Is the NHS winning the war against cancer
How is the NHS faring in the battle to stay ahead of the cancer curve, improve early diagnosis, survival rates and life beyond cancer? Fortis spoke to some leading innovators for their insights into the challenges they are facing and the investments and innovations that are making a difference.
A staggering one in two people in the UK1 can expect to develop cancer at some point in their lifetime and cancer causes one in four of all deaths. Figures from Macmillan Cancer Support2 predict there will be 3.5 million people with cancer by 2025, 4 million by 2020 and 5.3 million by 2040. Recent statistics from Cancer Research UK3 reveal there were 375,400 new cases of cancer in 2016 to 18 and 167,142 deaths.
But despite the pressures of an ageing population, the backlog of cases from Covid-19 and industrial action, impressive inroads are being made to improve survival. From the building of community diagnostic centres (CDCs), modular buildings (to expand capacity), major new cancer hospital builds, targeted screening programmes (to address health inequalities), AI, robotic surgery, genomics to building Cancer Alliances across the country – progress is being made.
Professor Peter Johnson, NHS National Clinical Director for Cancer, acknowledged this at the launch of new cancer standards last August when he said it was testament to the hard work of staff that the NHS is seeing and treating record numbers of patients for cancer, and diagnosing people at an earlier stage, giving them the best chance of survival. “On top of delivering record checks and treatments, staff have also made significant progress bringing down the longest waits, but we want to ensure even more patients are being diagnosed and treated as early as possible following referral,” says Peter.
NHS Long Term Plan to improve cancer outcomes
Although it’s good news that more people are now surviving cancer, the NHS Long Term Plan4 published in 2019 set out commitments that included an ambition to increase the number of people surviving cancer by 550,000 each year by 2028, and to aim for 75% of people with cancer being diagnosed with disease early at stage 1 and 2. The drive centred on improving national cancer screening programmes, giving people faster access to diagnostic tests, investing in cutting-edge technologies and making sure more people benefited from precise highly-personalised cancer treatments.
Then, in August 2023, NHS England announced three new standards,5 including the 28-Day Faster Diagnosis Standard (FDS), which means patients with suspected cancer who are referred for urgent cancer checks from a GP, screening programme, or other route should be diagnosed or have cancer ruled out within 28 days.
Others included the 62-day referral to treatment standard, which means patients who have been referred for suspected cancer from any source and go on to receive a diagnosis should start treatment within 62 days of their referral; and the 31-day decision to treat standard, which means patients who have a cancer diagnosis and who have had a decision made on their first or subsequent treatment should then start that treatment within 31 days.
Figures published in February 2024 revealed all three targets have been missed,6 with just 66% of patients beginning their treatments within two months of an urgent referral, illustrating how challenging the current climate is. But the drive to focus on screening and earlier diagnosis continues with 160 CDCs promised, 40 launched in 2021 and 127 open by September last year.7
Successful Capital Programme: The Wirral University Teaching Hospital NHS Foundation Trust
Matthew Swanborough, Chief Strategy Officer at Wirral University Teaching Hospital NHS Foundation Trust, says the Trust’s focus has been on building infrastructure support patient care across both its sites at Arrowe Park Hospital and Clatterbridge Hospital, both on the Wirral in the North West of England.
“As part of that, we have focused on external bids through government or NHS England to address a number of issues, including waiting list performance, elective recovery following Covid-19, improving access to healthcare for the Wirral population and reducing waiting times for diagnostics,” says Matthew.
The capital programme included a joint bid for funds for a major building refurbishment to create a CDC within the Clatterbridge Cancer Centre on Wirral, which opened in June 2021 and has seen 100,000 patients and reduced waiting times for patients.
“For the second phase of the CDC we’ve gone for a modular build, which was completed in April 2024. Modular builds are quicker to construct – the frame is built off-site while the foundations, work links, substations and core infrastructure is completed on site. We were originally quoted three years to complete a brick-built building, but it was 12 months for a modular build and obviously time is of the essence,” says Matthew.
