The Government’s NHS reforms – our view

What do Andrew Lansley's NHS reforms mean for cancer patients?

The Government’s Health and Social Care Bill has been hitting the headlines recently. We’ve been asked a lot of questions about what we think about the Bill and what we’re doing to champion the concerns of cancer patients and researchers.

The Bill means big changes to the way the NHS works. The reforms aim to move decision making away from the Department of Health towards local bodies, especially family doctors and local councils. It’s all about giving more power to patients through the ethos of “no decision about me, without me“.

Here at Cancer Research UK we’ve been looking hard at what the changes to the NHS might mean to cancer patients being treated or taking part in clinical research in the NHS in England.

We want to make sure that change happens in the right way to help improve cancer outcomes in the UK.

This is particularly important, because cancer survival rates in the UK are lower than in some other similar countries, even though UK research is responsible for developing life-saving treatments that are used around the world. It’s not entirely clear what’s causing the differences, (although researchers suspect that late diagnosis plays a key role) so we’re looking into why our patient outcomes are lagging behind, and how we can improve things.

So which proposals in the Bill will have the biggest impact upon cancer patients and will they make things better?

Commissioning

In recent years, commissioning – the official jargon for the very complicated process of working out, for a given geographic area, what medical care is needed, how it should be organised and how it will be paid for – has largely been done by organisations called Primary Care Trusts (PCTs). Each PCT covers a fairly large area, often a city borough or a large chunk of a county.

The Health Secretary, Andrew Lansley MP, introduced the Bill as a way to make the NHS more responsive to patients, in particular by involving GPs in commissioning. Under his system, much of the responsibility for commissioning health services will be transferred from PCTs to groups of GPs called Clinical Commissioning Groups (CCGs).

Under the current system, the commissioning of cancer services has improved, but is still not as good as it could or should be, so we want to use this opportunity to make sure that the new commissioners get it right. We believe it’s essential that people with years of expertise in commissioning cancer services can share what they know with commissioners.

That’s why we’ve been pushing for a range of experts to be involved in cancer commissioning, especially staff from cancer networks, which have been instrumental in improving the quality of cancer care.

Thanks to pressure from us and our friends in many other cancer and health charities, Andrew Lansley promised to keep funding the cancer networks earlier this year.

Early Diagnosis

Another very important issue for us is diagnosing cancer earlier, so we’re urging the Government to make sure that all parts of the health service work together to ensure cancers are diagnosed as early as possible.

Recent research has suggested that a major reason that the UK has worse survival rates than the best performing countries in the world is that we often diagnose cancer late in this country. Cancer Research UK is working really hard on improving this and we’re pleased that the Coalition Government committed to save an extra 5000 lives a year in England by 2015 through earlier diagnosis.

But we’re concerned that the NHS reforms could risk fragmenting some aspects of cancer services. The reforms split responsibilities for public health (which currently sit with the Department of Health) between many different organisations and this might pose a risk to efforts to improve cancer prevention and early diagnosis.

We believe the Government must commit to working hard to guard against this. We welcome their commitment to bring together doctors from different areas of the NHS to improve the quality of care for patients.

But we want the Government to tell us how staff in the reformed NHS will be sufficiently motivated and supported to encourage the early diagnosis of cancer and make improvements in this area.

Research in the NHS

Our third focus is making sure that research is put right at the heart of the NHS’s culture.

We believe the health service must encourage and support cancer research.

Patients treated in hospitals where lots of research is carried out can get new treatments more quickly. Fixing research at the core of the NHS’s culture is critical if we’re to be successful in improving cancer survival rates.

We’ve spent a huge amount of time talking to Ministers and MPs about beefing up research in the Bill. And we’ve been very successful: there are now several new clauses in the Bill which mean that all of the key parts of the new NHS must support medical research.

Now we need more detail from the Government on how they will actually act on these commitments, and how we will be able to monitor the NHS’s performance and hold the health service to account.

How do we make sure our voice is heard?

Cancer Research UK has played a crucial role, alongside our fellow medical research charities and in coalition with the other cancer charities, in amending the Bill. We’ve talked to MPs, Peers in the House of Lords, Ministers and government advisers.

We’ve produced detailed briefings which set out what we think and why. We’ve hosted meetings to let patients get their views across. We’ve worked with legal experts to draft new clauses for the Bill (e.g. Clause 23 14X ‘Duty in respect of research’). And we’ve still got more to do.

What happens next?

The Bill has already passed through the House of Commons and is currently at Committee Stage in the House of Lords.

We’ll carry on campaigning while the Bill passes through the House of Lords and continue to highlight commissioning, early diagnosis and research issues.

We want our message to be heard loud and clear so that the cancer patients of the future can get the best possible care and we can keep making research breakthroughs.

Rhiannon

Rhiannon Creasey works in the Cancer Research UK policy development team