The International Cancer Benchmarking Partnership (ICBP) has data on cancer survival in similar countries around the world going back to the 1990s. Back then, Denmark and the UK were two of the worst performers. 

We’re much better at preventing, diagnosing and treating cancer today, and many more people are now surviving much longer. But while the UK still isn’t doing as well as its peers, Denmark has surged ahead. 

In fact, since 1995, Denmark has seen some of the biggest improvements of any ICBP member, with survival across all seven ICBP-measured cancer types increasing by more than it has in the UK.

So, what sets the two countries apart?

ICBP analysis shows that one of the key factors has been Denmark’s focus on using consistent cancer plans to coordinate investment, drive reform and develop strong clinical leadership. 

England’s last dedicated cancer plan was replaced by the more general NHS Long Term Plan in 2019. But the UK Government now has a chance to bring back the focus we’ve been missing. The upcoming National Cancer Plan for England could help the country become a world leader for preventing, diagnosing and treating cancer – if it’s ambitious and properly supported.   

But what would that look like? Over the past 30 years, Denmark has turned dissatisfaction and confusion into steady progress and a sense of pride. What lessons can England, and the UK as a whole, learn about how to do the same?

The Danish model

It didn’t look like it at the time, but that was the starting point for something better. Denmark had what Fisker calls a “burning platform” – everyone agreed that things couldn’t stay the same, and everyone was ready to commit to changing them. 

That agreement has led to five successive cancer plans – each one building on the last, and each one backed with investment. 

“The most famous thing from Denmark is probably Lego, and we began to put these components together like Lego blocks,” Fisker says. “First there was the national agreement, and then on top of that we’ve built our cancer plans, which have directed our investments. All of those elements are essential.” 

So, as part of the first plan, which looked at technology and equipment, Denmark identified that its diagnostic scanners were old and outdated, and that it didn’t have enough to diagnose cancer effectively. The country then began to invest in fixing the problem, increasing its stock of PET-CT scanners, which allow for more accurate diagnosis and staging.  

Denmark now has 6.6 PET-CT scanners per million people, more than any of the other wealthy countries in the Organisation for Economic Co-operation and Development (OECD). The UK trails behind with only 0.8 per million.  

Putting patients first 

Denmark’s investment in diagnostic capacity also laid the foundations for its second cancer plan, focused on making sure the health system works for people affected by cancer. 

At the centre of that plan was the introduction of Cancer Care Packages (CCPs), which set out individual pathways to make sure patients are diagnosed and treated on time.  

“CCPs sort of turn the health system upside down,” Fisker explains. “Before, patients had to make their way through hospitals, but now hospital systems have to adjust to each patient pathway.” 

CCPs are supported with a set of ‘Patient Rights’, strict standards for how long patients should be expected to wait at each stage of the pathway. Hospital systems have to report whenever these targets aren’t met.  

Eight in 10 cancer patients in Denmark are included in CCPs, and 8 in 10 of those are seen within the target timeframe. On average, the waiting period for a cancer diagnosis in Denmark has decreased by 17 days since CCPs were introduced. 

Those reductions mean fewer people spend anxious weeks waiting for news or treatment, helping more of them feel the confidence Elisabeth does. They also lead to better outcomes over time. Since the CCPs were introduced, the three-year relative survival for all cancer patients has increased by nearly 10 percentage points, and for lung cancer patients it has almost doubled. 

The UK also has cancer waiting times targets for people to receive a diagnosis, start treatment and track their whole journey. But the key target for patients to receive a diagnosis and start their first definitive treatment within 62 days of an urgent suspected cancer referral hasn’t been met since December 2015. 

“In human terms, that means that hundreds of thousands of people have spent longer than they should not knowing whether they have cancer, or knowing they do but being forced to wait longer than they should to start treatment,” says Matt Sample, our senior health policy manager. “That’s unacceptable.”  

Patient Rights make it clear that meeting waiting times targets is fundamental to providing good care. We’re calling for the UK Government to do the same by implementing a ‘cancer guarantee’ to meet all waiting times targets by the end of this parliament.  

“It’s clear that we can’t have a sticking plaster plan here,” says Sample. “Denmark has had a really clear focus on making changes that improve outcomes, and we also need the National Cancer Plan to be bold, ambitious and have the investment behind it to deliver the change we need.” 

A new approach to treatment 

Denmark’s Lego blocks keep stacking. After the second plan reoriented the hospital system around patients with CCPs, the third focused on making sure each patient received the best treatment for their cancer type, partly by redesigning the way treatment services were organised across the country.  

“In 2004, we had 45 different departments which performed colorectal [bowel] cancer surgery,” explains Fisker. “In 2021, we got that down to 17 or 18. We’ve cut down the number of places where complicated procedures take place, and that has played a major role in improving the quality.”