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The challenge ahead for the NHS

In Cancer: The challenge facing the NHS BBC Health Correspondent Nick Triggle reveals the issues ahead for our struggling health service.

The analysis comes after the recent announcement of a new strategy by NHS England’s cancer taskforce aimed at improving cancer care. Figures released in May showed that more than 21,000 people had not been treated within 62 days of their cancer diagnosis in the last financial year. According to NHS targets, 85% of cancer patients should be treated within 62 days of being urgently referred by their GP, but just 83.4% were seen on time in 2014-15. While survival rates have been improving, England still lags behind some of the best performing countries.

The new measures aim to ensure that, by 2020, NHS patients in England get results for cancer tests within four weeks of being referred by a GP by 2020 under new plans to improve treatment. NHS England's cancer taskforce is also replacing old radiotherapy machines and increasing specialist staff to ensure it delivers "world class" cancer care. The five-year plan is expected to cost £400m a year but taskforce experts believe that in the long term, this will be recouped as better care costs less money. For example, bowel cancer caught at a late stage costs four times as much to treat as when it is caught early. They say the plan could help an extra 30,000 patients survive for 10 years.

Nick Triggle highlights the challenges these targets pose for an already struggling NHS, with today’s unprecedented levels of cancer incidence. “The disease has now become so common that one out of every two people born after 1960 will develop it during their lifetime,” he says. “It means that every two minutes someone in England is diagnosed with the disease.”

The good news is that, in spite of the difficulties, survival rates are also steadily increasing. Research by the London School of Hygiene and Tropical Medicine shows that five-year survival in England has risen substantially since the early 1970s. Fewer than a third of patients diagnosed during 1971-2 lived for another five years, but now more than half do. Survival rates vary significantly depending on the type of cancer, however. Among men, five-year survival rates for testicular cancer stand at 97%, skin melanomas 90% and Hodgkin lymphoma 84%, but for lung cancer it is 11% and pancreatic cancer only 5%. Among women the survival rates for those two cancers are the same, while the best rates are seen in skin melanomas at 93%, thyroid cancers at 87% and breast at 86%.

Nevertheless, Nick Triggle points out that “the NHS has some way to go before it achieves the results of some of the best-performing health systems.” A report by the Nuffield Trust think tank published earlier this month looked at how the UK was performing against 14 similar countries when it came to three common cancers, and showed it coming 11th for breast and cervical cancers. “A big part of England's new cancer strategy is improving earlier diagnosis,” concludes Triggle. “Half of patients are currently diagnosed at an advanced stage with a fifth only happening after a visit to an A&E department. Improving access to tests is a key part of this.”

Gordon Wishart, Professor of Cancer Surgery and Medical Director of Check4Cancer, comments: “Early diagnosis and speed of treatment are critical factors in any cancer patient’s survival, so any measures aimed at improving these are welcomed. But there are other ways to help, and employers can play their part in relieving some of the burden on the NHS by offering cancer screening in the workplace. This not only saves additional lives, but can help those employers safeguard investment in their most valuable resource – their staff. It really is a win-win for all concerned.”

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