The Trust’s capital programme has also included two sets of modular theatres at Clatterbridge Hospital, with the first £10.6 million build completed in November 2022 and the second £14.9 million phase completed in October 2023. “We’ve also undertaken an internal refurbishment of the theatre complex and that will allow 6,000 additional patients per annum to have procedures and surgery. It’s a success story, reducing our waiting lists – in the first year we had just one of them operational and more than 3,000 patients were treated,” explains Matthew.
The Wirral also received £2.2 million from the Cheshire and Merseyside Cancer Alliance for a Da Vinci robot, which enables them to take on colorectal, urological, and gynaecological cancer surgery. “We’ve been able to offer more precision surgery with shorter hospital stays and improved outcomes for patients,” says Matthew.
The final major project is a new multi-million-pound urgent care and emergency department at Arrowe Park Hospital, which is due for completion in 2025. “We’ve used the right experts in our strategy and estates functions to create bids and have successfully delivered on budget with our strong quantity surveying and costing support.”
Transformation in cancer diagnostics at Norfolk and Waveney
Sam Brown, Diagnostics Transformation Programme Lead at Norfolk and Waveney Integrated Care System (ICS), details their strategy to tackle cancer, including using volunteers to improve appointment attendance and prioritising diagnostic services and infrastructure investments.
“In imaging, around five to seven per cent of test appointments are do not attends (DNAs) – tackling this needs to be an absolute priority,” says Sam. An East of England volunteer pilot project includes Norfolk and Norwich University Hospital, Queen Elizabeth Hospital King’s Lynn and Broomfield Hospital, Chelmsford, in Essex.
Sam says: “A quarter of patients were waiting more than six weeks for a diagnostic appointment compared to three to four per cent before the pandemic. Through the collective effort of the Norfolk and Waveney ICS Diagnostics Transformation Team, the hospital sites involved in the project along with support from the national charity Helpforce, we are mitigating imaging DNAs utilising volunteers to contact patients in advance of their appointment to check/ reminding them of attendance and to support with any questions they may have. Amazingly, we were able to get a volunteer service designed and live within 12 weeks,” explains Sam.
The pathway for progress, says Sam, is on diagnostics and sourcing funds for the right type of site and the right location for the community. Norfolk and Waveney are investing more than £100 million on three imaging-only CDCs, being built on their acute hospital sites, and also within an existing community hospital site in Great Yarmouth. “It was a long and complex process to get funding approved,” says Sam. “We found it valuable to work with Health Spaces when we were looking for a suitable site for the CDCs, particularly their model which supports Health on the High Street initiatives, which although not used this time opened our eyes to options we hadn’t considered.”
In terms of type of build, causing less noise and pollution is a priority. Norfolk and Waveney’s £12.5 million investment into a 56-module state-of-the-art endoscopy unit at the Queen Elizabeth Hospital King’s Lynn is testament to this.
And the team are on target to meet the 28-day faster diagnosis national standard with their focus on diagnostics. Sam says Professor Sir Mike Richard’s report Diagnostics: Recovery and Renewal8 in 2020 was instrumental in identifying diagnostics as a priority and looking at things differently and was the ‘call to arms’ needed.
“It’s very difficult to differentiate between diagnostics for cancer and ‘other’ diagnostics, but endoscopy, imaging, pathology, and physiology tests are all key to being able to diagnose cancer faster,” says Sam.
“Workforce planning to support the diagnostic centres is also key to speeding up waiting times and diagnoses,” says Sam. “You may still have to wait for your results if you don’t have those most important ‘back-office’ reporting staff,” explains Sam.
And Sam continues to keep an eye on the future: “We need to look at how innovation could also support us in this. Capacity is not just about people, it’s also about the surrounding infrastructure, effective equipment, IT and the potential of AI, and how we can do things differently,” he says.
