NHS Leaders have today launched a five year plan to transform cancer services to meet the soaring numbers of Londoners surviving cancer.

Whilst cancer is still the biggest cause of premature death, the number of people living with and beyond cancer^[1]  is set to rise to 400,000 by 2030. Every hour three more Londoners^[2] are diagnosed with cancer, but as the NHS has become successful at treating the disease, it now needs a step-change in the way it cares for people living with the disease.

Through cutting-edge cancer treatments and follow-up support, the NHS in London has had real success in saving lives. However, mortality rates are poorer than many other countries^[3] and there are wide variations across the capital in screening and access to treatment, with many cases being diagnosed too late.^[4]

The new Cancer Commissioning Strategy from NHS England (London) sets out a five year plan to boost cancer services, enhance patient experience and raise survival rates.  Produced in partnership between NHS England (London), London’s CCGs, Public Health England, the Integrated Cancer systems and charity partners, the strategy sets out key recommendations for health services across the capital.

Specific actions include :

• Prevention – Clinical Commissioning Groups should commission well-evidenced prevention programmes to tackle factors such as smoking, unhealthy diets, alcohol and excess weight, which cause one third of all cancers diagnosed in the UK each year.
• Screening – Commissioners should improve the take-up of national screening programmes, support the rollout of Bowel Scope – the new bowel cancer screening for those on or around their 55^th, and join-up the pathway from screening to treatment.  Screening should also be a priority in Health and Wellbeing strategies.
• Early detection: More GPs should be trained to spot the signs of cancer early, for example, using a Macmillan decision support tool that flags up combinations of symptoms that could be caused by cancer. Public Health teams and CCGs should also commission awareness campaigns, such as Cancer Activists in the community and ‘Get to know cancer’ pop-up shops, such as one which is being launched in a Wandsworth shopping centre on 23 January, to raise awareness of symptoms and encourage early diagnosis.
• Reducing variation – Commissioners should use contracts to improve hospital performance, such as increasing resection rates for lung cancer, follow best practice on lung cancer and bowel cancer to reduce variations and should adopt Royal College recommendations on waiting and reporting times for diagnostic tests.
• Living with and beyond cancer – Commissioners should expand the roll-out of an integrated Recovery Package for all patients, which includes a full holistic assessment of their needs, a care plan, and an education and information event to help people to manage their condition and promote healthier lifestyles. This should also ensure that all Multi-Disciplinary Teams have referral pathways for issues arising from treatment, such as pelvic radiation disease , lymphodoema and treatment-related sexual problems.
• End of life care – Commissioners should commission a new proven system that co-ordinates care for people at the end of their life and supports them to die in their chosen place.

Every year, around 30,000 Londoners are diagnosed with cancer ^[5] and around 13,600 people die from the disease annually ^[6], making cancer the biggest cause of premature death in the capital^[7].

London also has the lowest coverage and uptake for cancer screening in England and low rates of early diagnosis, with more than a quarter of cancers diagnosed in A&E^[8].

Dr Andy Mitchell, Medical Director , NHS England London Region, said:

“London is a world class city, but it cannot currently claim to have world class cancer outcomes, nor to care for cancer patients in a way that puts them and their needs first.  It is unacceptable for 1,000 people to be dying unnecessarily each year because their cancers are not spotted early enough.^[4]

“Compared with other parts of the world, cancer services in London are falling short. As more people are expected to survive and live with cancer, the NHS faces new challenges in supporting patients to manage cancer as a long-term condition.

“Cancer is no longer the death sentence it once was – it can be treatable and beatable.  We want to make sure that no matter where people live, Londoners will receive excellent care. This means helping them spot the signs of cancer earlier and giving – without exception – the kindness and support that you would want for your own friends and family.”

In its last annual survey, Macmillan found that patient experience of cancer care across London is poor, with nine out of 10 worst reported hospitals rated by patients being in London.^[9]

NHS England’s strategy calls for commissioners to make patient experience a higher priority, including ensuring all hospitals take action to reduce waiting times, and improve staffing levels and behaviour.

Dr Anne Rainsberry, Regional Director for NHS England (London), said:

“Cancer services currently do not always put patients and their needs first – the NHS is better at treating the disease but now needs to be much better at treating people with care, respect and compassion.

“More than a quarter of cancers are diagnosed in A&E or as an emergency referral.  We need to change services so that London’s health services become better at preventing cancer and detecting it earlier.

“The increasing numbers surviving cancer will mean extra challenges for the NHS, when services are already under pressure – especially in primary care, where patients tell us they often can’t get an GP appointment quickly.”

Fran Woodard, Macmillan Cancer Support Director for England, said:

“Without question action is needed across London to improve cancer care. For the past three years London NHS trusts have filled the bottom places in Macmillan’s annual league table measuring patients’ experience of cancer care across England.

“It is simply unacceptable that some cancer patients in London are being let down by hospitals failing to provide crucial support, alongside medical treatment.  There is no reason why the capital should not have the best cancer outcomes of any major city. Today it falls woefully short.”

Sara Hiom, Cancer Research UK’s director of patient engagement and early diagnosis, said: “Cancer Research UK wants to see everyone with cancer diagnosed as quickly and accurately as possible and receiving prompt access to the best treatments. Sadly this is not the case all across London, with the city having some of the best and also the very poorest cancer outcomes anywhere in the country. This variation is totally unacceptable, unfair to patients and must be addressed.”

1. Estimated for London (SHA) based on population estimates and Maddams J, Uttley M, Moller H. Projections of cancer prevalence in the United Kingdom, 2010 – 2040. British Journal of Cancer 2012; 107: 1195-1202. Figures exclude non melanoma skin cancer’
2. Every year 30,000 Londoners are diagnosed with cancer – equivalent to three an hour.
3. Compared to other countries in the International Cancer Benchmarking Partnership. This partnership aims to understand how and why cancer survival varies between countries which all have comparable wealth, a universal access to health care and longstanding, high-quality, population-based cancer registration. Others in the partnership include Canada, Australia, Sweden and Norway.
4. See The Case for Change which suggests that around 1000 lives could be saved each year if early diagnosis of cancers matched the best in Europe.
5. See 2012 data, Encore Cancer Analysis System
6. London accounted for 10 per cent of deaths from cancer during 2009 (Source: The NHS Information Centre for health and social care).
7. Cancer is the leading cause of premature (or under 75) death in London. As documented in London borough Joint Strategic Needs Assessments
8. National Cancer Intelligence Network, (2012) Routes to Diagnosis.
9. See Macmillan’s Cancer Patient Experience Survey.
10. National Cancer Intelligence Network, (2012) Routes to Diagnosis.
11. Since 2010, London’s providers and commissioners implemented recommendations from a Model of Care, which brought the development of two integrated cancer systems – London Cancer and London Cancer Alliance – which bring together London’s 28 acute and tertiary care providers to deliver co-ordinated and integrated care along the whole patient pathway.  The Model of Care’s key recommendations were to: help diagnose cancer earlier; improve patient care and reduce inequalities in access to and uptake of services; improve patient outcomes; and, improve patient experience.
12. The proposed strategy is being launched at the first pan-London conference on the future of cancer services to enable NHS England (London) to hear the views of stakeholders across the capital including patients, leading cancer charities, doctors and commissioners. NHS England’s proposals are published here. The final version will then be published later this year.
13. For more information, contact the NHS England (London region) media team on 020 7932 3911 or email england.lsmedia@nhs.net