11

 


Written evidence submitted by #CatchUpWithCancer Campaign (CBP0073)
 

 

Executive Summary

The COVID-19 pandemic had an undeniably huge impact on non-COVID healthcare, creating backlogs, pent up demand and reducing capacity through COVID related risk mitigation. Delivering a more urgent response to the cancer backlog is the raison d'etre for the #CatchUpWithCancer campaign. Of all the healthcare backlogs, it is our view that the cancer backlog poses the deadliest threat to patients. International research shows that for every four-weeks delay in cancer diagnosis and treatment there is a reduction in survival of 10%. Therefore, this evidence will focus responses to the committee questions on the cancer backlog. We have worked throughout the pandemic with patients, frontline staff, cancer organisations and national and international cancer data gatherers. It is our firm conclusion that current plans for the recovery of cancer services are doomed to failure. Early on in the pandemic it was predicted that the COVID induced cancer backlog would cost around 35,000 additional lives. However, with the further disruption that has occurred and with as many as 40,000 starting treatment in the UK last year[i], this number is likely to be even higher.

The time critical nature of addressing the cancer backlog appears to be missing from Government plans to address it. Concerningly, while escalating cancer waiting lists need the most urgent attention, Government and NHS leadership language frames the cancer backlog in the context of the overall elective NHS backlog. Cancer treatment is time critical, and it is not elective healthcare. The current approach of bundling cancer in with the elective backlog fails to grasp the urgency of the situation and dilutes the “life and death” nature of the cancer crisis. Crucial opportunities to act are being missed as a result of this approach. The NHSE cancer recovery plan initially “hoped” to get cancer services back to pre-pandemic levels by April 2021.  This has already slipped to April 2022 with the problem now simply being devolved down to local Trusts without national coordination or any ringfenced investment. Before the pandemic the UK sat at the bottom of the cancer league tables for survival. If the limit of our ambition is to return to “normal” levels, we will fail to clear the backlog.

UK cancer services are starting from a position of weakness when dealing with the worst cancer crisis in a generation. If cancer is lumped in with the growing costs and competing priorities, and if overstretched Trusts are asked to tackle backlogs with no specific plan for cancer, the consequence will be continued failure. A continuation of the structures that created such poor pre-pandemic cancer outcomes will only serve to increase geographic and demographic inequalities with deadly results for patients. An NHS Providers and NHS Confederation report estimates a cost of £3.5-4.5bn for recovering the overall backlog[ii]; and a need for £10bn overall NHS England budget increase to meet COVID costs. It is vital that time critical cancer care backlogs receive dedicated attention and ring-fenced investment.

The pandemic ripped apart cancer pathways which were only just being held together pre-pandemic thanks to the hard work of the workforce. Capacity was at its limit before COVID. Estimates are that staff would need to be working at around 130% capacity to catch up with post-COVID demand[iii].  This is simply not possible. There is a desperate need for a new national cancer plan to clear the backlog and deliver world-class COVID resilient care. This needs to be backed by proper investment, both in long-term workforce capacity and technical solutions which can unlock more capacity and give staff the tools they need. Current plans mean that cancer services are left to fight for a share of the £1bn to help with the elective backlog. Areas which were already suffering underinvestment pre-pandemic, and could contribute more to address it, face a huge challenge to get the funding they need. A step change in the way cancer is funded is required to unlock the capacity needed.

Radiotherapy is one such example. It is already being used as a substitute for surgery and could do even more if properly prioritised and given the funding to undo years of under investment. Changes to tariffs to allow the most advanced techniques and investment to upgrade out of date machines could quickly “super-boost” capacity. And this could be done at a modest cost because radiotherapy is one of the most cost-effective cancer treatments. It typically costs £4-7k to cure a patient compared to often around £40-£100K for some drug-based treatments. There is huge potential for radiotherapy to tackle the surgical backlog, while AI and cloud technology is readily available and could mitigate some workforce gaps. However, existing NHS structures and budget flows mean the huge potential for radiotherapy to do more, at a modest cost and dramatic patient gain, is being overlooked.

To address the cancer backlog a new approach to cancer is needed, led from the top of Government, backed with investment, and underpinned by a radical new national cancer plan.

If we don’t act quickly, we risk passing the point of ‘no return’ at which the backlog grows so quickly that there is an avalanche of patients needing treatment so that whatever we do, the momentum is simply too great, with more patients presenting later with more advanced disease needing more treatment so we are unable to turn this around.

