The Cancer Control Programme in England Lindsay Wilkinson Head of Cancer Policy Team – Department of Health (England)

Overview »The problem of cancer in England in the 1990s »Developing the momentum for change »Agreeing what needs to be done »Making change happen »Monitoring progress »Keeping abreast with developments in science and society

The problem of cancer in England in the 1990s »High incidence/mortality »Poor survival rates compared with Western Europe (EUROCARE) »Inequalities (geographical and by socio-economic group) »Underfunding compared with Western Europe »Long waits »Fragmentation of services

Developing the momentum for change »Evidence of the problems »Acceptance of the problems (winning hearts and minds) »Effective advocacy »The role of the media »Political will »Leadership

Agreeing what needs to be done »Developing the NHS Caner plan relatively straightforward once the momentum for change had been built »Writing and publication took around 6 months

Components of a Cancer Control Programme (1) Themes: »Prevention »Screening »Early diagnosis »Treatment »Information and support »Supportive and palliative care »Research and development

Components of a Cancer Control Programme (2) Infrastructure »Service structure »Workforce »Facilities »Data systems and monitoring »Quality assurance and quality improvement processes »Funding

NHS Cancer Plan: 4 Key Aims 1.Save lives 2.Improve patients’ experience of care 3.Reduce inequalities 4.Build for the future

Making Change Happen (1) »Clear vision and consensus on the way forward (eg a National Cancer Plan) »Leadership at all levels »Continuing high levels of support (political, managerial, clinical & patient groups) »Clear commitments: targets and milestones »Funding arrangements

Making Change Happen (2) »Delivery systems -National: cancer taskforce -Local: cancer networks »Guidance on service configuration (Improving outcomes guidance – NICE) »Quality Assurance (Standards and peer review) »Quality Improvement (Cancer Services Collaborative) »Information systems »Levers and sanctions for non-achievers

Cancer Networks »Typically cover populations of 1 – 2 million »Partnership of organisations involved in commissioning and providing healthcare »Encompasses primary, secondary and tertiary care »Bring together all relevant clinicians, managers and patient representatives

Monitoring Progress on Cancer in the UK »The National Audit Office (which is independent of government) conducted 3 reviews into progress on cancer in 2004/5 (links at end). »These reviews show that substantial progress has been made, but more needs to be done

Cancer : Progress on Outcomes »Cancer mortality falling (14% in 7 years in people under 75) »Survival rates improving across a wide range of cancers »Experience of care has improved between 2000 and 2004 (surveys conducted by DH and NAO)

Cancer : Progress on Specific Areas Prevention:Tobacco strategy Adult smoking prevalence 28%  25% Screening:Extension of breast screening 31% increase in cancers detected Waits:Progress towards targets Services:Establishment of MDTs Workforce:1000 extra consultants More nurse specialists More radiographers being trained New ways of working Facilities:New CT and MRI scanners New Linacs Research:Accrual to clinical trials doubled

Keeping abreast of developments Societal Changes »Obesity »Ageing population »Rising expectations Scientific Developments »New technologies (eg PET-CT) »New treatments

Summary »Change is hard…….but possible »Cancer services in England are improving…….…but there is a long way to go

Useful links Department of Health NHS Cancer Plan: NHS Cancer plan 3 year progress report Cancer plan and the new NHS (4 th anniversary report) National Audit Office NAO Reports (2004/2005): Tackling Cancer: Improving the Patient Journey NHS Cancer Plan: a Progress Report Tackling Cancer in England, Saving More Lives

Lindsay Wilkinson Head of Cancer Policy Team – Department of Health (England)