Commissioners must help defuse England’s cancer time bomb

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Clinical commissioning groups need to act now in light of the soaring number of people in their local population living with cancer

By 2030 an estimated two in three clinical commissioning groups in England will have more than 10,000 people with cancer in their local population, compared with just one in four today.

This includes two CCGs - Dorset, and Northern, Eastern and Western Devon - where projections show more than 50,000 local people will be living with cancer in 2030.

‘The growing burden of the disease is a local issue just as much as a national one’

CCG populations vary, but even the smallest will have to support more than 2,000 people who have been diagnosed with cancer. We know that the number of people getting and surviving the disease is increasing in the UK year on year.

Figures from the new local cancer intelligence tool remind us that the growing burden of cancer is a local issue as much as a national one. Unfortunately, the soaring level of need in the local population is just one of the cancer issues facing commissioners.

Rates of survival

There is significant variation in cancer survival rates across England. Almost four in 10 people with cancer in Barking and Dagenham CCG’s area die within just 12 months of diagnosis, compared with only one in four in North East Hampshire and Farnham.

The variation cannot be explained by some areas having an older population or a greater proportion of cancers with poor survival rates. Nor is it simply a matter of deprivation. The figures have already been adjusted for the effect of deprivation on overall life expectancy, and one in three CCGs with the least deprived populations have worse age standardised one year survival rates than the England average.

Local system delays could be a factor. Figures for the last quarter of 2013-14 show that the CCGs with the poorest one year survival rates were, on average, failing to meet the 62 day referral to treatment cancer waiting time target, in contrast with the CCGs with the best survival rates.

This makes it all the more concerning to see that performance on cancer waiting times continues to decline.

‘More than half of CCGs were missing the 62 day referal to treatment target’

In the latest figures, for the second quarter of 2014-15, more than half of CCGs were missing the 62 day target, up from a third in the same quarter in the previous year. The CCGs with the best one year survival rates are now, on average, also missing the target, but continue to outperform those with the poorest survival.

Adding to the concerns about, and perhaps contributing to, declining local performance is the current state of the cancer commissioning landscape. An analysis of commissioning in England following the NHS reforms in 2013 revealed fragmentation and confusion about who is responsible for commissioning cancer services and those services falling between the gaps.

Certain stages of the cancer care pathway, such as diagnosis, treatment and end of life, are usually commissioned by CCGs, but this varies by type of cancer and treatment.

The extent to which CCGs use commissioning support services also varies across the country. Specialist services and primary care are currently commissioned by NHS England local area teams, screening by Public Health England, and social care, prevention and awareness raising by local authorities.

There are already examples of the harm this fragmentation could cause. For example, local Macmillan staff in some parts of the country are getting reports that psychological support services for people with cancer are at risk of being decommissioned because of lack of clarity about who is responsible for commissioning them. As the waiting time data suggests, this could be just the tip of the iceberg.

The Department of Health and NHS England must do more, but commissioners must also use all the tools at their disposal.

Understanding local needs

Commissioners tell us that much specialist cancer knowledge has been lost during the transition from primary care trusts to CCGs and from cancer networks to strategic clinical networks. So it is vital that they have access to local data on their cancer population. They need to understand what the needs of people in their area are now and what they are predicted to be.

Local data that enables cross-CCG comparisons can also help commissioners follow the lead of successful commissioners and establish strong collaborative relationships across geographies and organisational boundaries.

‘By the end of 2016 there will be more than 1,000 people diagnosed with cancer each day in the UK’

If we can use data to help improve outcomes in the poorest performing areas while keeping pressure on those performing better, we can go some way to closing another shameful gap: UK cancer survival rates that lag behind the best in Europe.

One year survival for lung cancer is just 30 per cent in the UK, compared with 44 per cent in Sweden. Five year survival for people over 75 in the UK with lung, stomach or kidney cancer is lower than in eastern Europe.

Cancer is a colossal challenge for the NHS. By the end of 2016, there will be more than 1,000 people diagnosed with the disease each day in the UK.

Only by taking local action now can we stop the cancer time bomb from crippling the NHS in the future.