An NHS view of the National Cancer Plan

What is your biggest takeaway from the plan?

This is far more detailed and impactful than other central NHS policy document of recent years, which have been high on aspirational vision and low on tangible outcomes. This is different but it still provokes constant responses of “how?”. That is a loud “how?” given the plan’s ambitions.

The NHS is going through a period of intense disruption and many of the plan’s vehicles of positive change lack practical reality. Regional teams, cancer alliances, ICBs, neighbourhood health teams and IHOs are all mentioned as key levers, but these are either undergoing disruptive transition or exist only as concepts.

We are headed toward an integrated NHS built around effective multi-disciplinary and multi-agency patient pathways. That is a long way from the fragmented and disconnected current reality and it is hard to see how we overcome the cultural and process challenges required.

How has the plan been received locally by the NHS?

The simple response will be “how can we implement this at a time of such uncertainty and disruption, and through vehicles that are nascent at best?” The work programme demanded of ICBs, for example, is challenging given the level of disruption many are experiencing.

Like so many NHS plans it is essentially inverted in that, despite its rhetoric, the clear focus is upon rare disease, specialisms, specialist centres, hospitals and big kit diagnostics. The success of FIT testing is mentioned but there is an overall lack of focus on primary care and some of the more prosaic reasons that need to be addressed – like availability of simple point of care testing.

It has to be said that much of the NHS will ruefully reflect on the special status of cancer services in respect of measured KPIs, protected funding, specific drugs fund, cancer alliances rejuvenation, commitment to named leads and simple political focus. There is no equivalent push for other services that many would argue are at least as demanding as cancers – diabetes, neurology, respiratory, mental health etc. The contrast is stark with the lack of progress on the promised Modern Service Frameworks (MSFs) for other areas.

Where do you see the biggest challenges and opportunities for it be delivered locally?

The plan aims to eradicate variation but gives additional powers to IHOs – a few health economies that are, by definition, already ahead of their peers financially and in performance terms. NHS per capita funding is highly varied by health economy, so how can we have equity of service? Most NHS insiders can name the half dozen areas that will move fastest to implementing the new systems of named leads, cancer alliances and boards. They will then move most effectively to set up the care plans, named nurses, named neighbourhood leads and new CDCs. We could also name the areas certain to struggle.

My biggest disappointment is the absence of a link to NHS internal finance systems and the chance to overcome fragmented pathways strewn with transactional obstacles. When can we have programme budgets for, breast cancer for example, that cover a whole patient journey? That would also give us the perspective to apply the value-based decisions around all elements of care and not just a few medicines or physical products within the pathway.

How far away is the system in delivering the diagnostic testing needed to make the plan a reality?

We need to turn a large part of the plan on its head and look at it from meta-primary and patient perspectives. That means prevention, detection, simple point of care testing and CDC spokes or variants that aren’t in hospital-controlled mega centres but in neighbourhood hubs.

This inverted focus is important for all kinds of reasons from equity through to effective clinical pathways. It is also something that is easily misunderstood as some kind of dilution of specialist leadership. I see the opposite; this is a chance for specialists to extend their reach by designing the kit, workforce and ways of working of a true local integrated diagnostic network. For diagnostic clinical and scientific colleagues that requires a fundamental shift of locations, professional relations and culture.

What does the plan mean for the life sciences sector?

The risk is that some will see this as a simplistic opportunity featuring a retained CDF, commitment to equip multiple new CDCs, easier routes to trial recruitment and NHSE and its management tiers enforcing delivery. As said above, the NHS perspective will be “how do we do this in practice?” That means the life sciences being an effective and understanding partner with empathy around the scale of challenge, and the ability to help find solutions that will work.

The sector also needs to realise that cancers are a relatively small part of NHS demand, activity and operational focus. Those within the NHS trying to make this work will invariably be spinning many other plates.

Where should the life sciences sector focus for quick wins?

As Covey said – seek first to understand before seeking to be understood. Any first steps should include working this through via NHS perspectives and then looking to see how best a company can support an NHS partner through the challenging response. Part of that has to be accurate segmented assessment of where the elements of a health economy start from – ie region, cancer alliance, ICBs, trusts/FTs, CDCs, candidate IHOs and neighbourhoods. Clumsily proposed “wins” will rebound if assumptions are made around opportunity, challenge and solutions.

It is clear that a whole new cohort of lead individuals needs to be identified, appointed, trained and put into effective teamwork. It is a remarkably broad cohort ranging from senior commissioners and the highest level of clinicians through to hospice nurses and health and wellbeing workers in neighbourhoods. Companies could immediately benefit from finding that prospective cohort and supporting them through that path.