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Cancer care and the NHS Long Term Plan

Peter Johnson, National Clinical Director,

NHS Cancer Programme

Tuesday 26 November, 2019

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NHS Cancer

Programme

We will continue to transform cancer care so that from 2028:

• An extra 55,000 people each year will survive for five years or more following their cancer diagnosis

• 75% of cancers will be diagnosed at an early stage.

The NHS Long Term Plan ambitions

Cancer care and the NHS Long Term Plan

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NHS Cancer

Programme

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10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

All cancer survival - patients diagnosed between 2001-2016

1 year 5 year 10 year

More people are surviving cancer

Cancer care and the NHS Long Term Plan

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NHS Cancer

Programme

But we have more to do….

0

10

20

30

40

50

60

70

80

90

100

Estimated 5-year survival in the UK and the 10% leading European countries (CONCORD, 2010-2014)

UK Top 10% of European countries

Cancer care and the NHS Long Term Plan

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NHS Cancer

Programme

How we will get there

Cancer care and the NHS Long Term Plan

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NHS Cancer

Programme

Cancer Alliances

Lead local delivery of Long Term

Plan ambitions

Unique strategic

view

Advice and expertise

to STPs/ICSs

Promote best

practice and reduce

variation

• 20 Cancer Alliances leading transformation

across the country.

• Working with Integrated Care Systems (ICS) and

System Transformation Partnerships (STPs) – as

the ‘cancer workstream’.

• The go to place for innovation and best practice.

http://bit.ly/Cancer_Alliance_Map

Cancer Alliances as local leaders

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NHS Cancer

Programme

Cancer Alliances – Priorities for 19/20

Sustainable operational performance

• Deliver Cancer Waiting Times standards.

• Improve time to diagnosis.

• Implement timed pathway for oesophago-gastric (OG) cancer.

Screening and early diagnosis

• Improve uptake of screening for bowel, cervical and breast cancers.

• Implementation of at least one Rapid Diagnostic Centre in each Alliance.

• Implementation of lung health checks for sites involved in national programme.

Personalisedcare

• Full implementation of breast cancer personalised (stratified) follow up protocols.

• Clinically-agreed protocols for stratifying prostate and colorectal cancer patients, and systems for remote monitoring.

Cancer care and the NHS Long Term Plan

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NHS Cancer

Programme

100,000

125,000

150,000

175,000

200,000

225,000

250,000

Year-on-year comparison of 2ww Referral Volumes

2016/17 2017/18 2018/19 2019/20

Referrals are increasing

Cancer care and the NHS Long Term Plan

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Chemotherapy use continues to rise

In 2018/2019 NHS England spent approximately £1.8 billion on chemotherapy with drug costs accounting

for 78% of this spend.

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NHS Cancer

Programme

• More people accessed treatment in 2018 than ever before, including CAR-T

and Proton Beam Therapy (PBT)

• In October, the 100th patient received Proton Beam Therapy

• Children, teenagers and young adults service specification

• GIRFT lung study undertaking trial visits.

Provide faster, safer and more precise treatments

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• Since July 2016 the CDF has:

• Remained within its £340m budget;

• Funded 78 drugs treating 155 different cancer indications.

• CDF has approved treatment of just under 40,000 patients of which:

• 8,300 patients registered to receive treatment sooner than they previously would have through interim funding arrangements in the CDF;

• 17,500 patients registered to receive promising new treatments while further evidence is collected to address clinical uncertainty, via managed access agreements;

• 2 treatments have completed their CDF managed access period and are now routinely commissioned following reappraisal at NICE.

Cancer Drugs Fund

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• Aim to provide earlier availability of promising new unlicensed medicines to patients that have a high unmet clinical need

• Current:

• Polatuzumab with bendamustine and rituximab for DLBL

• Previous

• Avelumab for kidney cancer

• Atezolizumab for lung cancer, breast cancer, bladder cancer

• Nivolumab for gastric cancer, kidney cancer, Hodgkin lymphoma, lung cancer, melanoma

• Pembrolizumab for lung cancer, melanoma

• Alectinib for ALK-positive NSCLC

• Osimertinib for lung cancer

• Venetoclax for CLL

Early Access to Medicines Scheme

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• We work with system partners to transform care by improving access to new innovative treatments:

• Children and young people in England will be among the very first in Europe to benefit from a new generation of CAR-T cancer therapies

• Eligible patients will be able to access new advanced therapies, some of which may be curative

Advanced therapy medicinal products

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• We have committed to accelerating access to histology-independent (tumour agnostic) therapies;

• This is a step-change in cancer treatments as the therapies target a molecular feature, instead of the tissue of origin

• Adoption of these is closely linked to the expansion of the genomic medicines programme, providing patients with new routes to innovative cancer treatments.

Histology-independent treatments

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2016 2017 2018 20192016-2017

change

2016-2017

% change

2017-2018

change

2017-2018

% change

2018-2019

change

2018-2019

% change

2016-2018

change

2016-2019

change

Histopathology 1,190 1,177 1,178 1,221 14- -1% 1 0% 43 4% 13- 31

Gastroenterology 1,080 1,147 1,235 1,296 67 6% 87 8% 61 5% 154 216

Clinical Radiology 2,835 2,921 3,038 3,144 86 3% 117 4% 106 3% 203 309

Clinical and Medical Oncology 1,058 1,105 1,155 1,198 47 4% 50 5% 43 4% 97 140

Diagnostic Radiography 13,579 14,049 14,548 15,019 470 3% 499 4% 471 3% 969 1,440

Therapeutic Radiography 2,634 2,724 2,802 2,846 89 3% 78 3% 44 2% 167 212

Total 22,377 23,122 23,956 24,724 745 3% 833 4% 768 3% 1,578 2,347

Workforce

None of this is deliverable without the workforce.

• We have a workforce plan through to 2021. Across six priority specialisms, workforce grew by 3.2% in the past year.

• Cancer Alliances are working with Health Education England (HEE) to deliver local workforce plans.

• New workforce Task and Finish Group brings together charities with colleagues in HEE, People Plan and National Cancer Team to identify national interventions required moving forwards.

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Thank you: questions after next presentation

Cancer care and the NHS Long Term Plan