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Spectator Briefing

Could cancer break the NHS?

14 December 2017

3:40 PM

14 December 2017

3:40 PM

Could cancer break the NHS? This was the provocative title of a debate at the British Museum hosted by The Spectator and sponsored by Philips. Two of the expert panellists suggested that it just might. Others were more optimistic. But all seemed to agree that, for the NHS to survive, bold action was required.

First, Neil Mesher, CEO of Philips UK and Ireland (UKI), presented some frightening statistics. One in two people will be diagnosed with cancer – a proportion that is rising because we are living longer. Greater awareness of cancer, too, means that more people are being referred for tests – so much so that the demand on diagnostic services is doubling every seven to 10 years. Investment in equipment and staff is in no way keeping up.

Costs have risen too. Professor Karol Sikora, founder of Proton Partners International, said that when he was made a consultant 38 years ago the average cost of treating one of the big four cancers was £10,000. Now it is up to half a million.

Fortunately, the speakers had firm ideas about what should be done. Top of the list was detecting cancer earlier. The path to diagnosis, said Professor Sikora, was often ‘painfully slow’. After visiting a GP, he said, a diagnosis could take six months. This was why Britain lagged behind Europe in terms of survival rates – it was, he said, ‘nothing to do with the quality of care’.

One way to speed up the process, said Sarah Woolnough, executive director of policy and information at Cancer Research UK, was through multidisciplinary community diagnostic centres – ‘one-stop shops’ where patients undergo a battery of tests that establish quickly if there is cancer. The idea, already being trialled by Philips with a number of private partners and the NHS, could stop people having to go to their GP ‘three, four or five times’ before diagnosis.

Better screening would help too, said Woolnough. That means finding smarter ways to identify cancers early. The three national screening programmes only pick up 10 per cent of cases. ‘We desperately need more biomarkers,’ she said.

George Freeman, Conservative MP for Mid Norfolk, suggested that, to rewire the system to incentivise the earlier detection and prevention of disease, the traditional method of funding health and care through fragmented silos from Whitehall has to be replaced with a new model of “Accountable Care” in which Local health economies are incentivised by a new freedom to put productivity and prevention savings into the local NHS. At the moment, if trusts do more for less, then they are given less. Changing that will ‘unlock the local leadership we need’, Freeman said.

The system, Freeman said, was ‘wired against innovation’. Woolnough agreed that the NHS had to get better at adopting new ideas quickly and widely. She cited a new test for bowel cancer that had the potential to save thousands of lives but hadn’t been rolled out very well, with only 50 or 60 per cent of people taking it up. ‘If we are to keep our NHS sustainable,’ she said, ‘we somehow need to grapple with a system that doesn’t take up and drive innovation.’

Also high on the list was a better use of data. Data is critical, said Woolnough, and the NHS is terrible at collecting it. She cited Sir Mike Richards, former national cancer director, saying he was ‘embarrassed’ that after 12 years in the job he did not know how many patients got chemotherapy in a year. That means the outcomes of treatments can’t be tracked. With NHS data going online, Woolnough said, ‘we can get much, much better at what we are doing’.

Neil Mesher agreed that NHS use of data was fundamental. Staff in different departments should really have access to the same information. ‘When my case is discussed I want clinicians to know everything there is to know about me.’

Several speakers offered reasons for optimism. In the 1970s, said Woolnough, a quarter of people with cancer survived long term. Now it’s half. Cancer Research UK wants that to be three quarters by 2035. Freeman, meanwhile, pointed to the ‘incredible science’ of the past 20 or 30 years that meant we can now understand ‘how cancer takes hold of the body’.

In healthcare, dramatic changes lie ahead. The discussion mapped out a route for the future. Will the NHS take it?

For more information, visit the Philips ‘Health Knows No Bounds’ site here.

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