Why is the NHS lagging behind on cancer care?

0:09Coming up, the NHS is preparing to launch its 10 year plan for cancer care with lessons learned from Denmark.

0:23I find it pretty difficult to talk about cancer. That's in part because I've seen what it does to the people you love but also because of the frustrations they've experienced being treated on the NHS. When you're waiting for a diagnosis a day feels like a year and waiting and waiting. Delays don't just cause anxiety, they cost lives. Last November, almost a third of cancer patients in England waited more than two months to start treatment after an urgent GP referral. That's twice as many as the NHS target allows. I was told that it was stage four. It was now not curable. So now the government says it's acting.

1:07It's announcing a 10-year cancer plan with a big emphasis on speeding up diagnosis and getting people into treatment faster. But why has it taken this long? Just have a look at Denmark, for example. Back in 2000, politicians there decided enough was enough. Survival rates have since improved dramatically. Waiting lists are almost a thing of the past. There was sort of an agreement between important politicians saying we need to do something about it. And that agreement has been lasting for the past 25 years. We're going to be getting into the detail of the Danish example shortly. But first, our health correspondent, Ashish Joshi.

1:45Ashish, just be honest, how bad is our oncology care right now? Cancer care in England is not as good as it should be, and I think everyone accepts that. If you look at probably the benchmark metric used to measure the quality of cancer care in this country, we haven't met our targets of 85 % of patients being seen for treatments within 62 days of referral. That target has not been met since 2014. And we know that if you present with a cancer diagnosis and you're not seen almost immediately and treatment doesn't begin almost immediately, then the outcomes are much, much worse. So if you look at that benchmark metric, our cancer care is lagging way behind the rest of the countries who have developed healthcare systems or richer countries, which we are measured against.

2:46So we're doing very badly in England. And it's not like they're short of a diagnosis or two. Yeah, according to Macmillan, the cancer charity, we have a new cancer diagnosis every 75 seconds. The problem here is 2014 was the last time we met that target. Between 2014 and 2025 or 2026, as we are now, not enough investment has been made in cancer care and cancer provision. We haven't invested the same in our cancer services as much as other countries have. And while cancer diagnosis continue to grow because we have an aging population. The older you become, the more likely you are to present with cancer.

3:28And that's a sad fact. People live longer, but they don't necessarily live healthier. So as you have an aging population, the chances are that you will find more cancer. Why is it such an imperative to get diagnosis and get onto that treatment pathway just as quickly as possible? Because cancer is a nasty, unpredictable disease. And what tends to happen with cancer is it spreads. The statistics are that if you do not act on cancer immediately, every month that it remains undetected, your risk of death increases by 10%. So that's pretty stark. If your cancer is detected early on, then the chances are with intervention, surgical and therapeutic interventions, you will be able to treat that cancer and extend your life, if not cure it completely.

4:21Internationally, how much of an outlier is cancer care in England then? How bad are we compared to our neighbours? We're very poor. We are somewhere near the bottom for most cancer outcomes compared to our European neighbours and compared to richer countries worldwide. And that's for every common cancer, breast cancer, prostate cancer. and it's because we haven't had this investment in cancer care. I ought to stress that we spend as much as anyone else on our health care and a large proportion of that does go on cancer care but we're not seeing those returns in terms of good outcomes for cancer patients.

5:01Why is that? Why are we spending so much money and not getting ROI, return on investment? Because we are spending money with patients who present late. We're getting to them later in their cancer care. We don't have enough diagnostic equipment. So when you look at CT scanners, we don't have as many per head of the population as our comparable European neighbours. So the investment hasn't been there. So we're spending money in cancer care with patients who present and for their cancer care packages. But sometimes and most of the time, it's too late and it's too ineffective. So we need to get to these cancer cases much sooner.

5:39And that's what we'll see, hopefully, with this cancer care plan when it's produced by the government. We'll have more community diagnostic centres. We'll have more around prevention. And we'll have more investment in specialities like the radiologists. And that's where the money needs to go. As you say, we're going to get the detail of the 10-year plan a little later this week. But on the basis of what we know, is this sticking fingers in the dike when it comes to cancer care? Or are we building a new wall? This has been described as a once in a generation opportunity to get England's cancer care package right.

