Last year, the Darzi Report painted a brutal but honest assessment of the huge challenges facing our health service.  

That was particularly true for cancer, as the report laid bare years of missed waiting time targets, limited progress on diagnosing more cancers earlier and how cancer death rates in the UK are higher than other countries.  

The 10 Year Health Plan set out to address the challenges identified in the Darzi report through three ‘big shifts’ – from a focus on sickness to a focus on prevention, from an analogue service to a digital one, and from relying on hospitals to provide care to offering care in communities. 

In their election manifesto last year, the UK Government promised to reduce the lives lost to cancer. The National Cancer Plan, expected later this year, will set out how they will make good on this promise. But the 10 Year Health Plan remains important, because it lays the groundwork for the Government’s health agenda as a whole – setting the context the cancer plan will be delivered in.  

So, what did the 10 Year Health Plan mean for cancer and what does this mean for what the National Cancer Plan now needs to do? 

In short, the plan included some important and welcome public health interventions that will help prevent more cancers. But it didn’t restate commitments on cancer wait targets as part of wider service improvement efforts. And it left a gap in terms of setting out just how important earlier cancer diagnosis will be in the ‘sickness to prevention’ shift. It is now critical that the cancer plan makes these commitments and sets out a roadmap for achieving them. 

But with any big, ambitious government health strategy, the devil is in the detail… 

From ill health to prevention   

Shifting the NHS from a service that primarily focuses on addressing ill health to one that prioritises prevention and early detection is much needed. Given a substantial proportion of cancer cases can be prevented, addressing risk factors like smoking and overweight and obesity could mean fewer people face a cancer diagnosis – or indeed a slew of other conditions, all of which can damage an individual’s quality of life, increase pressure on the health service and reduce an individual’s ability to earn.  

On this front, there were some good, specific steps. As well as a recommitment to delivering on the world-leading legislation in the Tobacco and Vapes Bill, which will take us one step close to a future free from tobacco, there were also welcome recommitments to measures which restrict junk food advertising. Plus, there were new measures to tackle obesity, like mandatory reporting of healthy food sales for large companies in the food sector and expanding access to weight management services through a better digital offer. But on both measures, implementation will be key. The Government will need to ensure the reporting leads to companies setting and meeting targets for healthy food sales, and that weight management services provide the long-term support people need, particularly as access to weight loss drugs expands.  

These are undoubtedly positive moves. But there is more the Government can do to make their vision on prevention a reality. The National Cancer Plan is an opportunity to be bolder, for example by implementing proven measures like minimum unit pricing for alcohol in England, introducing alcohol marketing restrictions to protect children, and exploring further measures to help create a healthier food environment. 

Of course, to drive the shift towards prevention, the NHS also needs to catch illness earlier and prevent disease progression. This couldn’t be more important for cancer, as diagnoses at an earlier stage can mean many more treatment options being available and dramatically improved outcomes.  

Though there was little new on this front for cancer, the plan highlighted some of the good things that are already happening, including the introduction of self-sampling in cervical screening for non-responders and a recommitment to the rollout of lung screening.  

But, whilst there was a commitment to rolling out lung screening across England, there was no date for full implementation. The previous Government committed to achieving full rollout by 2030, and we need to see the same commitment from this Government – we know lung screening saves lives and reduces inequalities.   

To really drive the shift to reducing the number of cancers diagnosed at a later stage, the Government needs to embed it into the wider health strategy through a bold ambition for earlier diagnosis. It is now critical the National Cancer Plan sets this out along with a roadmap for achieving it.  

From hospital to community 

The marquee policy in the 10 Year Health Plan is to roll out the ‘Neighbourhood Health Service’, bringing together a mix of professionals in neighbourhood teams to deliver care as locally as possible by default. To support this way of working, ‘Neighbourhood Health Centres’ will be established, which will bring together a whole range of services including GPs, diagnostics, rehab and public health services under one roof. If well designed, they could offer a range of benefits for cancer – whether that’s giving people better access to primary care, giving GPs better access to diagnostic tests for their patients, or giving patients better care in the community. This service model is already being taken forward, but we need more clarity on how the Government will get the most out of neighbourhood health approaches, especially as GP services and community care are already stretched.  

