularly for disadvantaged groups in inner cities and rural areas.
- Eight palliative care beacon partnership projects are spreading knowledge and good practice in joint working across the NHS and voluntary sector to improve specialist palliative care.
- We are funding the National Council for Hospices and Specialist Palliative Care to help cancer networks work with voluntary hospices to assess local needs for specialist palliative care and to develop strategic plans to meet those needs.
- NICE has been commissioned to undertake an evidence based review of supportive and palliative care services.
Making progress: more modern equipment
Patients want to be sure they are getting up to date diagnosis and treatment from modern equipment. A programme to upgrade and increase provision of equipment is well underway.
| New and replacement equipment provided through central programmes since January 2000 | % of equipment new since January 2000 | |
|---|---|---|
MRI Scanners | 21 | 23% |
Linear Accelerators | 22 | 19% |
CT Scanners | 52 | 30% |
Making progress: more cancer research
Cancer services in England must remain at the forefront of new cancer developments. The UK has some of the best clinical and laboratory researchers in the world. Patients should have the opportunity to play a part in developing cutting edge treatments.
- A new National Cancer Research Network (NCRN) has been established. This will double the number of patients involved in research trials for new treatment over three years.
- A National Cancer Research Institute (NCRI) has been established to bring together the major funders of research from Government, the voluntary sector and industry so that a more strategic approach can be taken to identify and support new cancer research.
Making progress: more to do
In the year since the Cancer Plan was published we have made a good start. Staff across the country have given the plan their support and are working hard to make it a reality. There remains much to be done but patients are already seeing benefit. Over the coming months and years still more progress will be made to cut waiting times, improve treatment and care and reduce inequalities so that our cancer services will indeed match the best in Europe.
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