NHS0023

Written evidence submitted by Cancer Research UK

 

The design of national recovery plans

  1. In February 2022 the Secretary of State for Health and Social Care announced the details of the elective Recovery Plan (ERP), a three-year plan intended to address the impact of COVID-19 on the NHS in light of growing elective care waiting lists and worsening performance against key cancer targets.
  2. Whilst the plan did outline some positive steps, including its promise to put reducing inequalities at the core of its approach, it lacked the ambition and urgency needed to tackle the pandemic’s impact on cancer, restating targets that have been missed for years and pushing back when the Government will meet them. Measures set out to expand capacity primarily repeated previous announcements on drawing on the independent sector, and setting up Community Diagnostic Centres and surgical hubs. Workforce needs were also left unaddressed, with the ERP failing to clarify how the “hundreds of millions” of additional funding promised at the 2021 Comprehensive Spending Review (CSR)[i] would be spent to grow the health and care workforce. It is very welcome that workforce was a key priority for the Chancellor at the 2022 Autumn Statement, and this must now translate into clarity on how the investment allocated for the cancer and diagnostic workforce will be spent over the last two years of the Spending Review period.
  3. As it stands, NHS England (NHSE) is not on track to meet the two key cancer targets set out in the ERP, which are:
  4. NHS figures also show that some of England’s key cancer waiting times target have not been met since before the pandemic, including the target to see at least 85% of patients begin their first cancer treatment within 62 days of a GP urgent referral, which has not been met since 2015[iv].
  5. A recent International Cancer Benchmarking Partnership (ICBP) report shows that consistent national cancer policies are essential if we are to make long term progress for services[v]. However, the new Government has so far failed to recommit to a long- term cancer strategy. The 10 Year Cancer Plan, originally due to be published in July 2022, provides a critical opportunity for the Department for Health and Social Care to set out an ambitious and long-term roadmap towards better cancer outcomes. For years, cancer targets have been set and missed due to a lack of concerted action and matched funding, and now following the impact of the pandemic on cancer services and patients, it is more important than ever that high levels of investment in cancer services are aligned to a clear, sustained plan.
  6. We need a long-term and fully funded plan for cancer that will set ambitious targets, deliver the funding and resources needed to meet them and transform cancer survival in this country.  Crucial to the success of the plan will also be ensuring there is adequate growth of the cancer workforce to deliver on it.

Early progress made in recovering services

  1. Cancer waiting times are currently at record highs and even before the pandemic, cancer patients were experiencing unacceptable waiting times for essential cancer care. Timely access to a diagnosis and high-quality treatment is important for patient experience and cancer outcomes. The Elective Recovery Plan should have improved services overall following the pandemic.
  2. However, we are concerned that cancer services are not making progress against the targets set out in the Plan. Currently, too many patients on the 62-day referral to treatment pathway are experiencing longer waits for treatment. Services are also not close enough to the 75% Faster Diagnostic Standard which aims to speed up cancer diagnosis[vi].

 

62-day wait from urgent referral to starting treatment for cancer target

  1. The NHS aims that 85% of patients will wait no more than 62 days between an urgent referral for suspected cancer and first treatment. However, this target has not been met since 2015. The ERP set out that performance against the 62-day target should return to pre-pandemic levels by March 2023, which were at 74.0% in February 2020[vii][1].
  2. 62-day wait performance, September 2022

 

  1. Whilst cancer services have until March 2023 to reach the ERP target of returning the 62-day wait to pre-pandemic levels, recent performance is concerning. Performance against the 62-day target in September 2022 (60.5%) was 13.5 percentage points below pre-pandemic performance in February 2020 of 74%, and 1.9 percentage points below when the ERP was published – only six months earlier in February 2022[ix]. Therefore, without an unprecedented increase in the proportion of patients being seen within the 62-day target, services will not achieve the ERP target of the 62-day wait returning to pre-pandemic levels by March 2023.
  2. The starkest example of worsening waits is the proportion of ‘longer waiters’- patients waiting more than 104 days to begin treatment for cancer after an urgent referral. Longer waits for treatment are likely to result in poor patient experience as well as lead to poorer outcomes[x]. In September 2022 around 12.9% of patients waited more than 104 days for treatment, which is the highest proportion of ‘long-waiters’ on record[xi]. More than 10,000 patients in the last six months have been long-waiters, which is more than triple the number from the same months in 2017[xii], further illustrating the continued significant pressures facing cancer services in recent
    months.
  3. While the ERP was established to return services to pre-pandemic levels, it must not be forgotten that this should only be an interim step to returning services to the long-term NHS target of 85% of cancer patients seen within 62 days. Failure of the ERP to achieve this interim step simply leaves a wider gap to make up to this long-term target.

