Select committee: Health and Social Care Committee

Cancer services

Closed Opened 6 Jul 2021 Closed 1 Aug 2022 15 recommendations 15 conclusions
Inquiry scope (the committee's words)
This inquiry will ask why cancer outcomes in England continue to lag behind comparable countries internationally and examine evidence relating to the underlying causes of these differences. We will also consider what impact disruption to cancer services during the covid-19 pandemic will have on efforts to catch up, and ask whether the ambitions set out in the NHS Long Term Plan will help close the gap with the best performing countries worldwide. Learn more about the inquiry.

Where it stands

The inquiry is closed, opened 6 July 2021.

The committee has published 1 report, most recently Twelfth Report - Cancer services on 5 April 2022.

The government's response

Published 13 June 2022. The deadline was 5 June 2022.

Summary written by Accountability Index from the government's response. It is not the government's own words.

The government's response sets out work under way on early diagnosis, screening, diagnostics and treatment, says it is "premature to suggest that progress is off track" on the 75% early diagnosis ambition, and points to the forthcoming 10 Year Cancer Plan on several recommendations.

  • On the 75% early diagnosis ambition by 2028, the government says it is "premature to suggest that progress is off track", noting that the full impact of its interventions was "always going to come through in the later years".
  • On diagnostic capacity, it states that £2.3 billion is being invested to "roll out up to 160 community diagnostic centres (CDCs) by March 2025", modelled to provide an additional 200 MRIs, just under 300 CTs and around 160 endoscopy rooms.
  • On the diagnostic workforce, it refers to the forthcoming 10 Year Cancer Plan and says the Department has commissioned NHS England to develop a workforce strategy, whose conclusions it "will set out ... in due course".
  • On radiotherapy, it says there is "no clear case for expanding the radiotherapy equipment fleet in England", and that a review of radiotherapy payment arrangements is "expected to be in place from April 2023".

Read the government's response ↗ Report an error

Recommendations and conclusions

All 30 recommendations and conclusions

Reports

All reports

Evidence

  • 5 oral evidence sessionsLatest 20 January 2022
  • 62 written submissions
  • 31 witnesses
All evidence

Recent activity

Recommendations and conclusions 30 shown

Conclusion 1

Conclusion · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Concluded (the committee's words)
We welcome the development of Rapid Diagnostic Centres and Community Diagnostic Centres, particularly in giving GPs more effective referral routes for possible cancer symptoms, especially those which are non-specific but concerning. However, we have heard differing accounts about the impact of the Covid-19 pandemic on the development of Rapid Diagnostic Centres in particular and would be concerned if there was a significant delay to their roll-out.

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Recommendation 2

Recommendation · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Recommended (the committee's words)
NHS England has been focusing on encouraging people to come forward with cancer symptoms during the pandemic, which is welcome, and has recently launched a marketing campaign to encourage people to overcome their reluctance to visit their GP to discuss symptoms. However, NHS England should continue to use marketing campaigns to increase public awareness of specific cancer symptoms. NHS England should also work with Primary Care Networks to build on the recent Early Cancer Diagnosis directed enhanced service and explore options to incentivise practices to encourage patients with possible cancer symptoms to consult with them early.

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Conclusion 3

Conclusion · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Concluded (the committee's words)
Cancer screening is a vital tool for early diagnosis, but even before the pandemic there were serious concerns about the effectiveness of national cancer screening services, particularly over IT systems and the speed at which innovations have been implemented. New programmes like the Lung Health Check programme offer some reason for optimism, but the pandemic has had a seriously disruptive impact on screening services.

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Recommendation 4

Recommendation · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The Government should implement the recommendations of Professor Sir Mike Richards’ review of cancer screening as a priority and ensure that there is a clear plan in place to rapidly conduct appointments missed during the pandemic.

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Conclusion 5

Conclusion · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Concluded (the committee's words)
We understand the rationale for simplifying the Cancer Waiting Times standards. It is important that NHS cancer services are given a clear set of targets to achieve and that these targets are the ones that are most important to patients. However, we note that there are no current plans to increase the target for 28-day faster diagnosis standard performance from 75% to 95%, given the importance of providing patients with a quick diagnosis of cancer.

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Conclusion 6

Conclusion · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Concluded (the committee's words)
The Government’s recent announcement of a £2.3 billion investment in 100 new Community Diagnostic Centres is welcome and could provide a significant increase in physical diagnostic capacity. However, it is not yet clear how much additional capacity this investment will yield and whether it will allow England to catch up with other countries in terms of numbers of scanners per patient. Moreover, while there is a commitment to invest in diagnostic equipment, there appears to be no detailed plan to address gaps in the diagnostic workforce.

