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Last month, Sir Simon Stevens departed as chief executive of the NHS in England. Our chief executive, Michelle Mitchell, reflects on his cancer legacy and the challenges still facing Amanda Pritchard as she steps into the role.
It was clear from the start that cancer was high on Simon’s priority list.
Having worked with him for many years, first as an NHS England board member and then as Cancer Research UK’s chief executive, I always admired his desire to work with and learn from others. He visited Cancer Research UK many times, meeting our experts and learning more about the innovations that could transform cancer survival in the future.
Early in Simon’s tenure a new cancer strategy was commissioned by NHS England. Independently developed by an expert group led by my predecessor Sir Harpal Kumar, the cancer strategy set out a comprehensive and visionary plan for cancer that was accepted in full by NHS England.
Since the 2016 strategy, there have been some real successes. The reformed £340 million a year Cancer Drugs Fund and £130 million invested in cutting edge radiotherapy machines have given cancer patients access to some of the most innovative new treatments. The Be Clear on Cancer awareness campaigns have raised public awareness of cancer symptoms, and millions in transformation funding has been invested tackling local challenges through regional Cancer Alliances.
And all the while, the NHS has provided care to the growing number of people diagnosed each year.
During his tenure politicians also prioritised cancer – most notably Theresa May when she was Prime Minister, who made a public commitment to reaching 75% of cancers diagnosed at an early stage by 2028, a commitment that was enshrined in the 2019 NHS Long Term Plan.
Given the important role of reducing late stage diagnosis in improving cancer outcomes, it’s a bold and welcome ambition. One that, if met, would help bring survival rates up to what we see in other comparable countries. But it’s also proved challenging, with the proportion of cancers diagnosed at stage 1 and 2 stubbornly stable in recent years, and on our current trajectory we’re highly unlikely to meet this target.
Clearly, there’s work to be done.
The Challenges Ahead
I would bet that one of Amanda Pritchard’s top priorities as she takes over will be clearing the backlog from COVID-19.
Our modelling suggests around 37,000 fewer people began cancer treatment in the first year of the pandemic in England, and experts warn the overall NHS waiting list might balloon to over 14 million in coming years. This isn’t a reflection the hard work of NHS staff, who’ve gone above and beyond, it’s a reflection that there just isn’t any more stretch in the system.
Reaching these missing people with cancer and giving them the diagnosis and care they need will need to be a top priority. The importance of this cannot be overstated – if we fail, it is highly likely that we will see more people diagnosed at an advanced stage of the disease, and more people dying as a result.
But of course, it isn’t enough to just get back to where we were before the pandemic, because where we were before wasn’t good enough.
While positive steps have been taken in recent years, the UK remains near the bottom on the league table of comparable countries when it comes to cancer survival, particularly in lung, bowel and pancreatic cancers. And important Cancer Waiting Time targets have been missed consistently for years – the target for cancer patients to begin treatment within 62 days of an urgent cancer referral hasn’t been met since 2015.
A stark illustration of the challenge can be found in diagnostic services – put simply, to diagnose more cancers earlier we’ll need to do more scans. But 1 in 10 diagnostic posts are vacant, and the UK lags well behind the average numbers of diagnostic scanners compared to comparable countries. We haven’t a hope of improving early diagnosis unless this is fixed.
Government’s bold ambitions for cancer are welcome – but to end years of insufficient progress, they must be matched with a clear, published plan to reach them.
This will mean optimising cancer screening programmes and expanding capacity in cancer services by training more staff and retaining those already in cancer services. It will also mean investing in more diagnostic kit and deliver the bold transformation to diagnostic services set out in Professor Sir Mike Richards’ review, and ensuring the NHS is ready to trial the latest innovations.
Here there’s momentum. The pandemic actually spurred innovation in the NHS, so for Amanda harnessing this spirit of innovation and keeping up the pace will be vital.
Making the change we need to see
Clearly, underpinning this all is the need for significant investment.
Simon was a skilled political operator and managed to protect the NHS budget through the hardest years of austerity, secured a 5 year, £20.5bn settlement for the NHS, and through the pandemic fought hard for the emergency funding to NHS so desperately needed. But this has not been enough to provoke the transformation needed, and underinvestment in training more health staff and a failure to buy more diagnostic kit has led to growing shortfalls in capacity, even as ‘frontline’ spending was apparently protected.
Now, after years of missed opportunities, the challenge for Amanda is to secure a multi-year funding settlement for the NHS that provides sufficient, long-term funding to tackle the fundamental issues in cancer services. If successful, this would mean capacity rising to match patient need, boosted efforts to diagnose cancer earlier, more time to deliver more complex, cutting edge treatments and unleash the potential of the NHS to support more life-saving cancer research.
But of course, the decision to invest doesn’t rest with Amanda – it’s up to the Treasury and Chancellor Rishi Sunak. As we approach the Spending Review in the autumn, Amanda and Health Secretary Sajid Javid must make the case for cancer services so that this vital opportunity to radically improve cancer outcomes isn’t missed once more.
The route away from the pandemic and towards transforming the prospects for the 1 in 2 of us who will be diagnosed with cancer in our lifetime is clear. And with so many of us affected by the devastating impact of cancer, the public are right behind us when we say that Government can, and must, make the investment needed to ensure their vision to improve cancer outcomes becomes a reality.
Anything less is unacceptable.
Michelle Mitchell is Cancer Research UK’s chief executive