Twelfth Report - Cancer services

Select Committee

Health and Social Care Committee HC 551 5 April 2022

Report Status Government responded

Conclusions & Recommendations 30 items (15 recs)

Source View on Parliament website

Government Response (AI assessment · 30 of 30 classified)

Accepted 17

Accepted in Part 1

Deferred 4

Recommendations

15 results

2 Accepted in Part

Para 46

NHS England has been focusing on encouraging people to come forward with cancer symptoms during...

Recommendation

NHS England has been focusing on encouraging people to come forward with cancer symptoms during the pandemic, which is welcome, and has recently launched a marketing campaign to encourage people to overcome their reluctance to visit their GP to discuss … Read more

Government Response Summary

NHS England will extend coverage of non-specific symptom pathways to at least 75% population coverage by March 2023, ensuring at least 65% of urgent cancer referrals meet the Faster Diagnosis Standard and will trial new approaches to prostate cancer and expanding routes into the system across primary care community.

Department of Health and Social Care

4 Accepted

Para 52

The Government should implement the recommendations of Professor Sir Mike Richards’ review of cancer screening...

Recommendation

The Government should implement the recommendations of Professor Sir Mike Richards’ review of cancer screening as a priority and ensure that there is a clear plan in place to rapidly conduct appointments missed during the pandemic.

Government Response Summary

The government states that through NHS screening programmes they are able to reduce mortality and morbidity and there have been important changes in screening programmes in recent years.

Department of Health and Social Care

7 Acknowledged

Para 63

The Government and NHS England must set out detailed plans for how the £2.3 billion...

Recommendation

The Government and NHS England must set out detailed plans for how the £2.3 billion investment in Community Diagnostic Centres will be utilised, in particular detailing how many additional CT, MRI and PET-CT scanners and endoscopy suites the investment will … Read more

Government Response Summary

The government acknowledges the recommendation by referencing the Delivery Plan for Tackling the COVID-19 Backlog of Elective Care and stating CDCs delivered over 880,000 diagnostic tests in 2021/22, projecting 17 million more tests over the next three years, increasing annual capacity by 9 million tests by March 2025, but does not give detail regarding additional scanners etc.

Department of Health and Social Care

8 Acknowledged

Para 64

The Government and NHS England must also develop a specific plan to address gaps in...

Recommendation

The Government and NHS England must also develop a specific plan to address gaps in the diagnostic workforce, setting out how it will address both short-term and long- term shortages in key professions, and particularly what investment will be required … Read more

Government Response Summary

Health Education England invested £52 million in 2021/22 in the cancer and diagnostics workforce and the Government's forthcoming 10 Year Cancer Plan will set a new vision for cancer care, and the Department commissioned HEE to review long term strategic trends for the health workforce.

Department of Health and Social Care

11 Acknowledged

The static trajectory in early diagnosis demands that the Government’s new plan for cancer services...

Recommendation

The static trajectory in early diagnosis demands that the Government’s new plan for cancer services must include a clear action plan for achieving the 75% early diagnosis ambition which goes beyond current plans and considers much more radical proposals to … Read more

Government Response Summary

The government welcomes the recognition of its work to diagnose 75% of cancers by 2028 and lists existing priorities, but doesn't commit to any new or radical action to achieve the target.

Department of Health and Social Care

13 Accepted

Para 87

The Department of Health and Social Care and NHS England must publish a detailed analysis...

Recommendation

The Department of Health and Social Care and NHS England must publish a detailed analysis of the extent of the cancer backlog to support the delivery of the elective care recovery plan. The Department should work with NHS England to … Read more

Government Response Summary

The government stated cancer diagnosis and treatment has remained a top priority throughout the pandemic with substantial funding and targets being set for local systems to reduce cancer diagnosis times and to reduce the shortfall in the number of first treatments.

Department of Health and Social Care

14 Acknowledged

Para 88

Based on these estimates the Department of Health and Social Care and NHS England should...