 

About #CatchUpWithCancer

The #CatchUpWithCancer campaign was founded in July 2020 in response to grave concerns from patients and the public about the COVID-induced disruption to cancer services. It has been a focus of public and media discussions providing real time information and insight into the causes, scale, and effects of the disruption to cancer services in response to the COVID pandemic. The campaign has had the backing and support of a number of cancer charities, has nearly 400,000 engaged supporters with high profile celebrity support and the backing of over 100 parliamentarians. The campaign has been working with the All-Party Parliamentary Group (APPG) for Radiotherapy which in turn has been working with the APPG for Health and the other APPGs related to cancer. We have provided informed and timely information to MPs, ministers, and the NHS on the real time effect of COVID and the NHS’s response to it on UK cancer services and patient outcomes. Through our networks, stakeholders, and communication channels we have rapidly disseminated real time information, forecasts and solutions put forward by professionals. Our communication work has been recognised by health care providers and professionals throughout the world.

 

About All-Party Parliamentary Group for Radiotherapy

The APPG for Radiotherapy was formed in 2018 to address the under-provision of advanced radiotherapy in the UK and the inequalities in access.

About radiotherapy and the urgent need for investment

Radiotherapy is internationally recognised as being needed in 50-60% of cancer patients, involved in 40% of cures[iv] and is relatively inexpensive costing between £4-7K per patient cure. Yet estimates are that only between 27% and 37% of patients in the UK receive radiotherapy[v]An  APPG-RT Inquiry August 2019 found that earlier NHSE Vision for Radiotherapy 2014-2024 modernisation plans had fallen woefully short of expectations due to i) central commissioning restricting services, ii) perverse bureaucracy preventing implementation of modern techniques, iii) different silos making up the NHS lacking the necessary coordination of the various aspects that make up radiotherapy delivery, and iv) only 5% of the cancer budget been spent on this effective treatment modality. A Manifesto for Radiotherapy launched in 2018 was agreed by all the professional bodies and was received positively by a series of cancer ministers. Since COVID, radiotherapy has been accepted internationally as the stand-out COVID secure cancer treatment which i) can continue to be practiced during a pandemic, ii) can substitute for surgery, and iii) has benefitted most from the digital/virtual/technology developments in the pandemic. Radiotherapy also plays a key role in early-stage curable disease, and if we are to make NHS long-term plan ambitions of diagnosing cancer patients earlier a success, we will need investment in radiotherapy capacity. NHS long-term plan ambitions combined with the key role it must play in post-COVID cancer recovery means a parallel radical new national pan for modern radiotherapy is needed. Fortunately, radically advancing technology is available, often implemented successfully in other countries (widespread use of SBRT, central automating radiotherapy planning, remote peer review etc.) and this offers the means for a radical restructuring. The key question for UK policy makers is whether the country is prepared to prioritise improving cancer outcomes by delivering the required investment in tools such as radiotherapy, which are available, needed and yet grossly under used. Radiotherapy is such a key area for investment because it i) is relatively inexpensive ii) is a highly effective anticancer treatment, iii) will be needed even more with the increased incidence of cancer and more early diagnosis, iv) is increasing used to enhance immunotherapy and v) is as an effective substitute for surgery to clear the backlog.

The APPG for Radiotherapy, together with the APPG for Health and all the nine APPGs related to cancer, has been working tirelessly since the start of the pandemic to gather independent published data and frontline staff feedback on the true scale of the disruption to cancer services and the unfolding and escalating cancer crisis. To address the current status and provide solutions, the APPGs held a cancer summit in May 2021 and launched aCatch Up With Cancer – The Way forwarddocument of solutions gathered from the cancer community. This submission to the Health and Social Care Inquiry builds on that summary and calls for an end to the perceived denial about the scale of the cancer crisis and for the Government to urgently take responsibility for solving it.

 

Background to the current cancer crisis and challenges

Cancer is one of the leading causes of death in England; around 1,000 people are diagnosed with cancer, and around 450 die from the disease every day. An ageing and growing population means the incidence of cancer continues to rise. By 2035, the number of people diagnosed with cancer in England is expected to reach over half a million per year, an increase of 40% since 2015.