 

Faster Diagnosis Standard

  1. Diagnosing cancer at an early stage is vital to improving cancer outcomes. For example, for bowel cancer 92% of people will survive 5 years or more after diagnosis when diagnosed at the earliest stage (stage I), compared to just 10% when diagnosed at the latest (stage IV)[xiii]. That is why the Government’s ambition to diagnose 75% of cancers early (stage I or II) by 2028 is very welcome. However, the proportion of cancers diagnosed early in England has not changed significantly for a number of years. If we continue on our current trajectory and do not close the gap on the NHS Long Term Plan ambition, over the course of the plan (2019 to 2028) around 343,000 cases would be diagnosed late (stage 3 and 4) instead of early (stage 1 and 2)[xiv],[xv]. In practice, this means that in 2028, we will fall 21 percentage points short of this goal, which equates to 65,700 patients being diagnosed late (stage 3 and 4) instead of early (stage 1 and 2) in that year. 

  1. The Faster Diagnosis Standard (FDS) was designed to speed up cancer diagnosis and improve patient experience. The ambition set out in the ERP is that, by March 2024, 75% of patients who have been urgently referred by their GP for suspected cancer are diagnosed or have cancer ruled out within 28 days.
  2. Faster diagnosis standard performance, September 2022

 

  1. Whilst cancer services have until March 2024 to reach the ERP objective of ensuring 75% of patients will be diagnosed or have cancer ruled out within 28 days of an urgent suspected cancer referral, recent performance is concerning. Performance against the 28-day target in September 2022 (67.2%) was 6.3 percentage points below it was when the target came into effect in October 2021 (73.5%), and 6.9 percentage points below when the ERP was published (74.1%) – only six months earlier in February 2022[xvii].

 

  1. The FDS target threshold of 75% as set out in the ERP is only an interim step to achieve the NHS’ long-term aim. The 2015 Cancer Strategy for England originally proposed introduction of the FDS with a target of 95%, a recommendation that was accepted by Government[xviii]. While we recognise that chronic staff shortages limiting diagnostic capacity meant the target was initially set at a more achievable level, the target as set lacks the ambition needed to meet the Government’s own target on early diagnosis.
  2. We therefore would like to see the Government commit to a trajectory to a more ambitious target for the FDS– to 80% in 2023, rising to 85% in 2025, 90% in 2027, to the originally proposed 95% by 2029.

Barriers to progress

  1. Government and the NHS have taken positive steps taken to increase diagnostic capacity. The 2021 Comprehensive Spending Review commitment of £2.3bn in health capital spending to transform diagnostic services[xix] was extremely welcome, with the investment targeted to Community Diagnostic Centres (CDCs), enabling expansion of diagnostic capacity.
  2. This commitment to roll out CDCs across the country was reaffirmed in the ERP, and it is positive that we are currently on track to have 160 community diagnostic centres across the country by 2025, with 92 now open (as of September 2022)[xx]. It is positive that the Government’s 2022 Autumn Statement has confirmed NHS budgets will receive an extra £3.3bn over the next two financial years[xxi]. In the face of the Covid-19 backlogs and lengthening diagnostic waiting times for patients, it is crucial that that NHS core budgets are protected, and the money allotted for the expansion of diagnostic capacity is maintained.
  3. In addition, the benefits of investment in equipment, facilities and infrastructure such as CDCs will not be fully realised without investment in the cancer workforce as well. The most recent data showed that NHS in England has 132,139 vacancies[2][xxii] . These staff shortages are a significant barrier to increasing efficiency in the health system and making best use of funding to improve outcomes. Investment and long-term plans to grow the workforce are necessary to improve productivity and transform cancer outcomes in the way successive Governments have committed to do through establishing clear, long-term targets for cancer care metrics.
  4. Shortages in the cancer workforce are evident across the whole cancer pathway and have long held back outcomes for patients. We welcome the Government’s commitment in the 2022 Autumn Statement[xxiii] to publish a comprehensive workforce plan next year, including independently-verified forecasts for the number of doctors, nurses and other professionals that will be needed in 5, 10 and 15 years’ time. This presents a vital opportunity to tackle the staff shortages that are a significant barrier to meeting waiting time targets, and the Government’s own early diagnosis target. However, we lack clarity on what level of detail will be included in the published plan, and to what degree there will transparency on projected staffing numbers in key speciality areas. Crucially, it also remains unclear on whether there will be additional funding to deliver workforce growth in shortage areas identified in the plan.
  5. Unless the plan, including the modelling for projections, is published in full, we will not be able to support the Government in achieving its’ aims, gauge the full extent of the workforce shortages or assess how far the Government’s commitments go against meeting demand. We therefore urge the Government to publish the NHS long-term workforce plan in full, alongside a commitment to provide the necessary funding to deliver workforce growth in shortage areas identified in the plan.
  6. Building a cancer workforce that is fit for the future will also be crucial for the delivery of a much needed and much anticipated long-term plan for cancer. In the face of lengthening waits for diagnosis and treatment, it is more important than ever that the Prime Minister and Secretary of State for Health and Social Care recommit to the promised 10 Year Cancer Plan. An ambitious and fully funded plan is vital to reverse the trend of worsening waits for diagnosis and treatment which have been explored above. CRUK’s response to the 10 Year Cancer Plan call for evidence outlines a number of recommendations for reform as well as areas for investment to help achieve the improvement needed to take cancer services in this country from lagging to world leading.

