While doom-laden reports about chronic underfunding appear daily in the news, the NHS is still committed to transforming cancer treatment in the UK by 2020. So is it all just pie in the sky? Our Policy Manager, Phillip Anderson, doesn't think so, but argues we must get smarter about making our case for investment in prostate cancer if we're going to get the best deal for men.
If you’ve been following the news recently, especially in the last couple of weeks, you could be forgiven for wondering if the health service exists in the same reality on a Tuesday as it does on a Monday.
One day we’re told about massive hospital deficits and the frenetic pressure in wards and GP surgeries (obviously terrible news). The next day brings the announcement of £130m for upgrading radiotherapy equipment (great news!), which followed a separate announcement of ambitious ideas to accelerate patient’s access to innovative new products as part of the so called ‘Accelerated Access Review’ (potentially great news, if the Government finds the money to take forward the proposals).
At Prostate Cancer UK, our main way of influencing these kinds of developments are the behind-the-scenes discussions we have on a daily basis with the NHS, researchers, the pharmaceutical industry, and the Department of Health. With patience and persistence, we've scored some successes recently: several of our key demands were included in the final accelerated access report. But success or not, we hear the same two themes mentioned over and over again.
The first is (predictably) that money is extremely tight in the health sector right now. But the second is universal agreement that the outcomes for cancer in the UK are simply not acceptable. Our survival rates for nearly all cancers, including prostate cancer, remain lower than in comparable developed countries. I think it’s the tension between these two themes that largely explains the Jekyll-and-Hyde effect in the news.
Nowhere is the tension more evident than around the Government and NHS England’s independently-developed cancer strategy, committing to achieve world-class cancer outcomes by 2020. A recent report on progress so far showed there had already been some important developments, like establishing Cancer Alliances to drive through improvements at local level.
But the strategy is unmistakably swimming against a tide of cost-saving initiatives, led by reforms to the Cancer Drugs Fund, a new bill to limit pharmaceutical industry profits, and proposals to delay expensive drugs from becoming widely available immediately after approval.
When I moved from the Department of Health to become policy manager here a few months ago, I was really excited to have a clear side to take in this debate, instead of the old civil service 'middle ground'. Finally I could be completely on the side of patients, and the budget was someone else’s problem!
But it turns out the NHS budget is still my problem. None of us at Prostate Cancer UK will ever apologise for influencing decision-makers to make improvements for men – that’s what we’re here for. But at a time of NHS financial meltdown, we have to get smarter about how we make our case for investment in prostate cancer.
So over the last two months, I and the rest of my team have been focussing on making the case for improvements in two areas that we know are of fundamental importance to men: diagnosis of prostate cancer, and the way that new drugs are appraised to decide if they will be funded on the NHS.
On diagnosis, there’s as yet unpublished evidence showing that multi-parametric MRI scans can make prostate cancer diagnosis more accurate and reduce unnecessary biopsies. So we’ve already been working hard behind the scenes to persuade decision makers that they should adopt this new technology as soon as possible.
On drug appraisal, we’ve worked hard over the last few years to get all new prostate cancer treatments to men – with great success. However, we must be out in front of the next generation of prostate cancer drugs that are currently in the research pipeline. So we’re working to ensure that appraisals of prostate cancer drugs are improved to capture the full range of benefits to men, giving them the maximum chance of getting into the NHS as quickly as possible.
So can the NHS carve out the space within its broader cost-saving drive to put in place changes, like these, that will actually achieve world class outcomes for prostate cancer? I absolutely believe that it can.
My main cause for optimism is the fact that everyone accepts things have to change. That doesn’t mean improvements are going to just happen: we need the willingness from politicians, NHS managers, doctors and nurses. But we also need charities, like Prostate Cancer UK, to continue to advocate for specific reforms that can make a real difference and to fight against other proposals that could get in the way.
I sometimes think of this in football terms: you have to score goals, but you can’t bomb forward too much and leave yourself exposed at the back. Over the next few months, we’ll be trying as usual to balance attack and defence, using important new developments (such as the forthcoming publication of the PROMIS trial results about mpMRI) to continue to drive change, but also defending strongly by engaging with the Government on their new efficiency proposals in order to protect the broader drive to improve cancer outcomes.
It’s going to be a busy winter, but with hard work and a bit of luck, we can make sure that men finish on the winning side of all these Jekyll-and-Hyde changes to the NHS.