Cancer Outcomes in the UK

Baroness Finlay of Llandaff Excerpts

Tuesday 21st April 2026 Grand Committee

[Baroness Finlay of Llandaff (CB)]

My Lords, like others I am most grateful to my noble friend Lord Patel for securing this debate today, which is acute myeloid leukaemia day—so it seems very appropriate. I declare my interests as a professor of palliative medicine at Cardiff University and am employed at Velindre cancer centre, as well as my vice-president roles with various hospices, particularly City Hospice, Marie Curie and Hospice UK. I also declare my position with Cicely Saunders International, because its research in palliative care is the main research point not only for the UK but across the world. My other declaration must be as chair of the Bevan Commission in Wales, because I am mentoring one of our fellows on a project on early diagnosis of post-menopausal bleeding.

I will take a slightly historic view on this. The Calman-Hine report came out in 1995; it was the first report on cancer services and set out a cancer plan to take things forward. The current cancer plan reflects the importance of having vision and ambition because, without that, things will not change. One has to set a path forwards, and the Calman-Hine report did. It changed the organisation and structure of cancer services at the time, started multidisciplinary team working, and created centres and units.

That report was also the first time that palliative care was recognised as an integral component of cancer services from the time of diagnosis through all stages, not only in end-of-life care. It tried to set uniform standards and ensure a holistic approach, with early intervention that recognised the physical, psychological and social support needed by people from the time of diagnosis onwards. There is evidence in oncology that, usually within eight to 12 weeks of diagnosis, if palliative care services are available in parallel with the cancer services, there are improvements in quality of life and mood, patient and caregiver satisfaction, and cancer survival overall.

Unfortunately, though, the NICE guidance recommendations on 24/7 access to specialist palliative care services have not been fully implemented, neither those from 2004 nor from 2011. So will this plan integrate with the palliative care plan and strategy that we anticipate will come forward in the autumn? Without that integration, we will not meet patient need. It has already been said that two-thirds of hospice funding is from the charitable sector, yet Marie Curie estimates that about a third of people dying have unmet palliative care needs. It has been estimated that up to 90% of people dying in hospital without any specialist palliative care support available have their needs unmet.

Frailty, of course, makes everything worse in cancer treatment, from diagnosis right through to outcomes. As has been said by the noble Baroness, Lady Nargund, and the noble Lord, Lord Patel, for the ethnic minorities there is poorer access to everything, including palliative care. There is poorer access to emergency palliative care in both deprived areas and rural areas.

Where financial data is available, it has been shown by Peter May and colleagues from Hull York that, in England in 2022, specialist palliative care supported over 20,000 patients to leave hospital and have their care outside it. They calculated that, overall, this input from specialist palliative care saved £800 million, with a saving of 1.5 million hospital bed days. That is not insignificant at all. For each patient with home specialist palliative care involved, there was a saving of almost £8,000, with quality-adjusted life years also improved. For hospital patients, it was not quite as much: it was £6,500 in cost savings, but with that same improvement in quality of life.

One of the problems has already been alluded to: although the faster diagnostic standard had been met, the delays from the decision to treat, and indeed from referral to start treating, has meant that targets have not been met to date. Almost half of young people later diagnosed with cancer attend three or more GP appointments before receiving a referral to cancer services for diagnosis, meaning that teenagers have the longest time to diagnosis, with 67% diagnosed as an emergency. This puts huge pressure on parents in particular, who have to provide emotional support and take time off from work, and it of course has an enormous financial drain on the whole family.

At this point, I point out that some of these young people have very rare tumours. If we look at ocular melanoma, which is a very rare tumour, there is a subgroup of patients who will respond extremely well to some treatments that are not yet NICE-approved and not available on the NHS, even though they have been used and developed for over 20 years. Therefore, families—here I declare an interest as having a family member involved—are having to support their treatment, because the dramatic response means that they are living, rather than having already died, leaving young families.

As well as putting pressure on NICE to review the way it looks at the management of some rare cancers, will the Minister also look at the workforce training needs? Sadly, there is evidence that, even though over 90% of those dying will have some palliative care needs at some level—which is often adequately provided by generalist services when they have back-up from specialist services—the electronic staff record of nursing staff in the community shows that only a small number have actually had palliative care and end-of-life role training. The problem is that this means that about 78%—over three-quarters—of home care workers report insufficient training in pain management or anticipatory prescribing, while two-thirds have never received formal training and do not have access to palliative care services during their shifts out of hours.

There is much to be done, but much that can be improved. I hope that this plan will move us forward with better integration. The evidence shows that where we have better integration of services, it costs less and the clinical outcomes are improved.