1. Improving Cancer Outcomes at a national level - The story from England Professor Sir Mike Richards National Cancer Director June 2012 1

2. Improving Cancer Outcomes in England ●What were the problems? ●What have we done? ●Where next? 2

3. Cancer in England 20 years ago ●High incidence (like other developed countries) ●Poor survival (most cancers) ●High mortality (especially lung cancer and breast cancer) 3

4. Cancer in England 20 years ago ●Why were outcomes so poor?  England had particularly high smoking rates in the 1950s and 1960s  Our services were very fragmented, both within hospitals and between hospitals and the community, with long waiting times  We were complacent – we believed our National Health service was amongst the best in the world  We chose to ignore emerging findings from the EUROCARE studies as unreliable  Our services were ‘doctor-centred’ not ‘patient-centred’ 4

5. Cancer in England: What changed? (1) ●The evidence of poor outcomes became more difficult to dismiss ●The voice of cancer experts, charities and patient groups started to be heard  by the media  by politicians ●The Chief Medical officers for England and Wales published a report highlighting problems – The Calman-Hine report (1995) 5

6. Five year period survival profiles from 1991 to 2002 for colorectal and breast cancer: The EUROCARE Studies 6

7. Cancer in England: What changed? (2) ●Tony Blair calls a “Cancer summit” in May 1999 and declares cancer ‘a top priority’ ●National Cancer Director appointed – November 1999 ●First comprehensive Cancer strategy published September 2000: The NHS Cancer Plan 7

8. What was achieved? 2000 - 2007 ●Reduced smoking rates (from around 28% to around 21%) – through concerted efforts (taxation; ban on smoking in public places; stop smoking services, etc) ●Improved cancer screening programmes for cervical, breast and colorectal cancer ●Reduced waiting times ●Improved services – with almost all patients being assessed by a multidisciplinary specialist team ●Centralisation of complex surgery ●Improved radiotherapy and chemotherapy services 8

9. How was this achieved? 2000 – 2007 ●“Community building” – nationally and regionally  clinicians ▪ patients  academics ▪ politicians  managers ▪ charities  civil servants ▪ industry ●28 cancer networks – each serving on average 1.8m population (range 1-3m) ●National Cancer Action Team – to support change ●Clearly defined targets/commitments ●Additional funding – but no more than for the rest of the NHS ●New cancer standards – and peer review assessment of individual services ●Rigorous monitoring and reporting 9

10. The position in 2007 ●Much better services ●Much shorter waits ●Better patient experience/satisfaction but… ●Survival rates still lagged behind other countries 10

11. Colorectal Cancer 5yr RS Lung Cancer 5yr RS Breast Cancer 5yr RSOvarian Cancer 5yr RS ICBP: 5 year relative survival. Coleman et al, Lancet 2011 AUS

12. Colorectal Cancer 1yr RS Lung Cancer 1yr RS Breast Cancer 1yr RSOvarian Cancer 1yr RS ICBP: 1 year relative survival. Coleman et al, Lancet 2011

13. Cancer Reform Strategy: 2007 ●Second cancer strategy – with a new emphasis on:  A National Awareness and Early Diagnosis Initiative (NAEDI)  A National Cancer Survivorship Initiative (NCSI) – “living with and beyond cancer”  A National Cancer Intelligence Network (NCIN) – to provide better data on all aspects of cancer 13

14. National Awareness and Early Diagnosis Initiative ●4 components  Public awareness campaigns to promote earlier presentation  Support for GPs  Better diagnostic services  Research and evaluation 14

15. How many deaths might be avoided if cancer survival in England matched the best in Europe? 15 [NB Prostate has been excluded as survival ‘gap’ is likely to be due to differences in PSA testing rates.] Data derived from Abdel-Rahman et al, BJC Supplement December 2009 Breast~ 2000Myeloma250 Colorectal~ 1700Endometrial250 Lung~ 1300Leukaemia240 Kidney/Bladder~ 990Brain225 Oesophagogastric~ 950Melanoma190 Ovary~ 500Cervix180 NHL/HD370Oral/Larynx170 Pancreas75 Total around 10,000 pa

16. Lung cancer – cough campaign 16

17. Be clear on cancer: Bowel cancer 17

18. Improving Outcomes: A Strategy for Cancer ●Third cancer strategy – with a new focus on outcomes  Survival  Quality of life (PROMs)  Recovery from treatment  Patient experience (survey)  Safety 18

19. Patient experience survey 19

20. National Cancer Intelligence Network ●We aspire to having the “best cancer intelligence network in the world”  Cancer registration as the foundation  Linking datasets (primary care, screening, radiotherapy, chemotherapy, hospital administrative systems, etc)  Bringing together the relevant expertise  Producing useful outputs for hospitals, commissioners, patients, etc 20

21. Summary ●We have definitely made progress over the past 12 years ●Even with a national focus it has not been easy ●We know we still have a long way to go 21