HC 1048-III Health CommitteeWritten evidence from Beating Bowel Cancer (PH 67)

Beating Bowel Cancer is dedicated to saving lives by working in partnership with individuals, local communities, clinical communities and government to improve public awareness of bowel cancer and to increase the rate of early diagnosis. We help patients access the treatment they need and provide emotional and practical support to improve the lives of everyone affected by bowel cancer.

Setting the Scene for Bowel Cancer

Bowel cancer is the UK’s second biggest cancer killer. Of the 100 people diagnosed every day, almost 50 will die. However advances in treatment in recent years mean that bowel cancer can be beaten if it is diagnosed at an early stage – a study by the National Cancer Intelligence Network found that 93.2% of patients diagnosed with early stage bowel cancer will survive five years from diagnosis compared to just 6.6% of patients diagnosed with late stage disease. Bowel cancer is a common cancer killer. With earlier diagnosis there is an opportunity to make it a rarer cancer killer.

Despite the devastating impact of bowel cancer, awareness is still too low. The result is that many people with symptoms do not know to seek help, resulting in later diagnoses and poorer outcomes. There are, however, opportunities to encourage earlier diagnosis.

A key first step would be to improve uptake of the existing national screening programme for bowel cancer. Currently 54% of those eligible in England take up their offer for bowel cancer screening, compared to that for breast cancer (76.5%).

Beating Bowel Cancer has a great deal of experience in communicating to the public about bowel cancer and we are ready to play our part in assisting relevant authorities to maximise the impact of any communications.

1. Context – Bowel Cancer and Public Health

1.1. Bowel cancer is the UK’s second biggest cancer killer. Of the 100 people diagnosed every day, almost 50 will die. However advances in treatment in recent years mean that bowel cancer can be beaten if it is diagnosed at an early stage – a study by the National Cancer Intelligence Network (NCIN) found that 93.2% of patients diagnosed with early stage bowel cancer will survive five years from diagnosis compared to just 6.6% of patients diagnosed with late stage disease.

1.2. Public Health England and local authorities will play a key role in improving outcomes for bowel cancer as they are responsible for both screening and awareness campaigns. Raising awareness of bowel cancer is vital in increasing participation in national screening and ensuring that people with symptoms present to their GPs for a diagnosis. Research by the NCIN on routes to diagnosis found that relative one year survival for patients was 84.5% for patients diagnosed through the urgent or GP referral pathway compared to 48.4% for those diagnosed as an emergency.

2. The creation of Public Health England within the Department of Health

2.1. The creation of Public Health England is welcome although joint working with the Department of Health will be important for bowel cancer as it is a condition that spans both Public Health England and the Department of Health. For cancer patients, diagnosing cancer at an early stage can have a positive impact – the Government’s new cancer strategy Improving Outcomes: A Strategy for Cancer has estimated that 5,000 lives could be saved each year if cancers were detected earlier.

2.2. Public Health England should play a role in ensuring that a proportion of the public health budget is spent by local authorities on targeted information campaigns. Beating Bowel Cancer welcomed the Department of Health’s pledge to raise cancer awareness, through a £10.75 million signs and symptoms campaign, focusing on breast, lung and bowel cancers, and we provided advice and support to the Department to help deliver a successful campaign. Public Health England should monitor the efficacy of the national pilots of bowel cancer awareness campaigns with a view to rolling these out more widely.

2.3. Public Health England will also be responsible for screening programmes. Bowel cancer screening is essential for early diagnosis however only 23% of the population are aware that there is a bowel cancer screening programme and just over 50% of those eligible are completing their screening tests. Beating Bowel Cancer is calling for an increase in uptake of bowel cancer screening to match the best cancer screening programme participation rates of around 76.5% with the potential of saving up to 1,279 lives each year. Public Health England should prioritise research on improving bowel cancer screening participation, particularly for harder to reach groups, and ensure that participation rates are continually bettered.

