The UK Government’s proposal to roll England’s long-term plan for cancer into one strategy covering all major conditions is "a catastrophic decision that will cost lives", warn experts writing in The BMJ.
The NHS Long-Term Cancer Plan was published in 2019 with the plan's endpoint being in 2028. It set out an ambition that by the end date the proportion of cancers diagnosed at stages 1 and 2 would rise from around half now to three-quarters of cancer patients. "Achieving this will mean that, from 2028, 55,000 more people each year will survive their cancer for at least 5 years after diagnosis," the Department for Health and Social Care (DHSC) proclaimed.
The Long-Term Plan outlined a number of commitments to achieve this target, explained the DHSC, and included raising "greater awareness" of symptoms of cancer, "lowering the threshold" for referral by GPs, "accelerating access" to diagnosis and treatment, and "maximising" the number of cancers that are identified through screening. It also included expanding the use of genomic testing to deliver personalised and risk stratified screening, and beginning to test the family members of cancer patients where they might be at increased risk of cancer.
Then last year, a new cancer plan was outlined, the 10-Year Cancer Plan with an end goal of 2032, which was described as an opportunity to:
- Take stock of the innovations and improvements that the pandemic had helped to accelerate
- Identify what additional interventions and innovations might be adopted
- Look beyond the end date for the Long-Term Plan to shape and improve cancer services into the next decade
However, the Health Secretary, Mr Steve Barclay, recently announced a plan to "bring things together" with a new Major Conditions Strategy, an announcement that created a divide in opinion amongst major condition stakeholders.
The strategy, which will be developed in "consultation with NHS England and colleagues across Government", will combine existing Government commitments on mental health, cancer, dementia, and health disparities "into a single, powerful strategy", Mr Barclay extolled, with the goal of tackling major conditions – namely cancers, cardiovascular diseases, chronic respiratory diseases, dementia, mental ill health, and musculoskeletal disorders – that lead to people spending "more years in ill health".
To date, the health and care system had been "built in silos", often focused on specific diseases or organs, criticised Mr Barclay. The new strategy would redirect the Government's health course by shifting away from the current approach to integrated, whole-person care, with the aim of alleviating pressure on the health system, increasing healthy life expectancy, and reducing ill-health related labour market inactivity, he stressed.
Low Priority Given to Cancer 'Astonishing'
Writing in the BMJ, Professor Richard Sullivan, Institute of Cancer Policy, King’s College London, and Dr Ajay Aggarwal, London School of Hygiene & Tropical Medicine, highlighted that cancer is the "single largest cause of death" in the UK and one of the most serious healthcare "burdens" for societies.
They exclaimed that the decision to roll major health conditions into one plan "jettisons decades of global consensus that, to deliver affordable, equitable and high-quality cancer care, dedicated cancer plans are required".
The English NHS, for example, has 60 radiation therapy centres, 50 prostate cancer surgery centres, 163 bowel cancer centres, and 176 chemotherapy units, not including the specialised diagnostics that are only available at selected hospitals, they pointed out.
"Delivering effective and equitable care requires the coordination of an extensive array of interlocking cancer specific pathways," they emphasised.
The strategic direction and coordination of all these services requires both a cancer specific plan and an array of operational tools to deal with issues of centralisation and variation in practice to avoid inequalities in access and outcomes, they advised. Cancer is also extremely costly for health systems, patients, and wider society, they pointed out.
The current plan to subsume England’s long-term plan for cancer into a generic chronic disease strategy "is totally inconsistent with internationally accepted benchmarks set by the World Health Organization (WHO) and followed by all other member states," they argued.
Asked to comment by Medscape New UK, Professor Karol Sikora, consultant oncologist and former director of the WHO Cancer Programme, said: "It's astonishing that this Government is giving such a low priority to cancer. Most countries have a defined cancer plan tailored to their resources."
Cancer Research UK's chief executive, Michelle Mitchell pointed out that evidence had shown "unequivocally" that countries that "enjoy the best outcomes" benefit from disease-specific strategies.
