The Green Room event series

The cancer lottery - what will it take to harness innovation and spark a revolution in cancer care?

On the eve of the Government launching the 10 Year Health Plan for the NHS, this discussion brought together panellists from across the NHS, business and the third sector to discuss the role of innovation in addressing variation in cancer treatment and care. So, what did we discuss?

The challenges faced by the health system

With incidence of cancer going up at about 3% year on year as our population ages, and referrals into the NHS for investigation for possible cancer up 10%, the result is that we have a system under immense pressure. Last year we saw 3 million people referred for investigation of possible cancer, about 1/4 of all GP referrals into secondary care – that is, into the hospital system. Innovations in diagnosis, treatment and care can significantly improve outcomes for patients while better supporting the healthcare system to meet this challenge. But how do we harness that potential and ensure it delivers for everyone?

The 10 Year Health Plan for the NHS

Launching on 3 July, the 10 Year Health Plan for the NHS includes initiatives such as the roll out so-called ‘innovation passports’ in the NHS. That means that something which is proved to work well in one particular place – where we've done the evaluation, shown it saves the NHS time, saves the NHS money, and helps patients to have a better experience – doesn't have reapply for the same permissions everywhere in the country. Once we’ve done it once, we can take it everywhere – and that could have a real impact on the variation people experience in diagnosis, treatment and care.

Variation is real, but it’s not a ‘lottery’

People can experience variation based on where they live: recent figures show that in some areas of England, 15% of those with bowel cancer were having robotic surgery, while in others it was as low as 2%. Or it can be based on who you are: it’s reported that 1 in 3 people from an ethnic minority need at least 3 interactions with their GP before being diagnosed with cancer – almost double the UK average. But ‘cancer lottery’ infers that it's random. It’s not. It’s often down to systemic issues.

Sometimes long-accepted practice can disadvantage certain groups

It has only recently been agreed that men don't have to have a digital rectal examination as part of their prostate cancer assessment, because that discriminated against certain groups and cultures that didn't find that an acceptable thing for a man to come forward for a health check. But that has taken significant time, and campaigning for the change that was needed.

Clinical entrepreneurs are coming up with game-changing solutions

Dr Saif Ahmad at Addenbrookes Hospital had seen the data of around 50,000 admissions each year in the NHS for people with neutropenic sepsis (where for people on chemotherapy, they lose white blood cells and their ability to fight infection). And yet there was no point-of-care diagnostic for white cell count, meaning that on average, people were presenting up to three days after symptoms had started. Saif developed Neutrocheck, a finger-prick blood test that tells you if your white counts are normal or elevated. But getting investment is really hard, and that’s where Macmillan stepped in. -with the Impact Investment Fund.

Equitable access to clinical trials is key to tackling variation in patients’ experience

Black people are significantly under-represented in clinical trials, making disparities even worse. That’s down to many factors – from whether you’re given the opportunity to participate in a trial, to whether you trust that staff would listen to you if you joined a trial and then had concerns. We heard from one panellist that her mum wasn’t offered the opportunity to participate in a trial, and when she proactively asked, was dismissed and told it would be too complex to understand. We have to think about trial diversity right from the beginning – because innovation without equity and inclusion is just plain exclusion.

Partnership has to be two-way and long term

Too often, under-represented groups are asked to participate either too late in the development of an innovation, or in a transactional way. We hear people say, “You can’t just come to us when you need something from us”. Meaningful power-sharing and trust has to be built over the long-term. But together – working between the NHS, life sciences, marginalised communities and the third sector as a whole – innovation has huge potential to address the inequities we see, and improve the experience of cancer diagnosis, treatment and care for all.

The Frontier Funders Club is a fundraising product aiming to raise £2 million over 2 years. The money will fund partnerships and investments in start-ups and small businesses at the forefront of developing groundbreaking innovations in cancer care. The purpose of the Frontier Funders Club will be to:

• Raise money to fund partnerships and investments in innovations that people experiencing cancer need (each member joining the Club will give £50,000).
• Connect donors to innovators, providing the opportunity for them to use their skills and experience to support the development of groundbreaking innovations
• Build a community of supporters passionate about innovation who can work with us to drive transformative change for people with cancer.

What will the money be spent on?

The money raised will be invested in developing, testing, and rolling out new products and diagnostic tools for people with cancer. We estimate that £2 million could fund the next 10 groundbreaking innovations in cancer.

“I can absolutely assure you, the level of rigor and professionalism far outstrips my prior employer, which is one of the most commonly known and most active VC funds in Europe. So if it's a question around professionalism and competence, there is absolutely no doubt.”

Joe Stringer, venture capital investor & former Head of Healthtech, Octopus Ventures

If you are interested in joining our Frontier Funders Club, or would like to find out more about Macmillan’s innovation work, please email us at philanthropyenquiries@macmillan.org.uk.

We know that some people want to do their own thing, and we’re lucky that people organise all sorts of wonderful events to support Macmillan.