Efforts to improve cancer outcome/survival and reduce inequalities in NHS care in England have been ongoing since the Calman-Hine report in 1995. Much progress has been made in our principles for cancer care and the clinical organisation of services and underpinning national support. These include: i) the introduction of specialist services, national guidelines/quality measures/targets, ii) the recognition of urgency of treatment and the cancer treatment pathway, iii) the integration of the charity sector in providing services and resources, iv) the increased use of large clinical trials, v) the introduction of new diagnostics and treatment, and vi) and various key public health awareness messages etc. However, policy development and implementation have taken place against a backdrop of multiple NHS re-organisational changes with the resultant tensions, conflicts, and delays as well as what most see as inadequate investment to keep up with costs and the increasing number of patients diagnosed with cancer. The NHS Long Term Plan published in January 2019 aimed to increase cancer survival by increasing the percentage of patients diagnosed with early-stage disease to 75%, thereby increasing the number of patients who are curable.

However, all has not gone well. The baseline in 2019 was far worse than advertised; at the beginning of 2020 going into the pandemic, 25 years after Calman-Hine, international data showed the UK 5-year survival rates for nearly all cancers were amongst the lowest in all G7 and EU15 countries. The COVID pandemic then dealt a body blow to cancer services with disruptions to all the cancer pathways (GP, diagnosis, multiple treatment, follow up, end of life care), exposure of the cumulative underlying deficiencies, caused bottle necks and delays, and the build- up of a huge backlog over the last 18 months, which has left frontline staff exhausted. Academic estimates suggest this disruption has set back UK survival to where it was 10-15 years ago[vi]. The cancer backlog has increased cancer inequalities; the reduction in the number of two week wait referrals and first treatments for all cancer has been largest for those living in poorer areas. Yet cancer has all but slipped off the radar in assessments of the effects of COVID and the post-COVID world; its catch up has even been bundled in with the elective backlog. Cancer treatment is time critical to save lives and not elective!

 

Questions posed in the committee terms of reference

What is the anticipated size of the backlog and pent-up demand from patients for cancer care?

 

Compared with the real time COVID statistics, sadly the size of the cancer backlog is not published and not really known. This lack of data significantly impairs planning a national cancer recover strategy and modelling options to save as many lives as possible. In the first four months of the pandemic, before the second and third lockdowns, there were anticipated to be likely 35,000 lost lives and 60,000 lost lives years from just four cancer types, with the economic loss per cancer patient more than for COVID patient loss.

 

NHS figures suggested that the COVID induced cancer backlog in November 2020 already stood at 40,000. Since then, there has been the 2021 lockdown with another drop in cancer referrals and treatment through December2020-April 2021. Cancer departments have had to deploy staff to COVID wards during each of the lockdowns, and at least one large cancer centre has already this summer told their cancer department to plan to make 10% of their staff available for COVID patients in winter 2021.

 

It is beyond doubt that the cancer backlog will have continued to grow since April 2020. As the backlog grows, more patients become incurable, often needing more treatment and survivals decrease, creating a vicious circle. Without catching up with cancer, this vicious circle can only be mitigated by those patients dying before they get to treatment (evidence for this is already sadly emerging in lung cancer-the second largest cancer incidence in the UK).

 

Often the backlog is talked about in terms of just the new cancer patients who are missing from the system and this figure has been estimated as 40,000 fewer people than normal starting cancer treatment last November 2020.[vii] Referrals of suspected cancer fell by 350,000 in March-August 2020 compared to 2019. However, the backlog is made up of patients at different stages of their disease. There are not only those who have not been referred by the 2-week pathway or screening services, but many cancer patients who have had incomplete treatment or delayed follow up. As a result, the true size of the backlog and pent-up demand could easily be 100,000 now. Worryingly, currently available data makes this hard to measure. Patients already in the NHS system, and therefore not likely recorded as being in the backlog under existing waiting times targets and measures, are reported to still be waiting for the next stage of their treatment. For example, definite surgery or radiotherapy for prostate cancer patients who are currently being delayed with hormone therapy.  The Charity Breast Cancer Now have highlighted delays to monitoring scans for secondary breast cancer patients and the fact that the pandemic has exacerbated waits for breast reconstructions after mastectomy. Patients have also contacted the #CatchUpWithCancer campaign to highlight longer than expected waits for stoma reversal surgery and were subsequently admitted to A&E with infection. Cancer Research UK’s Patient Experience Survey 2021 recorded 29% of those surveyed experienced delays, cancellations, or changes to their treatment and found that those cancer patients who experienced delays and cancellations, were waiting on average 13.4 weeks for tests and 13.5 weeks for treatment. Also 25% of cancer is not diagnosed via the 2-week wait or emergency pathway but diagnosed at routine appointments. If these routine outpatient clinics are not able to be prioritised, more cancer patients will be undiagnosed and present with more advanced disease. These cancers will be more costly and complicated to treat, leading more backlog and poorer patient outcomes.