The other big political commitment here was to hit the elective waits target – the expectation that 92% of people waiting for treatment are seen within 18 weeks – by the end of this parliament in 2029. This pledge is an important one, and should hopefully precipitate the sort of investment in speedier diagnosis and treatment that will benefit the whole NHS.   

But this pledge doesn’t cover cancer waiting time targets (CWTs), leaving a big gap for people affected by cancer in the drive towards NHS recovery. A commitment to meeting the 18-week target is important for patients and driving NHS improvements, but it’s far too long to ensure timely diagnosis and treatment for cancer patients. It’s critical that the National Cancer Plan now commits to meeting CWTs, to ensure that the focus on elective waits does not draw all the attention at the cost of cancer patients, given CWT performance is well below targets.   

Analogue to digital 

The third key shift the 10 Year Health Plan is looking to make is towards a ‘digital first’ offering for accessing the NHS. For example, upgrades to the NHS App promise big changes including letting people choose where they receive care, book tests directly, manage their own care, and access online consultations.  

For many people, better digital tools will improve access to healthcare and their health information. But particularly for those whose health or digital literacy isn’t as strong or who don’t have good access to technology, these changes could create new issues. It’ll be really important that, as the NHS App is upgraded and promoted, efforts are also made to make sure that services are accessible for everyone.  

The use of digital tools, tests and technologies underpins much of the rest of the plan too. And it’s ambitious about what can be achieved, with commitments to create a new Single Patient Record, implement tools to improve productivity and support clinicians, and harness innovative technologies like AI. All of these measures hold a lot of potential to improve NHS services and care, but the challenge will be in getting them implemented in the NHS, where much of the IT infrastructure is well past its prime. The basic systems and infrastructure that these new technologies will rely upon need upgrading, and NHS staff will need to be given the time to train up to use them. 

The plan also included positive measures to support research and innovation, like the recently announced Health Data Research Service which has the potential the transform access to data for health research and service improvement. There was also a recommitment to speed up clinical trial set up, to get new treatments to patients more quickly – but the 150-day set up target is still longer than in similar countries, and it doesn’t apply to non-commercial clinical trials, which are particularly important for less common cancers, including those that affect children and young people. These studies should be fully included in improvements, so non-commercial research is not left behind.  

Getting the NHS fit for the future 

Beyond the headline new initiatives, the Plan also outlines the new operating model for the NHS. Much of this was trailed in advance, like changes to the role of Integrated Care Boards, the merger of DHSC and NHSE, and giving increased autonomy to high performing NHS providers. Reforming NHS structures at the same time as delivering on new priorities – and within tight financial constraints – will be tough and creates a very real risk of disruption and destabilisation at a critical time for the NHS.  

And there remain some unanswered questions. Most notably for cancer, it’s unclear how the network of Cancer Alliances across England will be supported and evolve to be most effective within the new model. Evidence shows that having cancer delivery architecture at the local level is a key factor for success in improving cancer services. With the National Cancer Plan on the horizon, securing the relationships, expertise and local knowledge that Cancer Alliances hold couldn’t be more important. Conversely, if these reforms lead to cancer being deprioritised within the health system, we risk undermining efforts to improve cancer services now and deliver the cancer plan over the next decade.

Looking forward to the National Cancer Plan 

So where does the 10 Year Health Plan leave us? 

Undoubtedly, the ‘three shifts’ are all moves in the right direction – though there’s still much more we need to know about how they’ll be delivered. Many of the individual measures are welcome and will help drive the system to prevent more cancers.  

But little was said on the Government’s ambitions for cancer, with no commitments made on cancer wait targets or an earlier diagnosis ambition.  

We now look to the National Cancer Plan to do this. The plan needs to set out how it will deliver on the Government’s manifesto commitment to reduce the number of lives lost to cancer and address the challenges being faced in cancer care. We cannot accept another decade of missed cancer waiting time targets and survival outcomes that lag behind similar countries. 

So Cancer Research UK is focusing hard on the National Cancer Plan, to make sure that it delivers on what we know will make a difference and make it a turning point for cancer.  

Over this summer, we’ll be setting out our views on some of the biggest issues the cancer plan will need to address – how we should measure our ambitions for earlier diagnosis, tackle variation in access to the best treatment, and prepare to implement risk-based approaches to cancer detection and diagnosis.  

In the meantime, you can join us in calling on the UK Government to ensure the National Cancer Plan for England is bold enough to meet the scale of the challenge that faces us.