Featured, News

UK cancer patients waiting longer for treatment than comparable countries, research finds


The research compares access to radiotherapy and chemotherapy across four countries and eight cancer types.

New research by University College London reveals that cancer patients in the UK wait longer for treatment compared to several other nations. In a first-of-its-kind study, researchers analysed data from two studied published in the Lancet Oncology, covering more than 780,000 patients diagnosed with eight different types of cancer between 2012 and 2017 in the UK, Australia, Canada, and Norway. The cancer types were oesophageal, stomach, colon, rectal, liver, pancreatic, lung and ovarian cancer.

The study found that UK patients had the longest average waiting times for both chemotherapy and radiotherapy across all four countries. The average wait for chemotherapy in the UK ranged from 48 days in England to 65 days in Scotland, while Northern Ireland and Wales fell in between. Norway had the shortest average wait at 39 days.

For radiotherapy, the wait times were even longer in the UK, ranging from 53 days in Northern Ireland to 81 days in Wales. Newfoundland, Canada, had the shortest average wait at 42 days, followed by Northern Ireland (11 days longer), England (three weeks longer), and Scotland and Wales (seven weeks longer).

The study also highlighted that a lower proportion of UK patients with certain cancers received chemotherapy and radiotherapy compared to the other countries. For example, only 59 per cent of ovarian cancer patients in the UK received chemotherapy, compared to 73 per cent in Australia, 72 per cent in Norway and 67 per cent in Canada.

Similar disparities were observed for pancreatic cancer patients, with UK pancreatic cancer patients the least likely to receive chemotherapy or radiotherapy (27 per cent), compared with Canada (41 per cent), Norway (44 per cent) and Australia (47 per cent).

While not all patients require these treatments, chemotherapy and radiotherapy are key treatment options for cancer. The research suggests that countries with better cancer survival rates tend to have shorter waiting times and more frequent use of chemotherapy and radiotherapy. Cancer Research UK, which partly funded both studies, attributed the delays in treatment to a lack of long-term planning for cancer care in the UK compared to countries with strong cancer strategies and allocated funding.

This research offers valuable insights into the current state of cancer treatment in the UK and raises important questions about potential improvements to benefit patients.

Michelle Mitchell, Chief Executive of Cancer Research UK, attributed part of the UK’s poor performance on cancer treatment to the NHS’s longstanding workforce challenges, saying: “When it comes to treating cancer, timing really matters. We can learn a great deal from other countries who have stepped up and substantially improved cancer services. With a general election on the horizon, the UK government has a real opportunity to buck the trends we see in this research and do better for people affected by cancer.”

Cancer surgeon and Clinical Lead for the International Cancer Benchmarking Partnership, Dr John Butler, said: “Lower use of chemotherapy and radiotherapy in the UK could impact people’s chances of survival, especially for older patients. This study captures missed opportunities for patients in the UK to receive life-prolonging treatment.”

The Department of Health and Social Care said it has invested substantial sums into cancer care since the period covered by the research, citing £162m invested into radiotherapy equipment and £2.3bn invested into community diagnostic centres.

Featured, Mental Health, News

New BMA report highlights ‘broken’ mental health system


Persistent lack of funds and trained staff, combined with soaring demand, are placing unprecedented strain on NHS mental health services, new report finds.

A new BMA report, based on first-hand accounts from doctors working across the NHS, reveals the state of England’s ‘broken’ mental health services.

The current annual economic cost of poor mental health has been conservatively estimated at more than £100 billion in England alone, and £117.9 billion across the whole UK. The report from the BMA, “It’s broken.” Doctors’ experiences on the frontline of a failing mental healthcare system, identifies that a compound of funding, staffing, infrastructure and systemic challenges have led to the “dysfunctional” and “shocking” deterioration of NHS mental health services.

Without concerted efforts from central government to resource mental healthcare according to demand, which continues to outstrip NHS capacity, as well as societal change, the report argues that the future is bleak for those suffering from poor mental health, especially children and those with neurodevelopmental disorders.

Despite there being a greater focus on mental health from successive recent governments, the report finds that words have rarely translated into action, and that there has been no overall improvement to services in the last decade.

