On 22 December 2015 NHS England published the the third annual collaborative Planning Guidance document entitled ‘Delivering the Forward View: NHS planning guidance 2016/17 – 2020/21’. The guidance was developed in collaboration with NHS Improvement, Health Education England, the National Institute for Health and Care Excellence, Public Health England, and the Care Quality Commission. The guidance is aimed at commissioners, NHS trusts and foundation trusts.
The planning guidance outlines nine “must dos” for local health and care systems and also calls for the NHS to develop ‘Sustainability and Transformation plans’ designed to accelerate the implementation of the Five Year Forward View.
Included in these nine “must dos” for NHS England is the following:
- Deliver the 62 day cancer waiting time target, including the two week referral and 31 day treatment targets. The guidance also calls for progress in one year survival rates by increasing the proportion of cancers diagnosed early
The guidance further outlines the expectation that a quarter of providers in England should, by the end of March 2017, meet at least four of the 10 clinical standards for seven-day services, which were originally published by NHS England in December 2013. Half of providers in England are subsequently expected to meet these standards by 2018 ahead of “complete coverage” by 2020. The ten clinical standards include improving seven-day access to diagnostic services and key services including interventional radiology and endoscopy.
The Department of Health has published The Government’s Mandate to NHS England for 2016-17 (the Mandate), setting out objectives for NHS England for 2016-17 and to 2020. In the foreword to the document, Jeremy Hunt MP, Secretary of State for Health, outlines his ambition “to make the NHS the safest, most compassionate and most efficient health system in the world”. Within seven broad objectives, the document sets specific goals for cancer, dementia, diabetes and obesity. Of specific interest to cancer:
- The Mandate sets a 2020 goal of implementing the recommendations of the Independent Cancer Taskforce
- In 2016-17, NHS England should agree a trajectory for increases in diagnostic capacity required to 2020
- NHS England will “invest” £340 million in 2016-17 in the Cancer Drugs Fund and “ensure effective transition to the agreed operating model to improve its effectiveness within its existing budget”
- NHS England should achieve the 62-day cancer waiting time standard in 2016-17
- One-year survival rates should rise to 75 per cent by 2020 for all cancers combined (up from 69 per cent currently)
- Contribute to the agreed child obesity implementation plan
Separately, The NHS public health functions agreement 2016-17 has also been published. The guidance for NHS England Regional Directors, details the arrangements for how public health responsibilities are delegated to NHS England. The guidance covers the following services.
The document sets out outputs and outcomes to be achieved by NHS England and arrangements for funding them. The agreement focuses on achieving positive health outcomes for the population and reducing inequalities in health, through provision of services including immunisation programmes and cancer screening programmes. Of particular interest, there has been a near £800 million cut to the public health budget next year, which has decreased to £1,069 million from £1,804 million in 2015-16.
Britain Against Cancer was held on Tuesday 8 December, with attendees and speakers from across the cancer community. Headline points emerging from the conference are outlined below:
Cally Palmer, National Cancer Director
- Ms Palmer is setting up a ‘National Cancer Transformation Board’, which will have representatives from NHS England and each arms-length body
- A National Cancer Advisory Group, Chaired by Harpal Kumar, will scrutinise the work of the Transformation Board
- Stated that the CDF has helped thousands and Ms Palmer said she wants it to become “sustainable” part of care in “equal, fair and appropriate” way
- Committed to establish “integrated accountable clinical networks”, with patients at the centre; primary, secondary, tertiary pulling together; clinicians working with patients; having data behind that
- Pivotal to this will be the commitment to an integrated cancer dashboard
- The intention is for these networks to eventually become accountable care organisations (ACOs)
- NHS England has not fully bottomed out the role and function of proposed cancer alliances. The basic premise is that they are “quality and accreditation” organisations
- The cancer vanguard, led by The Royal Marsden NHS Foundation Trust, The Christie NHS Foundation Trust and UCLH is looking to develop an Accountable Care Organisation for cancer. The vanguard will start testing capitated budgets in 2016/17
- Work has progressed on the National Cancer Dashboard, and Ms Palmer shared a prototype. From April 2016, CCGs will be able to see their data
- Ms Palmer wants the NHS to move to a place where we can measure long-term quality of life of cancer patients
- Definitive diagnosis within four weeks is also seen as an early priority
Jeremy Hunt MP, Secretary of State for Health
- Started his speech by saying that there had been good news and bad news for cancer in the past 12 months – progress was being made with more cancer tests and improving survival but Britain was still behind in international league tables
- Two major events affecting cancer this year had been the launch of the independent taskforce in January 2015, leading to the cancer strategy in July, and the Spending Review in November 2015, which had provided the money to the NHS to implement the strategy. Local plans to achieve this were now being developed to be signed off by April
