The Times recently revealed details of a leaked memo from Churchill Hospital in Oxford, which outlined that there could be delays to the start of chemotherapy treatment for cancer patients, as well as the suggestion that the number of cycles to alleviate symptoms be reduced from six to four. The author of the memo cited a “chronic shortage of specialist nurses”, as the reason why these measures are being considered - pointing to a much broader problem than a hospital simply acting in isolation. A hospital spokesman has since been forced to explain that no final decisions have yet been made regarding such changes to patients’ treatment and the Prime Minister herself was challenged about the hospital’s plans during PMQs earlier this month.
The reason why this leaked memo has attracted so much attention (and concern) at the highest levels is that many patients, particularly those with terminal cancer, rely on chemotherapy to relieve their symptoms, as well as extend survival to allow them to spend precious time with family. If the decision is taken to go ahead with these plans, it will be absolutely devastating for patients and their families.
The challenge of improving the UK’s cancer survival outcomes, which have long lagged behind much of Western Europe, is one that has dominated UK health policy for many years. Attempts to improve patient outcomes have included the introduction of the highly controversial Cancer Drugs Fund in 2010 (updated in 2016) and in 2015, the publication of Achieving World-Class Cancer Outcomes which Jeremy Hunt boldly declared would make the NHS “the best in the world at cancer care”.
However, it is now clear that despite the positive rhetoric from Government and policy makers, the chronic lack of investment and forward planning in the NHS now threatens its ability to deliver on these promises.
Specialist nursing is central to delivering the Government’s Cancer Strategy, yet a short-term approach has been taken to workforce planning over the last three years, with a greater focus on delivering efficiencies than the best possible patient care. With rates of cancer incidence increasing, staff numbers have failed to keep up and the impact is now being felt. There is also no ‘quick-fix’ solution - specialist oncology nurses take five or six years to train - and experts blame current shortages on the lack of central Government planning.
The Royal College of Nursing has gone so far as to describe the lack of investment and poor workforce planning as “deplorable”. This view is supported by patient groups, with National Voices’ Andrew McCracken stating that the staffing shortages are unacceptable and highlighting that “cancer treatment is a priority for the NHS and it is wrong that access to treatment could be cut back”.
However, the NHS still finds itself in an extremely challenging position. It remains under huge pressure to deliver the efficiency savings set out in the Five Year Forward View at a time of great innovation in cancer. In addition to the rationing of services and treatments at a national level, it now looks as if the drive for efficiency savings is beginning to impact on cancer care at a local level.
So whilst, as Andrew McCracken rightly says, cancer is a priority for the Government and NHS England, this has not prevented the financial pressures and drive for efficiency savings beginning to bite on services at a local level. Responding to the reports from Oxford, Sir Harpal Kumar, who led the independent taskforce behind the Cancer Strategy, has warned that the Government must deal with these workforce challenges “otherwise problems like the one at Oxford will become more widespread and more severe”.
He may well be right.