This is partly attributed to a lack of adequate resources within the system, but also to the impact of wider social determinants, such as housing, unemployment or financial concerns. It accuses the government of failing to grasp “the significance of the issue and how failing to tackle these wider societal issues is increasing demand for NHS mental healthcare.

Among its recommendations, the BMA report calls on the Department for Health and Social Care to “plan for and incentivise the expansion of the professionally trained workforce, including within psychiatry and general practice,” as well as to “embed mental health social care within the NHS, for example through in-house social workers.”

It also makes argues that attempting to quantify how much extra funding and staff levels are needed is incredibly difficult due to a lack of consistent data on the prevalence of mental illness, and echoes recommendations from Healthwatch that NHS England collect and publish national data on referrals and waiting times.

The BMA carried out in-depth interviews with doctors across the mental health system, including those working in psychiatry, general practice, emergency medicine, and public health. “[Support for people with mental health conditions] is shocking,” said a practicing psychiatrist quoted in the report. “We would not accept this in any other area of medicine.”

Quotes in the report:

“Mental healthcare in this country is dysfunctional. It’s broken.” – GP, Nottingham

“Patients always know that they can come into the emergency department…between spring this year and spring 2022 there was a doubling of Mental Health Act assessments in the emergency department. Which I think is fairly indicative of more systemic issues and obviously it impacts on our workload.” – Consultant psychiatrist working in A&E, Oxford

“Everybody wants to do the right thing. Everybody’s trying really hard, but we’re just not putting our money where our mouth is when it comes to saying we need to invest in prevention and early intervention.” – Public health consultant, West Yorkshire

Dr Andrew Molodynski, a consultant psychiatrist in Oxfordshire and the mental health lead at the British Medical Association, said: “As doctors struggling to provide mental health care, we know only too well that the system has crumbled. Some of our patients wait as long as four years for treatment, meaning too many people – including children – continue to fall through the gaps, and all the while funding remains insufficient. We’re having to make hard prioritisation choices that leave many patients without care and support that they urgently need.​

“The demand for mental health services has changed dramatically, but funding has not kept pace. Mental healthcare funding must be based on what people need today, instead of being based on what we spent yesterday, which was inadequate even then.

“We need these changes to the system to be able provide good quality care and tackle the huge cost of mental health to people’s lives, the NHS, and the economy.”

Featured, News

Patients support expansion of at-home testing, report finds


Patients report declining mental and physical health while waiting for test results, as well as desire for greater transparency on waiting times and testing options.

A new report from the Patients Association, the independent charity campaigning for improvements to health and social care for patients, finds that patients would be supportive of an expansion of at-home testing, if it means speeding up diagnostic pathways.

The Patient Experience of Diagnostics Report analyses the opinions and experiences of more than 1,000 NHS patients, 77 per cent of whom stated they would be happy to test themselves at home, if this was available.

The paper also illustrates patient frustration with long diagnostic waiting times, as well as with the opacity of testing and treatment options. 60 per cent of respondents said that they would consider paying privately for tests if they faced a long wait on the NHS, but 93 per cent said they would like to see an increase in investment into testing capacity over the coming years, with 91 per cent stating that this investment should be a priority for the NHS.

The report captures the real impact of long waiting times for diagnostic tests, with more than a third of respondents reporting declines in both their physical health (36 per cent) and their mental health (34 per cent) while awaiting tests.

It also highlights calls for greater transparency throughout the patient journey, as 73 per cent of respondents reported wanting a better understanding of why they are being sent for tests, and what the tests will involve, and 82 per cent said they want more discussion about the different types of tests they could be referred for. 88 per cent reported wanting more explanation of how their results may impact their treatment options.

Respondents also voiced their backing to improving access, with 78 per cent stating they would be happier to travel outside their local area for testing if it meant faster access. As well as the 77 per cent who would be happy testing themselves at home, 44 per cent said they would willingly test themselves in a clinical setting.

Based on the findings of the NHS patients who responded, the report makes the following recommendations to improve access to diagnostic testing in the NHS:

  • Expand community diagnostic hubs by removing NHS estate restrictions and expanding the number and types of tests offered. With demand rising by 7 per cent annually, the current 5 per cent capacity target for new hubs is described as inadequate.
  • Increase transparency on waiting times through better use of data held by the NHS.
  • Support appropriate expansion of at-home testing options where considered clinically safe and effective.
  • Improve communication with patients throughout the testing process. This includes explaining the reason for tests, available options, timelines for results, and what results mean.
  • Ensure political commitments to improve diagnostic access from all parties in upcoming election manifestos.
  • Review NHS Constitution pledges on waiting times based on patient experiences.
Featured, News, Population Health

Heart disease single largest factor behind out of work ill health


New report finds that people are more likely to leave work due to a heart condition than any other health issue, and warns that faltering efforts at prevention have cost thousands of lives.