6:22It's going to be a long journey. It takes investment and it takes a buy in from absolutely everyone who's involved. It will take commitment from the politicians and commitment from clinicians, healthcare leaders, and obviously from patients too. This will be about a long-term solution to what is being described as the biggest threat facing the NHS and the biggest healthcare threat facing our society. Cancer, it's so prevalent. One in two people will present with cancer. I think almost everyone who listens to this podcast will say that they will know someone who has been affected by cancer. I've been affected by cancer.

7:04Two of my family members over the last few years have presented with cancer and I've lost friends and family to cancer. Everyone talks about cancer. So it's there. And we really need a plan which looks at prevention, at treatment, at faster diagnosis. and also this is the interesting part is we need to look at what happens to cancer survivors because the medicine the scientific advancements being made in cancer are so good that people will live longer better lives when they present with cancer because of these interventions which can be made thanks to science we're talking about cancer vaccines we're talking about tailor-made cancer therapies according to somebody's DNA.

7:52So these are advancements being made in cancer treatment all the time. What other countries are looking at now, Neil, is their cancer success rates are so impressive that they are not looking at interventions now. They are looking at using AI modelling to prevent cancer, identifying patients who will be undergoing surgery, who will present with comorbidities using AI to identify these patients so more care can be given to them pre-surgery. It's a perverse position to be in and it's almost counterintuitive but because we've been so bad with our cancer care and other countries have been so good at it we can take that knowledge from all of these cancer care plans which have been in place for 15 to 25 years and take them all on board for our first cancer care package.

8:42Let's take one example of international best practice, one that you've been looking very closely at, Denmark, which I suppose is a parallel system, at least in the sense that healthcare there is, as it is in England, free at the point of delivery. So Denmark's a very good example, and it's one that's often quoted by cancer experts. 25 years ago, the Danes and the English were languishing at the bottom of almost every league table for cancer outcomes and cancer survival rates. And then 25 years ago, the Danes decided that they needed to do something about it. So they introduced their Cancer Care Plan 1, and they looked at treatment and faster diagnosis.

9:22Let's start right at the beginning. Let's treat people quickly. Let's make sure that once they are diagnosed, they start on their cancer journey almost immediately. 99 % of Danes who present with cancer will start their cancer pathway within four weeks of a diagnosis. 99 % within four weeks. That is staggering. And that's something that just hasn't happened overnight, but they've worked really hard at this over 25 years. And even our own health secretary, West Streeting, has described Denmark's healthcare system as a beacon of excellence. They've been sending ministers out there over the past couple of years and learning from the Danish model.

10:03And we'll be back to Ashish in a bit. But let's have a proper look at the example set by Denmark. Jesper Fisker is chief executive of the Danish Cancer Society. Jesper, what on earth happened in Denmark 25 years ago? I mean, just how bad was Danish cancer care? Oh, it was terrible at that stage. There was an atmosphere of despair. You had people dying while they were on waiting lists. You had clinicians being really depressive about the perspectives in cancer treatment. You had hospitals that didn't know what to do. Politicians, they were getting desperate. So there was this general atmosphere of this is just not good enough.

10:44We need to do something about this because we are a welfare society. We cannot accept these standards within cancer treatment. So there must have been then a recognition, not just on the part of the patients, the doctors, but also the politicians, that this was going to be a process that lasted longer than one, two, three, four, five years. Exactly. There was sort of an agreement between important politicians working in the regional level, which in Denmark is the level that are responsible for the hospital system, and the national politicians in the Danish parliament. And there was this alliance saying we need to do something about it, and we agree on the fact that we need to work on this probably for many, many years.

11:25And that agreement has been lasting for the past 25 years. And it's been passed on to other politicians as well, which is really interesting. So nowadays it's more or less a very integrated part in any political party's health policy. So take us back to the early days. What concrete changes did Denmark put in place in those first couple of health plans? I think the point of departure was the fact that our survival rates overall was really, really poor. And that was a wake-up call because we were in the bottom when it came to overall survival rights. And the initial problem was we didn't have scanners, enough scanning capacity.

