As the NHS faces a growing backlog and workforce shortages, cancer care is suffering. In early June, the Royal College of Radiologists (RCR) published research conducted with all 60 directors of the UK’s cancer centres, which found that lack of staff at 97 per cent of centres was leading to longer waiting times and delays in treatment.
Indeed, workforce capacity has been recognised as a major challenge in NHS cancer services. “This has long been a problem across the UK, but the pandemic further shone a light on a severely stretched health system,” says Scott Cooke, general manager of UK and Ireland at the biopharmaceutical company Bristol Myers Squibb (BMS). Last year, BMS commissioned analysis from the Office of Health Economics (OHE) which found that, even if activity in cancer services were to increase by 2.5 per cent, clearing the backlog could take almost ten years in some parts of the UK.
However, innovation is advancing at pace. In June, the Galleri blood test – which can detect more than 50 types of cancer at an early stage by looking for abnormal DNA – showed successful results in an NHS trial. It correctly identified two out of every three cancers among 5,000 people who had visited their GP with suspected symptoms in England or Wales.
But the widespread adoption of new diagnostic tests and treatments is being curtailed by an understaffed system. “Given the continued rapid pace of innovation in cancer treatment, it is vital that opportunities for at-scale collaboration with the NHS are generated,” says Cooke. “An overstretched cancer workforce needs protected time and support to adopt and embed innovation.”
“People in the NHS do not have the headspace for innovation,” adds Dr Richard Simcock, a practising oncology clinician and chief medical officer at the cancer charity Macmillan. “People are optimistic that there will continue to be exciting innovations, but they’re pessimistic about their ability to deliver those because of workforce pressures.”
Collaboration between sectors is crucial in tackling issues like workforce shortages, late diagnosis and inequitable access to new treatments. “We need synergies to improve care,” he says.
Therefore, Macmillan has partnered with BMS to create two innovative tools that aim to improve cancer patients’ outcomes, currently being piloted in NHS trusts. The first is a workforce planning tool, which assesses a trust’s existing skills mix and the resources it will need to deliver future treatment innovations. It reduces costs by identifying opportunities for retraining, rather than focusing solely on recruiting new staff. The tool will help clinicians plan their time by looking at the “downstream impacts” of new treatments, says Simcock, such as the resource needed for follow-up clinical care and investigations.
The second tool is a “prehabilitation” method, which prepares cancer patients for non-surgical treatments through advice and support on diet, exercise, and psychological well-being. This aims to improve post-treatment outcomes, such as by reducing hospital stays and the risk of emergency care, also saving the NHS money and reducing the backlog.
“The prehab case has been relatively well proven in surgery,” says Simcock. “But non-surgical cancer treatments like immunotherapy are also extremely physiologically stressful.” Exhaustion is a common side effect, and lifestyle interventions such as exercise can be very successful in remedying this.
“If we can get a person to be healthier before and throughout treatment, we know they’re likely to recover faster and better, and get back to living a fuller, more normal life,” he adds.
Policy can play a vital role in spreading innovation. Simcock says he is “hugely disappointed” that the ten-year cancer plan, proposed by former health secretary Sajid Javid, has been replaced with a Major Conditions Strategy.
However, there is scope for improvement – the cross-party Health and Social Care Committee recently launched an inquiry into the future of cancer care, which will explore innovation in diagnosis and treatment. Strong recommendations for the government will help to ensure innovation is “spread equitably, at pace and permanently embedded in the health system”, says Cooke.
Collaboration with the life sciences industry should be at the heart of these, he says. Measures to tackle inequalities in patient outcomes and treatment access should also be prioritised, to ensure that “existing gaps are not simply exacerbated” as cancer services improve.
The new Department for Science, Innovation and Technology (DSIT) also shows promise in prioritising medical innovation. DSIT recently published the UK Science and Technology Framework, a strategy to make the UK a science and technology “superpower”, and the life sciences is a core tenet of this.
To deliver on this ambition, there needs to be cross-departmental working to improve the UK’s standing in delivering clinical trials and developing medicines, says Cooke. Between 2018 and 2021, the UK slipped from fourth to tenth place globally as a place to conduct clinical trials, and the time between a medicine receiving marketing authorisation and being available to patients has increased, and is now 329 days in England.
“Clinical trials give patients access to potentially transformative treatments at no extra cost to the NHS,” says Cooke. “[In terms of] making licensed products available to patients, we know that outcomes are improved the earlier a person is diagnosed and treated.”
From workforce planning tools to multi-cancer blood tests, new methods can help patients while reducing the NHS burden. But their widespread adoption cannot rely solely on clinicians working in an already-stretched system.
“[NHS staff] are exhausted and burnt out,” says Macmillan’s Simcock. “We need to bring people together and the corporate and third sector have more time, space and capital to do that.”
Approval code: June 2023 | ONC-GB-2300314
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