Cancer services weakened by coalition’s NHS shakeup, says report

In In The News by Barbara Jacoby

Thumbnail for 8562By: Denis Campbell


Cancer services have been weakened by the coalition’s shakeup of the NHS and lack the money to cope with the growing number of people getting the disease, a report on Monday claims.

Diagnostic and treatment services are under such strain that improvements in recent years are in danger of unravelling, according to the charity Cancer Research UK. Its findings are based on anonymous interviews with 45 leading cancer experts and an online survey of 450 other NHS cancer personnel.

Specialists have been struggling to keep up with the rising demand for care at the same time as their budgets have shrunk amid the NHS’s £30bn efficiency drive, it says.

The NHS’s failure to meet its target for treating cancer patients quickly enough for the last six months may be a sign of deepening problems in the years ahead, the charity predicts.

“Increasing levels of activity combined with the financial squeeze is being felt within cancer services, and although services have been holding up well, the cracks are beginning to show, as the drop in achieving the 62-day waiting standard demonstrates,” says the report, which was produced for Cancer Research by the health services management centre at Birmingham University .

It paints a picture of cancer services at a tipping point, with staff doing their best to give the growing number of patients high-quality care. The number of people in England being referred each year by their GP for investigation for suspected cancer rose by 50% to 1.4 million between 2009-10 and 2013-14, with big knockon increases in the numbers tested or receiving chemotherapy, radiotherapy or surgery.

Real-terms spending on cancer reached a record high of £5.9bn in 2009-10 but then declined to £5.7bn in 2012-13, despite rising rates of diagnosis and people living longer with the disease, the report found.

The strongly worded analysis claims that the government’s unpopular radical restructuring of the NHS last year has damaged cancer services.

Responding to the report, a minister said the government was making progress, and that it had inherited some of the worst cancer survival rates in Europe when it came to power.

The abolition of scores of NHS bodies and wide-ranging organisational overhaul, such as the scrapping of the highly regarded National Cancer Action Team and cancer clinical networks, has produced an unhelpful “vacuum” and loss of leadership in cancer delivery and confusion about who does what in the new system, the report says.

It found that there is no England-wide group to advise on cancer strategy and “in addition, the ability to pull together the different parts of the system – primary care, acute care, tertiary care and social care – had been weakened”.

While various organisations have a key role, including NHS England, NHS Improving Quality and the 211 GP-led local clinical commissioning groups, exact responsibilities and capabilities are unclear, especially around the commissioning of cancer services. “There is a significant level of confusion about who does what within the new architecture and a lack of clarity about where responsibility and accountability for this sort of work should lie,” it finds.

One cancer specialist interviewed for the research said: “What really seems to have been the big change is the loss of central coordination and leadership, and I think what it felt like a year ago was that we were just tossed out into the sea. There’s the potential for inefficiency, in terms of service running and service delivery and I think there’s a potential for that to lead to poorer outcomes.”

Another said more money was needed, adding: “Instead of progressing our cancer services, which are already significantly underfunded, our services are actually being cut. It is becoming impossible to deliver all the new cancer targets and quality of care is deteriorating.”

Regarding money, “it is clear that demand is starting to outstrip the resources available. It is unlikely that more efficiency gains can be achieved without them having a detrimental impact on staff, services and hence, patients”, the report says.

The battle to reconcile demand with finite resources is also affecting staff morale, motivation and wellbeing, with some describing themselves as “tired, disenfranchised, unmotivated and unloved”.

There is also concern that the NHS does not have enough equipment and personnel to undertake the growing number of diagnostic tests, such as MRI and CT scans.

Harpal Kumar, Cancer Research’s chief executive, said: “The people that have propped up these NHS services tell us in this report that ‘enough is enough’. They can’t go on like this with no help or support coming over the horizon. And they certainly can’t improve services so that our outcomes are up there with the best in the world.”

Andy Burnham, the shadow health secretary, said: “This report from one of the UK’s most respected charities makes devastating reading for David Cameron. The verdict from cancer experts is clear: David Cameron’s NHS re-organisation has damaged cancer care just as Labour always warned it would.”

Jane Ellison, the public health minister, said the coalition was making progress after inheriting some of the worst survival rates in Europe in 2010. “This government has prioritised cancer, investing £750m over four years to improve early diagnosis and treatment, and just last month announced an extra £160m for the Cancer Drugs Fund and £6m towards a revolutionary new type of radiotherapy.”