12:02So we needed to buy lots of technical equipment at that time. So the first cancer plan was on adjusting our capacity technologically and buying new equipment. Then we moved on to other areas. Then the next cancer plan was patient rights where we introduced the cancer pathways where you introduced limits for the time that people were allowed to wait. Then the next cancer plan was on clinical guidelines, so heavily centralization, cutting down the ward number by about two-thirds in that period, making the clinical quality higher. This is fascinating to me, yes, but largely because, actually, when it comes to oncology and cancer treatment in this country, it always strikes me that all we need is just more money.

12:47but what you have done in Denmark is look at the whole system not just the outcomes not just the mortality rates but the whole system including patient experience and clinical guidelines so it's all of these different factors coming together to make the system as efficient as it is you know when I'm trying to explain what we've done in Denmark I use the Lego experience like you have different building blocks and you need all the building blocks but they can be put together differently, you know, compared to in what country you're working with it. But I think in a Danish context, all the building blocks, they have played a crucial role in the overall improvement.

13:26And we couldn't do without one of them, because they're a part of the overall improvement. But take a look at where England is right now. I'm sure you're aware of kind of outcomes in this part of the world. How do we compare to where Denmark was 25 years ago? If you're looking at overall survival rates, we were at the bottom with UK 25 years ago. And we've been moving up the ranks from a bad point of departure. And so has England, but not as far as we've made it. I think if you want to somehow get inspired from the Danish case in Britain, I think you should actually look at the different components, not necessarily to put them together the same way we've done it.

14:10Every country, every healthcare system is different. It's got its strengths and its weaknesses, but you need to work all the way through the cancer journey and you need to have a long-term perspective because those two components, they've been essential in the Danish progress, but also investment. You cannot do this exclusively with money, but you cannot certainly do it without money either. We know that for some time now, politicians have been racking up the air miles and heading over to Denmark to look and see firsthand exactly what you have been doing. What can we learn and just put straight into the health service right now that would have a positive effect on our cancer care?

14:48I think the foundation or the background for our progress has been the national cancer plans. Five different national cancer plans every five years, basically. And I think this constant focus on improvement with one cancer plan, you know, starting dealing with, for instance, early diagnosis or something else, and then you have the next cancer plan dealing on different matters concerning the cancer journey. So I think the national cancer plans, if I should point to one thing in Denmark, has been the backbone of our progress over the past years. Let's get one final thought from Ashish Joshi. Ashish, look, I've seen just how bad things have gone with certain aspects of cancer care, if not across the board.

15:31We have had health secretary after health secretary saying that they had the answer. So what hope is there that this 10-year plan is the thing that will actually do the trick? Even when there's political uncertainty, the health leaders will have to ensure that cancer funding, NHS funding, isn't impacted. Will that happen? I don't know. But one would hope that given how much politicians from all sides talk about the NHS and what it means to the people in this country and how much a good NHS brings rewards in terms of the economy, in terms of the labour market and all the hidden costs that sickness brings, we need a thriving NHS.

16:15And one of the biggest threats facing the NHS is cancer. I mean, look at how much we've struggled with just the general waiting list. And that was a key manifesto pledge to bring down this waiting list, which is over 7 million. Stubbornly hasn't come down in the way that the Labour government would have hoped. With cancer, they have to do something to bring down the waiting times to get onto a cancer treatment. because what happens is people will get sicker, some will die, and they will need more treatment, and then it's going to cost more. So if you want to look at this from a desensitized, purely cost analysis, it will cost much more for the politicians in this country to carry on the way they're doing now without getting to really the roots of the mass with cancer, which is interventions very early on, diagnosis very early on, and good public health messaging as well.

17:11If they don't do that, it's going to cost them much more in the long run. Fingers crossed. Ashish, thank you. My thanks to Ashish, to Jesper, and of course to you for listening. For details of the government's 10-year plan, just check out the website after launch, skynews.com. The Sky News Daily is back tomorrow.