 

Current figures, particularly the 62-day waiting times target or the 31-day target to treat, only tell us NHS staff are working incredibly hard to get those patients who are in the system and can get a diagnosis to complete the first treatment. This does not tell us how big the backlog is or how advanced the cancers have become while waiting, or who had died before they got into the system. The fact that 40,000 fewer new patients started cancer treatment, highlights the surge in cancer patients who will soon enter the NHS, not the overall level of demand. There is a huge bottle neck in diagnosis as well as treatment. Usually, 20% of cancer is diagnosed as emergency; this metric is much higher now particularly in bowel cancer, putting more pressure on emergency services.  Published data shows how survival is decreased with such emergency presentation and treatment. In the absence of coordinated NHS data, cancer charities and academic groups have been collecting data as best they can. We want, and need, to see the Government and devolved administrations, develop figures to quantify the cancer backlog.  They also need to understand the complexities involved, model best and worst-case scenarios and develop a data led strategy to catchup with cancer backed with investment to reverse this downward spiral.

 

What capacity is available within the NHS to deal with the current backlog? To what extent are the required resources in place, including the right number of staff with the right skills mix, to address the backlog?

The whole of the cancer pathway has been disrupted. Due to COVID procedures, capacity is now only a maximum of around 80%. However, there is also a workforce crisis. One recent survey reported that of 65% of responders said that either they themselves, or someone they knew, are sufficiently despondent to be thinking of leaving the profession[viii]. Cancer staff are exhausted. There is no cannot guarantee that they won’t be reallocated to COVID wards in the winter. The effects of the backlog are starting to emergeA bottleneck is showing in diagnostics (imaging and pathology) so just for now the subsequent treatments have not all breached capacity. Once the backlog does emerge for treatment, services will be overwhelmed. In cancer there is still some capacity in the private sector at the moment. There is no ringfenced funding to tackle the cancer backlog and no national plan. The NHSE cancer recovery plan initially “hoped” to get cancer services back to pre-pandemic levels by April 2021.  This has already slipped to April 2022 with the problem now simply devolved down to local Trusts without national coordination or any ringfenced investment. Estimates are that staff would need to be working at around 130% capacity to meet this target[ix].  This is simply not possible.  These current plans serve to trivialise the complexity of the herculean task to turn the cancer crisis round. These arrangements are far from the NHS leading us out of a major national crisis. The announcement of the £1 Billion to help the NHS recover is being allocated to all elective backlogs so its impact on cancer services is diluted and minimal (estimated at perhaps only £144 per patient).  A step change in cancer specific investment is required.  One recent survey carried out by Action Radiotherapy showed that 77% of staff surveyed disagreed or strongly disagreed that the Government response to the COVID-induced cancer backlog has been sufficient[x].

 

How much financial investment will be needed to tackle the backlog over the short, medium, and long-term; and how should such investment be distributed? To what extent is the financial investment received to date adequate to manage the backlog?

 

Economic cost of cancer

 

Over and above direct healthcare costs, cancer loses the UK economy an estimated £7.6 billion in costs associated with time off work and premature death.  Experts believe the backlog caused by the COVID disruption may cause up to an additional 35,000 unnecessary cancer patient deaths if no action is taken[xi]; this could add a further £1.6 billion in economic costs to the Treasury.[xii]

 

Before the COVID pandemic, the UK was at the bottom of the league of cancer survivals,[xiii] and now the UK cancer backlog caused by COVID is set to put back some cancer survival rates to where they were 15 years ago[xiv]For every unnecessary cancer death caused by the COVID pandemic disruption, 20 years of life is lost[xv]. This will therefore be a major economic cost to the Treasury. In simple terms, tragic and unnecessary loss of life aside, it will cost the country more not to put this right.