Heart disease is the single largest driver of people leaving the workforce due to ill health, according to new research from the Institute for Public Policy Research (IPPR).

The new paper, Broken hearted: A spotlight paper on cardio-vascular disease, finds that a heart disease diagnosis brings with it the largest risk of a person leaving the labour market, and that someone diagnosed with cardiovascular disease (CVD) has a 22 per cent chance of leaving their job. This compares to a 14 per cent risk for someone with a mental health condition and 16 per cent for a person with cancer.

Almost one in three of all working-age people who are economically inactive have a heart, blood pressure or circulatory condition, the report says. This figure rises among over 50s, a group the government is currently targeting in its efforts to get people back to work.

The report also reveals significant variation in CVD mortality across England and Wales, with the North West the worst affected region. It estimates that if the entire UK saw the same outcomes as the best tenth of local authorities, there would have been 32,000 fewer deaths in 2021 along – equivalent to 5 per cent of total CVD mortality.

Around 80 per cent of deaths from heart disease are preventable, with diet and nutrition, metabolic risks (e.g. high BMI) and tobacco use constituting the three greatest risk factors.

The report cites analysis from the British Heart Foundation that since February 2020, there have been nearly 100,000 more deaths involving CVD than would otherwise have been expected. It attributes this decline in outcomes to a slowdown in progress on prevention over the last decade. If the last decade had seen even half of the progress on preventable CVD mortality observed between 2005-2020, the report estimates that there would have been nearly 33,000 fewer deaths in 2019- equivalent to one in 20 deaths that year.

While virtually all NHS waiting lists have grown steadily in recent years, exacerbated by the pandemic, cardiology is something of an outlier, and waiting lists have tripled since 2012, higher than the overall growth in NHS waiting lists.

IPPR is calling on the government to implement a recovery plan for treating cardiovascular disease, helping both the NHS and the economy, by:

  • Delivering new preventative policies, such as extending the current ‘sugar levy’ on soft drinks to all high-fat and high-salt products, and using the revenue to subsidise healthy food options.
  • Getting waiting lists for cardiology down, through increasing access to preventative medications, retaining staff and expanding access to personalised care.
  • Investing in research, with an immediate injection of £220 million for R&D in cardiovascular disease prevention – with an explicit goal of crowding in private investment.

Chris Thomas, author of the report and Head of IPPR’s Commission on Health and Prosperity, said: “After great strides in tackling cardiovascular disease in the 20th century, the UK is now stalling if not reversing. This is not just costing lives, but also livelihoods. The good news is that heart disease is one of the most preventable health conditions, but the government has to get on to the front foot and deliver proactive policies. Both human lives and economic prosperity depend on it.”

The full report can be accessed here.

Featured, News, Workforce

BMA survey finds widespread concern among doctors over role of physician associates


The BMA calls for immediate pause to recruitment into Medical Associate Professional (MAP) roles and to limit the scope of MAP roles to administrative and low-risk clinical tasks.

A majority of doctors have expressed concern that physician associates (PAs) and anaesthesia associates (AAs) are undertaking tasks beyond their competence, according to a new survey from the BMA.

In the survey of more than 19,000 doctors, nearly 80 per cent reported concerns that MAPs were “occasionally or frequently” working on tasks for which they are underqualified, with 87 per cent believing that the current rules pose a risk to patient safety, some or all of the time.

A majority of doctors also believe that working with PAs and AAs has increased their workloads, according to the survey. Only 21 per cent of respondents reported a decrease in their workloads since the employment of MAPs, while more 55 per cent reported that their workload had instead increased.

Professor Phil Banfield, BMA Chair of Council, said: “NHS England tells us that ‘Physician Associates support doctors in the diagnosis and management of patients,’ supposedly giving doctors more time to deliver the high-quality care only they can give.

