John Baron, MP for Basildon and Billericay, discusses the evolution of cancer treatment so far and the stategies the NHS must adopt to continue its progress.
You have been the chair of the All-Party Parliamentary Group on Cancer[i] (APPGC) for over five years now. What are the main changes you have seen during this time?
The last parliament saw a significant shake-up of the English NHS through the Health and Social Care Act. In this, there were two overarching themes – reorganisation and a focus on outcomes. The APPGC – and myself – were never in favour of the former, and made this clear to Andrew Lansley at the time, but we remain very supportive of the latter.
As a result, and for almost the first time in its history, the NHS is now moving towards assessing the success of its treatments, rather than the volume. This is excellent news for patients and their families, as emphasis is placed on the quality of healthcare, rather than merely meeting targets for the number of procedures or treatments undertaken.
In my view, this has been the greatest change in recent years, particularly as it has enabled the APPGC to work with the government and NHS to keep up a relentless push to improve cancer survival rates through prioritising earlier diagnosis.
What are your priorities for this year’s Britain Against Cancer (BAC) conference?
BAC is the cancer community’s opportunity each year to come together, which in today’s fragmenting health service is something attendees tell us they find very valuable. We believe it is now the UK’s largest one-day cancer conference, with over 450 delegates. In addition to parliamentarians, healthcare professionals, officials and charity representatives, we are pleased to have a growing number of patients amongst our number.
At BAC we place a strong emphasis on two-way interaction. We set aside time for networking amongst the numerous stalls, and our breakout sessions allow delegates to follow their particular interests and develop them in discussions. In addition, our panel and keynote speeches are followed by Q&A sessions. We are always sure to mix in spontaneous and unvetted questions from the floor, so that delegates receive answers to their questions directly from our speakers.
This year, we will be analysing progress one year on from the publication of the England Cancer Strategy, following on from the report we released in September, as well as raising such issues as earlier diagnosis, patient experience and rarer cancers. For further details, and to register, please visit: https://goo.gl/jlmaUm.
NHS England published its latest Cancer Strategy in July 2015, which set out a number of recommendations for improvement in NHS cancer services.[ii] How would you assess progress towards delivering these aims?
The APPGC’s most recent report looked at progress one year on from the publication of the England Cancer Strategy, and considered three main areas: funding, transparency and accountability, and involvement.
On funding, the APPGC believes that it is imperative that the government continues to show its commitment to cancer by setting out funding commitments for the England Cancer Strategy per year, for each of the next four years, in every area of the cancer pathway.
The need to look at where new initiatives outlined in the Cancer Strategy can save costs requires more focus, including treatment cost savings from achieving earlier diagnosis, as well as the role of health economics generally.
On transparency and accountability, although progress is being made in key areas, the APPGC believes there needs to be further clarity on how the England Cancer Strategy is being delivered, how recommendations are being rolled out (particularly at a local level) and how this will be monitored.
Moreover, the importance of transparency was emphasised throughout the inquiry, with the Cancer Dashboard and Clinical Commissioning Group Improvement and Assessment Framework being highlighted as two ways to improve cancer outcomes.
It is crucial that these mechanisms are used effectively to hold the health system to account on key metrics such as one-year cancer survival figures, something the APPGC and cancer community has long campaigned on and successfully got the into the DNA of the NHS at a Clinical Commissioning Group (CCG) level.
Finally, there needs to be a greater collaborative effort to involve organisations with expertise and interest in cancer, along with their networks of patients and clinicians, to help shape the roll out and implementation of the Cancer Strategy.
Although a number of those who submitted to our report sit on the National Cancer Advisory Group, many have not yet been approached to offer their support and advice. On a similar note, there needs to be an increase in engagement and involvement of all cancer patients, and particularly those people affected by rarer cancers.
There are two and a half million people now living with or beyond cancer in the UK.[iii] With people living longer following a cancer diagnosis, what implications does this have for the NHS and cancer policy more widely?
It is very good news that so many people are either living with cancer, or are free from it following treatment. There is no doubt that survival rates have been rising over recent decades, and in the case of some cancers the chances of successful treatment have greatly increased.
The consequences of this are that the NHS must gear itself up to look after an increasing cancer population, and to prepare and structure itself to manage cancer as a long-term condition as life expectancy continues to increase. In particular, the NHS must finally resolve the vexed issue of drugs pricing – the Cancer Drugs Fund has enabled tens of thousands of patients to access cutting-edge treatments, but it can only be a stopgap until a more permanent settlement between the pharmaceutical industry and the NHS can be arrived at.
