10 January 2019
Monday 7th January saw NHS UK publish the delayed ‘NHS Long Term Plan’ (NHS LTP). Cancer was noted as one of the key priorities within the document. Organisationally the LTP commits to the current cancer plans laid out in the ‘5 Year Forward View’ document which run until 2020. 2019/20 is seen as the transition year. In terms of organising cancer care the LTP sees Integrated Care Systems (where acute trusts and community organisations share aims and budgetary plans) becoming coterminous with Cancer Alliances and Clinical senates.
The screening and health promotion section of the LTP points out that some cancers can be attributed to obesity, alcohol consumption and air pollution. There are commitments to reduce childhood obesity, roll out ‘Alcohol Care Teams’ in areas with high alcohol-related hospital admissions and cut business mileage and aircraft emissions. There is a recognition that deprivation and poverty lead to health inequalities particularly linked to smoking, obesity and alcohol misuse, and that these inequalities will be addressed.
The plan proposes to improve cancer survival by increasing the proportion of cancers diagnosed at stage 1 and 2 from 50% to 75% by 2028. This will be achieved by improving awareness of cancer symptoms and accelerating access to diagnosis and treatment. Screening will become more centred on those at risk via genetic testing of patients with cancer and their families and improvements will be made to existing cervical and bowel screening programmes. Sir Mike Richards will lead a review of the current cancer screening programmes and diagnostic capacity. This will make initial recommendations by Easter 2019 and be finalised in summer 2019.
The success of pilots for Lung Health Checks has resulted in these being rolled out more widely. Patients have a breath test and a discussion to assess their individual lung cancer risk. Any patient assessed as being at high risk of lung cancer will have an immediate low-dose CT scan.
The new faster diagnosis standard will apply from 2020 to ensure most patients receive a definitive diagnosis or ruling out of cancer within 28 days of referral from a GP or from screening.
The LTP commits to rolling out Rapid Diagnostic Centres (RDCs) across the country to upgrading and bringing together the latest diagnostic equipment. In time, RDCs will play a role in the diagnosis of all patients with suspected cancer, including self-referral for people with red-flag symptoms. The majority of patients will not have cancer, but may have other conditions, will be referred on quickly to get the right support.
There is a large section on cancers in young people and a commitment to simplify pathways, improve outcomes and ease access to expert opinion in this patient group as well as offering children with cancer whole genome sequencing to aid diagnosis and personalise treatment. Children and young people will be encouraged to take part in cancer trials and will also have improved access to ‘cutting edge’ technology such as proton beam and CAR-T therapy. Boys aged 12 and 13 will be offered vaccinations against HPV recognising the links with throat, oral and anal cancers.
Whilst the main focus for improving survival in adult cancers is on community and diagnostic services there is also a commitment in the LTP to improve access to high quality radiotherapy, completing the current upgrade of radiotherapy equipment and improving the commissioning of hypofractionated regimens. There is also an emphasis on improving access to genomic testing for patients with cancer and improved access to immunotherapies.
Interestingly for specialist cancer nurses there is a promise that all patients with cancer will be offered a needs assessment, a care plan and health and wellbeing information and support in addition all patients, including those with secondary cancers, will have access to the right expertise and support, including a Clinical Nurse Specialist or ‘other support worker’.
Critique and analysis of the NHS LTP at this point have included the views that the staffing and workforce development required to deliver the proposed outcomes is not specifically addressed within the plan and that the requirements of acute trusts, currently struggling with workload and financial challenges, have not been adequately addressed.
The full document can be accessed here