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Cracks in cancer commissioning due to NHS reforms

Experts call for more investment to prevent ‘cracks’ in services

Adrian O'Dowd

Monday, 08 September 2014

Experts are warning of fragmented commissioning of cancer services in England due in part to the introduction of last year’s NHS reforms, in a report published today.

Cancer Research UK has published Measuring up? The health of NHS cancer services in which it calls for more investment in cancer to help deal with growing demand and predicted rises in cases.

The charity commissioned the Health Services Management Centre at University of Birmingham to conduct interviews and surveys with clinicians, commissioners, GPs, public health experts and patients in order to measure the health of NHS cancer services, around 18 months after the reforms were introduced in April last year under the Health and Social Care Bill.

Several concerns and challenges facing the NHS emerged including rising demand for services, lack of capacity to respond to this demand and a fragmentation of commissioning across the patient pathway.

Due to the removal of the National Cancer Action Team and cancer networks, there has been a loss of leadership capacity at national and local level, said the report authors, and there is also wide variation in the roles and responsibilities of new NHS organisations and the need to rebuild relationships and regain expertise.

Urgent action was needed to increase investment, particularly in diagnostic services, and also to review both the leadership and commissioning of cancer services.

The report recommends that the Department of Health and NHS England should explore longer-term budgeting arrangements to allow commissioners the flexibility to invest and innovate.

One way of doing this would be allowing CCGs to carry a percentage of their budget over a three-year period to allow genuine outcomes-based commissioning rather than short-term contracting, and time for long-term cost savings to be realised.

It also proposes that commissioners at a national and local level should work together to make realistic long-term plans to meet demand for cancer services.

In 2013-14, more than 1.4 million patients in England were referred by their GP for suspected cancer, which represented a 50% increase in referrals from 2009-10, says the report.

There have also been significant increases in the number of diagnostic tests being carried out and the number of patients receiving treatment for cancer following a referral from their GP.

Harpal Kumar, Cancer Research UK’s chief executive, said: “Staff have bravely dug-in and done their best in the face of overwhelming change, increased demand, squeezed budgets and fragmented leadership, but that cannot continue indefinitely.

“We’ll be diagnosing more people, treating more people and helping more people recover from cancer in coming decades. The NHS will need to be fit to meet that purpose and that needs increased investment, planning and leadership now.”

Responding to the report, Mike Hobday, director of policy and research at Macmillan Cancer Support, said: “Cancer commissioning is in a state of utter confusion and uncertainty.

“The NHS reforms have made commissioning much more complex. Today numerous organisations in each local area are responsible for commissioning different aspects of cancer care. This means that commissioners often don’t know who is commissioning what or even who to speak to.

“We’re worried this mess means some cancer services, in particular aftercare and end of life care, are being completely neglected in certain parts of the country.”

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