Richard Pugh argues the Cancer Delivery Plan requires a refresh to improve survival and standards of care
This week marks two years since the Welsh Government published its four-year plan for cancer care in Wales. Both individually, and as a collective of cancer charities, we welcomed the plan on its publication and the Welsh Government’s ongoing commitment and vision for improving cancer care in Wales.
For us it was the second iteration of a cancer strategy that we had known since 2011. While other major health conditions followed with delivery plans or strategies, this is the plan that set the standard. It was the first in its class.
There is a now a growing reticence within Welsh Government to adorn anything new with the title of plan or strategy, especially in health. Frameworks will now fill that void. But whatever your views on these documents and whatever term is deemed to be en vogue, the Cancer Delivery Plan has managed to create lucidity in what is often a disparate system of health governance in Wales.
At the heart of the Cancer Delivery Plan is a firm commitment to deliver the best possible care, support and outcomes for the growing number of people with cancer in Wales. Over the course of the plan’s first two years we have seen several hard-won wins when it comes to improving cancer care for patients.
We have seen innovation in projects like the rapid diagnostic centres in Neath Port Talbot and the Royal Glamorgan Hospital, pilots designed to deliver a diagnosis for people on the same day or soon after a test has been undertaken. Based on similar centres in Denmark, these pilots have supported people to be diagnosed with cancer (as well as other conditions) quickly – something which is key to improving outcomes.
Just last week the Welsh Government announced its plan to record cancer waiting times in a new way, from the point a GP thinks a person could have cancer rather than when they are diagnosed. Again, something that Macmillan warmly welcomes.
As Wales reaches the half-time mark on the cancer plan, it is right that we reflect on performance.
Overall it has been a story of relative progress, with the cancer workforce growing and people now living for longer. We are moving in the right direction, but we know demand will continue to rise and increase pressure. There remain critical areas for improvement.
Worrying gaps in Wales’ cancer care workforce have started to emerge, with Macmillan’s recent census of clinical nurse specialists revealing that almost three quarters of breast cancer nurses could retire in the next decade, and that vacancy rates appear to be rising.
Earlier this month the National Assembly’s Public Accounts Committee’s report revealed the NHS’ forced reliance on a patched-up IT system for managing cancer care, something which also needs to be addressed urgently.
What makes the monitoring of wider progress difficult, is that the plan includes very few milestones or targets we can use to truly evaluate overall performance.
One area we can analyse is the targets for cancer treatment waiting times. Under the current system, the situation is far from positive. Wales hasn’t met its urgent cancer treatment waiting time target for a decade, meaning hundreds of people did not start their cancer treatment on time during each of these 10 years.
Without early diagnosis and timely treatment, Wales will not match the far better outcomes already being achieved in other areas of the UK and Europe – an aspiration which the plan clearly commits to delivering. While the new waiting times system may go some way in addressing this, by identifying areas for improvement and targeted investment, there is a great deal of work still to be done.
The next two years of the cancer plan must address these issues to achieve on its ambition of providing high quality, timely cancer care that gives people the best chance of a good outcome. To truly transform cancer care for the ever-increasing numbers of people affected, we must turn our attention to what matters most to people with cancer – and for many their concerns are far wider than what happens in hospital.
The often-devastating impacts of a cancer diagnosis reach into every corner of a person’s life – from their finances to their day-to-day lives and the way they feel.
One of the most concerning things to come out of the latest Wales Cancer Patient Experience Survey, is that people with cancer do not always receive the wider information and support they need to address, alleviate and help them cope with these concerns. Over half of people surveyed did not get advice on issues like finance, which the plan says every person with cancer should be offered.
As well as adding years to life through timely and high-quality treatment, our cancer care system needs to help people with cancer to live a full life during the years they have been given.
The tools for helping deliver this are already widely available. Macmillan’s Electronic Holistic Needs Assessment (eHNA) puts the ability to explore all the pressures being caused by a cancer diagnosis in the palm of people’s hands. Functioning on all devices from laptops to smartphones the eHNA is an easy-to-use tool that can be used to identify concerns, sign-post people to support and highlight areas for service improvement.
It would be remiss not to recognise the current context of changing political tides, with a new First Minister due in a matter of weeks and probable changes to the faces at the top of government. Against such a backdrop, I hope this well-worn strategy is reflected upon, scrutinised and refreshed to meet clear changes in needs and demands for high-quality cancer care.
We’ve seen politicians from all different political hues working hard to deliver improvements to the cancer care system in Wales, but the journey to improving survival and standards of care is a long one. Refreshing and revising the plan to include clear performance milestones and driving greater integration between health boards and social care will all be critical for taking us to the next level.
I hope our current and future leaders recognise that we certainly haven’t fixed cancer care, not by a long shot. This is a pivotal moment in the life of the Cancer Delivery Plan, and not a moment to shy away from the challenges of the day. While it has been a story of relative progress, now is the time to make personalised and holistic care the new normal for people with cancer in Wales.
This article is an unabridged version of Richard’s column in the Western Mail published on 26 November 2018.
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