UK cross-parliamentary committee calls for action on survival rates and treatment gaps

2 Mar 2011

Each year in England, around 255,000 people are diagnosed with cancer and around 130,000 die from the disease. The NHS spent £6.3 billion on cancer services in 2008-09. Tackling cancer has been a priority for the Department of Health (the Department) since its ten year NHS Cancer Plan was published in 2000. In 2007 the Department published its five year Cancer Reform Strategy (the Strategy) to deliver improved patient outcomes.

Over the last ten years, the NHS has made significant progress in delivering important aspects of cancer services, with falling mortality rates and consistent achievement of the cancer waiting times targets. Since publication of the Strategy in 2007, improvements have also been made in reducing the average length of stay and numbers of patients treated as day cases. A significant increase in resources has contributed to these improvements, but the progress has also been achieved through clear direction and high profile leadership underpinned by strong performance management linked to waiting times and mortality targets.

The cross parliamentary team welcomed the Department's and NHS's commitment to improving the outcomes for cancer patients. They were concerned, however, that early diagnosis does not happen often enough. Whilst cancer survival rates have improved and mortality rates have fallen, the gap in survival rates between England and the best European countries has not been closed. There remain wide, unexplained variations in the performance of cancer services and in the types of treatment available across the country.

They are disappointed that ten years after the publication of the NHS Cancer Plan 2000 there remain significant gaps in information about important aspects of cancer services, in particular information on chemotherapy, on follow-up treatment, and on the stage that a patient's cancer has reached at the time of diagnosis. The Department can not yet measure the impact of the Strategy on key outcomes, such as survival rates, and does not know if it is commissioning cancer services cost-effectively, due to poor data on costs and because outcomes data are not sufficiently timely.

They were also surprised that value for money has not been a stronger focus for commissioners, both in securing services to meet the health needs of their local population or in assessing the performance of its suppliers. Few commissioners make best use of the information available and most do not know whether their commissioning is cost-effective.

The Department has recently refreshed its approach to delivering improvements in Cancer Services, with the publication in January 2011 of Improving Outcomes: A Strategy for Cancer. The committee consider it a priority that the Department should continue to improve information on cancer-related activities. We look to the Department to develop robust mechanisms to ensure the collection of high quality, comprehensive and timely data to raise awareness of cancer, provide transparency in the performance of commissioning consortia, and ultimately drive improved outcomes for cancer patients.

On the basis of a Report by the Comptroller and Auditor General, we took evidence from the Department on its and the NHS's performance in delivering cancer services; on improving information on activity, cost and outcomes of cancer services; and how the Department intends to deliver cost-effective cancer services in the new NHS.

The committee's conclusions:


1.  We fully support the work that the Department has done over the last 10 years to make tackling cancer a priority. We welcome the progress made by the Department and NHS in reducing mortality rates and consistently achieving the waiting times targets. We also note the National Audit Office's value for money conclusion that further improvements can be achieved by tackling variations in service delivery and raising performance to the standard of the best. The key driver of further improvements is the need for high quality, comprehensive and timely data that is understood and used to make decisions about how services should be configured. In the transition to a new NHS structure, the Department must maintain the momentum it has recently established in improving information on cancer-related activities. The recommendations that follow are intended to help the Department further improve delivery of cancer services and improve outcomes for cancer patients.

2.  Early diagnosis is still not happening often enough and this is reflected in poor one year survival rates for most cancers compared to other countries. Whilst cancer survival rates have improved and mortality rates have fallen, the gap compared to the best performing countries in Europe has not been closed. The Department estimated that around 10,000 deaths from cancer could be avoided each year if the one year survival rates in England were the same as the best performing countries. Key to improving survival is improved awareness and early diagnosis.

  • We welcome the Department's plans to pilot and evaluate public awareness campaigns about the symptoms of cancer at a local and regional level. The Department should report back to us by the end of 2011 on the outcome of the pilots and the impact that raising public awareness of the symptoms of cancer has on achieving earlier diagnosis.
  • We are concerned that there is an eight-fold variation between GP practices urgently referring patients with suspected symptoms of cancer to specialists. We accept that there will be variation between GPs as some will choose to refer patients to specialists whilst other GPs will carry out their own diagnostic tests. However, the Department should ensure that commissioners investigate as a matter of urgency those GP practices that have both high and low referral rates and compare their referrals with their use of diagnostic tests.

3.  There remain wide, unexplained variations in the performance of cancer services and the delivery of treatment across the country. There are wide variations in, and poor understanding of: the extent of emergency admissions; the use of urgent referrals; cancer screening coverage; the use of radiotherapy machines; and chemotherapy treatment. The Department should work with commissioners to get a firmer grip on the reasons for variations and what impact this has on patient outcomes. In order to reduce the risks of a postcode lottery in access to treatment and services, the Department should identify and implement clear and practical actions that can be taken to spread good practice quickly so that the worst performing Primary Care Trusts (PCS)s can be brought up to the standards of the best.

4.  It is very disappointing that ten years after the publication of the NHS Cancer Plan 2000, there are significant gaps in information about important aspects of cancer services. The lack of information inhibits effective decision making and limits patient choice. There are shortcomings in the availability, consistency, timeliness and quality of key data such as on chemotherapy which accounts for a fifth of the overall cancer budget. The Department lacks a coherent strategy to address these gaps and limitations. The Department should develop a cancer information strategy which includes common standards for the quality and timeliness of data on cost, activity and outcomes. It should clarify how it intends this information to be used to improve patient outcomes and to inform patient choice.

5.  A particular problem is the paucity of data in most regions about the stage that a patient's cancer has reached at the time of diagnosis. This information, known as 'staging data', is key to making better use of resources and improving outcomes, yet only the Eastern region has anything like acceptable coverage. The Department needs to convey to cancer registries and, in turn, to clinical teams the value and importance of recording accurate staging data at the point of patient diagnosis. The Department should ensure that staging data is complete and timely in at least 70% of cases in each region by the end of 2012.

6.  The Department cannot measure the impact of the Strategy on key outcomes, such as survival rates, and does not know if it is commissioning cancer services effectively, because cost and outcomes data are not sufficiently timely. Cancer registries should be required to provide data to the Office for National Statistics within six months of the end of the relevant calendar year to enable the Department to speed up the provision of comprehensive national and regional outcomes data to commissioners.

7.  Many commissioners do not do enough to understand costs and value for money in their delivery of cancer services. We are concerned that only a fifth of PCTs had assessed the value for money delivered by their providers and that 12% had no plans to carry out such an assessment. In moving towards commissioning by GPs, the Department should work with the NHS Commissioning Board to set out clear standards requiring commissioners to demonstrate how they are obtaining value for money. The Department should say how it will measure improvements and what incentives and penalties will be used to ensure that value for money is at the heart of commissioning decisions.

8.  The numbers of cancer survivors is expected to increase from 1.7 million in 2010 to 2 million by 2020, yet the Department is unable to measure whether it is delivering on its commitment of more cost-effective provision of follow-up and care outside hospital. The Department expects commissioners to identify more cost-effective ways of providing follow-up services to increasing numbers of cancer survivors and intends that meeting the increased demand for such services should be cost neutral. The Department should improve its information on outpatients and other forms of follow-up care by requiring such activity to be properly coded. The Department should also identify and disseminate examples of good practice where savings and benefits to patients are identified and evaluate what impact alternative approaches to follow-up care have on hospital activity. 




Source: UK Parliament