The Cancer Strategy in England

NHS England’s National Cancer Transformation Board has now published its implementation plan for the Independent Cancer Taskforce’s Cancer Strategy for England: Achieving World-Class Cancer Outcomes (the Strategy). This sets out a plan to deliver the recommendations within the Strategy and is accompanied by a commitment to a £200 million cancer transformation fund.

Key reports:

What is the cancer strategy in England?

Macmillan was part of an Independent Taskforce created to improve survival rates and experiences of people affected by cancer. The Taskforce developed a new report called Achieving world-class cancer outcomes - A strategy for England 2015-2020, published in July 2015. This sets out a proposed new five-year Cancer Strategy for England.

How will it be implemented?

NHS England’s National Cancer Transformation Board published its implementation plan for the Strategy in May 2016. This sets out a plan to deliver its recommendations and is accompanied by a commitment to a £200 million cancer transformation fund.

Macmillan is pleased that both the Strategy and the implementation plan cover the whole cancer patient pathway, and put significant emphasis on improving patient experience and support for people with the long-term side effects of treatment. It is also essential that Cancer Alliances [PDF] are established as a crucial first step in implementing the strategy across the country.

Next steps

We have an excellent blueprint for transforming cancer services in the shape of the cancer strategy, and as of 2016 we also now have the funding committed. Good progress has been made, but as Macmillan’s Warning Signs report [PDF] shows, we cannot be complacent. This investment must now be ring fenced so that these plans become a reality. 

It is also a difficult time to try to achieve transformational change when the NHS is struggling to see everyone who needs treatment. The government and NHS must act decisively and make sure that cancer services are equipped to meet the considerable challenge cancer poses the health service in the immediate future.

Life after cancer treatment

The Strategy called for an acceleration in the commissioning and provision of services to support people during and after their cancer treatment. With more people being diagnosed, and surviving, than ever before this is crucial. Macmillan estimates that there are 2 million people living with and beyond cancer in England, so the focus on personalised treatment and care, measuring quality of life and supporting people after their treatment has ended, is welcome. Therefore we were pleased to see the following commitments in the plan:

  • By March 2017, NHS England will agree an approach for collecting data on long-term quality of life for cancer patients. This approach will be tested during 2017 for roll out of a national metric from 2018. This data can then be used to drive improvements locally.
  • By March 2017, NHS England, through Cancer Alliances, will drive the spread of personalised follow up pathways, tailored to the needs of individual patients.
  • NHS England will review good practice for managing long term consequences of treatment.
  • In 2017/18, the use of the Holistic Needs Assessment (HNA) will be piloted as a means of better management of the transition between phases of the patient pathway including ensuring timely access to palliative care. The HNA ensures that people's physical, emotional and social needs are met in a timely and appropriate way, and that resources are targeted to those who need them most.
  • The Government has said it will ensure that by 2020 a tailored recovery package will be provided for everyone surviving cancer.

Find out more about our work on Life after cancer treatment across the UK.

A strategic approach to workforce

The traditional cancer workforce model, set up in a single disease framework and focused on treatment and survival, cannot meet current and future demands and deliver the right care and support for people with cancer at all stages of the cancer pathway. We were therefore pleased to see the implementation plan recognise that none of these actions can be realised ‘without having the right workforce with the right competences in the right numbers in place’.

The key commitment here is that Health Education England (HEE) will rapidly assess the current status of cancer and related workforce to identify current gaps and uncover the issues that need to be addressed. Macmillan has already begun to consider how it can support and feed into this review. A system-wide action plan will then be developed and work with Cancer Alliances, Sustainability and Transformation Plan footprints and employers, to address capacity issues immediately.

  • Find out more about our work on Workforce across the UK.

Patient experience

The Strategy recognised that a person’s experience of their care, at every stage, can be just as important as the result of their treatment. So it was good to see that the plan aims to ‘realise the Taskforce’s ambition of putting patient experience on an equal footing with other patient outcomes’. The implementation plan sets out that:

  • The Cancer Patient Experience Survey (CPES) will continue and will be improved.
  • NHS England will explore improvements to the patient experience metrics in the cancer data Dashboard, and along with the wider metrics this information can be used to ask questions locally on what more could be done across pathways to improve experience
  • NHS England will work with partners in the NHS and beyond to ensure all patients have access to a Cancer Nurse Specialist or other key worker from diagnosis onwards.

Find out more about our work on Patient Experience across the UK.

Cancer Alliances

As a key driver of improvements the establishment of Cancer Alliances is vital and we were delighted to see this reflected in the plan in the form of a commitment to roll out Alliances from September 2016. Macmillan is in agreement with the Transformation Board that the form of the Cancer Alliances should follow the function, so we were also pleased to see this reflected in the plan:

  • Working together in Cancer Alliances, clinical and other leaders from across different health and care settings in a local community will look at whole pathway data and information in the new Cancer Dashboard – including survival, early diagnosis rates, treatment outcomes, patient experience and quality of life – and use it to pinpoint areas for improvement locally through pathway redesign and changing clinical behaviours.

You may be interested in reading Warning Signs: Challenges to delivering the Cancer Strategy for England by 2020.

End of life care

The implementation plan’s only mention of end of life care is to say that next steps will be set out in the government’s response to the Choice Review, which is clearly disappointing and we will continue to work to ensure that action is taken to move this forward.

Next steps

The implementation plan also sets out six oversight groups that will be driven by NHS England and made up of relevant experts and officials. Macmillan is represented on a number of these and we will work closely to ensure that detailed workplans are now developed to ensure that this plan can be turned into action.

Overall the announcement of NHS England’s plans to drive forward the Strategy is welcome, and we hope that the added investment in early diagnosis that accompanied the plans and the setting up of Cancer Alliances will play an important part in tackling recurring problems such as missed waiting time targets. In general we were pleased to see commitments in the plan to ensure more people benefit from personalised care after treatment. But it is not clear how these parts of the strategy will be funded over the next five years.

NHS England and the government must set out how they propose to fund this essential part of the cancer strategy if the improvements described in the plan are to be delivered. NHS England must also guarantee that necessary funding will be ring fenced in future budgets to ensure the plan can credibly be put into action. Read the plan in full below.

Further information

For further information please contact: Victoria Woods, Senior Public Affairs Officer

  • 0207 840 4843 
  • Twitter: @MacmillanPA