26 March 2023

Capacity to deliver: new ways to increase cancer service capacity

Cancer services are under unprecedented pressure, but there are steps we can take to free up capacity.

By Mike Birtwistle, Senior Counsel, Evoke Incisive Health

We are in a golden age of scientific discovery but cancer services are facing significant pressures. Delays in diagnosis and treatment cost lives and are placing intolerable strain on staff. Yet there are steps we can take now to free up capacity, improving the experience of patients and supporting staff. Our Senior Counsel, Mike Birtwistle, spoke to cancer and policy experts to identify the changes required to support local action to free up capacity and improve cancer outcomes.

This should be a time of great opportunity in cancer care. Scientific progress has transformed our ability to diagnose and treat cancer, enabling many people who receive a diagnosis to lead longer, healthier and more active lives, often being ‘cured’ of the disease. 

We will squander this opportunity, however, unless we ensure that cancer services have the capacity to deliver cancer care effectively to those who need it when they need it. Cancer waiting times provide a good barometer of the capacity challenges facing services. Standards have not been met for nearly a decade. Without the necessary capacity, diagnoses will be delayed, patients will miss out on the best possible of care, opportunities to improve outcomes will be squandered and NHS staff will be placed under intolerable pressure. 

The pressures facing cancer services predate the COVID-19 pandemic but have been made worse by it. All health systems are under pressure, but the situation in the NHS is particularly pressing. With cancer outcomes in England already poorer than in other countries, the challenge is significant.

Capacity to deliver: unlocking the resources required to improve cancer outcomes in England examines the steps that can be taken to free-up cancer capacity. In preparing the report, we spoke with experts from a range of backgrounds, including national and local health service leaders, central government departments, royal colleges, charities, as well as professionals working in the NHS and independent sector. In order to enable experts to speak candidly and offer their considered personal perspective rather than repeating an established organisational position, all views have been anonymised.

Despite technological advances, cancer care is still fundamentally a human endeavour. There are insufficient staff to meet current or future demands and the starting point for any effort to improve cancer capacity must be a fully-funded workforce plan. Recent government commitments on this are welcome and need to be followed through with action.

Efforts to address workforce shortages will, however, take time. There is a risk that the scale of the challenge, or the recognition that additional workforce is required, leads to paralysis. Yet there are steps that can and should be taken now to free up capacity. The good news is that there are no shortages of ideas. Actions identified include:

  • Simplifying cancer pathways by reducing the number of steps between a referral, diagnosis and treatment, meaning that patients have fewer unnecessary appointments and time to diagnosis is accelerated

  • Prioritising technologies and interventions that free-up capacity, releasing staff time for other tasks

  • Streamlining the work of multidisciplinary teams, enabling more time to be devoted to considering complex cases and reducing bottlenecks for those needing more routine care

  • Improving the coordination and personalisation of cancer care, reducing unnecessary duplication and focusing support in the areas that will make the most difference

  • Drawing on the skills and expertise of the widest range of professionals in delivering cancer care, enabling professionals such as nurses and pharmacists to play a greater role

  • Making better use of the independent sector, particularly in scaling up the delivery of accessible diagnostics

  • Preventing disruption to capacity by ringfencing cancer and elective services from acute care

  • Focusing resources on interventions which can reduce future health need, including prevention and early diagnosis

There are examples of these ideas already being put into practice. However, progress is unequal and action is required to accelerate implementation. Otherwise, some areas of the NHS risk being left behind.

Now is the time to inject urgency into efforts to free up capacity. If we get this right, we will make the working lives of staff easier, improve the experience of patients and enable us to continue to rise to the challenge of increasing health need.

Capacity to deliver makes 15 recommendations for policy change which are intended to support local action to unlock capacity. You can read them here.

We hope these recommendations will make a constructive contribution to discussions on how best to recover cancer service performance and build a service equipped to deliver the best possible outcomes.

2023 will be a big year for health policy, as hospitals grapple with backlogs, Integrated Care Boards get to grips with their new responsibilities and ministers develop a new major conditions strategy. All will ignore the actions which can free-up capacity at their peril.

This paper was initiated and funded by AstraZeneca. AstraZeneca had no editorial control and the views expressed are not necessarily those of the funder, although the draft was reviewed to ensure compliance with the Prescription Medicines Code of Practice Authority Code.

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