Better, faster, stronger: Incentivising capacity for NHS cancer care

Everyone’s talking about NHS capacity. It dominated the conversation at both the recent HSJ Cancer Forum and the UK SACT Board conference last November. That’s because demand for SACT services is growing at 6–8 per cent per year, and the already stretched cancer workforce is struggling to keep up.

AstraZeneca is proud to be part of an industry that is bringing a breadth of oncology innovation: around half of new drugs appraised by NICE are for cancer. But we know this also means we have a responsibility to help address the SACT capacity crisis.

We believe that one part of the answer is another “live” policy topic — the future of financial incentives. Incentives can play a role in creating system capacity, especially at a time when organisational reform and major financial investment are unlikely.

We already work with the NHS to minimise the challenges associated with the introduction of new medicines, as well as to help manage rising demand. For example, we’re piloting promising new technologies that utilise AI to facilitate earlier diagnosis, supporting self-referral chest X-rays for symptomatic patients and collaborating to optimise lung cancer pathways.

With a general election later this year… there seems to be an opportunity to chart a new reform agenda that refocuses financial mechanisms where they will have the biggest impact

We also want to contribute to the broader policy debate on improving capacity in cancer services. This was the driving ambition behind a report that we commissioned last year, Capacity to deliver, which set out a series of policy recommendations to unlock resources to improve cancer outcomes.

To build on the report recommendations and connect with the current review of financial incentives, AstraZeneca brought together experts including patients, clinicians, managers, and commissioners to discuss the future role of incentives in cancer care. Together, the group identified principles that should guide the development and application of future incentives in cancer care, such as:

• Incentives should be clinically-led and manager-enabled to improve quality and outcomes;
• Incentives should rapidly change existing behaviour across the health system, and therefore have a distortive effect at least in the short term;
• The effect of an incentive should be felt at the service line, enabling teams who have introduced changes to further invest in the services they provide.

What could this look like in practice? High-level outcomes-based objectives set nationally but measured and paid at the Integrated Care Board level. This would provide much-needed national direction, whilst allowing flexibility to focus on the specific changes required to improve cancer services for their local populations.

With a general election later this year, which will certainly feature conversations about the public’s experiences of the NHS, there seems to be an opportunity to chart a new reform agenda that refocuses financial mechanisms where they will have the biggest impact. Alongside health inequalities and quality of care, system capacity should be a key area of focus for improving care and outcomes.

By prioritising a new approach to incentives, policymakers can facilitate an NHS that invites and rewards innovation and, in doing so, delivers better outcomes for UK cancer patients.