2.4 Public Health England should work with local NHS providers to ensure early implementation of the introduction of flexible sigmoidoscopy (flexi sig) for bowel cancer in England. Flexi sig screening has been found to reduce deaths from the disease by 43% and the incidence of bowel cancer by one third when carried out once in those aged between 55 and 64 years. Beating Bowel Cancer welcomed the Government’s commitment to allocate £60 million to fund the introduction of a flexi sig screening programme over four years. Beating Bowel Cancer fully supports the introduction of a national flexi sig screening programme for people aged 55 and over – extending to those aged 50 and over as the evidence justifies it. Our Chief Executive is a member of the Bowel Screening Advisory Committee and we are committed to playing our part to ensure the roll out of flexi sig is a success.

3. The abolition of the Health Protection Agency and the National Treatment Agency for Substance Misuse

3.1 Beating Bowel Cancer does not have any comments on this area.

4. The public health role of the Secretary of State

4.1 The Secretary of State should take his responsibilities to protect the population’s health seriously. This could include:

4.2 Ensuring that the ring-fenced public health budget is used on measures that are linked to clear health improvements such as awareness campaigns for bowel cancer and improving participation in screening programmes.

4.3 Ensuring that the activities of Public Health England and the Department of Health are effectively coordinated so that services for conditions such as bowel cancer are properly streamlined.

4.4 Ensuring that measures in the Public Health Outcomes Framework are focused on real health outcomes such as the proportion of patients diagnosed at Stage one or Stage two cancer and improved bowel cancer survival.

5. The future role of local government in public health (including arrangements for the appointment of Directors of Public Health; and the role of Health and Wellbeing Boards, Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies)

5.1 Directors of Public Health should take a lead in ensuring that local government focuses on measures that have a tangible public health impact.

5.2 Health and Wellbeing Boards will be key to ensuring that services are joined up – these should include input from local cancer networks. Where necessary, there should be joint performance measurement across the NHS, public health and social care as some of these interventions will require high quality commissioning from more than one commissioner. For example, early diagnosis may involve awareness (public health), screening (public health), primary care diagnostics (NHS) and secondary care investigation (NHS). Therefore it will be important to develop joint commissioning outcome indicators which can be shared at a local level.

6. Arrangements for public health involvement in the commissioning of NHS services

6.1 Health and wellbeing boards should work to ensure that specific public health expertise within a local area are consulted on. On issues relevant to bowel cancer, the cancer networks should be included in relevant discussions around commissioning. Charities such as Beating Bowel Cancer should also be consulted as we have a wealth of experience in running effective public awareness campaigns on a local level. We are accredited by the Information Standard, a certification scheme for health and social care information, supported by the Department of Health. The Information Standard enhances our reputation as a reliable and authoritative source of bowel cancer information by helping us ensure that we provide clear, accessible information for everyone affected by bowel cancer.

7. Arrangements for commissioning public health services

7.1 Coordination will be key to commissioning effective public health services. Some public health interventions will require high quality commissioning from more than one commissioner. For example, early diagnosis may involve awareness (public health), screening (public health), primary care diagnostics (NHS) and secondary care investigation (NHS). 

7.2 Cancer networks should play a key role in coordinating the commissioning of cancer services to ensure seamless care for the patient. This will also ensure that appropriate expertise is available to inform commissioning. It is welcome that future funding for cancer networks has been secured to support the implementation of the reforms to the NHS and public health service.

8. The future of the Public Health Observatories

8.1 Public Health England and local authorities will be responsible for the functions of Public Health Observatories and cancer registries. This change in responsibility should allow time for reflection in the timeliness of data collection around cancer.

8.2 Beating Bowel Cancer has been analysing the availability of bowel cancer data in England, with a focus on the following key areas:

Topic

Data that could be included

Epidemiology

Diagnosis, prevalence, mortality, survival

Early diagnosis

Screening uptake, proportion diagnosed through two week referral, staging data (where it is available)

Treatment

Number of patients received surgery, Cancer Drugs Fund cases

Care

Patient experience survey

8.3 In compiling the data for this, we have noticed that information published on incidence and mortality is now four years old. This kind of time-lag is unacceptable and should be remedied. If the Information Revolution is to work in practice, these systems should be streamlined to ensure that data are collected, verified and published as quickly as possible. Public Health England, in conjunction with local authorities, should take a lead in making this happen.

