Health and Social Care Bill

Memorandum submitted by Cancer Research UK (HSR 04)

Context

1. Cancer Research UK’s ambition is for the UK to have world class cancer outcomes. We know that our outcomes currently lag behind the best performing countries in the world, even though we fund world-class research and are responsible for developing many of the innovative treatments that have aided improved cancer survival here and elsewhere in the world.

2. It is essential that the Health and Social Care Bill is fit for purpose to deal with the challenges that the NHS in England will face in the next few years. It is vital that cancer services continue to deliver improvements in treatment for patients in a system of changing responsibilities where significant efficiency savings are being made.

Summary

6. This briefing focuses on three key issues of concern for Cancer Research UK. First, expertise in commissioning cancer services, second, the role of public health in promoting awareness and early diagnosis of cancer, and third, embedding research within the new NHS structures.

Expertise in cancer commissioning

7. We welcome the Government’s commitment to establishing clinical senates and strengthening clinical networks. We also welcome the commitment to including clinicians and healthcare professionals in Clinical Commissioning Groups. Involving a range of experts in cancer commissioning and ensuring different parts of the service are joined up is crucial to delivering high quality treatment for a complex set of conditions like cancer.

8. Commissioning of cancer services is not as good as it could or should be and information about the quality of cancer services that would aid commissioning is not fully utilised by the health service. Commissioners require information about what an excellent service looks like and the current quality of different cancer services if they are to commission effectively. In addition, commissioners benefit from advice about appropriate levels at which to commission certain services.

9. Good practice guidelines will no doubt encourage Clinical Commissioning Groups to ‘buy in’ appropriate support for cancer commissioning, but we are concerned by conversations we have had with GPs. They highlight that finances will be tight, that there will be no compulsion to use this expertise and that GPs with a special interest in cancer will potentially be more likely to utilise their own expertise and buy in support than others.

· Recommendation: Clinical Commissioning Groups and the NHS Commissioning Board should be required to obtain appropriate advice from cancer commissioning experts where appropriate.

The role of public health in awareness and early diagnosis

10. There is a concern that the reform programme will risk fragmenting cancer services, at least in the short term. The Government must commit to working hard to guard against this. We welcome the commitment which guarantees the future of clinical networks as the place where clinicians from different sectors come together to improve the quality of care across integrated pathways. This will maintain the vital expertise in coordinating learning, disseminating initiatives and ensuring non-duplication of effort that has been developed by cancer networks.

11. The creation of Public Health England poses a risk to the efforts to improve the early diagnosis of cancer. To ensure cancer is diagnosed as early as possible, local authorities and GPs will need to work together. Local authorities will have shared responsibility with Public Health England, who will commission national campaigns where evidence supports them, for raising awareness of the signs and symptoms of cancer and encouraging early presentation. GPs will have an interest in public awareness and responsibility for the patient once they present with suspected cancer. To guard against fragmentation, local authorities and GPs should be jointly incentivised to prioritise early diagnosis, including by having shared indicators in the Public Health and NHS Outcomes Frameworks.

12. The burden of cancer is increasing rapidly: it is expected that there will be 100,000 more cases per year over the next 15 years in the UK. New treatments are becoming increasingly sophisticated and expensive. At a time of cost pressures in the NHS, the combination of these factors is likely to mean even less money spent on prevention and early diagnosis – the very areas that could help to counter the epidemiological pressures. There is concern that the new arrangements will exacerbate rather than address these concerns.

· Recommendation: We would like local authorities to be responsible for providing services for promoting awareness and early diagnosis of cancer. We would like guidance issued requiring Clinical Commissioning Groups to work with local authorities to input into and arrange services to promote awareness and early diagnosis of cancer.

Embedding research in the NHS

13. We are pleased that the Government has committed all parts of the NHS to promoting and supporting research. We particularly welcome the commitment for Clinical Commissioning Groups to have a duty to promote research and innovation.

14. Clinical research studies in the NHS are vital in cancer research, whether they are epidemiological studies or clinical trials of interventions. Ongoing support for cancer research is critical to underpin improvements in cancer services, and outcomes. An essential component of this support is ensuring that research is embedded across the NHS, and that the barriers to setting up research studies at the local level are removed.

15. Ongoing support for cancer research is critical to underpin improvements in cancer services, and, ultimately, outcomes. Patients treated in research-active environments receive better care and the UK has led the way in increasing the number of cancer patients involved in clinical trials. Research conducted in the NHS has supported many breakthroughs in cancer treatment and service design.

· Recommendation: Sufficient measures need to be put in place to enable Clinical Commissioning Groups and the NHS Commissioning Board to uphold their duty to promote research. These measures should include guidance on how treatment costs of patients taking part in research will be met within the system, together with clear and measurable targets to monitor the conduct of research in the NHS.

Key messages about Cancer Research UK:

· We spent circa £334 million on research in 2009/2010;

· We receive no Government funding for our research;

· We are a national charity with local roots – 90% of the population lives within 30 miles of one of our research sites;

· For every pound we receive, excluding retail, 80p is available to spend on our work to beat cancer*

· We fund over 4,000 scientists, doctors and nurses throughout the UK .

* This includes our life-saving research, information and work we do to influence public policy.

June 2011

Prepared 30th June 2011