“But the reality appears to be the exact opposite – too many doctors are telling us that working with PAs is instead draining their time and energy. The responsibility for signing off prescriptions and ensuring the PAs are working within their proper scope of practice quite rightly falls on the supervising doctor, but also those doctors working alongside them; as scope has inappropriately crept ever further it has made far more work for doctors than it has saved.

86 per cent of doctors also reported concern that the role of MAPs, and the difference between MAPs and fully qualified doctors, is not well understood by the public, and that many patients may wrongly assume they are being seen by a fully trained doctor. 80 per cent said they would support the change of terminology from Associates to ‘Assistants’, as they were known until 2013.

The House of Lords is expected to consider this week the Anaesthesia Associates and Physician Associates Order 2024 statutory instrument, which if passed, will see the GMC appointed as regulator of MAPs. 72 per cent of respondents to the BMA survey expressed their opposition to the move. The BMA itself has called for all legislators to oppose the Order, arguing instead that regulation of MAPs should fall to the Health Care and Professions Council.

Liberal Democrat Peer, Baroness Sal Brinton, has tabled a motion of regret outlining concerns about the regulation of MAPs falling under the remit of the GMC, as well as about the nomenclature applied to MAPs, which the motion states “risks confusion for patients”.

Professor Phil Banfield added: “The House of Lords will soon have a chance to oppose damaging legislation that aids that blurring of lines by regulating PAs under the GMC, the doctors’ regulator rather than the more appropriate Health and Care Professions Council.

“The Government and NHSE should be instead ensuring that PAs return to their original purpose of supporting, not replacing doctors, so that doctors can get on with utilising the diagnostic and treatment skills they have spent so long at medical school gaining their expertise in.  Their scope should be strictly defined and, to ensure patients are not confused, the title returned to the more accurate “physician assistant” – then they can play their valuable role in supporting the delivery of NHS care safely.”

The BMA has made the following recommendations:

  • There should be an immediate halt to the recruitment of Medical Associate Professionals (MAPs) in the UK, including PAs and AAs on the grounds of patient safety (as called for by the BMA in November 2023). Long term expansion plans for the roles must be paused.
  • All legislators must oppose the Anaesthesia Associates and Physicians Associate Order 2024. The House of the Lords must vote against it in the days ahead. MAPs should be regulated by the Health Care and Professions Council, as called for by the BMA in response to the original DHSC consultation on regulation in 2017.
  • The titles should revert to physician assistant and physician assistant (anaesthesia) / anaesthesia assistant to avoid public confusion.
  • The scope of the roles should be strictly limited to the original intention of supporting doctors with administration tasks and a defined range of low-risk clinical tasks.
  • The UK has a severe shortage of doctors. This should be urgently addressed by fully funding increased specialty training places and opening Additional Roles Reimbursement Scheme (ARRS) funding to GP recruitment.
  • Training opportunities for doctors must be protected. Doctors and medical students should be prioritised for all clinical and training opportunities. This means that within a department/practice any procedure, clinic opportunity, or other structured learning event must be offered to doctors first before being offered to non-doctor staff.  The training of physician associates and anaesthesia associates must not compromise the training of current or future doctors
  • MAPs should not be utilised on any level of doctor rota or perform, train in, or consent to invasive or life-threatening procedures. They should not be receiving any specialty referrals or be in roles requiring them to give specialty advice. They should not make unsupervised treatment decisions or management plans. They must work under direct on-site supervision at a level commensurate with their qualification and not be using on-the-job experience to work beyond their formal level of qualification.
Featured, News, Thought Leadership

Developing Joint Forward Plans: how ICBs can strengthen integrated planning


Integrated care boards (ICBs) have been tasked with reviewing and updating their Joint Forward Plans, setting out their priorities and how they will deliver care over the next five years. The challenge is not so much in writing or reviewing their plans, but in making them workable and achievable in the face of mounting pressures.

National priorities and objectives for the NHS continue to focus on recovering core service delivery and maximising productivity. Meanwhile, we are all aware of the significant challenges facing the service, including access to primary care, ambulance response times and elective care waiting lists, exacerbated by a limited workforce, financial pressures and strike action.

Although system-based working is designed to address some of these challenges, it brings its own pressures as partners need to establish new ways of working together and shift towards more outcomes-focused activity. System partners must manage day-to-day organisational priorities alongside system-led direction, making best use of the skills and resources available to deliver more joined up care.

