Time for the next Government to take cancer seriously

The COVID-19 pandemic was the straw that broke the cancer back. It illuminated and accelerated all the structural, organisational, and fiscal deficits in cancer services and systems across all the UK’s Devolved Nations. Cancer care was ‘burning hot’ before the pandemic.

A rapid succession of dramatic changes to the NHS choice through outsourcing in the 1990s; the creation of autonomous Foundation Trusts in 2003; the creation of 200+ clinical commissioning groups from 2012 onwards; and in 2022 the re-structuring into 42 Integrated Care boards all took their toll.

Adjusting for inflation, planned total healthcare spending has also decreased by £1.5bn (-0.8%) in 2024. Healthcare spending in England increased by only 0.1% a year on average in real terms over the last decade. This is well below the average (2%) seen in the decade preceding and the historical average of 4% in England since 1980. Since 2010 expenditure on health and cancer has been, at the very best, flat-lining.

The social determinants of cancer

Austerity has not only reduced cancer services capacity and capability from primary care through to palliative services but its effects on the social determinants of cancer have been even more insidious.

Why is this important?

It is these determinants, coupled with diagnostic capacity, that determine whether a patient presents with earlier-stage disease, the level of pro-cancer risk factor exposure, and even their ability to complete treatment.

Although overall cancer death rates have decreased in all districts of England, the reductions were unequal, with the largest decline almost five times that of the smallest. Some of the largest inequalities across districts … were observed for cancers strongly associated with behavioral and environmental risk factors i.e. social determinants.

Sir Michael Marmot’s ten-year review in 2020 painted a bleak picture. People can expect to spend more of their lives in poor health; Improvements to life expectancy have stalled and declined for women in the most deprived 10% of areas and the health gap has grown between wealthy and deprived areas. What all this says is that for the next government addressing the social determinants, social care, including a revitalised primary care system is as important as pouring money into secondary and tertiary cancer care.

Why a national cancer control plan is needed

Since January 2023, England has become the only high-income country to jettison a national cancer control plan in favour of a watered-down, generic major condition strategy. Whilst these two approaches share some commonality, not least the need to deliver cancer care to populations that increasingly have other conditions such as diabetes, heart disease, or dementia, the idea that a major condition strategy can substitute a proper cancer plan flies in the face of every piece of evidence we have.

The complexity of patient pathways to diagnosis and treatment, the complexity of treatments, and the structural and organisational complexity all speak to the absolute need for a dedicated National Cancer Control Plan. In parallel, the loss of the National Cancer Research Institute (NCRI) was also a regressive step.

The UK needs critical oversight, scrutiny, and strategic planning across all the major philanthropic and government funding routes for cancer research. As a country we have become too myopic when it comes to research, choosing to focus almost entirely on discovery science, cancer drugs, and high-end medical technology with little consideration for the societal needs for implementation, health services, research into palliative care or surgery. The UK also needs refresh in it’s engagement with European and global cancer. Only a new NCRI-like body can create the right strategic direction for the UK as a whole.

Complex care for complex patients

There has been, rightly, a significant focus on early detection with major strides in trying to address diagnostic capacity through the creation of early diagnostic centers. This needs to continue but the wider systemic issues of delivering more complex care to more complex patients that is both equitable and affordable to the UK economy needs fresh eyes.

Better cancer intelligence is key; to building on the successful model of National Cancer Audits which should be UK-wide, and expanded. Patients cannot ‘shop around’ they need proper, rapid pathways to diagnosis and treatment. Too many delays are due to intrinsic structural and organizational issues. Technology is also not the panacea that people think. Workforce capacity has to remain front and central. There are ready-made plans already developed which, given the right funding and political support, will deliver. But in parallel the deficits in infrastructure from radiotherapy to the availability of dedicated operating theatres for cancer surgery need urgent addressing in the medium term. It’s not sufficient to accept the ‘business as usual’ approach. The UK has outstanding clinical expertise which needs to be brought into the integrated planning that a new National Cancer Control Plan will require.

Better patient outcomes and more equitable and affordable cancer care cannot be addressed in isolation. It will not be enough to have a revolution in national cancer control. Cancer reflects all the strengths and weaknesses of health systems. Much of the cancer care we deliver is intimately linked to and dependent on the wider integrity of the NHS. This needs serious attention; proper sustainable long-term investment focused on workforce and basic infrastructure, the integration of social and hospital care, and much more intelligent governance of services and systems to improve patient pathways.