Mr Hunt recommitted to:
- Achieve diagnosis or an all clear for patients within 28 days
- Investment in diagnosis including endoscopy
- All patients having a full tailored recovery plan
- A nationwide quality of life indicator for people with cancer by 2018
- Indicators on the number of cancers diagnosed at stages one and two and diagnosed in emergency care. Reported on quarterly through MyNHS
- Annual Ofsted style ratings for CCGs reported on annually giving a view of the quality of cancer care throughout the pathway enabling variation to be seen more clearly and tackled
- Harpal Kumar, CEO, Cancer Research UK, Chairing an independent advisory board to assure this process
Heidi Alexander MP, Shadow Secretary of State for Health (full speech here)
- Confirmed Andrew Gwynne MP is leading on public health and cancer for the shadow health team
- Stated that cancer must remain at the top of the political agenda and Labour supports the cancer strategy
- The strategy is an opportunity which mustn't be squandered
- We should be honest: implementing the cancer strategy will have a price tag attached to it
- There has been a massive step back in public health, "the worst kind of short-termism". Ms Alexander called for guarantees on the future of Be Clear on Cancer, given the cuts to the public health budgets
- We need to learn from the three cancer vanguards and we must preserve the UK’s status as a world leader when it comes to cancer research
- We must ensure that excess treatment costs continue to be funded, that the new EU Clinical Trial Regulations are implemented to reduce the time it takes to get studies set up, and that research is viewed as a core responsibility for everyone working in the health service
- The CDF is one of the hardest questions for the NHS in 2015. The consultation is welcome but there is a big question over the timing, with responses due at the end of February not long before the new scheme starts in April
- Ms Alexander called for a similar focus on surgery and radiotherapy as there has been on the Cancer Drugs Fund
Other speakers and panellists
- Harpal Kumar: Noted that this an exciting time in cancer, but added that we have not yet seen commitments to all cancer strategy recommendations, citing radiotherapy as an example where progress is needed. He called for investment in the clinical workforce and diagnostic capacity. Mr Kumar emphasised the need for patients to be involved in cancer alliances and the need for changes to be made to workforce planning
- Sean Duffy: Highlighted the importance of developing an integrated cancer dashboard and the need for diagnosis within four weeks. Mr Duffy Called for a greater focus on both rarer cancers and older people living with cancer
On Monday 30 November, the Public Accounts Committee held two evidence sessions on the Cancer Drugs Fund (CDF), as part of their inquiry.
For the first session, the witnesses were:
- Mark Hicken, Managing Director, Johnson and Johnson
- Deborah Lancaster, Director of Market Access, Roche
- Harpal Kumar, Chief Executive, Cancer Research UK
Questions focussed on the UK comparative cancer survival rates, the NICE process for drug assessments, data collection for evaluation of the CDF and implications for the devolved nations.
The witnesses at the second session were:
- Will Cavendish, Director General, Innovation, Growth and Technology, Department of Health
- Simon Stevens, Chief Executive, NHS England
- Professor Peter Clark, Chair of the Cancer Drugs Fund, NHS England
- Sir Andrew Dillon, Chief Executive, National Institute for Health and Clinical Excellence
Questions focussed on similar themes to the first session, such as data collection for evaluation of the CDF, NICE processes and comparative survival rates. Witnesses were also asked specifically about rare cancers and cancer research in the UK.
A transcript of both sessions is available here.
On Wednesday the Chancellor, George Osborne MP, laid out his spending plans for the next five-years with cuts and new investment spread across Government Departments.
For cancer services the most significant elements of the Spending Review were:
- The recommendations of the Independent Cancer Taskforce will be implemented so that by 2020 patients referred for testing by a GP should be diagnosed for cancer or given the all clear within four weeks
- This will be delivered by investing up to £300 million a year by 2020 to fund new diagnostic equipment as well as 200 additional staff trained to perform endoscopies by 2018
- The ring-fence on public health spending will be maintained in 2016-17 and 2017-18
- The Government will take a national lead in tackling obesity as the leading cause of preventable ill-health, with a specific focus on protecting the health of children. Details will be set out in a Childhood Obesity Strategy
Major announcements relating to health service funding were also made, most notably:
- The NHS will receive £10 billion more in real terms than in 2014-15, with £6 billion available in 2016/17 with the Government stating this will ensure it funds the NHS’s own Five Year Forward View
- NHS spending in England to increase from £101 billion in 2015-16 to £120 billion by 2020-21. This is £2 billion more than the NHS asked for in its Five Year Forward View
- The Government expects the NHS to deliver £22 billion of the efficiency savings it said it can find in the Five Year Forward View
On Thursday 19 November, a Backbench Business Debate on the topic of the Cancer Strategy was brought to the House by the Chair of the APPG on Cancer (APPGC), John Baron MP (Con, Basildon and Billericay). Within his remarks, Mr Baron specifically thanked the Cancer Campaigning Group for our on-going work.