Truly integrated planning requires organisations to combine a coordinated strategic approach with integrated operational delivery so that plans are grounded in reality, and sufficient flexibility is built into the planning process to enable teams to adapt to changing demands. This means drawing together three layers of planning; the strategic-level Integrated Care Strategy which sets out what will be done, the Joint Forward Plan which describes how the strategy will be achieved, both supported by more detailed operational business plans setting the specifics of what will be done when, where and by whom.

Drawing on our experience of delivering complex national programme such as the COVID-19 vaccination programme, as well as system-level change projects such as demand and capacity planning, there are five key elements ICBs should consider in developing strategic and operational plans.

1. Establishing a clear starting point. When assessing priorities and opportunities for change, start by building a clear picture across the system of what is already in place and what resources and skills are available. Notwithstanding some of the obstacles that may yet need to be addressed to enable fully integrated working, systems have an opportunity to bring together truly multidisciplined teams, involving specialists across primary and secondary care as well as local authorities and the voluntary and community sector.

How can these skills be combined to achieve more for patients? Although access to employee information is not universal across systems, NHS data is readily available through the Electronic Staff Record (ESR) and the national workforce Minimum Data Set (wMDS), and workforce data sharing with local authorities can and is being done to aid planning in some areas. This information, combined with details of related services, estates and other assets, can provide a much richer starting point for planning, building in existing learning and reducing the risk of duplication.

2. Intelligence-led decision-making. Access to data and analytics has advanced significantly and continues to grow at pace across the NHS. From identifying priorities using population health management and risk stratification, through to modelling new pathways and monitoring impact via dashboards and other interactive tools, effective use of data provides the evidence to underpin a case for change, target resources efficiently and evaluate the impact of new initiatives. Integrated planning requires a single source of truth that gives system partners a transparent view of priorities, opportunities and impact to support decision-making at both a strategic and operational level. This intelligence has to be coupled with an understanding of the benefits and impact that need to be delivered as a result of the interventions, creating an integrated measurement approach describing triple value and social value impact.

3. Connected outcomes and drivers of change. The most effective dynamic plans are those that connect the drivers of change to the outcomes being sought and consider this from a whole system perspective. In implementing a new pathway, for example, considerations should include the impact on wider services, such as A&E, diagnostics, outpatients and primary care and the equity of access and outcome for the population concerned. What skills and resources will be needed – both in effecting the change and in altering how this may impact wider teams? Will this impact how a system’s workforce or estate is used, or the budget required? Are the right supply chains in place? This level of detailed impact assessment enables system leaders to fully understand, plan and implement the necessary activities to achieve the intended outcomes.

4. Effective engagement. Clinical engagement is essential in gaining a realistic understanding of the impact of activities – existing and new – and the opportunities for improvement. In delivering more integrated working, we need to build in joined-up, multidisciplinary engagement to fully understand some of the potential opportunities and barriers that need to be addressed. Alongside patient engagement, this input can inform the drivers for change, leading to more resilient plans. Moreover, ensuring staff and patients feel heard and appropriately engaged and supported through change can improve both staff retention and patient experience.

5. Clear, integrated governance. Underpinning strategic and operational plans should be clearly defined, multidisciplinary, connected governance to enable effective decision-making at every level across the system. ICSs need to work at scale and at pace, able to make confident decisions without unnecessary bureaucracy. There is a balance to strike, of course, and appropriate safeguards must be in place, but if we are to deliver change by drawing together multi-disciplinary teams to work on joint projects across system partners, the governance and risk management needs to be equally integrated and clear.

Systems are facing similar challenges across the country. Although each place and system will have its own characteristics, there is much we can learn from each other. Drawing on best practice, building networks, such as the Integrated Resource Planning Network, and sharing both successes and failures will help the NHS fast-track improvements and eliminate unnecessary duplication.

By developing integrated plans that connect the strategic with the operational, incorporating clear governance and evaluation, systems can not only achieve more using their collective resources, but also encourage more effective information sharing across England to support the NHS’s national priorities.

Alison Tonge is Executive Director of Strategy and Innovation at NHS Arden & GEM

Featured, News, Population Health

New study finds no cervical cancer cases in HPV-vaccinated women


Study proves efficacy of HPV vaccination at preventing cervical cancer, as UK Health Security Agency statistics show that uptake has still not returned to pre-pandemic levels.