And mindset matters too, says Sam: “The culture around change can be quite difficult, particularly in lean years – this idea that we continue to do what we do because we always have can become quite embedded and it takes strong clinical leadership and system working to change that mindset,” says Sam.
Healing the whole person: Dyson Cancer Centre
Due to open in spring 2024, the new Dyson Cancer Centre at the Royal United Hospitals (RUH) Bath will provide a purpose-built cancer services hub for half a million people in the southwest, backed by £40 million in government funding as part of the New Hospitals Programme, a £10 million campaign from RUHX (the hospital’s charity) and a £4 million donation from the James Dyson Foundation
The state-of-the-art cancer facility brings together chemotherapy, radiotherapy, and oncology services under one roof. The three-storey building also has a Macmillan Wellbeing Hub, a 22-bed inpatient ward, a clinical trials department and accommodation for families of patients.
The new centre has been specially designed to provide a nurturing and therapeutic environment, alongside high-quality clinical care. Interior design, the use of natural light, artworks, and art installations (may influenced by the local environment) all have an important role to play.
Hetty Dupays, Art and Design Manager at the RUH, says: “The main themes are land, water and sky, and we are using art to create an environment that is calm and conducive to healing. But all the installations are robust enough to withstand wear and tear and meet infection control and fire safety standards.”
Visitors to the centre walk into a light-filled atrium decorated with a five-metre-high mural by the artist Mark Sands depicting olive trees and bee eaters on canvas. There is also an ambient room, where patients and staff can relax and watch a moving image and soundscape by Chrystel Lebas of a bluebell wood from dawn to dusk from the high canopy of trees down to ground level on a 60-minute loop. “We are so excited about this – it will be a tranquil space for patients to take time out from their treatment and just breathe and relax,” says Hetty.
Other art designs include a light installation by Bruce Munro called ‘Time and Again’ in a courtyard garden inspired by the lily ponds at Chatsworth House, and a light box by Amy Shelton created with hundreds of plants gathered from the renowned garden ‘Open Field’ by Piet Oudolf at Hauser & Wirth, Somerset, which have been dried and pressed.
“All patient spaces have a view out onto trees and the gardens we are designing,” says Hetty. “Partly funded by Macmillan Cancer Support, the Macmillan Wellbeing Hub has been designed with patient input as a non-clinical, calming space and will have all the practical and emotional support services cancer patients and their loved ones can benefit from, including a room for lymphoedema patients, counselling services, a hairdressers and benefits advice. There are also rooms for relatives to stay in and isolation rooms.”
Artist Natasha Clutterbuck has created hand-painted murals for many of these rooms, along with vinyl manifestations for glazed areas, all inspired by precious pollinators and the forest gardens.
How Cancer Alliances are leading the way
The 21 Cancer Alliances in England bring together experts to tackle cancer care across regions, with a vast remit, Michael Ryan Managing Director of the East Midlands Cancer Alliance explains. These alliances, covering millions, aim to enhance outcomes by connecting people and streamlining processes.
“We are also involved in targeting funding investments into services and new ways of working, multi-disciplinary team (MDT) decision making, workforce development and co-ordination, tracking of patients, as well as personalised care for people who are living with and beyond cancer, who still need subsequent treatment and support.
“Our mantra is to try to make the right thing to do for the patient the easiest thing to do for a clinician, which can be quite difficult in the NHS system. Cancer Alliances themselves are ‘guilty’ for increasing demand onto treatment capacity with our work for earlier diagnoses to improve outcomes for people and survivorship.
“A diagnosis at a stage 1 or 2 cancer means your management plan is different and the likelihood of living five years or more is much greater than if you were diagnosed at stage 3 or 4. This makes the work that we do and the pace at which we do it even more important for all of us considering statistically 50 per cent of people over age 50 will experience cancer at some point in their lives.”