 

About Cancer Research UK

Cancer Research UK (CRUK) is the world’s largest cancer charity dedicated to saving lives through research. We support research into over 200 types of cancer, and our vision is to bring forward the day when all cancers are cured. Our long-term investment in state-of-the-art facilities has helped to create a thriving network of research at 90 laboratories and institutions in more than 40 towns and cities across the UK, supporting the work of over 4,000 scientists, doctors and nurses. In 2021/22, Cancer Research UK spent £388 million on new and ongoing research projects into the causes and treatments for cancer.

 

 

                           


[1] Pre pandemic performance is determined using NHS England Cancer Waiting Time Statistics from February 2020.

[2] Total workforce vacancy FTE in NHS England, April-June 2022. Please note, due to the complex nature of how NHS vacancy data is defined and collected, all data sources should be treated with a degree of caution. These data do not indicate how much of the reported substantive gap is filled by temporary staff.


[i] HM Treasury (2021), Autumn Budget and Spending Review 2021, Accessed November 2022 via https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1043689/Budget_AB2021_Web_Accessible.pdf

[ii] NHS England, Cancer Waiting Times, Accessed November 2022 via https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/

[iii] NHS England, Cancer Waiting Times.

[iv] NHS England, Cancer Waiting Times.

[v] Nolte. E, Morris. M, Landon. S, McKee. M, Seguin. M, Butler. J et al. (2022) Exploring the link between cancer policies and cancer survival: a comparison of International Cancer Benchmarking Partnership countries, The Lancet,  https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(22)00450-8/fulltext  

[vi] NHS England, Cancer Waiting Times.

[vii] NHS England, Cancer Waiting Times.

[viii] NHS England, Cancer Waiting Times.

[ix] NHS England, Cancer Waiting Times.

[x] Lowes. S, (2022) The rise of the ‘long-waiter’ – why cancer waiting times are showing the pressure more than ever before, Cancer Research UK, Accessed November 2022 via https://news.cancerresearchuk.org/2022/11/10/the-rise-of-the-long-waiter-why-cancer-waiting-times-are-showing-the-pressure-more-than-ever-before/

[xi] NHS England, Cancer Waiting Times.

[xii] Lowes, S (2022)

[xiii] Cancer Research UK, Bowel Cancer Statistics, Accessed November 2022 via https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer#heading-Two

[xiv] Smittenaar. CR, Petersen. KA, Stewart. K, Moitt. N (2016), Cancer incidence and mortality projections in the UK until 2035. Br J Cancer. https://pubmed.ncbi.nlm.nih.gov/27727232/

[xv] Public Health England (2021), Stage at Diagnosis, Accessed November 2022 via https://www.cancerdata.nhs.uk/stage_at_diagnosis

[xvi] NHS England, Cancer Waiting Times.

[xvii] NHS England, Cancer Waiting Times.

[xviii] Matson, L (2022), Breaking down the new standards for cancer care proposed by NHS England, Cancer Research UK, Accessed November 2022 via https://news.cancerresearchuk.org/2022/03/11/breaking-down-the-new-standards-for-cancer-care-proposed-by-nhs-england/

[xix] HM Treasury (2021), Autumn Budget and Spending Review 2021, Accessed November 2022 via https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1043689/Budget_AB2021_Web_Accessible.pdf

[xx] Department of Health and Social Care (2022), 7 new community diagnostic centres to offer more patients life-saving checks. UK Government. Accessed November 2022 via https://www.gov.uk/government/news/7-new-community-diagnostic-centres-to-offer-more-patients-life-saving-checks

[xxi] HM Treasury (2022) Autumn Statement 2022. Accessed November 2022 via https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1118417/CCS1022065440-001_SECURE_HMT_Autumn_Statement_November_2022_Web_accessible__1_.pdf

[xxii] NHS Digital (2022), NHS Vacancy Statistics England April 2015 – June 2022 Experimental Statistics, Accessed November 2022 via https://digital.nhs.uk/data-and-information/publications/statistical/nhs-vacancies-survey/april-2015---june-2022-experimental-statistics

[xxiii] HM Treasury (2022) Autumn Statement 2022. Accessed November 2022 via https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1118417/CCS1022065440-001_SECURE_HMT_Autumn_Statement_November_2022_Web_accessible__1_.pdf

 

 

November 2022