The UK currently spends only 5% of its healthcare budget on cancer[xvi].  Before Covid it was estimated that the UK needed an additional cancer spend of £2.1 billion a year to match the European average (we currently spend less as a percentage than countries like Spain and Slovenia)[xvii]. The current challenge for cancer is that the backlog is pressing and urgent but we already started from a point of catch up. Investment was already needed to catch the UK up to international standards. A choice about that investment is faced by policy makers and this needs to be properly communicated to the public. The economic case for curing cancer patients has never been in clearer focus and more urgent.

There can be no denying that the overall backlog will require a substantial investment in the NHS to recover. Within cancer a number of smart investments will be needed. The recent All-Party Parliamentary Group for Radiotherapy joint Cancer Summit (May 2021) calls for an end to the perceived denial about the scale of the cancer crisis and for the Government to urgently take responsibility for solving it. The report Catch up with Cancer-the way forward found a number of cost effective solutions from across the cancer community, medical colleges and frontline clinicians. Solutions were plentiful and effort needs to be focused on referral, diagnosis and treatment with speed and capacity the key elements. The recommendations of the report are:

 

How might the organisation and work of the NHS and care services be reformed in order to effectively deal with the backlog, in the short-term, medium-term, and long-term?

The pandemic served to expose all the areas in cancer which were shown not to be robust and needed a radical re-think including;

i)                     the fragile cancer pathway organisation held together with sticking plaster,

ii)                   the distortion of treatment priorities,

iii)                 the siloed organisation of the NHS and distortion of national networking,

iv)                 the lack of accountability,

v)                   the woeful IT infrastructure,

vi)                 out of date equipment,

vii)                the harmful bureaucracy,

viii)              perverse tariff structure which worsened treatment,

ix)                 the lack of real time transparent data,

x)                   decision making being in the hands of those who held the purse strings with insufficient inclusion of clinicians, specialists and data,

xi)                 and ultimately the lack of any real accountability.

We do not have to wait for ‘Silver Bullet’ new medical breakthroughs to improve cancer care in the UK. We just need a new plan, better organisation and ring fenced investment.

There are so many solutions available and yet there is no radical national plan to comprehensively capitalise on them. COVID demonstrated just what could be done with modern available technology in the pandemic and when obstructive bureaucracy was temporarily lifted.  Examples included:

There is so much more that is only just an investment and decision away. Many decisions such as those around the radiotherapy tariff could be solved with the flick of a pen and would allow clinicians to do so much more. There is a pressing need for proper investment in replacement of modern diagnostic and radiotherapy equipment which can diagnose and treat patients three times quicker (or comparable to three times the amount of staff) to increase capacity. AI for diagnosis and treatment would improve speed, quality, outcome and mitigate the immediate workforce crisis. There are huge benefits to bringing diagnosis and cancer treatments as close to home as possible. The new diagnostic hubs are absolutely the way forward as well as chemotherapy delivered at home, but so much more needs to be done. Radiotherapy can and should be delivered nearer to home. Setting radiotherapy free from some of the bureaucracy currently holding it back, combined with relatively modest investment, will deliver rapid improvements in treatment capacity and survivability.

Overall, we need to see new systems that are independently scrutinised, and outcome and quality data led. The cancer pathway is complex and vital.  We believe it requires a dedicated Minister to oversee its development. We will need an oversight commission and independent health services research programs providing strategic intelligence.

The COVID induced cancer backlog is a national health emergency, causing significant disruption to treatment and diagnosis. The pandemic harshly exposed the weaknesses in UK cancer services, broke the cancer pathway and is estimated to have set back cancer survival rates in the UK sadly to where they were 10-15 years ago. Two things need to happen:

