Working to end variance in cancer care

NHS England’s National Clinical Director for Cancer explains why the Cancer Patient Experience Survey published last week is key to improving services:

We focus far too often on the ‘clinical’ outcomes of treatment, without considering what that treatment was like for the patients themselves.

But the experience of treatment and the care they receive is often just as important to people as its success, and we should recognise a good experience of care as an outcome in its own right.

Cancer care is complex and often fractured, with people requiring all sorts of different care and support, often from many different parts of the health and care system. It is easy for this to become a disorientating experience for patients and carers, particularly at what is bound to be a stressful and difficult time for many people.

The publication of the latest National Cancer Patient Experience Survey last week is a timely reminder to all of us of the importance of ensuring that the experience each patient has of their care is as positive as possible. Having surveyed over 71,000 people with cancer from across the country, the responses provide us with our best indication of what patients in England think about the care they received.

The news is generally good – respondents gave an impressive average rating of 8.7, on a scale of zero (very poor) to 10 (very good), when asked to rate their overall experience of care, testament to the hard work of NHS staff and the compassion and care for patients I see every day.

But there is always more we can do to ensure that everyone with cancer has a good experience of their care, treatment and support.

Indeed, this average rating hides significant variation between geographical areas and hospital trusts in the care people experience. There is also clear variation between different ethnic groups and ages.

The independent Cancer Taskforce set us an ambition last year to achieve continuous improvement in the experiences people have of care. So what are we doing about it?

Firstly, it is essential that we keep collecting the data we need to understand people’s experiences of cancer care. The Cancer Patient Experience Survey will continue to provide vital insight both into where we are doing well, and where we need to focus the most on improvement. It shines a light on variation in experience, so that we can continue to work to ensure that everyone has a good experience, regardless of location, age or ethnicity.

Secondly, we need to make sure the data is available both to the health system and to patients themselves, so that they can understand where experience is poor and take action to address it. We are already publishing this local data side-by-side with data on other outcomes in the new Cancer Dashboard. From September, the Dashboard will help Cancer Alliances – made up of local clinical leaders, commissioners and providers – to quickly identify areas for improvement across the whole cancer pathway, including patient experience.

Thirdly, we need to do more to understand the problems where we know they exist. We are looking at ways to improve our understanding of the poor experience often reported by Black and Minority Ethnic (BME) communities and younger patients. Having a better understanding of these problems means that we can take action to tackle them in the future.

Beyond improving our understanding of patient experience, we are actively exploring steps we can take now to improve the situation. The independent Cancer Taskforce recommended online access to test results and other communications for patients, to help improve communication. This year, we are focussing on understanding what needs to happen to achieve this securely, and most conveniently for patients.

Access to a Cancer Nurse Specialist or other key worker has also been shown to support a positive patient experience, and over the next year we will be working with partners in the NHS and beyond to find the best way to ensure that patients receive this support.

For patient experience to continue to improve, it is essential that clinicians, nurses and patients work together as equal partners in their care. When people feel their doctor is communicating well with them and involving them in decisions, not only does experience improve, but these aspects of care are also likely to contribute to better clinical outcomes.

I’m excited to see what we can achieve and look forward to working with you to continue to make improvements in this often overlooked but vital area.

Don’t forget to refer to the Dashboard and your more detailed CPES data for the latest insight and picture of your local area.

Chris Harrison

Professor Chris Harrison is NHS England’s National Clinical Director for Cancer and he is Medical Director (Strategy) for The Christie NHS Foundation Trust in Manchester.

He qualified in Medicine from Manchester and, following experience in both hospital medicine and primary care, trained in epidemiology and public health.

Chris held a series of Director of Public Health Posts in Lancashire before becoming Cancer Director for the North West Region in 2000, and then Medical Director of Greater Manchester Strategic Health Authority in 2002.

He became Executive Medical Director at The Christie from 2006 until 2013 when he moved to London becoming Medical Director at Imperial Healthcare NHS Trust before returning to Manchester in March 2016.

Between 2011 and 2013 Chris was seconded part time from his role at The Christie to be Clinical Director for Cancer to NHS London.

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