Over a decade ago I sat in a press briefing to launch a cancer plan I had helped to write, full of anticipation to see how it was received and genuinely excited to see how it would shape cancer care for the coming years.
I rapidly learnt that a plan is, of course, just a plan. It is the start of the negotiation not the agreement. And what is more important is who is in that conversation going forward and how plans evolve over time as they are implemented - it’s through that lens that I read today’s equivalent blueprint.
Today is the first opportunity the Government has had to set out how their 10-year health plan will work when put to work on a specific disease.
Ministers know how critical it is that they are seen to progress on cancer, not only because of the desperate need to improve outcomes for patients in this country but also because ‘Get cancer care right, we get healthcare right’.
Pulling together a cancer plan is no easy task. It is not one disease – it is over 200; it is not a minority of patients and families – it is over half of us.
Within each cancer type there can be numerous genetically significant subtypes.
Cancer care spans the whole of our healthcare system, and beyond.
Multiple disciplines are involved, there are a wealth of expert organisations to consult, and the pace of scientific understanding and innovative breakthroughs can feel overwhelming.
Therefore, above all, a heartfelt congratulations to everyone that had a role in pulling this together, it will have been a tremendous amount of work.
My initial reflections:
The ambition is welcome. We have always been ambitious in our national cancer plans. In 2015 the cancer strategy I worked on set out an ambition that - by 2034 - 3 in 4 cancer patients would survive at least 10 years. Three years later, the Government’s ambition was to increase the % of cancers diagnosed at stage 1+2 – when it’s most treatable - from 50% to 75% by 2028. Everyone will want to get behind this latest push – it will be critical to assess which initiatives are the most critical in reaching this, and keep focus on these in the coming years.
The political narrative aligns with what we have seen since Government took power – namely that progress in cancer care has been poor over the last 15 years and that we haven’t had the right plans in place to radically improve. What follows in many ways sets out an evolution of many existing initiatives, and an attempt to remould approaches and pathways to the propositions in the 10-year health plan. I think there is an opportunity to be bolder, and more radical. But that would need to come with funding to do so.
It’s brilliant to see the Cancer Alliance infrastructure maintained and strengthened – it was a battle to get them created in 2015 and given the ongoing changes/reform agenda having the continuity of their expertise in the NHS architecture feels critical to drive the actions in this plan. Many people won’t have heard of these organisations, but they are nothing short of the engine room of cancer care in this country.
It is disappointing that the plan doesn’t set out a holistic future view of cancer care, with more integral thinking on the treatments of the future. Crystal ball gazing is never easy, however it is striking how little the plan has to say on medicines given the central role they play in cancer care: in what other disease area would we accept a plan that said so much about how we’ll spot the condition without the same attention paid to what we do about it? It feels like a particular omission given the strong focus on the role of genetics and biomarker testing, are we confident that patients in this country will have access to a world class range of cancer drugs once they have this tumour profiling available to them? Having said that – clearly the new cancer manual/s that will follow this plan – guides for frontline staff on A* care planning - will be the home for best practice in care pathways, and therefore the new advocacy opportunity. Hopefully they can pick up some of the thinking about the core role of treatment
I remain unconvinced that we have learnt our lessons on how to do effective workforce planning for these reform agendas. I fully endorse an approach that isn’t just fixated on getting more people into posts, and the plan does a good job of identifying new approaches to how we think about roles and optimising e.g. digital and AI in order to free up capacity. But I think it is evident from all the accompanying analysis from expert groups that there will be a need for increased numbers of staff in certain disciplines if we are to see the scale of improvement that the plan sets out. And without a workforce plan to assess, which considers the priorities and trade-offs in any workforce decisions, it is hard to endorse what is set out here. Perhaps something for the new National Cancer Board to pick up.
Finally, hugely positive development to see a more intentional approach to accountability and governance with a reformed National Cancer Board, annual progress reports and an in-depth 3 year review. It is essential that this Board represents the key stakeholders and operates in such a way as to ensure other voices are heard. Crucially, I hope it can ensure we optimise the brilliant offer of our third sector and industry partners in the delivery of this plan. It is just a moment in time, and what will matter most for success is what follows.
It is inevitable when plans like this land, which are hugely anticipated, that there will be much analysis and commentary. Hopefully there is space in the national leadership of cancer to consider these reflections, and adapt implementation plans where needed.