Recommendation

Based on these estimates the Department of Health and Social Care and NHS England should set out: a) an estimate of what level of additional capacity in NHS cancer services will be needed to address the backlog in cancer services … Read more

Government Response Summary

Cancer diagnosis and treatment has remained a top priority and there were over 4.9 million urgent referrals and over 600,000 people started cancer treatment between March 2020 and March 2022 and describes existing NHS Long Term Plan ambitions on early cancer diagnosis and actions local systems are required to take.

Department of Health and Social Care

16 Accepted

Para 96

As part of its new cancer plan, the Government should include a plan for how...

Recommendation

As part of its new cancer plan, the Government should include a plan for how to better align the technology appraisals carried out by NICE with the regulatory process applied by the MHRA, in order to reduce the delay between … Read more

Government Response Summary

The government states that NICE is committed to publishing guidance around the time of licensing and has consistently delivered on this commitment in the majority of cases, with measures in place for funding ahead of NICE guidance and collaboration between MHRA, NICE, and NHSE&I.

Department of Health and Social Care

20 Deferred

Para 109

As part of the Government’s new cancer plan, the Government and NHS England should review...

Recommendation

As part of the Government’s new cancer plan, the Government and NHS England should review the organisation of cancer surgery with a specific focus on whether more specialist hospitals should be established to ensure that more cancer surgery is carried … Read more

Government Response Summary

The government deferred action, stating that the Cancer Call for Evidence is being analysed and the 10-Year Cancer Plan will address the organisation of cancer surgery.

Department of Health and Social Care

21 Accepted

As part of the long-term plan for the cancer workforce, the Government and NHS England...

Recommendation

As part of the long-term plan for the cancer workforce, the Government and NHS England should develop specific proposals for improving the retention of experienced cancer staff, including targeting burnout and improving the day-to-day working conditions of staff. (Paragraph 115) … Read more

Government Response Summary

The government states that the forthcoming 10 Year Cancer Plan, NHS People Plan and 22/23 NHS priorities address workforce wellbeing, including staff mental health hubs and a retention programme.

Department of Health and Social Care

24 Accepted

Para 129

Cancer Alliances must reflect on new data provided to them by NHS England and the...

Recommendation

Cancer Alliances must reflect on new data provided to them by NHS England and the Department of Health and Social Care about cancer outcomes by ethnicity in their areas. In particular they should review the care provided to people from … Read more

Government Response Summary

The government states that tackling inequalities is a key focus of the NHS Long-Term Plan and 22/23 Planning Guidance, with actions in place to increase accessibility of surveys, target lung health checks, and target messaging in campaigns to minority audiences.

Department of Health and Social Care

25 Acknowledged

Para 130

The new Office for Health Improvement and Disparities should review the drivers of disparities in...

Recommendation

The new Office for Health Improvement and Disparities should review the drivers of disparities in cancer outcomes and develop a joint strategy with NHS England to address these disparities.

Government Response Summary

The government states they remain committed to levelling up outcomes across the UK and are planning on publishing the Health Disparities White Paper later this year to break the link between people’s backgrounds and their prospects for a healthy life.

Department of Health and Social Care

27 Deferred

The Government must consider rare, less common and less survivable cancers specifically as part of...

Recommendation

The Government must consider rare, less common and less survivable cancers specifically as part of its new cancer plan. NHS England should also produce an action plan for rare, less common and less survivable cancers, containing clear commitments to address … Read more

Government Response Summary

The government deferred action, stating that it is analysing responses to the Cancer Call for Evidence and that the 10 Year Cancer Plan will address all cancer types, including rare and less survivable cancers.

Department of Health and Social Care

29 Accepted

Para 148

The Government should set out how it will build on the lessons learnt during the...

Recommendation

The Government should set out how it will build on the lessons learnt during the pandemic by making it easier for researchers to: a) access vital patient data; b) access staff needed for their studies, by providing more protected time … Read more

Government Response Summary

The government outlines actions to improve data access, staff access for studies and streamlining of approval processes, referencing the Vision for the Future of UK Clinical Research Delivery, investment in Trusted Research Environments, a single front door for study approvals, and the Innovative Licensing and Access Pathway.

Department of Health and Social Care

30 Accepted

The Government should also establish a ring-fenced fund for cancer research infrastructure targeted at NHS...