The debate was co-sponsored by David Tredinnick MP (Con, Bosworth) and Jo Churchill MP (Con, Bury St Edmunds). A full transcript of the debate is available. The debate largely focussed on:
- The implementation of the Cancer Strategy
- The importance of early diagnosis and the use of one-year survival as a marker for success
- Accountability of Clinical Commissioning Groups (CCGs) toward improving cancer outcomes and the establishment of a National Cancer Advisory Board (NCAB)
- The Cancer Drugs Fund (CDF)
- Reductions in public health expenditure
Ben Gummer MP (Parliamentary Under-Secretary of State for Health) responded for the Government.
On the issue of CCG scorecards, he said that they are immensely complex and have behind them a huge volume of data. He added that consultation on the operation of CCG scorecards will be launched next month. Mr Gummer said that the CDF will have to change in order to respond to the changes in genomics research over the last 5 years. He continued to say that the PM made a personal commitment to the CDF and will be watching very carefully how the CDF develops. Mr Gummer added that the CDF‘s growth since 2010 demonstrates the commitment to cancer drugs; the recently published consultation by NHS England and NICE aims to build on the success of the CDF.
On early diagnosis, Mr Gummer stated that, as an outcome of NHS England's Accelerate, Coordinate Evaluate (ACE) programme, imaging will be expanded within primary care and that the Department will write shortly to provide more details to members.
Public Health England has published the complete Routes to Diagnosis 2006-2013 data. The data confirms that the proportion of cancers diagnosed as an emergency in hospital has decreased, whilst the proportion diagnosed through urgent GP referral with a suspicion of cancer has increased.
The now publically available data covers in excess of two million patients diagnosed with cancer from 2006 to 2013, from across 56 different cancer sites. The data shows that in 2006, almost 25 per cent of cancers were diagnosed as an emergency, compared to 20 per cent in 2013.
Julia Verne, Head of Clinical Epidemiology at Public Health England, said: "The latest Routes to Diagnosis data shows a positive trend in how cancer is diagnosed in England. The earlier the better if we are to catch up with comparable European countries. It is hugely satisfying to see innovative use of big data help improve cancer diagnosis and thus, survival. Our work however, is not complete; while emergency presentation is declining it still remains high for cancers like liver and pancreas"
The Guardian, BBC News and the Telegraph led the coverage of the story that a one-year old with acute lymphoblastic leukaemia is the first person to have been treated with cells which were genetically engineered to target her cancer. Layla Richards was given the highly experimental treatment, which had only been trialled on mice, after specialists applied for emergency permission from health regulators and Great Ormond Street Hospital's ethics committee.
The process, developed with a team at University College London, involved using microscopic scissors - or Talens - to precisely engineer the DNA inside a donor's immune cells. The cells were designed to seek out and kill only leukaemia cells which were then injected into Layla. Doctors have emphasised that, at this point, this should not be considered a cure, but said that Layla's progress to date was "almost a miracle".
The ‘postcode lottery’ which exists in cancer diagnosis in England was highlighted by new statistics highlighted this week. Extensive coverage, including in The Telegraph and The Guardian, showed that patients in many regions in England were not getting the early diagnosis (stage one or two) which can increase, by more than three times, the survival rates for those with of some of the most common cancers. Sara Hiom, Director of Early Diagnosis at Cancer Research UK, who published the data said, “Wherever you live, an early diagnosis of cancer will give you more treatment options and a better chance of survival”. If all the regions of England achieved the same rates of early diagnosis as in South-West England, the best in the country, nearly 20,000 patients would have been given a better chance of survival.
The Guardian reports on a potentially 'game-changing' trial into the effect of aspirin on preventing the recurrence of some of the most common cancers.
The study, which will take place over 12 years and involve around 11,000 patients who have had, or continue to receive treatment for bowel, breast, oesophageal, prostate or stomach cancer.
The BBC noted the debate that has long engulfed the effect of a drug which has been shown to reduce the likelihood of heart attack or stroke in some patients.
The lead investigator Prof Ruth Langley, from the Medical Research Council's clinical trial's unit, based at University College London, said: "There's been some interesting research suggesting that aspirin could delay or stop early stage cancers coming back but there's been no randomised trial to give clear proof. The trial aims to answer this question once and for all."