Cancer Long-Term Plan More Critical Than Ever
The editorial's authors acknowledged the need to "strengthen" primary and social care, along with ensuring "parity of attention" to other chronic diseases but said "subsuming cancer into an overall non-communicable disease agenda simply signals that cancer is no longer a political priority or reflects a government not willing to deal with its complexity and escalating costs".
The discarding of the Long-Term Cancer Plan was "hugely disappointing and a major downgrade from what was promised", said Gemma Peters, chief executive at Macmillan Cancer Support. A "watered-down plan", she said, "risks failing to focus on the problem at hand", and urged ministers not to "further dilute" their commitment to cancer.
Ms Mitchell also expressed disappointment with the announcement, particularly that the Government had "opted to publish a 'catch-all' major conditions strategy rather than the ambitious 10-year cancer plan they had originally promised".
"Whilst some of the challenges facing cancer services affect the whole NHS, there are life threatening problems in cancer care that require special attention. It's vital that the specific issues facing cancer care aren't neglected," beseeched Ms Peters.
A long-term plan for cancer is more critical than ever after over a decade of declining funding for cancer services compounded by the COVID-19 pandemic, the authors exclaimed. "Such a plan needs to deal with the post-pandemic realities of backlogs for care, sicker patients with more advanced cancers, and huge deficits in cancer specific workforce," they urged.
With reference to four specialist oncology treatment centres in England and Wales being mothballed as they lay idle for 7 months, despite the NHS struggling to catch up on cancer treatment backlogs, Professor Sikora had recently tweeted: "Having four world-class cancer centres empty during the worst cancer crisis of my lifetime is scandalous."
The authors noted that national cancer audits in England and Wales report wide variations in access to the most effective cancer treatments, and in quality of care.
These quality gaps "reflect systemic and structural problems across multiple and complex cancer pathways that can only be tackled by an evidence driven dedicated cancer control plan that considers the key determinants of cancer outcomes - in particular, workforce, infrastructure, quality assurance, and health service delivery", they stressed.
'Action Not Platitudes' Needed
Mr Barclay had previously explained that the Government's change in direction was about "shifting our model towards preserving good health, and the early detection and treatment of diseases". To achieve this, he said, "the workforce model needs to adapt, reflecting that the NHS is caring for patients with increasingly complex needs and with multiple long-term conditions".
Greater emphasis on generalist medical skills to complement existing deep specialist expertise in the NHS was needed, Mr Barclay pointed out, supporting clinical professionals to "heal with whole-person care".
Professor Sikora challenged that: "Whilst proposing a long-term strategic plan for a range of non-communicable diseases is laudable, the very fact that Britain's languishes at the bottom of European cancer league tables in terms of quality and outcomes means this disease needs the highest priority. Speedier diagnosis and treatment is the key."
Cancer Research UK's executive director of policy and information, Dr Ian Walker, said: "Cancer survival in the UK lags behind similar countries, and patients are facing unacceptable waits for cancer diagnosis and life-saving treatment. With a growing number of people expected to be diagnosed with cancer in the years to come, the task ahead is huge."
Ms Peters alerted that people living with cancer "can't afford further delays".
Responding to the editorial, Prof Sikora said: "This hard hitting commentary must trigger a total rethink." However, he feared "we will just get bland words about how millions more are being spent on diagnosis and treatment facilities from the anonymous 'oncocrats' deep in the bureaucracy of the NHS".
The authors cautioned that without a dedicated long-term plan for cancer, services will "fracture, costs will increase, inequalities widen, and patients will experience even greater delays leading directly to lost lives".
"The UK Government must take a long-term approach to transforming cancer care, and give it the attention it deserves," said Dr Walker.
"It's time for a radical change for the sake of all future cancer patients," added Prof Sikora. "We need action not platitudes."
Professor Karol Sikora contributes regularly to Medscape UK