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Further developments in cancer policy

Country: 
United Kingdom
Partner Institute: 
London School of Economics and Political Science
Survey no: 
(16)2010
Author(s): 
Adam Oliver
Health Policy Issues: 
Prevention, Access
Reform formerly reported in: 
Screening for bowel cancer
Developments in cancer care
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Abstract

Among OECD countries, the UK's cancer survival rates have traditionally been reported as poor, although there have been signs of improvement over the last decade. Improving cancer-related outcomes has been an important feature of government health policy during this time. In this report, the latest cancer care policies are summarised, some of which are a continuation of previous government policy, while other aspects are innovations of the new coallition government.

Recent developments

There are several aspects to recently announced cancer care policy developments in the UK. First, in July 2010, the new government announced that £50 million was being allocated to ensure better access to cancer drugs for NHS patients (effective from October 2010), partly in response to evidence that shows that access to such drugs is low in the UK compared to other European countries. This will be an interim measure, effective until a new Cancer Drugs Fund is introduced in April 2011 (the exact details of the Cancer Drugs Fund have yet to be worked out, proposals for which will soon be opened up to consultation). 

In January 2011 a new campaign will be launched to alert people to the early signs of cancer, particularly for breast, bowel and lung cancer, which are apparently the three big cancer killers. The campaign will consist of 59 locally-led initiatives, which will share £9 million to fund their efforts (e.g. social marketing campaigns). Also, a centrally-led bowel cancer awareness campaign will be piloted in two regions.  

Although not exclusively related to cancer care (although clearly of relevance to people with advanced cancer), in August 2010 the government highlighted the need to improve end of life care, even though the UK performs very well in international comparisons on this aspect of care. The government will be launching a number of initiatives, including a £40 million capital grant for hospices to improve their infrastructure, the launch of end of life e-learning for health and social care staff, the raising of public awareness around issues of death, dying and bereavement, and the improved co-ordination of care for end of life patients.

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Characteristics of this policy

Degree of Innovation traditional neutral innovative
Degree of Controversy consensual controversial highly controversial
Structural or Systemic Impact marginal neutral fundamental
Public Visibility very low high very high
Transferability strongly system-dependent neutral system-neutral
current current   previous previous

I have stated that the degree of innovation is neutral, because the initiatives are largely a continuation of existing policy. The £50 million fund for end of life cancer drugs is a little controversial, for the reasons outlined in section "Stakeholder positions". I don't think the policies will have a huge structural impact on the the NHS, but the cancer detection campaigns could have high public visibility - indeed, they will need to have, if they are to work.  

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Initiators of idea/main actors

  • Government
  • Providers
  • Civil Society
  • Opinion Leaders: Mixed opinon of the 50 million cancer fund

Stakeholder positions

Improving cancer care has the support of all poliitcal parties, and the new policies are, on the whole, a continuation of previous government initiatives in this area. The allocation of the £50 million fund specifically to pay for cancer drugs is not, however, without controversy. When in opposition, the Conservative Party criticised the Labour Government for poor access to end of life cancer drugs for cancer patients, and committed itself then to providing a specific fund for these drugs if elected to government. As the senior party in the current coalition government, it has honoured this pledge, although some criticise this move by arguing that end of life cancer drugs are very expensive and do not provide much benefit, and that the money could more cost-effectively be used elsewhere. However, cancer does seem to hold heavy resonance in the public consciousness, and thus whether or not this initiative is perceived as good or bad boils down to being a value judgement. The cancer pressure groups - particularly the bowel cancer pressure groups - have of course expressed strong support for initiatives that potentially improve outcomes in this disease area.

Actors and positions

Description of actors and their positions
Government
Central Governmentvery supportivevery supportive strongly opposed
Providers
Hospitals, GPsvery supportivesupportive strongly opposed
Civil Society
Cancer lobby groupsvery supportivesupportive strongly opposed
Opinion Leaders
Academicsvery supportiveneutral strongly opposed
current current   previous previous

Influences in policy making and legislation

Not applicable

Legislative outcome

n/a

Actors and influence

Description of actors and their influence

Government
Central Governmentvery strongvery strong none
Providers
Hospitals, GPsvery strongneutral none
Civil Society
Cancer lobby groupsvery strongstrong none
Opinion Leaders
Academicsvery strongneutral none
current current   previous previous
Central GovernmentHospitals, GPsCancer lobby groupsAcademics

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

There are not, I think, overwhelming losers as a result of these initiatives, although one could of course argue that some of the money might be better spent in other disease areas, if the sole focus of concern is improving health outcomes. That said, the amount of resources committed to these developments is not as yet overwhelmingly large, and in the current economic climiate, is unlikely to become so. The new government is placing much emphasis on local decision making, and therefore early cancer detection initiatives, and decisions regarding the new cancer drug fund, will be predominantly devolved to the local level. Thus, GPs, hospices and (currently, until they are abolished), PCTs are playing a large role in implementation of these measures.

Monitoring and evaluation

These are new initiatives, and have not been evaluated yet. It is not clear how they will be evaluated. Presumably, the local campaigns to improve the early detection of cancer will be evaluated by the local NHS organisations that are designing and implementing them, whilst the Department of Health will be monitoring and evaluating the centrally-led pilot projects that aim to raise awareness of bowel cancer symptoms. Regarding the new fund for cancer drugs, doctors will be put in charge of how this money is spent, and will be informed by cancer specialists, and thus although not an evaluation per se, decision making will presumably be informed by the best available evidence.

Expected outcome

It's too early to tell the outcomes of this policy. Presumably, there will be some improved access to end of life cancer drugs, although, from a societal perspective, I can't say whether this is a good or a bad thing, because these drugs do at the average level tend to offer very little benefit, and are very expensive. It might be better to direct this money to palliative care and hospice care for cancer patients, which could possibly improve average health outcomes more than the drugs themselves. Also, investing in palliative care might be the better course of action to improve 'dignity in dying'. Hopefully, the early detection of cancer will improve as a result of the local health promotion campaigns, as this may improve cancer survival rates. It has been estimated, for example, that 10,000 lives could be saved in England each year if survival rates matched the best in Europe, and that 90% of early detected bowel cancer patient survive more than 5 years, compared to only 6.6% of those who are late detected.

Impact of this policy

Quality of Health Care Services marginal neutral fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low neutral very high
current current   previous previous

It depends how one defines quality. If quality is defined by access to expensive cancer drugs, then quality may improve, but if this is bought at the cost of investing less in, say, palliative care, then quality might deteriorate. Similarly, the cost-efficiency of some of the initiatives may not be good if efficiency is defined in terms of improving health outcomes as much as one can, because the end of life cancer drugs might not be as cost effective as many other aspects of health care where the money could have alternatively been used. That said, the sums involved are not huge, and therefore the overall impact regarding NHS expenditures is unlikely to be large. All in all, I obviously hope that cancer care and outcomes will improve as a result of these policies.  

References

Sources of Information

Economist Intelligence Unit. The quality of death: ranking end of life care across the world. Economist Intelligence Unity: London, 2010.

Department of Health: Equity and excellence: liberating the NHS. The Stationery Office: London: 2010.

www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_117970

www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publications
PolicyAndGuidance/DH_117962

www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_119576

www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_118948

www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publications
PolicyAndGuidance/DH_118810

Reform formerly reported in

Screening for bowel cancer
Process Stages: Implementation
Developments in cancer care
Process Stages: Implementation

Author/s and/or contributors to this survey

Adam Oliver

Suggested citation for this online article

Adam Oliver. "Further developments in cancer policy". Health Policy Monitor, October 2010. Available at http://www.hpm.org/survey/uk/a16/2