Cancer survival rates in England are higher than they have ever been and earlier diagnosis is the key to improving survival rates further.
In 2016 NHS England made £200m available to ensure we can diagnose cancer earlier and faster, and achieve the Independent Cancer Taskforce ambition that 57% of patients would survive ten years or more by 2020, with 75% surviving one year. Earlier cancer diagnoses will enable us to meet this ambitious goal, as it means patients can receive treatment when there is a better chance of achieving a complete cure. Progress made on achieving early and faster diagnosis includes:
- Introduction of new models of care
- Launch of Be Clear on Cancer campaigns
- Developing new diagnostic tests
- Introducing Rapid Diagnostic and Assessment Centres
- Began to pilot a new 28-day faster diagnosis standard
- Released the new Cancer Workforce Plan
In 2016, NHS England made more than £200m available to Cancer Alliances over the period 2016-2018 to help develop new models of care that will transform services by speeding up diagnosis. The Cancer Alliances have developed bids for funding in four areas:
- Whole pathway redesign
- Early access
- Rapid Diagnostic and Assessment Centres
- Secondary care networks
In February 2017, Public Health England launched the latest Be Clear on Cancer campaign, a new regional pilot focusing on abdominal symptoms such as persistent diarrhoea, bloating or discomfort. The messaging was developed in collaboration with clinicians and the relevant charities and was tested extensively with the target audience of adults aged 50 or over from lower socio-economic groups.
Feedback has been positive, with more than 90% of the target audience saying the adverts made them realise certain symptoms could be a sign of something serious and well over 80% saying the adverts made them more likely to go to a GP.
From 2018, NHS England will be introducing a new bowel cancer screening test for over 4 million people that is easier to use than the current test. The faecal immunochemical test for haemoglobin (FIT) will replace the faecal occult blood test (FOBt) and is expected to increase the take up of bowel cancer screening by around 7%.
Bowel cancer is the fourth most common cancer in the UK. If it is detected at an early stage, before symptoms even appear, it is easier to treat and there is a better chance of survival. With up to a third-of-a-million more people expected to self-administer the FIT test, it will increase the number of early-stage bowel cancers that are detected.
From April 2019 a new cervical cancer screening programme will be introduced. More than 99% of cervical cancers are caused by Human papilloma virus (HPV). The introduction of primary HPV testing for cervical cancer will see more than three million women a year tested and could prevent around 600 cancers a year.
Rapid Diagnostic and Assessment Centres are designed to speed up cancer diagnosis, presenting many patients with test results the very same day. The NHS Five Year Forward View Next Steps document calls for the introduction of 10 new multidisciplinary rapid diagnostic and assessment centres across England by March 2018.
Nine centres have now been set up and have begun to take patients with complex symptoms through to diagnosis. GPs, hospital doctors, radiologists and other healthcare professionals can refer patients to these centres if they suspect cancer and a multidisciplinary clinical team undertakes the necessary investigations all at the same time and in the same place. Cancer Alliances are also developing and establishing similar centres for specific conditions, such as prostate cancer. These models are scalable and can be rolled out across the country.
In all variants of the model, patients are met by a senior member of the clinical team who screens referrals to help speed up the process. Clinic staff coordinate care, organise tests and ensure good communication every step of the way.
Patients who are diagnosed with cancer are rapidly referred to specialists, while those with other conditions receive appropriate treatment and tailored advice about prevention.
Not only will these rapid diagnostic and assessment centres deliver better care for patients, they will increase diagnostic capacity and ease pressure on GPs and accident and emergency teams who might otherwise have to organise multiple referrals.
A new cancer diagnosis standard, designed to ensure that patients find out within 28 days whether or not they have cancer, will be introduced in 2020.
To prepare for the future 28-day standard, NHS England recently introduced a new Cancer Waiting Times System (April 2018). The clinical teams will work on how to collect the data for the new standard this year, before data collection for all patients starts in 2019 with full monitoring against the standard from April 2020.
Five sites are already piloting the new 28-day standard across six cancer pathways – gynaecology, urology, head and neck, lung, lower and upper gastrointestinal. We will be sharing the knowledge gained from these pilot sites during the year. The pilot sites are: Bournemouth, East Lancashire, Ipswich, Kingston, Leeds.
The Health Education England (HEE) led Cancer workforce plan sets out how it will make sure the NHS has enough staff with the right skills to deliver improvements for people affected by cancer over the next three years. It provides detailed data on key professions so that local Cancer Alliances, HEE and employers can agree the actions needed to help recruit, train and retain the staff necessary to deliver improvements in cancer care.
This includes a wave of new cancer specialists who will be employed by the NHS to speed up cancer diagnoses and get more people into treatment more quickly. It includes plans for:
- 200 extra clinical endoscopists – specialists who use tiny cameras on a long, thin, flexible tube to investigate suspected cancers, such as bowel and stomach, inside the body.
- 300 reporting radiographers – specialists who use x-rays and ultrasound to identify certain cancers including breast and lung.
Real-life examples of achieving earlier and faster diagnosis
An innovative scheme in Manchester to catch lung cancer early. Mobile scanning trucks have picked up 1 cancer for every 33 patients scanned over one year.
West London, hospitals are working together, supported by charities, to pilot the use of high definition MR scanning to reduce the average prostate cancer diagnosis time to 8 days, and potentially to double the chance of finding life threatening prostate cancers.
A digital pathology centre of excellence, a pioneering project in Leeds to speed up cancer patients’ test results and diagnoses is being rolled out across West Yorkshire and Harrogate. The use of digital technology to scan specimen slides produced in the library enables pathologists to make diagnoses on a high-resolution computer display.
A new way of working has enabled optometrists to make direct patient referrals to specialist neuroscience services is leading to earlier diagnoses of brain and central nervous system tumours in the North East of England. The initiative will soon expand into North Yorkshire.