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Improving Cancer Outcomes at a national level - The story from England

Improving Cancer Outcomes at a national level - The story from England. Professor Sir Mike Richards National Cancer Director June 2012. Improving Cancer Outcomes in England. What were the problems? What have we done? Where next?. Cancer in England 20 years ago.

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Improving Cancer Outcomes at a national level - The story from England

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  1. Improving Cancer Outcomesat a national level- The story from England Professor Sir Mike Richards National Cancer Director June 2012

  2. Improving Cancer Outcomes in England What were the problems? What have we done? Where next?

  3. Cancer in England 20 years ago High incidence (like other developed countries) Poor survival (most cancers) High mortality (especially lung cancer and breast cancer)

  4. Cancer in England 20 years ago • Why were outcomes so poor? • England had particularly high smoking rates in the 1950s and 1960s • Our services were very fragmented, both within hospitals and between hospitals and the community, with long waiting times • We were complacent – we believed our National Health service was amongst the best in the world • We chose to ignore emerging findings from the EUROCARE studies as unreliable • Our services were ‘doctor-centred’ not ‘patient-centred’

  5. Cancer in England: What changed? (1) • The evidence of poor outcomes became more difficult to dismiss • The voice of cancer experts, charities and patient groups started to be heard • by the media • by politicians • The Chief Medical officers for England and Wales published a report highlighting problems – The Calman-Hine report (1995)

  6. Five year period survival profiles from 1991 to 2002 for colorectal and breast cancer: The EUROCARE Studies

  7. Cancer in England: What changed? (2) Tony Blair calls a “Cancer summit” in May 1999 and declares cancer ‘a top priority’ National Cancer Director appointed – November 1999 First comprehensive Cancer strategy published September 2000: The NHS Cancer Plan

  8. What was achieved? 2000 - 2007 Reduced smoking rates (from around 28% to around 21%) – through concerted efforts (taxation; ban on smoking in public places; stop smoking services, etc) Improved cancer screening programmes for cervical, breast and colorectal cancer Reduced waiting times Improved services – with almost all patients being assessed by a multidisciplinary specialist team Centralisation of complex surgery Improved radiotherapy and chemotherapy services

  9. How was this achieved? 2000 – 2007 • “Community building” – nationally and regionally • clinicians ▪patients • academics ▪politicians • managers ▪charities • civil servants ▪industry • 28 cancer networks – each serving on average 1.8m population (range 1-3m) • National Cancer Action Team – to support change • Clearly defined targets/commitments • Additional funding – but no more than for the rest of the NHS • New cancer standards – and peer review assessment of individual services • Rigorous monitoring and reporting

  10. The position in 2007 Much better services Much shorter waits Better patient experience/satisfaction but… Survival rates still lagged behind other countries

  11. ICBP: 5 year relative survival. Coleman et al, Lancet 2011 AUS Lung Cancer 5yr RS Colorectal Cancer 5yr RS Breast Cancer 5yr RS Ovarian Cancer 5yr RS

  12. ICBP: 1 year relative survival. Coleman et al, Lancet 2011 Colorectal Cancer 1yr RS Lung Cancer 1yr RS Breast Cancer 1yr RS Ovarian Cancer 1yr RS

  13. Cancer Reform Strategy: 2007 • Second cancer strategy – with a new emphasis on: • A National Awareness and Early Diagnosis Initiative (NAEDI) • A National Cancer Survivorship Initiative (NCSI) – “living with and beyond cancer” • A National Cancer Intelligence Network (NCIN) – to provide better data on all aspects of cancer

  14. National Awareness and Early Diagnosis Initiative • 4 components • Public awareness campaigns to promote earlier presentation • Support for GPs • Better diagnostic services • Research and evaluation

  15. How many deaths might be avoided if cancer survival in England matched the best in Europe? Total around 10,000 pa [NB Prostate has been excluded as survival ‘gap’ is likely to be due to differences in PSA testing rates.] Data derived from Abdel-Rahman et al, BJC Supplement December 2009

  16. Lung cancer – cough campaign

  17. Be clear on cancer: Bowel cancer

  18. Improving Outcomes: A Strategy for Cancer • Third cancer strategy – with a new focus on outcomes • Survival • Quality of life (PROMs) • Recovery from treatment • Patient experience (survey) • Safety

  19. Patient experience survey

  20. National Cancer Intelligence Network • We aspire to having the “best cancer intelligence network in the world” • Cancer registration as the foundation • Linking datasets (primary care, screening, radiotherapy, chemotherapy, hospital administrative systems, etc) • Bringing together the relevant expertise • Producing useful outputs for hospitals, commissioners, patients, etc

  21. Summary We have definitely made progress over the past 12 years Even with a national focus it has not been easy We know we still have a long way to go

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