Recommendation

The Government should also establish a ring-fenced fund for cancer research infrastructure targeted at NHS trusts which have historically low levels of research activity. (Paragraph 149) 46 Cancer services

Government Response Summary

The Department provides sustained investment in research expertise, specialist facilities, a research delivery workforce and support services through the NIHR Infrastructure including Experimental Cancer Medicine Centres (ECMCs) and NIHR Biomedical Research Centre at the Royal Marsden BRC.

Department of Health and Social Care

Conclusions (15) Observations and findings — click to expand

1 Conclusion Accepted

Para 43

We welcome the development of Rapid Diagnostic Centres and Community Diagnostic Centres, particularly in giving GPs more effective referral routes for possible cancer symptoms, especially those which are non-specific but concerning. However, we have heard differing accounts about the impact of the Covid-19 pandemic on the development of Rapid Diagnostic …

Government Response Summary

The government states there are already 84 pathways live transforming the way that people with symptoms not specific to one cancer are diagnosed or have cancer ruled out, and have set expectations in the NHS Operational Planning Guidance for 2022/23 to extend coverage.

3 Conclusion Accepted

Para 51

Cancer screening is a vital tool for early diagnosis, but even before the pandemic there were serious concerns about the effectiveness of national cancer screening services, particularly over IT systems and the speed at which innovations have been implemented. New programmes like the Lung Health Check programme offer some reason …

Government Response Summary

The government describes the existing cancer screening programmes, including the introduction of primary Human Papilloma Virus (HPV) screening in cervical screening in 2019, continued work to evaluate self-sampling for HPV, expansion of the home testing programme, and progress in tackling the backlog of invitations caused by the pandemic.

5 Conclusion Acknowledged

Para 61

We understand the rationale for simplifying the Cancer Waiting Times standards. It is important that NHS cancer services are given a clear set of targets to achieve and that these targets are the ones that are most important to patients. However, we note that there are no current plans to …

Government Response Summary

The government acknowledged the importance of a quick cancer diagnosis, referring to the Delivery Plan for Tackling the COVID-19 Backlog of Elective Care and investment in Community Diagnostic Centres to increase diagnostic capacity and reduce waiting times.

6 Conclusion Accepted

The Government’s recent announcement of a £2.3 billion investment in 100 new Community Diagnostic Centres is welcome and could provide a significant increase in physical diagnostic capacity. However, it is not yet clear how much additional capacity this investment will yield and whether it will allow England to catch up …

Government Response Summary

The government announced a £2.3 billion investment to increase the volume of diagnostic activity and to roll out up to 160 community diagnostic centres (CDCs) by March 2025 and outlined workforce planning measures including expanding training places, streamlining training routes, optimising the use of existing cross-professional workforce good practices to free up capacity and improving workforce productivity through digital diagnostic investment.

9 Conclusion Acknowledged

Para 70

There is huge potential in NHS cancer data, and a large amount of data from NHS cancer services is already collected and reported. However, there is significant room for improvement, particularly in reducing the two years it takes to collect and publish data on cancer stage. A major overhaul of …

Government Response Summary

The government welcomes the committee's recognition of work underway to diagnose 75% of cancers by 2028, highlighting six priorities to increase early diagnosis and stating it is premature to suggest progress is off track.

10 Conclusion Accepted

Para 71

Notwithstanding the lag on published data, on the basis of evidence supplied by the Government and the NHS, and Cancer Research UK’s analysis, we do not believe that the NHS is on track to meet the 75% early diagnosis ambition set by the Government. It is clear that there is …

Government Response Summary

The Government welcomes the Committee's recognition of the work that is already under way to deliver on the ambition to diagnose 75% of cancers by 2028 and describes programmes already underway.

12 Conclusion Accepted

Para 86

We recognise that the disruption to cancer services during the pandemic was primarily driven by the need to mitigate the risk posed by Covid-19 to patients undergoing cancer treatment. We also recognise the efforts made by the NHS to maintain treatment or offer alternative treatment options. Nonetheless, we remain extremely …

Government Response Summary

Cancer diagnosis and treatment has remained a top priority and there were over 4.9 million urgent referrals and over 600,000 people started cancer treatment between March 2020 and March 2022 and describes existing NHS Long Term Plan ambitions on early cancer diagnosis and actions local systems are required to take.