  1. Catch Up With Cancer

Tackling the cancer backlog must be done quickly to prevent tens of thousands of avoidable deaths. A new data led proactive national cancer recovery plan is needed and must identify and address pre-pandemic weaknesses, with a particular focus on high tech potential solutions which are COVID safe, empower the workforce with more capacity and can rapidly bring down waiting lists. Discussions about backlogs and healthcare pre-pandemic waiting lists must recognise that cancer is the most time critical and deadly of all the backlogs. Without urgent action the cancer backlog will only disappear as a result of patient dying. A CRUK survey in July 2021 Cancer Research UK’s Patient Experience Survey 2021. confirmed that 80% of cancer patients has reported that their care had been impacted in COVID with cancer patients who experienced delays and cancellations reported waiting on average 13.4 weeks for tests and 13.5 weeks for treatment; that is over 27 weeks wait for cancer treatment! The Europeans have already commissioned a data led seven-point plan and their campaign “Time to Treat” focuses on fast recovery on top of their 2021 Europe Beating Cancer Plan. The UK needs a similar proactive initiative. Capacity needs to be increased using the independent sector and industry enabled to deliver their technology solutions. Crucially, it needs to be backed by investment. The announcement of the £1 Billion to help the NHS recover needs to be seen in context.  It is being allocated to all elective backlogs so its impact on cancer services is minimal (estimated at £144 per patient).  A step change in cancer specific investment is required. If we keep doing the same things as now, we will get the same poor outcome and never catch up with cancer.

  1. Create a new radical cancer plan to ensure the NHS long term cancer plan delivers the expected benefit and is COVID secure and fit for the technology age

The country needs, and deserves, an independent radical new national cancer plan for the post-COVID era which is data led and patient focused.  It should be focused on the future and what is right for patients. It needs to cut across current bureaucracy, be technology led and should aim to not just get us back to where we were pre-COVID (the bottom of the league) but build a world class cancer service delivering outcomes that are among the best in the world. A step change in investment is needed, but efficiencies IT solutions will change in priorities will reinforce how cost effective such an investment is. If the necessary investment cannot be found, then the public need to be told why as a leading high-income country, we are unable to prioritise saving cancer patient’s lives. A national technology led plan needs to be supported by local implementation. We need to recognise the enabling technology which has swept in over the last few years, the complexity of cancer care and the speed of response needed. We will need an oversight commission and independent health services research providing strategic intelligence backed by implementation science to ensure an evidenced based comprehensive new national cancer plan which is accountable and delivers improved cancer outcomes.

  1. Invest now in radiotherapy services and consider integrating with some of the new diagnostic hubs

Investment in radiotherapy has the potential to bring down waiting lists, provide a COVID safe treatment alternative to surgery and chemotherapy in some cases, and will be a key element of efforts to bring down the treatment backlog as patients present. Radiotherapy is a treatment used to destroy cancer cells through aiming high-energy radiation at the tumour. Internationally, it has emerged as one of the most COVID secure cancer treatments, able to substitute for surgery. Modern radiotherapy is accurate to within millimetres, limiting damage to healthy cells around the cancer. It is extremely effective and is needed in over 50% of cancer treatments and involved in 40% of cures. 1 in 4 people will need radiotherapy in their lifetime and it is estimated that by simply allowing patients access to the radiotherapy they need will worldwide save 1million lives a year. However, the value of radiotherapy and the technological revolution which has accelerated techniques during COVID has been largely unrecognised by Government Ministers and NHS England.  There is a lack of provision of radiotherapy in the UK with only 27-37% of cancer patients receiving it against an international recommendation of 50-60%. During the COVID pandemic cancer treatments were triaged by curative potential so radiotherapy became more important.

The APPG recommendation for radiotherapy in January 2020 APPG-RT Call for Action 2020, at the start of the pandemic, was informed by the APPG-RT Inquiry 2019 and at the start of the pandemic led to the APPG -RT mini inquiry 2020. The APPG has presented a coherent six-point plan APPG-RT 6-point Covid-recovery plan to transform radiotherapy now, and long into the post-COVID future. After a further year of disruption and growing cancer backlog this has now been updated within the 2021 updated radiotherapy manifesto, being launched on 15 September 2021.

Specifically, it calls for:

  1. Reprioritisation of radiotherapy within the cancer pathway ensuring the UK meets international standards of radiotherapy access of 50-60% of cancer patients.
  2. Levelling up of access to radiotherapy so that new networked treatment delivery centres to bring treatment closer to home and avoid long travel for the 3.5 million of the population who live further away than 45 minutes recommended travel time.
  3. Invest in IT and technology solutions: work with industry and modernise radiotherapy with use of cutting-edge IT technology software solutions, AI and Machine learning products to help improve quality, access, and alleviate workforce issues. It is the only way to rapidly increase work capacity, streamline services, and share expertise.
  4. Replace ageing radiotherapy machines: create a ring-fenced central funding pot to replace machines over 10 years old to secure fast and uninterrupted patient treatment. This will address the £140 million backlog in machine replacement costs and secure the future; replacing a machine only works out at around £400 per patient.
  5. Increase the workforce by funding the 10-20% increase in the professionals needed to run the service. 
  6. Simultaneously clear the cancer backlog as well as planning a new radical UK radiotherapy service fit for purpose and pandemic resistant
  7. Appoint a radiotherapy minister to form a national task force of medical and industry professionals to ensure all available solutions already used in other countries are rapidly introduced in the UK.  This could involve modernising the service with technology already available by:

