|Screening for bowel cancer|
|Smoking ban in public places|
|Implemented in this survey?|
Over the past several months, the government has announced a wave of cancer treatment and prevention initiatives, stung somewhat, perhaps, by reports that the UK lags behind other countries in Europe and North America in terms of mortality and survival rates for several types of cancer. This report will outline these new initiatives.
In December 2009, the Department of Health's Cancer Reform Strategy released a report that showed that there is significant regional variation in cancer outcomes and services in the UK, which, together with recent reports that the UK performs relatively poorly for several types of cancer (an argument that featured quite heavily in the recent US health care reform debate), prompted the government to challenge the NHS to publish local data on cancer survival and mortality rates. The public disclosure of this information is intended to prompt the NHS to identify priorities for action, and will also hopefully incentivise poor performing localities to improve. The types of data that the DH wants disclosed include breast and cervical cancer screening coverage, one-year survival rates, compliance with a 62-day standard time for referral to treatment and the length of inpatient stays and emergency admissions, among other things.
Moreover, in January 2010, the DH, in collaboration with Macmillan Cancer Support (http://www.macmillan.org.uk/Home.aspx - to which the DH is awarding £1.6 million to fund the initiatives below), published the National Cancer Survivorship Initiative vision, which proposes that all cancer survivors should receive a personalised assessment and care plan, support to self-manage their condition, information on the long-term effects of living with and beyond cancer, and access to specialist medical care if complications occur following their cancer treatment. These practices are being piloted in 38 sites throughout the country and include, for example, telephone-based support services staffed by cancer nurses, and wellness and exercise programmes for cancer survivors. Ultimately, it is hoped that they will serve to better meet the medical, psychological, social, spiritual, financial and information needs for cancer survivors and their carers.
Also in January 2010, a new National Black and Minority Ethnic (BME) Cancer Patient Advisory Panel was established by the DH, which is intended to give ethnic minorities a greater voice in cancer care. The Panel will comprise of over 1,000 members (cancer sufferers and carers) from across England who will be surveyed up to four times each year, and their comments on how cancer services might be improved for the BME community will be disseminated throughout the NHS.
There have been some concerns about delays in diagnosing some types of cancer in the UK. Thus, in March 2008, the DH announced an £8 million fund to improve early detection of breast, colorectal and lung cancers. Primary care trusts (PCTs) are being invited to bid for funds of up to £100,000 to run innovative campaigns relating to advertising and outreach that serve to encourage people to be tested earlier if symptoms are present. It is intended that successful initiatives will then be rolled out nationally. Moroever, the government has pledged that patients with cancer symptoms will receive the results of their diagnosis within one week of being tested, and has announced that an overall quickening of cancer diagnoses could save up to 10,000 lives per year.
The government also announced in March 2010 new guidance for the early detection of cervical cancer, and has emphasised that GPs should follow NICE guidelines around gynaecological care. The new guidance says that young women (aged 20-24) should receive a full pelvic examination if they visit their GP with abnormal bleeding, a practice that is currently apparently often overlooked and which delays the diagnosis of cervical cancer, reducing the chances of survival.
In a broader policy initiative, the government has decided to make treatments for very rare conditions - that have not yet been assessed by NICE - available on the NHS. Some of these interventions will of course relate to rare forms of cancer, although all drugs allowed through this measure will be submitted for NICE appraisal at the end of three years.
Finally, in terms of cancer prevention, the DH announced in February 2010 the government's further plans to create 'a smoke free future'. As part of this strategy, they have laid out a number of commitments, which include a crack down on cheap illicit cigarettes, more convenient (in terms of time and place) smoking cessation support and advice for those smokers who wish to quit, a consideration of enforcing plain packaging of cigarettes (as opposed to the current attractive packages), the banning of tobacco selling from vending machines (from which young people often purchase cigarettes), and a consideration of whether to extend the smoking ban from public places to the entrances to buildings. Through measures such as these, the government has stated that it expects to halve the smoking rate by 2020 (currently, about 20% of the population smoke). If all this were to happen, one would of course expect cancer-related mortality and morbidity to decline, ceteris paribus.
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
There is no real comment to make. The initiatives generally seem reasonably innovate (if marginal from a structural change perspective), and I don't think that they are hugely controversial on the whole. The specific iniatives have not, as far as I can tell, received much attention in the popular media, and thus I don't think public visibility of them is particularly high. I see no reason why they could not be transfered to other country contexts.
|Implemented in this survey?|
Clearly, the central government supports, and is influential regarding, its own initiatives. Civil society, in the form of patient groups etc., seem to broadly support the initiatives that the government has announced, and I don't detect much opposition. Moreover, the announcement that drugs for very rare conditions will be made available on the NHS pre-NICE assessment has received explicit support from patient groups (who want quicker access to treatments), NICE (who know that they will be assessing these interventions within three years), the NHS, and industry (who no doubt have a keen eye on profits).
|Central government||very supportive||strongly opposed|
|Macmillan cancer support, regarding the initiative to publish local data on cancer survival and mortality rates||very supportive||strongly opposed|
|Royal College of GPs, regarding improvements in the early detection of cervical cancer||very supportive||strongly opposed|
|Jo's Trust, regarding improvements in the early detection of cervical cancer||very supportive||strongly opposed|
|Cancer Research UK||very supportive||strongly opposed|
|Central government||very strong||none|
|Macmillan cancer support, regarding the initiative to publish local data on cancer survival and mortality rates||very strong||none|
|Royal College of GPs, regarding improvements in the early detection of cervical cancer||very strong||none|
|Jo's Trust, regarding improvements in the early detection of cervical cancer||very strong||none|
|Cancer Research UK||very strong||none|
I have nothing to add here over and above what I have written above. The improvement of cancer outcomes has been a government goal for many years - cancer patients, one would hope, will gain from these initiatives.
The initiatives are new, and thus haven't been evaluated yet. One can say, however, that cancer mortality and survival rates in the UK have improved significantly over the past several years. For example, in 2009, cancer mortality had fallen by 20% as compared to what it was in 1997, and, according to the National Cancer Director, Mike Richards, there have been considerable improvements in breast, colon, rectum and prostate cancer survival rates over that period. Moreover, smoking rates in children over the decade 1998 to 2007 were halved, and the total number of smokers fell by a quarter. Therefore, these initiatives will presumably add to this continuing success.
More specifically, in terms of the Primary Care Trust (PCT) initiatives to improve the early detection of cancer, the DH, the National Cancer Action Team and Cancer Research UK will partner the PCTs in running, monitoring and evaluating their advertising and outreach campaigns.
Regarding the initiatives announced over the past few months, it is not yet possible to observe any real change in service delivery or outcomes. Indeed, changes in outcome, if any, will likely be lagged, and will not be observable until several years have passed.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
Some of the initiatives - for example, the public dissemination of poor performing localities so as to aim to improve performance in those areas and thus reduce health inequalities, and establishing the Black and Ethnic Cancer Patient Advisory Panel - could quite feasibly help to address some health inequality, and thus it is possible that equity concerns will be to some extent addressed. Moreover, given that rather few resources are in general being directed towards these initiatives, it would only require a rather modest improvement in health outcomes for the efforts to be deemed cost-efficient. However, along those lines, I am a little concerned that the amount of money being invested is rather too small for the initiatives to have a substantial effect (although I may be proved wrong, of course), and I am also worried that some of the proposals to further reduce smoking rates - for instance, to ban people from smoking in entrances to buildings - represent an undue violation of civil liberties.
|Screening for bowel cancer|
Process Stages: Implementation
|Smoking ban in public places|
Process Stages: Implementation, Evaluation, Legislation, Change