The government’s new National Cancer Plan is admirable in its ambition. It promises to increase survival, end unwarranted variation in treatment and radically improve patient outcomes compared to international peers. The plan says that the level of ambition signalled “cannot be delivered within the bounds of our existing care model”. But can the NHS reinvent a new model quickly enough? And what does this mean in practice? As ever, success will lie in the detail of delivery.
The gap between aspiration and current capability should not be underestimated. Cancer waiting time standards have been missed for years, and England has steadily slipped down global rankings for outcomes. Staff across radiology, pathology, oncology and specialist nursing describe the same challenges: rising demand and complexity, limited headspace and the constant pressure of trying to restore waiting times performance in a very tight timescale. In short, the system is severely stretched with little to no breathing room. This all points to the same conclusion – reinvention on the scale required will not happen without changing care models, and the necessary resources and capacity to match.
Take diagnostics. Even with pathway redesign and new investment in technology, diagnostic capacity cannot grow without enough radiologists, pathologists and specialist nurses to staff it. Scaling up genomic and biomarker testing to support earlier stage, personalised treatment requires not only additional laboratory capacity but bioinformatics expertise and clinical time to act on results. A new report from The King’s Fund shaped by convening leaders in cancer care underscored that modernising the way that multidisciplinary cancer teams work will be essential if specialist time is to be freed for adopting new technologies or redesigning pathways. It is encouraging to see the plan committing to review this.
There is credible cause for optimism. The rollout of Rapid and Community Diagnostic Centres, in some cases significantly speeding up the wait for a diagnosis, and progress in standardising access to clinical trials and genomic testing, show that when national direction, infrastructure, workforce planning and local leadership align, the system can adapt quickly. Cancer Alliances, regional partnerships of clinical and managerial leaders, have long demonstrated what is possible in coordinating pathway reform and spreading best practice. A new generation of cancer manuals has the potential to bring clarity on what ‘good’ looks like, giving staff a clearer route from policy to practice.
Despite this, challenges remain. Workforce capacity remains a key limiting factor, and not just for cancer services. Digital infrastructure is yet to be brought fully into the 21st century, with too many providers still wrestling with incompatible systems. Integrated Care Boards (ICBs) – local NHS commissioning organisations, which provide leadership and offer headroom and support for change – are being halved in size while day-to-day operational pressures dominate commissioners’ decision-making and absorb the funding necessary to implement new ways of working.
Difficult choices lie ahead. Restoring cancer waiting times performance is rightly one of the plan’s early milestones, but it is unlikely in the committed timeframe. The plan places early diagnosis as its north star, but this requires the NHS to focus relentlessly on the basics: improving diagnostic turnaround times, increasing take-up of screening and freeing up staff capacity. The most powerful lever for improving survival from cancer is prevention – around a third of cancers are preventable – but this aspect is drastically overlooked, despite the government’s promised shift from treatment to prevention. So, is the cancer care of the future promised in the National Cancer Plan within reach? Yes, but only if the scale and urgency of ambition is backed by the resources and capacity to deliver care differently. Only then will patients receive the faster, fairer care they deserve.
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