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Hanover - Uncertain Times Require Uncommon Sense

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23 Apr 2018

Cancer remains an important priority for the NHS and for the Government. NHS England’s Cancer Strategy, published in May 2016, set out a vision to improve care and services by 2020. Delivering these ambitions will not only improve outcomes but also ensure the NHS is able to manage growing demands. The Cancer Alliances were intended to be the key vehicles to bring together local leaders to coordinate care pathways and improve clinical quality. However, despite the Strategy recently reaching its halfway point, there remain a number of barriers to the Alliances’ implementation that need to be addressed if they are to be successful.

Established in 2016, the 19 Cancer Alliances bring together senior clinical and managerial leaders, patients and other key partners to represent the whole cancer pathway within a specific geography. They were set up to enhance outcomes for people with cancer, reduce variation and improve access to high-quality care pathways for their local population. In their infancy, the Alliances played a significant role in piloting new care models and metrics that could, in time, be rolled-out across the country and they will continue to drive the NHS’ attempts to improve early diagnosis rates, patient experience and quality of life. However, while they are an important driver of the Cancer Strategy, they face three barriers that risk holding them back.

Firstly, while concerns about funding are commonplace in any discussion about the NHS, the decision to allocate the Alliances’ funding based on their quarterly performance against quality and waiting time targets has proven controversial. The APPG for Cancer’s recent report on the progress of the Cancer Strategy was highly critical of this conditionality and consequently recommended that the waiting time target be immediately un-coupled from funding. Otherwise, Alliances will be heavily incentivised to focus on short-term performance and targets at a time when discussions about how to achieve long-term service transformation and modernisation are needed.

Secondly, it is important to recall how much the landscape has changed since Alliances were introduced. Since then, Sustainability & Transformation Partnerships (STPs) and Integrated Care Systems have been introduced, as have the pilot sites for the cancer diagnosis ‘one-stop shops’. While all will look to transform care pathways, one could not be blamed for wondering how local NHS managers are meant to manage so many competing priorities, delivery plans and budgets with the little financial headroom that is available to them.

Finally, workforce numbers and capacity will have an important bearing on the success of the Alliances. While Health Education England’s cancer workforce plan is a much-needed step in the right direction, the limited progress that has been made over the last few years means that capacity challenges have intensified. It will therefore be of great interest to see how the Cancer Alliances set out their workforce needs (in plans due to be released later this month) and how NHS England is able to respond.

The delivery of the Cancer Strategy is a top priority for the NHS and with the right support, the Alliances will be able to take a more decisive role.

As the recent NHS England Mandate restated, the delivery of the Cancer Strategy is a top priority for the NHS and with the right support, the Alliances will be able to take a more decisive role. For example, linking funding to long-term objectives and priorities would help local leaders invest in transformation. Continued support from the centre, particularly through NHS England’s National Cancer Programme cross-functional team, would also give Alliances greater bandwidth. Finally, greater alignment between the footprints of the STPs and Alliances could support more collaboration and facilitate the sharing of best practice both locally and regionally.

For the NHS to deliver the vision of the Cancer Strategy, local services need to change for the long-term. To be most successful, Cancer Alliances need to have the headspace and capability to lead this process and help best practice spread across the country. With just two years to go to complete the improvements of the Cancer Strategy, the Cancer Alliances might be about to become even more pivotal to NHS reform.