Cancer Reform Strategy

Health secretary Alan Johnson has launched a comprehensive five-year plan to further improve NHS cancer services. In the biggest review of cancer services since the Cancer Plan of 2000, the NHS Cancer Reform Strategy contains a wide-ranging package of measures to tackle cancer and improve patient care. Supported by an investment of £370million by 2010, the Cancer Strategy aims to transform existing cancer care from prevention and diagnoses, through to treatment and aftercare and build a world-class cancer service for NHS patients in England.

NHE asked four cancer charities for their views

Harpal Kumar, chief executive, Cancer Research UK

The government’s Cancer Reform Strategy will have a significant impact on people with cancer and, if fully implemented, will save hundreds of lives.

Cancer is the biggest cause of death in the UK and more than one in three people will develop the disease at some point in their lives. Each day around 800 people across the UK learn of a cancer diagnosis for the first time.

The £130 million investment in radiotherapy services is especially welcome. Cancer Research UK has campaigned hard for the government to significantly increase the UK’s investment in radiotherapy capacity as these vital life-saving services offer the possibility of improving survival rates across the country.

I am extremely pleased with the increased focus on prevention. The announcement that further action on sunbeds is being considered is crucial because melanoma is one of the fastest rising cancers in the UK.

But still, smoking remains the single biggest preventable cause of cancer so the commitment to go further on tobacco regulation I applaud. The fact is that half of all lifetime smokers will die from cancer or another smoking-related illness. We must try to stop young people getting hooked on tobacco. Smoke free legislation and the increase in age of sale are important steps, but still a child can be marketed to at point of sale and tobacco vending machines offer easy access to cigarettes. Therefore regulation of cigarettes is a priority, together with helping more people give up smoking.

We are also very encouraged that the time between receiving a cancer diagnosis and completing treatment is to be speeded up, not just for the first treatment, but for all stages of cancer treatment. This step, which will require considerable investment, will maximise survival chances and reduce anxiety for patients.

Finally, we welcome the commitment to ensuring that all cancer drugs will be assessed by NICE as soon as they are licensed. This will help put an end to the current situation where patients are left in limbo waiting many months, or even years, to find out if new treatments are to become available on the NHS.

Cancer Research UK was one of the many expert groups involved in developing the strategy so we look forward to working with the NHS to deliver these recommendations. It’s vital that these proposals are followed through and the required investment is made by the government if we’re to become among the best in the world at beating cancer.

Joanne Rule, chief executive, Cancerbackup

Information is at the heart of the government’s Cancer Reform Strategy. Being informed improves and empowers people’s lives. It’s a high patient priority but until recently has been seen as a nice-to-have. The CRS challenges commissioners and providers to ensure that patients receive high quality information at each step in the care pathway. Working in partnership with Cancer Research UK, Macmillan Cancer Support and the NHS, Cancerbackup will help to implement information prescriptions by providing high quality content which can be put together with local and personal information. Currently about 50% of information is locally produced, much of it without the benefit of expert input and quality assurance. The Cancer Reform Strategy envisages face-to-face communication with your healthcare professional supported by excellent written information.

The strategy also emphasises access to information about outcomes. In future we will all be able to access information about the performance of our cancer services, enabling us to make informed choices based on what matters to us most.

All of this will be underpinned by annual surveys on patients’ experience which can be used locally to drive service improvements.

Cancerbackup nurses are often asked “what can I expect?” by people who want to know how long they have to wait. I think it’s crucially important that the strategy contains national standards on waiting times. Throughout the strategy there is an emphasis on world class commissioning and the role of PCTs. But when it comes to cancer, people also want national norms – it makes them feel safer and helps to remove some of the fear and uncertainty of cancer. That’s why we welcome the pledge that no patient should wait more than 31 days for treatment and the roll out of the 62 day pathway to cover everyone with a cancer diagnosis.

