In the last 50 years, the proportion of people in the UK dying from cancer has fallen by over a fifth. But progress hasn’t reached everyone equally. Across England, we still see issues with varying access to cancer treatment, with slow rollout of cutting-edge treatments and inconsistent use of best practice. This variation may partly explain why cancer patients in the UK can be less likely to receive treatments when compared with other patients internationally.  

Some variation is understandable – for example, differences in diagnosis stage and informed patient choice play a role. However, we have lots of evidence to suggest that there is significant unwarranted variation too, leading to inequalities in outcomes – this is unacceptable.  

Take ovarian cancer as an example. UK survival lags behind comparable nations, even when patients are diagnosed at the same stage. This suggests treatment of patients in the UK could be suboptimal. While international comparisons are complex, recent evidence suggests UK patients receive less chemotherapy, and that clinicians may be less likely to undertake radical or extensive surgery. 

Audit data from England, Wales, and Scotland also highlights variation in practice, and other studies suggest access to specialist expertise in decision making and to clinical trials could improve ovarian cancer care and outcomes. 

The National Cancer Plan for England now gives the UK Government the opportunity to tackle this variation head-on. However, for the Government to successfully empower local systems to deliver cancer care that works for their populations – and to make sure variation in treatment is addressed and not exacerbated – there are lots of things to consider. 

We convened clinical, academic, health system and policy experts to examine the factors that influence the equitable delivery of high-quality, timely cancer treatment, and here are some of the things we discussed. 

Commissioning and funding  

Many cancer treatment services are considered to be specialised and in England, decisions about if and how these should be made available to patients have been made at a national and regional level for many years. Responsibility for this is now being delegated to Integrated Care Boards (ICBs) who in their role as strategic commissioners are being tasked with planning and commissioning more integrated services across whole pathways.

It was always going to be a challenge for ICBs to take on this work, primarily because they may not have the expert capacity to make the best decisions and their population sizes may not be big enough to make decisions about services that require bigger investments. However, with changes to the role and number of ICBs in recent months, coupled with the planned 50% cut in staff, there is now even more uncertainty as to whether ICBs will be able to fulfil this role effectively.   

Organising services optimally 

Decisions about how cancer treatment services should be configured i.e. what services are delivered where and by whom, is an important factor impacting the treatment a patient receives, how they access their care and how quickly. 

Over time, many cancer treatment services (and some diagnostic services) have been concentrated into a smaller number of bigger, high-volume centres. These changes have aimed to concentrate specialist expertise in fewer places to improve patient outcomes, deliver economies of scale enabling a better range of service provision, and get better value from expensive kit.   

But there are different ways of organising services and deploying the workforce, each with pros and cons and there isn’t a one size fits all approach. For example, services might be configured into a hub and spoke model where specialist expertise and resources are concentrated in a hub, but patients can receive less specialist care in spoke centres that might be closer to home. In other areas, services might be delivered in more centres with healthcare staff moving between hospitals to improve access for patients. 

Decisions about this need to consider a range of factors such as the specific clinical pathways and technologies, the local population, local geography and how patients get to services, current configuration of services, and ensuring no services are destabilised when changes are implemented so all can continue to deliver quality care for patients.  

What works will also change over time, for example when new technologies change the pathway or population needs change. Innovation may also support improvement in how services run, for example digital technologies could make accessing specialist expertise easier. 

The UK Government must ensure robust decision-making processes are in place to help strike the right balance,  and ensure that decision makers have the resources they need to support changes to services, including the implementation of evidence-based interventions put in place to mitigate barriers.  

Workforce  

How best to use the cancer workforce is also a key consideration. At our seminar, experts discussed how different models of care delivery use the cancer workforce in different ways. The pros and cons of different approaches were also discussed, not just in relation to ensuring patients have access to specialist expertise, but also how these affect the appeal of roles for staff. This affects not just the effectiveness of a service but also how research active a centre may be.  

For example, moving towards a more centralised model could reduce the number of more specialised roles available in non-specialist centres, making these less attractive places to work. Attendees suggested encouraging hospitals to work more closely with universities to improve opportunities for staff to engage in research and detailing how the 10 Year Health Plan commitments to expand dedicated staff time for research will be implemented and funded. 

We must also address staff shortages and retention challenges. In 2024, the Royal College of Radiologists reported a 15% shortfall in clinical oncology consultants. These shortages likely contribute to cancer treatment variation, so the National Cancer Plan must not only consider how NHS staff can be used most effectively and efficiently, but also the number of staff in post.  

To build service resilience and ensure care is delivered equitably, Cancer Research UK has called for the National Cancer Plan to commit to dedicated cancer workforce planning at national, regional and local levels that aligns with calls in the upcoming 10-Year Workforce Plan. 

Understanding what works and making improvements   

In the seminar, experts emphasised the importance of sharing successes and learnings between settings. Strong leadership is key to encourage local organisations to learn from each other and work together in the interests of patients. This could include Integrated Care Boards, Cancer Alliances and individual hospital trusts.  

To support this, the Government must fund and expand the 10 current cancer audits (NATCAN) for the length of the National Cancer Plan. This will help identify unwarranted variation within and between localities, and support providers to implement best practice.   

Local systems, and the NHS more widely, also need good quality data to identify where treatment delivery can be improved. Looking forward, at Cancer Research UK we are setting out how the National Cancer Plan can improve cancer treatment data collection and linkage to maximise the insights from audits and benchmarking. This will improve our understanding of cancer and health inequalities, and ensure we are maximising our learning when evaluating new interventions.  

Sharing innovations to benefit everyone 

Access to innovative treatments is vital for improving outcomes and efficiency in the health system. Yet we still see variation in which innovations are implemented and how. When our experts discussed this, they flagged that some hospitals can adopt newly approved innovations more quickly than others because they have pre-existing expertise, funding and support. Others aren’t able to adopt as quickly, meaning their patients could be missing out on some treatment or need to travel. 

We need to see the National Cancer Plan lay the groundwork to ensure everyone benefits. In our response to the government’s Call for Evidence, Cancer Research UK called for the plan to implement clear pathways, including sustainable funding arrangements, to speed up the adoption of proven innovations, including new drugs and technologies, into standard care. Alongside this, local systems must be supported to focus only on the innovations and technologies with the greatest potential.  

What next? 

Looking towards the publication of the National Cancer Plan later this year, we’re calling for the UK Government to seize this opportunity for meaningful change. With an estimated 2.2 million new cancer cases expected during this parliamentary term, now is the time to make a meaningful difference for people affected by cancer and reduce unwarranted variation in cancer treatment.  

Without targeted investment and strategic ambition, we risk sitting by as variation persists and patients are let down by not having access to the best, timely care. The UK Government must make the National Cancer Plan a turning point for cancer.