Throughout my time in Parliament I have taken a strong interest in cancer issues. From 2002-2003 (I resigned to vote against the Iraq War) I was a Shadow Health Minister with responsibility for cancer, and from 2009-2018 I was Chairman of the All-Party Parliamentary Group on Cancer (APPGC).
It remains an inconvenient truth that, despite successive governments pointing to improving cancer survival rates, they continue to lag behind international comparisons. The primary reason for this is that the NHS does not diagnose cancers early enough: catching cancers early overwhelmingly increases the chances of successful treatment thereby leading to better survival rates.
The Government once estimated that if we matched the best survival rates in Europe, 10,000 lives each year would be saved. In 2013, the OECD confirmed that our survival rates rank near the bottom when compared to other major economies, and for some cancer types we only fared worse than Poland and Ireland.
As we have improved our survival rates, so have those of other countries. Unfortunately, there is very little evidence of our closing the gap with international averages, despite the considerable increases in health spending in recent decades. A more fundamental change is required to address this.
Back in 2009, when I first became Chairman, the APPGC conducted a major enquiry which uncovered that the main reason our survival rates lag behind international averages is not because the NHS is worse at treating cancer. The evidence suggested that once a cancer is detected, it largely performs as well as other comparable health services. However, the NHS is not as good at catching cancers in their crucial early stages.
Late diagnosis therefore lies behind our comparatively poor survival rates, and getting the NHS to raise its game in this crucial area would be a major step along the road to improving our cancer performance. Armed with this evidence, the APPGC together with the wider cancer community campaigned over the years, with some success, for a one-year cancer survival rate indicator to be built into the DNA of the NHS, especially at a local level.
The logic was straightforward: as earlier diagnosis makes for better survival rates, holding the local NHS accountable for their one-year rates would encourage it to promote initiatives which boosted earlier diagnosis. A key advantage of focusing on this type of ‘outcome measure’ is that it gives healthcare professionals the freedom and flexibility to design their own solutions – this could include by running wider screening programmes, by establishing greater diagnostic capabilities at primary care or by promoting better awareness campaigns of the signs and symptoms of cancer.
However, from discussions with those involved at the front-line of designing cancer services the APPGC came to appreciate that this one-year survival rate indicator was generally being sidelined by the managements of Clinical Commissioning Groups who are focused on ‘process targets’. These are often linked to funding, with funds being released in accordance with performance against these targets.
In recent decades, the NHS has been beset by numerous process targets, which rather than measuring the success of treatment, measure instead the performance against process benchmarks – A&E waiting times being one high-profile example. These process targets have a role to play in improving the NHS, but all too often are a blunt tool offering information without context and can, in some circumstances, hinder rather than help access to good treatment – especially when funding flows are associated with them, which can serve to skew priorities.
In addition, these process targets tend to be ambitious and therefore have a tendency not to be fully met except in the very best of circumstances. This can lead them very easily to becoming a political football between the parties eager to score short-term points. All sides are guilty of this, but it rarely helps patients.
Research from the House of Commons Library uncovered nine process targets applicable to cancer. These include the ‘two week wait’ to see a specialist after a referral and the ’62-day wait’ from referral to first definitive treatment. Such targets are only part of the journey when trying to improve cancer performance, and yet the NHS cleaves to process targets because often they are the key to unlocking funds. Furthermore, by implication improved outcomes can only be facilitated by improved processes.
In addition, the APPGC learnt process targets are not the best means of improving performance amongst the rarer cancers. These cancers often fall between the cracks of process targets, as data on these cancer types are not used routinely in much of the NHS. Instead, the NHS tends to focus on the ‘low hanging fruit’ of the ‘Big Four’ cancers of breast, prostate, bowel and lung.
However, given rarer cancers account for more than half of cancer cases, serious improvements in cancer survival will be less possible unless performance gets better for these cancer types. Outcome measures have the advantage of encouraging their inclusion when seeking to improve overall survival rates.
Given the advantage of outcome measures like one-year survival rates, in November 2021 I tabled an amendment to the Health & Care Bill ensuring that outcome measures are put above process targets by NHS England, better encouraging the NHS to focus on earlier diagnosis and ensuring it bears down on what really matters to cancer patients and their families. I wrote an article in Conservative Home explaining this amendment in more detail.
The amendment received strong support from 80 cross-party MPs, and the Government accepted it during the Bill’s Commons Report Stage. With some slight changes, which were agreed with me and supportive Peers, the amendment became Clause 5 of the Health & Care Act 2022. This important change will make a real difference, and I am grateful to all those who helped support this initiative.