Public Health Scotland announced this week that a new study has found no cases of cervical cancer in young women vaccinated as part of the HPV vaccination programme. The news comes as the UK marks Cervical Cancer Prevention Week 2024 and MPs commit to tackling inequality in the uptake of cervical screening and HPV vaccination.

The HPV vaccination programme was introduced in 2008 and aimed to vaccinate young women against HPV to prevent the development of cervical cancer, on the advice of the Joint Committee on Vaccination and Immunisation (JCVI).

The human papillomavirus (HPV) is a type of sexually transmitted virus, of which there are more than 100 strains. Many individuals will be infected with HPV over the course of their lifetime and in most cases the infection is harmless and clears on its own. However, persistent infection with high-risk strains of HPV can occur and lead to the development of cervical cancer.

Cervical cancer is the 4th most common cause of cancer in women worldwide, and HPV is responsible for almost all cases. Infection with the HPV virus is also linked to an increased risk of mouth, throat, and urogenital cancers in both men and women.

From 2019, the JCVI recommended that 12-13-year-old males, as well as females, should be offered the HPV vaccine to protect against these non-cervical cancers. Further, in 2023 the dosing schedule of the programme also changed to one dose only, as it was shown to be just as effective as two doses at protecting from HPV infection.

However, the most recent UK Health Security Agency statistics on HPV vaccination coverage published on 23 January this year demonstrate that although vaccination uptake has increased since the previous year, it has still not returned to pre-pandemic levels. Further effort is required to bolster vaccination programmes in schools to ensure young people across the UK are getting sufficient coverage.

“It is possible to make cervical cancer a rare disease”

NHS England announced in November last year that it aims to eliminate cervical cancer by 2040. To meet this ambition, it must ensure as many people as possible are vaccinated against HPV, as well as come forward for cervical screening. In addition to the vaccination programme in schools, NHS England plan to improve access to online vaccination appointments and offer vaccinations in more convenient settings such as libraries, community centres and local leisure facilities.

The Scottish study published in the Journal of the National Cancer Institute also concludes that “women from more deprived areas benefit more from vaccination than those from less deprived areas.” It found that cervical cancer incidence was significantly higher in women from the most deprived areas in Scotland, and that incidence substantially decreased for those who had three doses of the vaccine. This demonstrates the role that vaccination can play in the reduction of health inequality, emphasising the importance of ensuring vaccination efforts cover deprived areas.

Dr Kirsty Roy, a consultant in health protection at Public Health Scotland and co-author of the study, said: “It shows how effective the HPV vaccine is as there have been no cervical cancer cases to-date in fully vaccinated women who were given their first dose at age 12-13 years. Vaccination against HPV is shown to be effective in preventing cervical cancer, and along with regular screening for early detection and treatment, it is possible to make cervical cancer a rare disease.”

Dr Vanessa Saliba, UKHSA consultant epidemiologist, said: “The HPV vaccination programme is one of the most successful in the world with millions of doses given since it started in 2008. It has dramatically lowered the rates of cervical cancer and harmful infections in both women and men – preventing many cancers and saving lives.”

Jenni Minto, a Scottish Minister for Public Health, said: “The HPV vaccine programme is having a huge impact on preventing these cancers for those who have been vaccinated. Vaccination and screening remain the most effective ways of preventing and detecting cervical cancer and I would encourage those eligible to come forward to have the vaccine or attend screening appointments.”

Public Policy Projects’ (PPP) 2024 Cancer Care Programme will be investigating how to implement innovation in cancer care, as well as discussing how to overcome inequalities in access to care like screening and vaccination. Working with a range of cancer care stakeholders, including ICB and ICS leadership, cancer alliances, diagnostic and imaging networks, trusts, health innovation networks and charities, PPP will use examples, such as the work leading to Scotland’s exciting results, to produce policy recommendations aimed at improving cancer care for all across the UK.

For more information about PPP’s Cancer Care Programme in 2024 please contact:

Willy Morris, Senior Partnerships Manager, willy.morris@pppinsight.com.

Samantha Semmeling, Policy Analyst, samantha.semmeling@publicpolicyprojects.com.