All this is being done against a backdrop of ever-increasing demand, with a 5 to 7% increase in cancer cases every year on top of addressing delays in access to treatment and diagnosis due to the Covid-19 pandemic. “Capacity and workforce as a whole are facing unprecedented levels of demand and therefore transformation of pathways, physical spaces and how we operate have to change in parallel to investing additional resource.”
Michael says one of the many areas where the East Midlands Cancer Alliance has been successful is in meeting the faster diagnosis standard for diagnosis within 28 days. “We’ve used that strategically and technically as the conduit to pull primary and secondary care clinicians and operational teams together,” says Michael. “Seventy-eight per cent of our patients were advised whether they did or did not have a diagnosis of cancer within 28 days against the national target of 75 per cent (and we were at 70 per cent a year ago).
The Alliance is delivering initiatives in personalised care, including service development for psycho-social support for people living with and beyond cancer, as the number of people living with and beyond cancer is set to double in the next decade. “Mental Health Trusts for services historically didn’t exist,” says Michael. “We have also launched a programme specifically aimed to identify and address health inequities and inequalities to ensure we have a full scale and scope framework to consolidate and share multiple initiatives.
Through a targeted screening initiative, the Cancer Alliance has engaged black men – who are at double the risk for prostate cancer – for early diagnosis, significantly enhancing and saving lives. “Last year, we identified nine people with prostate cancer out of 500 mainly black men invited for screening,” says Michael.
Other notable successes in the East Midlands include adapting existing NHS spaces and making use of modular buildings to create more physical space for cancer multidisciplinary team (MDTs). “Staff came up with ideas on how to expand surgical space and co-locate pathway functions. I’ve seen MDT teams taking turns using a sledgehammer to (safely) bring down a wall to make best use of space,” he says.
The NHS has also rented space from the private sector to boost capacity to meet cancer demand, provided more modular endoscopy suites and is also working on increasing histopathology capacity for the use of genomic screening.
“We are still improving cancer services despite a massive increase in demand. However, there is a lot more to do. We need to prioritise cancer service improvement and ensure we enable and develop services that can service both current and future patient needs.”
The Gold Standard – The Christie NHS Foundation Trust, Manchester
Sam Brown of Norfolk and Waveney reflects, “Our journey is one of continuous education, observing and integrating practices from the gold standard in cancer care at institutions such as the Royal Marsden, The Christie, and Clatterbridge into our own.”
The Christie proudly stands as Europe’s most extensive dedicated cancer treatment facility at a single location and is the UK’s first to receive the honour of being a comprehensive cancer centre. Every year more than 60,000 patients are treated at the Christie. As a vanguard in oncological therapy and patient care, The Christie has introduced pioneering diagnostic and treatment methods. These include the trial of a novel melanoma blood test, a strategic tool for selecting and timing treatments. Research at The Christie also explores the potential of blood tests to monitor secondary cancer in women, offering a less invasive alternative to CT scans.
The Christie’s excellence has been widely recognised, with the designation as one of the first European Prostate Cancer Centres of Excellence, making it the sole UK institution to achieve this status. This recognition comes from meeting a variety of benchmarks in three fundamental domains — clinical care, research, and training — as established by the European Association of Urology.
FOOTNOTES
1 https://www.bmj.com/content/350/bmj.h614
3 https://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence#heading-Two
4 https://www.england.nhs.uk/cancer/strategy/
6 https://news.cancerresearchuk.org/2024/03/14/cancer-waiting-times-latest-updates-and-analysis/
7 https://www.kingsfund.org.uk/insight-and-analysis/blogs/how-are-community-diagnostic-centres-doing
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This article was taken from the May 2024 edition of FORTIS magazine.
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This article was written for the November 2024 edition of FORTIS magazine; a forum for the NHS to share ideas, innovations and case studies. To read the publication in full and access digital copies, visit FORTIS magazine. FORTIS magazine is free for NHS change-makers and leaders and is available as a print or digital copy. FORTIS magazine is managed and owned by Health Spaces Ltd.
