Cuts in cancer spending expose a funding challenge

The political focus on cancer is undeniable. At the last election the parties fell over themselves to commit to improving cancer outcomes (if not in explaining how they would do so). Previous elections saw a similar pattern.

The reasons for this are based on both need and desire. Cancer outcomes in England are poorer than those achieved in comparable countries and the public continues to identify cancer as a priority for action.

‘The public continues to identify cancer as a priority for action’

In politics this is an attractive combination; you have the chance to do something that matters on an issue that the public really cares about.

This weekend’s announcement by Jeremy Hunt demonstrates the priority this government is giving to cancer and we can expect to see further announcements in the near future.

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Spending skew

Cancer’s position as a political priority has long led to accusations that cancer campaigning is skewing the priorities of the NHS.

It is undeniable that, every time a new generation of clinical strategies is developed, cancer is near the front of the queue. Given the need in cancer, the numbers of people affected and the level of expenditure on cancer services, it is difficult to argue with this.

Yet what if this prioritisation is skewing spending, diverting resources into cancer from elsewhere?

High profile policies on cancer drugs, radiotherapy and public awareness give the impression of money being poured into cancer services. At a time when resources are particularly scarce in the NHS, this is an issue that is worthy of exploration.

‘Every time new clinical strategies are developed, cancer is near the front of the queue’

To help inform the development of the cancer taskforce’s report, Incisive Health was commissioned by Cancer Research UK to analyse trends in funding for NHS cancer services.

The results show that, far from occupying an increasing portion of NHS expenditure, services have experienced a cut. It is this reality – rather than perceptions created by announcements – that should inform decisions about future expenditure.

Spending on cancer grew at just over 2 per cent between 2009-10 and 2012-13 (the latest years for which nationally comparable figures are available). This is a rate of increase that is far below that observed for conditions such as diabetes and obesity (20 per cent), sight loss (16 per cent), musculoskeletal problems (15.8 per cent) or neurological conditions (13.3 per cent).

It is even lower than the change for mental health services (6.3 per cent) – an area where there is consensus that services are underfunded and there is now a target to deliver real terms increases in funding.

In real terms

In the early years of the last Parliament, cancer spending actually saw a small real terms reduction.

When changes in health need are taken into account, the fall becomes much greater. Expenditure per newly diagnosed cancer patient has fallen by almost 10 per cent in real terms, equivalent to over £2,000 per patient between 2009-10 and 2012-13.

‘Spending on cancer grew at just over 2 per cent between 2009-10 and 2012-13’

Had spending on this basis remained the same since 2009-10, then just over an additional £1.49bn would have been available to cancer services over the period.

To put this in context, the money would have been enough to pay for over 10,000 cancer nurse specialists, or 1.9 million MRI scans or all expenditure on cancer drugs for a year.

This is the real context for discussions about funding the cancer taskforce’s recommendations.

The fact that this reduction has been possible is in part due to the success of cancer services in finding efficiencies. Despite the increasing burden and complexity of cancer, which have seen admissions related to cancer continue to rise, emergency admissions have been reduced by 9 per cent since the issue was identified as a priority in 2007 and the average length of stay in hospital has decreased by near a day (6.6 days compared to 7.4 days). Bed days have reduced by 15 per cent since 2007, releasing significant resources.

These changes are good news.

Given that they were identified as priorities in the 2007 cancer reform strategy, they are also an indication of how national strategies can deliver big results (and savings).

However, similar gains are unlikely to be possible in future. That services are creaking under the pressure can already be seen in the repeated failure to meet cancer waiting times standards. Delivering a better service to more people on less money is unlikely to be possible in the coming years.

‘If ministers wish to deliver on their commitment, the money will need to be found’

This weekend’s announcement was certainly a statement of intent but, as I have written previously, implementing the taskforce’s recommendations will require expenditure beyond the now totemic £8bn, although the hope is that some of this will be recouped by lower costs in a few years.

Recent trends in expenditure on cancer provide important context for the discussions ahead of the spending review.

Few people in the Department of Health are optimistic about the outcome of November’s settlement. Yet, if ministers wish to deliver on their commitment for “world class” cancer services, the money will need to be found. There will be no easy choices.

Mike Birtwistle is a founding partner at Incisive Health, a specialist health policy and communications consultancy