NHS reform bill protest

The UK Government's NHS reforms are controversial

Unless you’ve been avoiding the news during the past months, you’ll have heard the phrase ‘NHS reform’ at least a few times over your morning cornflakes, and witnessed the intense political debate this phrase can stir up.

This is because the Government is setting out to make significant changes to how the NHS is run, and have set out their proposals to Parliament in the Health and Social Care Bill.

The Bill is currently making its way through Parliament, as politicians discuss and debate its merits.

Last year, we outlined our view of the Bill, and the priorities we believe are crucial if these changes proposed within the Bill are to benefit cancer patients.

But while the debate continues, many of the ideas in the Bill are already being enacted ‘on the ground’ throughout England (the Bill only really affects England). So we thought that now was a good time to discuss what these changes already mean for cancer patients, and to highlight some of our successes so far in terms of influencing these changes.

Our priorities

As a cancer charity that wants to the UK have world-class cancer outcomes, it’s not for us to comment on the wider merits of the Bill as it affects the structure of the NHS. For this reason, we’re neither supporting nor opposing the Bill.

But we do care about the detail where it has the potential to affect cancer patients. So, before getting into the nitty-gritty detail, it’s worth taking a step back and re-visiting our main priorities when it comes to ensuring cancer patients get a fair deal.

From the outset, we’ve had three overarching questions, the answers to which are crucial to whether or not these reforms will be a good thing for cancer patients:

  1. Where does the responsibility for the early diagnosis of cancer sit?
  2. How will cancer services be planned and bought (or ‘commissioned’, in health policy speak)?
  3. How will cancer research be promoted? (particularly as we need the NHS to help carry out lots of our research)

We’ve been regularly speaking to MPs, Peers and Civil Servants regarding these three key issues since the Bill was first published in January 2011.

Out with the old (PCTs), in with the new (CCGs)

Since our last post on the subject, some details have come into sharper focus. For instance, as part of the NHS reforms three different ‘outcomes frameworks’ have been developed.

Simply speaking, these documents outline how various health outcomes and quality of care will be measured in the revamped NHS.

There is one outcomes framework for the NHS overall; another for public health services (covering a range of areas such as obesity and smoking); a third for social care (which Cancer Research UK does not focus on, but which other charities do); and a new one, published in draft form last week, called the ‘Commissioning Outcomes Framework’. This most recent document will provide national guidelines for the groups of local commissioners known as Clinical Commissioning Groups (CCGs).

These CCGs are replacing the existing organisations, called Primary Care Trusts (PCTs), and will be led by doctors, with other professionals’ input. They will formally take over commissioning health services in their area in April 2013 when PCTs are abolished, but are already being created in preparation. There are currently 266 CCGs across England, and Cancer Research UK is closely monitoring their development.

The Commissioning Outcomes Framework will allow the NHS Commissioning Board, which oversees commissioning across England, to hold CCGs to account for the quality and outcomes of the healthcare services they commission. It will also provide information for patients and the public.

We were extremely pleased to see two key measures (or ‘indicators’, to use policy-speak) in the first draft, both of which we’ve been actively highlighting to MPs for several years:

Emergency diagnoses

First, CCGs will be encouraged to make sure that the proportion of cancers diagnosed through emergency routes – e.g. via Accident & Emergency units – is reported on and reduced.

This is important because we know that cancers diagnosed as emergencies, rather than through GP referrals or via screening, tend to be later-stage cancers, and consequently are harder to treat.

Measuring early diagnosis

Secondly, and related to the measure above, CCGs will be encouraged to count how many cancers in their area are being diagnosed at early stages, and to take steps to increase this figure. Over 70 of our Cancer Campaigns Ambassadors lobbied their MPs on this issue in November 2010 and we are delighted that the Government is continuing to take action on it.

Again, this is important because we know that the earlier a cancer is diagnosed, the better the chances of successful treatment.

Next steps

But the work doesn’t stop here. We’ll be continuing to speak to MPs and other decision makers about the Outcomes Frameworks that affect cancer patients. As we’ve said, the Government has published this latest document in draft form, with the aim of getting feedback from the wider community. We’ll be sending them our thoughts, including our support for the two indicators as outlined above.

We also believe that things for patients would be further improved if the indicators in the various Outcomes Frameworks were better linked together and shared across different Framework documents.

We‘re beginning to see a few shared indicators – for example, the proportion of cancer deaths under the age of 75 are a shared measure across both the NHS Outcomes Framework and the Public Health Outcomes Framework. But we want to see more, and we need it to be absolutely clear where the responsibility for early diagnosis lies in the new health landscape.

As the political debate on the Health and Social Bill continues over the coming months we’ll be keeping a keen eye on the reforms’ impact on cancer services in England. Watch this space.


Simon Kirkland is a policy officer at Cancer Research UK