A growing cancer population, coupled with ever more expensive drugs and procedures, adds more weight to an NHS budget under pressure – even after the real-terms increases in funding provided to the NHS by both the Coalition and present governments. It is clear the NHS must find ways of reducing expenditure to squeeze as much bang out of every buck as possible.
One area the APPGC has recently highlighted as offering significant cost savings is earlier diagnosis. We all know that catching cancer early is the so-called ‘magic key’, as diagnosing the disease in its early stages offers the best chances of successful treatment.
This is why the APPGC, together with many in the cancer community, has successfully campaigned in recent years to get the NHS, particularly at a local level, to do more on earlier diagnosis as a means of improving overall survival rates.
This has been by successfully persuading NHS England to hold CCGs accountable for their individual one-year cancer survival rates though the Delivery Dashboard and the new ‘OFSTED-style’ ratings. The APPGC has further maintained this focus by recognising those CCGs which have most improved their one-year survival rates at its annual Summer Reception, by encouraging MPs to contact their local CCGs to what is being done to improve survival rates, and also by raising early diagnosis at BAC.
However, cancer also accounts for the third-largest NHS spend, and late diagnosis is a major driver of costs. For example, stage I treatment for colon cancer costs £3,000, whereas stage IV treatment costs over £12,000. Stage I treatment for ovarian cancer costs £5,000, whereas stage IV treatment costs over £15,000.
Overall, late-stage diagnosis of colon, rectal, lung and ovarian cancers costs almost 2.5 times the amount spent on cancers detected at stages I and II. These treatments also tend to be more aggressive, causing additional stress for patients and their families, and sadly less successful.
A recent study suggests the NHS could save around £210 million each year if all CCGs achieved the level of earlier diagnosis of the best CCGs, potentially benefitting up to 52,000 patients. Quite apart from the improvements in human terms, this would help reduce the pressure on the NHS budget, or could be used on the next generation of drugs or innovative treatments.
The UK spent 5.0%[iv] of total health care expenditure on cancer in 2014, this is lower than the EU average of 6.0%. Is the government investing in, and prioritising, cancer care appropriately considering the wider societal impact?
Following on from my response to the previous question, it is not simply a question of spending more money. Whilst investment is important, the APPGC welcomed the extra funding for cancer services in the Cancer Strategy; structures and prioritisation also have a large role to play.
A good example are the cancer networks, which provided valuable support and expertise, particular to the local NHS. Caught in the gulf between commissioners and providers in the post-Lansley NHS, cancer networks were either disbanded or withered on the vine, allowing a significant pool of knowledge and expertise to ebb away from the NHS.
However, some CCGs have begun to club together to share information and expertise, so in a sense the networks are re-emerging. It will be interesting to see what role Cancer Alliances, the creation of which was one of the Strategy’s 96 recommendations, will play in this regard.
One area of spending I have tried to delve into is how our spending on cancer drugs compares with other countries, as I suspect the NHS is not as far ahead in this as we would like to think. In particular, I have been looking into what percentage of its budget the NHS spends on generic versus branded medicines, though it has been difficult to draw firm conclusions as this information is not routinely collected.
Furthermore, there is not much data available from other countries – we sometimes forget how transparent and open the NHS is compared to other healthcare systems – but I believe this area would be ripe for further study, and would be grateful if others have information they would be willing to share with the APPGC.
Bristol-Myers Squibb developed the questions for this interview, but had no input into the responses or editorial write-up.
[i] John Baron MP, About John. Available at: http://www.johnbaron.co.uk/cancer.html (Accessed September 2016)
[ii] Independent Cancer Taskforce (2015), Achieving World-Class Cancer Outcomes A Strategy for England 2015-2020. Available at: http://www.cancerresearchuk.org/sites/default/files/achieving_world-clas…http://www.cancerresearchuk.org/sites/default/files/achieving_world-class_cancer_outcomes_-_a_strategy_for_england_2015-2020.pdf (Accessed September 2016)
[iii] Macmillan Cancer Trust, Living with or Beyond Cancer. Available at: http://www.macmillan.org.uk/getinvolved/campaigns/weareaforceforchange/survivorship/livingwithorbeyondcancer.aspx (Accessed September 2016)
[iv] IHE Report (2016), Comparator Report on Patient Access to Cancer Medicines in Europe Revisited. Available at: http://www.ihe.se/filearchive/2/2651/IHE%20Report%202016_4_.pdf