9. The structure and purpose of the Public Health Outcomes Framework

9.1 The overall structure and purpose of the Public Health outcomes framework is welcome. It is positive that when the management of conditions span across all three areas, such as bowel cancer, there are shared indicators in the NHS, public health and social care outcomes frameworks.

9.2 The inclusion of cancer survival measures across public health and NHS outcomes frameworks is welcome. The indicator on: Patients with cancer diagnosed at stage one and two as a proportion of cancers diagnosed in domain four is particularly welcomed as this is an area where coordination between the NHS and public health services will be vital.

9.3 Beating Bowel Cancer is committed to working with local authorities on awareness campaigns and to improve participation in screening programmes to support local authorities in improving outcomes.

Case Study: Thames Valley Cancer Network NAEDI campaign

We partnered in a major public health campaign in the Thames Valley under the banner “Early Diagnosis Saves Lives”, highlighting the possible signs of bowel and lung cancer and urging people who have the symptoms to go to their doctor as soon as possible.

More than 250,000 pieces of literature were distributed by the Thames Valley Cancer Network as part of the campaign, Don’t Sit on Your Symptoms’, to libraries, GP surgeries, hospital waiting areas and community centres.

10. Arrangements for funding public health services (including the Health Premium)

10.1 It is important that the funding for public health services is directed at evidence-based interventions that are directly linked to health improvement such as the national bowel cancer screening and bowel cancer awareness programmes.

10.2 Local authority budgets are being reduced and there is a risk that many activities that may be cut could be covered by a public health budget. In order to maintain a focus on reducing inequalities, there should be measures focused on at-risk groups – for example those with an increased chance of developing bowel cancer.

11. The future of the public health workforce (including the regulation of public health professionals)

11.1 The public health workforce should be encouraged to be flexible and spread across wide areas of the community including the use of health in the workplace schemes, forging new partnerships across primary care and supporting the implementation of national awareness programmes.

12. How the Government is responding to the Marmot Review on health inequalities

12.1 It is concerning that certain elements of the equality impact assessment within the Department of Health’s public health white papers were not properly analysed.

12.2 Public awareness and screening campaigns should be targeted at harder to reach groups, including older people, ethnic minorities and deprived communities.

12.3 There are three forms of information that are vital in reducing inequalities in cancer outcomes:

Information to enable patients to make informed decisions about their treatments. To support this, information prescriptions should be rolled out without delay.

Information on quality and access of services to enable all patients to make a choice not just about where or when they access treatment but what form and what team delivers it.

Information for the continuing professional development of clinicians to ensure early recognition and diagnosis of high risk cancers.

12.4 Steps should be taken to ensure that patients have access to the best treatment across the patient pathway as soon as possible – this will help to ensure outcomes improve to match the best in Europe.

12.5 Community action to improve the awareness of bowel cancer, particularly in screening, access to services and outcomes will be vital if inequalities in bowel cancer are to be effectively treated.

12.6 Improving outcomes: a strategy for cancer (IOSC) and the National Cancer Equality Initiative (NCEI) have underlined the need for the NHS, public health and social care to have information that is appropriately analysed by “inequality/equality group, to enable them to make the right decision around commissioning and providing quality services”.

12.7 The Equalities Portal is an early example of how the principle of the information revolution can be applied to cancer services. The commitment in IOSC to examine survival, mortality and incidence by geographical data and to publish one-year survival data is welcome as it will support identification of groups that are more likely to present late. National pilots for a bowel cancer awareness campaign are currently underway – equalities data could support the public health service in introducing targeted awareness campaigns aimed at particular equality groups to improve early diagnosis of the cancer.

June 2011

Prepared 28th November 2011