By making the 31 day wait for treatment a fully comprehensive pledge, PCTs across the country will have to focus on bringing improvements to radiotherapy services. The single biggest service concern of people ringing our helpline is from those worried about delays and long waits for radiotherapy. A shortage of machinery and radiographers, combined with the need for greater efficiency, has created a longstanding problem that must be solved if we are to provide world class cancer care.

Cancer is not just about diagnosis and treatment, so it’s right that the strategy has placed new emphasis on survivorship. With earlier diagnosis and advances in treatment there are more and more people of working age living with cancer. Cancerbackup produces information for both employees and employers on dealing with cancer in the workplace and we welcome the government’s recommendation that commissioners should make sure that this kind of information is made available to patients as soon as they are diagnosed.

Implementation is the key to success for the Cancer Reform Strategy which is why we have particularly welcomed the government’s commitment to an annual progress report. As a country we have a duty to hold ourselves to account, to ensure that people receive the high standards of care they expect and deserve.

Ciarán Devane, chief executive, Macmillan Cancer Support

Two years ago Macmillan started talking publicly about the need for a new national cancer plan for England.

We liked the first plan with its focus on saving more lives. But when we talked with most cancer patients surviving wasn’t their only concern – they also worried about the life they, and those around them, would lead after their life changing experience.

Convincing some that we needed a new plan initially proved difficult. “You can’t just abandon a 10 year plan after five years!” was the standard retort. “You’ve already got a plan – you’ll have to wait until the other diseases have had their first one before you get a second” was another.

But we never wanted to throw away the first plan. We certainly never saw a second plan as an admission of failure. The Cancer Reform Strategy launched on 3 rd December is a recognition of success. More people are living longer and they have higher expectations – that’s a good thing!

The CRS provides us with the opportunity to bring about a step change in the delivery of cancer care. The many hundreds of stakeholders who worked on its development are to be commended. Macmillan can only hope the innovative ideas set out in it – such as using patient experience surveys to build quality into services – are an exemplar for other diseases and Lord Darzi’s Next Stage Review.

We’re most excited about the announcement of a National Cancer Survivorship Initiative to help people living with and after cancer to deal with the many consequences of the disease. We’re looking forward to playing our part in making the initiative a reality.

It is rare for a government health launch to be met with near universal approval. The CRS will have Macmillan’s wholehearted support for the next five years. It deserves the support of everyone who wants to see world class cancer services in England by 2012. We want to work in partnership with the government and the NHS to make sure the strategy is implemented effectively. We may need a third cancer plan after that but we really need the second one first.

Dr Teresa Tate, medical adviser, Marie Curie Cancer Care

Marie Curie Cancer Care welcomes the government’s announcement of the Cancer Reform Strategy with its strong focus on prevention, early diagnosis and living with and beyond cancer. However it remains a fact that nearly a quarter of people with cancer will die of their disease, reinforcing the need for high quality, well coordinated care at the end of life.

The Cancer Reform Strategy cites the Marie Curie Delivering Choice Programme as an example of good practice in end of life care, but we are particularly anxious to ensure that the Cancer Reform Strategy and the awaited End of Life Care Strategy are seamlessly joined to work together for the benefit of patients.

Around 125,000 people die of cancer every year in England, with a large proportion currently having no access to specialist palliative care and little choice over their place of death. As the size of the elderly population increases over the next few decades, the number of people needing palliative care is expected to increase dramatically.

Studies have shown that the majority of people wish to be cared for and to die at home. However, in practice, only one in five patients die at home and the majority die in hospitals.

Marie Curie Cancer Care is working to double the number of terminally ill people able to die at home, and one of the ways it hopes to achieve this is through its Delivering Choice Programme.

Emerging findings from the pilot Marie Curie Delivering Choice project in Lincolnshire have shown that, since its inception, not only have 25 per cent more patients been given the choice of where they would like to die, but the total cost for end of life care had decreased by eight per cent.

The Cancer Reform Strategy is a great step forward for cancer patients and by linking it with the End of Life Care Strategy we will be able to improve the care of cancer patients from the beginning to the end of the journey.