Health and Social Care Bill

Memorandum submitted by The Roy Castle Lung Cancer Foundation (HS 85)

1. Background information

1.1 The Roy Castle Lung Cancer Foundation (RCLCF)

RCLCF is the only UK-wide charity, dedicated solely to the defeat of lung cancer. We fund basic science research, tobacco control initiatives and work in lung cancer patient information, support and advocacy. Ensuring equitable access, for lung cancer patients, to the best treatment and care, supported by clear and meaningful information, is of paramount importance.

1.2 RCLCF and this submission

As a site-specific cancer charity, lung cancer is RCLCF’s focus. As such, our comments are concerned with this one cancer only. Many of our observations may be relevant to other cancers, although lung cancer is characterised by many features which accentuate inequality.

1.3 Lung cancer

Lung cancer is the UK’s most common cause of cancer death for both men and women, responsible for nearly a quarter (24%) of all male cancer deaths and a fifth (20%) of all female cancer deaths. Each year around 39,500 people are diagnosed with lung cancer in the UK (more than 100 people each day) [1]  .

Although a common cancer, outcomes of treatment are generally poor, with only 7% of lung cancer patients surviving five years after diagnosis. Long term survival has only improved slightly in recent years. However, patients diagnosed at an early stage have a better prognosis, largely as a result of being suitable for radical treatments, particularly surgery.

Smoking causes almost 90% of lung cancer deaths. It should, however, be noted that over 4,000 UK lung cancer deaths each year, are unrelated to tobacco.

1.4 Early diagnosis and lung cancer

The delayed diagnosis of lung cancer has been identified as a major reason for the poor prognosis for patients diagnosed with lung cancer, as well as the lower survival rates reported by the UK when compared with other countries in Europe. Research by the National Cancer Intelligence Network (NCIN) found that 38% of lung cancer diagnoses were in made in an emergency setting – this further illustrates that the signs and symptoms of lung cancer are too often not identified in primary care.

RCLCF is coordinating a campaign to secure a greater focus on lung cancer within general practice, ensuring that GPs are supported in identifying the signs and symptoms of lung cancer earlier and referring appropriately.

2. Summary of RCLCF response to the Health and Social Care Bill

There are a number of opportunities within the Health and Social Care Bill to support earlier diagnosis of lung cancer in primary care. These include:

2.1 Ensuring GP commissioning consortia are given a role in guaranteeing that national guidelines such as those prepared by the National Institute for Health and Clinical Excellence (NICE) on cancer referral are implemented by GPs.

2.2 Ensuring that GP commissioning consortia take a role in encouraging active learning among their constituent practices. This could include promoting significant event reviews on cancer diagnosis.

2.3 GP commissioning consortia should work to reduce inequalities in lung cancer through raising awareness of the signs and symptoms of lung cancer to encourage earlier presentation with symptoms.

2.4 Payments in respect of performance should be taken into account measures within the NHS Outcomes Framework such as one-year survival and percentage of cancer patients diagnosed at stage 1 or stage 2.

3. RCLCF comments on the Health and Social Care Bill

3.1 The RCLCF has identified a number of opportunities within the Health and Social Care Bill to support earlier diagnosis of lung cancer in primary care. These briefing notes outline the relevant issues that we would ask the Bill Committee to consider.

3.2 General duties of commissioning consortia (Section 22)

Section 22 details the general duties of commissioning consortia. RCLCF has identified specific duties within this which may improve referral and diagnosis rates in primary care.

3.3 Sections 14L and 14M – "Securing continuous improvement in the quality of services
provided to individuals for or in connection with the prevention, diagnosis of treatment of illness"

"Securing continuous improvement in primary medical services"

3.31 GP commissioning consortia should be given a role in ensuring that guidelines on lung cancer are followed by their constituent GP practices. This would ensure that the appropriate cancer referral guidance from the National Institute for Health and Clinical Excellence (NICE) is fully implemented and that patients with symptoms are referred for appropriate diagnostic tests in a timely manner.

3.32 GP commissioning consortia should take a role in encouraging collective learning among their constituent practices. This could include the promotion of significant event reviews on cancer diagnosis to encourage reflective learning and improvement in practice. The advantages of this approach are:

· There is already a precedent for significant event reviews to be included in the QOF, reflecting the Department of Health’s recognition of their value

· Significant event reviews take place in a ‘no blame’ environment thereby allowing all members of the team to learn from the case, even if they have not personally seen the patient

· The learning value of these reviews is important for the ongoing professional development of GPs

· Records of participation in significant event reviews can be submitted as part of portfolios for GP reaccreditation

3.4 Section 14N - "Reduce inequalities between patients with respect to the outcomes
achieved"

3.41 GP consortia should play a role in reducing inequalities in outcomes for patients with lung cancer. Evidence in the National Lung Cancer Audit has identified regional variations in access to lung cancer treatments and services. There are also social inequalities that GP commissioning consortia should play a role in reducing. This could include:

· Raising awareness of symptoms and encouraging all people with symptoms to present

· Targeting people from high-deprivation groups where lung cancer prevalence is higher

· Reducing the stigma around lung cancer to encourage earlier presentation with symptoms

3.5 Section 14Z – "In each financial year, a commissioning consortium must prepare a report (an "annual report") on how it has discharged its functions in the previous financial year"

3.51 The annual report should include reference to measures on improving outcomes for cancer patients (including those on lung cancer mortality). This should include use of additional GP powers on referral to diagnostic tests and adherence to existing guidelines on lung cancer.

3.52 Where the board gives directions as to the content of a report, they should refer GP commissioning consortia to outcomes strategies produced by the Department of Health, including Improving outcomes: a strategy for cancer.

3.6 Section 23 – Financial arrangements for consortia

Section 23 includes measures on the financial arrangements for GP commissioning consortia.

3.61 Sections 233L – "Payments in respect of performance"

3.62 Payments in respect of performance must take into consideration details on measures to improve outcomes in lung cancer as outlined above. Given its impact on one-year survival, this will ensure that earlier diagnosis of lung cancer will be prioritised.