 

Other counties have already pivoted their radiotherapy (Spain and Italy announcing a €0.5Bn investment in radiotherapy equipment). New technology will save workforce time; new machines cost only around £400 per patient and are 99% reliable with little downtime. Remote planning and networked interactions allow radiotherapy delivery to take place out of mainstream hospitals and nearer patients and is already delivered in local NHS and private centres and could be considered for integration into some of the new diagnostic hubs.  This has the potential to allow same day cancer treatment; some lung cancer patients can now be cured with a 20-minute outpatient non-invasive radiotherapy treatment. There could be a transformational cancer care delivery model which will improve survival and save money.

 

Conclusions

The pandemic had a devastating impact on our health services and as a result we are faced with huge backlogs and pent-up demand in the NHS. Of all the backlogs, cancer is the most deadly. Cancer must be considered separately from the elective backlog. The crisis has exposed the weaknesses in our cancer services and the reasons why we were at the bottom of the pre-pandemic cancer league tables. It is widely accepted that, without a radical change, cancer services will be set back 10-15 years. This cannot be allowed to happen. The result will be tens of thousands of patients lost who could have been saved. We don’t need a medical breakthrough ‘Silver Bullet’ to solve this crisis. We need the right prioritisation, funding, and planning to act. There is an opportunity in modern digital technologies and capacity building tools to underpin a radical new cancer strategy that will build the capacity to tackle this crisis and leap frog the UK to the level of service patients deserve. This is the moment to be bold and honest. The technology is available, and the frontline staff have the passion and dedication to play their part.  In particular, areas like radiotherapy are particularly able to contribute even more with the right investment. What is needed to solve the COVID induced cancer crisis and catch up to international standards if the political will, bravery, wisdom and vision, up-front investment and a fit for purpose bespoke underpinning organisation.

References


[i] https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(21)00148-0/fulltext

[ii] https://nhsproviders.org/media/692003/a-reckoning-continuing-cost-of-covid-19.pdf

[iii] The Covid effect: clearing the cancer backlog - Raconteur

[iv] How many new cancer patients in Europe will require radiotherapy by 2025? An ESTRO-HERO analysis. Borras et al Radiother Oncol 2016; 119 (1): 5-11.

[v] Cancer treatment statistics | Cancer Research UK

[vi] State of health and care: The NHS Long Term Plan after Covid-19 | IPPR

[vii] The Lancet O. COVID-19 and cancer: 1 year on. The Lancet Oncology 2021; 22(4): 411.

[viii] Flash Survey May 2021

[ix]v. The Covid effect: clearing the cancer backlog - Raconteur

[x] Flash Survey May 2021

[xi] 6 July 2020 https://www.bbc.co.uk/iplayer/episode/m000kqzv/panorama-britains-cancer-crisis

[xii] Appendix see below

[xiii] Arnold M, Rutherford MJ, Bardot A, Ferlay J, Andersson TML, Myklebust TA, et al. Progress in cancer survival, mortality, and incidence in seven high-income countries 1995-2014 (ICBP SURVMARK-2): a population-based study. Lancet Oncol. 2019;20(11):1493-505.

[xiv] https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30392-2/fulltext

[xv] Bloomberg.com/news/articles/2020-07-20

[xvi] https://www.abpi.org.uk/media/3459/report-access-cancer-medicines-in-europe-revisited-uk-perspective.pdf

[xvii] https://demos.co.uk/wp-content/uploads/2020/01/Cancer-Costs-FINAL-Jan-2020.pdf

 

Appendix

CRUK estimate over 165,000 people die of cancer each year in the UK (1 in 4 of all UK deaths) including 20% juts over 33,000 aged between 15-64 (https://www.cancerresearchuk.org/health-professional/cancer-statistics/mortality#heading-Two). If the economic cost of 165,000 patients is £7.6bn, the cost of 35,000 will be £1.6bn.

 

Sept 2021