NHS off-target for early cancer diagnosis goal

The committee’s report – Cancer services – acknowledged improvements in cancer survival over the past half century, but said that cancer outcomes in England remain behind comparable countries. The Covid-19 pandemic has had a ‘damaging impact’ on cancer services, with 36,000 fewer people in England (45,000 in the UK) beginning cancer treatment during the period compared with previous years. 

This impact is continuing to be felt. And while urgent cancer referrals have begun to recover, the recent Omicron wave resulted in more cancellations of treatment.  

Early diagnosis is the key to improving survival rates. Diagnosing bowel cancer at stage 1 means that 90% of people will live for five years, compared to just 10% of people diagnosed at stage 4. Similarly, 98% of people diagnosed with breast cancer at stage 1 will live for five years, compared to just 24% at stage 4.

The NHS long-term plan set a target to diagnose 75% of cancers at stage 1 or 2 by 2028, but the committee doubted this would be achieved. ‘We do not believe that the NHS is on track to meet the government’s target on early cancer diagnosis by 2028,’ said committee chairman Jeremy Hunt (pictured). He added that this assessment was reinforced by the committee’s expert panel, which rated progress against the target as inadequate.

‘We are further concerned at the damaging and prolonged impact of the pandemic on cancer services with a real risk that gains made in cancer survival will go into reverse,’ he said.

According to the committee the proportion of people being diagnosed at stages 1 and 2 has been static for years at around 54% and current modelling suggested it would remain static until 2028.

The report said that neither earlier diagnosis, nor additional prompt cancer treatment, would be possible without addressing gaps in the cancer workforce. The committee found ‘little evidence of a serious effort to do this’. Workforce targets were inadequate to address current shortages. And while the cancer workforce grew between 3% and 4% a year between 2016 and 2021, this is a small increase when viewed alongside cancer incidence growth of 2% per year.

The committee said the NHS was short of 189 clinical oncologists, 390 consultant pathologists and 1,939 radiologists. And by 2030, the shortfall in specialist cancer nurses would be nearly 3,400. There was no detailed plan to address these shortages. And the committee pointed out that the government continued to reject calls for independent projections of workforce need.

GPs also play a major role in identifying cancer – with more than 60% of cancers diagnosed following a GP referral. However, general practice was under increasing pressure, had its own workforce challenges and had insufficient access to tests such as CT scans. New rapid diagnostic centres would help, but GPs in general needed more support.

The committee also highlighted regional differences in early diagnosis rates and links with deprivation.

Miriam Deakin, director of policy and strategy at NHS Providers, said that trusts were doing everything they could to tackle care backlogs, but more staff were needed. ‘The number of urgent cancer referrals and diagnoses are at very high levels again, and recent national investment in diagnostics is welcome, but the bottom line is that we need a significant boost in staffing numbers to tackle this challenge,’ she said. ‘It’s vital that the government comes up with a fully-costed and funded workforce plan to ensure that the NHS has the staff it needs to meet increased demand for cancer and other services now and in the future.’

She repeated calls for the government to back an amendment to the Health and Care Bill going through Parliament, requiring ministers to publish regular independent assessments of the number of health and care workers needed.’

Royal College of Nursing council chair Carol Popplestone said the committee was right to highlight the lack of a detailed plan to address the shortage of specialist nurses. ‘Investment is vital to ensuring more nursing staff are supported to train as cancer nurse specialists,’ she said. ‘They are key to treatment being available as quickly as possible.’