NHS: Standards of Care and Commissioning

Lord Patel Excerpts

Thursday 31st March 2011 Lords Chamber

[Lord Patel]

My Lords, good healthcare systems deliver good standards of care and good commissioning should reflect that. I would like to focus on cancer, the insights that it offers into the performance of our healthcare system and the challenges that it poses in the new healthcare structure. The proportion of deaths attributable to cancer has risen from 17 per cent in 1948 to 27 per cent in 2008. It is predominantly a disease of the elderly. Alongside its human impact, cancer is also costly. The National Audit Office estimates the cost as £6.3 billion and the total cost to society as £18.3 billion. These costs will rise as the population ages and new treatments are developed.

Cancer survival is a key metric of the performance and quality of healthcare systems. It is a function of the population awareness of cancer symptoms, primary and secondary care assessment and referral, treatment quality and effective screening programmes. Each year around one in three people is diagnosed with cancer and one in four will die of cancer.

The Lancet in January 2011 compares the survival of patients diagnosed in England, Wales, Northern Ireland, Denmark, Norway, Sweden, Australia and Canada. All these countries have comprehensive cancer registration and broadly similar healthcare spending and systems. The study examined relative survival—the excess deaths due to cancer after allowing for competing causes of death—from 1995 to 2007. Despite the improvement in cancer survival in the UK, the survival gap—the difference between the UK and the best-performing nations—appeared to have showed only some narrowing in breast cancer but was static in colorectal and ovarian cancer and worse in lung cancer. The difference in survival in lung cancer is equivalent to at least 1,300 avoidable deaths each year if we matched the best in Europe. It has been estimated that this survival gap from England to the best-performing countries in Europe for all cancers accounts for 10,000 avoidable cancer deaths each year.

The healthcare system in the UK is not improving at a fast enough rate to narrow the survival gap. This accounts for thousands of avoidable deaths each year. A far greater proportion of people die within one year of cancer diagnosis in the UK than in better-performing countries such as Sweden. This is due to later diagnoses in the UK; when patients in the UK are diagnosed with cancer, it is more often at an advanced stage where survival is shorter.

The coalition Government published in January Improving Outcomes: A Strategy for Cancer. This strategy aims to deliver health outcomes that are among the best in the world. It aims to do this alongside the seismic reforms that are taking place in healthcare in England. These new reforms as they stand rely on high-quality information and organisation of cancer services. The strategy does not ensure the continued existence of cancer networks, but says that,

“it is likely that GP consortia will purchase services from a new style of cancer network”.

That does not go far enough. Cancer networks are essential organisations to ensure the delivery of improved cancer outcomes and, in particular, the geographical areas that allow robust outcome data to be derived. The centralisation of cancer services since the NHS cancer plan has helped to deliver improvements in cancer outcomes. The National Cancer Intelligence Network is now providing detailed cancer outcome data according to network, PCT and age. These powerful data can be used to improve outcomes.

Much of the variation in outcomes in cancer is due to late diagnosis or referral by general practitioners. There is no process in place for assessing the quality of GPs in the assessment of patients with potential cancer symptoms. The Teenage Cancer Trust survey reveals that one in four teenage cancer patients visited their GP four or more times before referral to hospital. Without cancer networks, there is a danger that the cheapest services will be purchased that meet basic but not world-class quality standards. Healthcare is a complex process and we will never be able to define and record every metric that will contribute to high-quality outcomes. I hope that the Minister will confirm today that there are no plans to abolish the cancer networks.