15 Conclusion Acknowledged

Para 95

For patients with limited treatment options the approval of a new drug or therapy can make a significant difference even when the survival benefit is only months. Despite the effectiveness of the Medicines and Healthcare products Regulatory Agency’s regulatory process, and despite some progress by NICE in approving medicines more …

Government Response Summary

The government acknowledges that the drug approval process is too slow but states that NICE is committed to publishing guidance around the time of licensing and has consistently delivered on this commitment in the majority of cases.

17 Conclusion Accepted

Para 101

The Government and the NHS have recognised some of the issues with radiotherapy delivery in the NHS and have made welcome commitments to resolve these, such as investing in new radiotherapy machines and the proton beam centres in Manchester and London. However, it is clear that there are still significant …

Government Response Summary

The government claims to be already addressing concerns about radiotherapy services by investing in new equipment and supporting optimal machine utilisation, staff training, and technology.

18 Conclusion Accepted

Para 102

The Government’s new cancer plan should provide an update to the 2014 radiotherapy vision which should include a long-term rolling investment programme for outdated radiotherapy equipment as well as changes to the national radiotherapy tariff to incentivise the delivery of modern radiotherapy techniques and remove perverse incentives.

Government Response Summary

The government stated that until the 2021 Spending Review, replacing equipment resided with NHS Trusts, but since 2016 NHS England has taken steps to ensure every NHS Trust has access to modern equipment and has invested £162m to replace or upgrade over 100 radiotherapy treatment machines.

19 Conclusion Deferred

Para 108

Major specialist cancer hospitals have better access to staff, expertise and technology, and patients referred to these sites are more likely to be offered potentially life- saving surgery. During the pandemic, these hospitals were the ones most likely to be able to continue treatment, perpetuating regional disparities. Creating more of …

Government Response Summary

The government's response states the Cancer Call for Evidence has closed, and the responses are being analysed alongside wider evidence for a new vision for cancer care in their 10-Year Cancer Plan.

22 Conclusion Accepted

Para 127

Cancer Alliances have had a positive impact on transforming cancer services and sharing best practice, and enjoy strong support from the sector. However, it is clear that while they are having some success, there is still significant unwarranted variation across regions in England and that the ability of Cancer Alliances …

Government Response Summary

The government states that Cancer Alliances already lead the planning and delivery of cancer services and their improvement across their local systems.

23 Conclusion Accepted

Para 128

To support Cancer Alliances to embed transformation into local cancer services, new Integrated Care Systems must be required to appoint cancer leads, with responsibility for working directly with Alliances to embed best practice into their own systems. Cancer performance should also be Ofsted-rated by Integrated Care Boards as a sub- …

Government Response Summary

The government states that Cancer Alliances already lead the planning and delivery of cancer services, and the ICS Design Framework has made clear that Integrated Care Boards (ICBs) will look to the Cancer Alliances to continue to undertake these roles from July 2022.

26 Conclusion Deferred

There are specific challenges facing people with rare and less common and less survivable cancers, including that they are often harder to diagnose and that issues with spreading best practice for treating less common cancers are more pronounced. Despite some positive changes such as Rapid Diagnostic Centres, it is not …

Government Response Summary

The government is analysing responses to the Cancer Call for Evidence to develop the 10 Year Cancer Plan, which will address all cancer types, including rare and less survivable cancers.

28 Conclusion Accepted

Para 147

The impact of Covid-19 on cancer research was significant and it is concerning that trial recruitment has not yet reached pre-pandemic levels. However, the pandemic has provided a model for how cancer research can be conducted more efficiently, in more hospitals, to bring greater benefits to patients.

Government Response Summary

The government describes the multi-year Vision for the Future of UK Clinical Research Delivery, how it will build on the lessons learnt during the pandemic, and sets out the ambition to create a patient-centred, pro-innovation and digitally enabled clinical research environment.