Cancer care in the new NHS in England

Changes are afoot in the NHS – what will they mean for cancer patients?

As of Monday (1^st April) the Government’s reform of the NHS became a reality, with the Health and Social Care Act coming into force.

We’ve blogged a number of times about our views on the reforms as they took shape over the last couple of years, and more recently about our report on the state of cancer services during transition to the new system.

But now that the reforms are actually in place, and more of the detail has emerged, we thought we would take this opportunity to look at how the new NHS will work for cancer patients.

The reforms are intended to move decision making closer to patients and put more responsibility for how the NHS is run in doctors’ hands.

Local bodies called Clinical Commissioning Groups (CCGs) now hold a majority of the budget for the NHS, overseen by the arms-length NHS England, and responsibility for public health moves to Public Health England and local authorities.

The Act also puts a duty to promote research at the heart of the health system, which we were very pleased to see.

What is ‘commissioning’?

We explained the concept of commissioning in detail in a previous blog post but, in essence, it’s the process by which different parts of the NHS plan and pay for services from each other (or from external companies).

So a local hospital may be commissioned to perform certain services, such as diagnostic scans (e.g. x-rays or MRIs).

How will the new system affect cancer services?

The first thing to say is that, on the surface, it is unlikely that the services patients actually use – GP surgeries and local hospitals, for example – will have changed substantially as of Monday.

But the way NHS services are commissioned is now significantly different, and this could lead to changes in the long run. The new structure is complex and somewhat hard to put in words:

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We hope that the diagram above helps explain how the NHS will work for cancer patients, but just in case, looking at it from a patient perspective might make it easier.

Say a person is worried they may have bowel cancer having seen a local awareness campaign. They might first go their local GP, who may then refer that patient to a hospital for diagnostic tests.

Then if cancer is diagnosed, that patient could need treatment with surgery, radiotherapy or chemotherapy.

All of these services along the ‘patient pathway’, from the awareness campaign to the types of treatment, are now commissioned by different parts of the NHS.

So, thinking about that pathway:

• Efforts to prevent ill-health and promote awareness of cancer symptoms are now the responsibility of Public Health England and local authorities.
• GPs and the services their practices provide are commissioned nationally by NHS England.
• Clinical Commissioning Groups (CCGs), made up of local GPs, will plan and buy cancer services in the local area – such as hospital diagnostic and surgical services – but only for the more common cancers (breast, lung, bowel and prostate).
• Treatments such as radiotherapy and chemotherapy (for all cancers), and services for rarer cancers will be commissioned nationally by NHS England.

As you can see, it is a complicated picture. And as we move forward in this new system it is crucial that different parts of the system work closely together – particularly in areas like early diagnosis of cancer, for which local authorities and CCGs share responsibility at the local level.

Some other bodies involved

As well as these organisations directly commissioning care and treatment, there are a number of other bodies that help the whole system to plan and work together.

Health and Wellbeing Boards play an important role in bringing together representatives of all the different organisations in the local area (the local authority, CCGs, national commissioners, patients) to set coherent local strategies. Bringing all these groups together effectively is crucial in ensuring cancer services are well coordinated in the local area.

Strategic Clinical Networks and Clinical Senates are the ‘engines of change’ in the new system and will work across all bodies in their area to promote collaboration and service improvement.

The patient voice in decision making will be organised by Healthwatch England. Patients can get involved through their Local Healthwatch organisations, which have a place on Health and Wellbeing Boards, to have their say on local health priorities.

Next steps

As we have set out in this post, there’s going to be a great deal of change and complexity in how the NHS is run.

We want to make sure that these changes help to improve outcomes for cancer patients, but there is still a lot of uncertainty about how the NHS will actually perform under the new arrangements. We will therefore be keeping a close eye on how things progress.

Emlyn