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Recommendation 7

Recommendation · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The Government and NHS England must set out detailed plans for how the £2.3 billion investment in Community Diagnostic Centres will be utilised, in particular detailing how many additional CT, MRI and PET-CT scanners and endoscopy suites the investment will provide.

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Recommendation 8

Recommendation · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The Government and NHS England must also develop a specific plan to address gaps in the diagnostic workforce, setting out how it will address both short-term and long- term shortages in key professions, and particularly what investment will be required to deliver sustainable long-term increases in these key professions.

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Conclusion 9

Conclusion · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Concluded (the committee's words)
There is huge potential in NHS cancer data, and a large amount of data from NHS cancer services is already collected and reported. However, there is significant room for improvement, particularly in reducing the two years it takes to collect and publish data on cancer stage. A major overhaul of data collection and timeliness is urgently needed.

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Conclusion 10

Conclusion · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Concluded (the committee's words)
Notwithstanding the lag on published data, on the basis of evidence supplied by the Government and the NHS, and Cancer Research UK’s analysis, we do not believe that the NHS is on track to meet the 75% early diagnosis ambition set by the Government. It is clear that there is good work underway to improve early diagnosis, which is welcome, but wholesale improvement is required if the 75% target is to be met. The stated focus on early diagnosis for the Secretary of State’s forthcoming cancer plan is therefore welcome.

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Recommendation 11

Recommendation · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The static trajectory in early diagnosis demands that the Government’s new plan for cancer services must include a clear action plan for achieving the 75% early diagnosis ambition which goes beyond current plans and considers much more radical proposals to kickstart progress.

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Conclusion 12

Conclusion · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Concluded (the committee's words)
We recognise that the disruption to cancer services during the pandemic was primarily driven by the need to mitigate the risk posed by Covid-19 to patients undergoing cancer treatment. We also recognise the efforts made by the NHS to maintain treatment or offer alternative treatment options. Nonetheless, we remain extremely concerned at the ongoing disruption to cancer treatment and the lives lost prematurely as a result. While NHS England has continued to prioritise cancer services, we are yet to be convinced that there is sufficient recognition of the scale of the issue, and we are deeply concerned that the target for clearing the backlog for cancer diagnosis and treatment has been moved back by an entire year.

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Recommendation 13

Recommendation · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The Department of Health and Social Care and NHS England must publish a detailed analysis of the extent of the cancer backlog to support the delivery of the elective care recovery plan. The Department should work with NHS England to set out: a) the latest estimate for how many fewer cancer referrals and treatment starts there have been seen since the beginning of the pandemic; Cancer services 43 b) the latest estimate for how many of these people may still not have come forward for treatment, based on expected referral rates by cancer type, cancer incidence projections, and mortality rates; c) the breakdown of these estimates according to region and cancer type.

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Recommendation 14

Recommendation · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Recommended (the committee's words)
Based on these estimates the Department of Health and Social Care and NHS England should set out: a) an estimate of what level of additional capacity in NHS cancer services will be needed to address the backlog in cancer services and treatment by March 2023; and b) an action plan to ensure that NHS cancer services are able to provide this additional capacity above normal levels.

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Conclusion 15

Conclusion · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Concluded (the committee's words)
For patients with limited treatment options the approval of a new drug or therapy can make a significant difference even when the survival benefit is only months. Despite the effectiveness of the Medicines and Healthcare products Regulatory Agency’s regulatory process, and despite some progress by NICE in approving medicines more efficiently for use in the NHS, the whole process is still too slow.

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Recommendation 16

Recommendation · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Recommended (the committee's words)
As part of its new cancer plan, the Government should include a plan for how to better align the technology appraisals carried out by NICE with the regulatory process applied by the MHRA, in order to reduce the delay between a drug being approved by the MHRA and recommended for use in the NHS by NICE. The Government should also review the uptake of NICE-approved treatments in the NHS and ensure that its new cancer plan includes measures to improve the pace of adoption of newly-approved treatments in the NHS on a fair and equitable basis.

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Conclusion 17

Conclusion · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Concluded (the committee's words)
The Government and the NHS have recognised some of the issues with radiotherapy delivery in the NHS and have made welcome commitments to resolve these, such as investing in new radiotherapy machines and the proton beam centres in Manchester and London. However, it is clear that there are still significant concerns for the sustainability of radiotherapy services, particularly in regard to workforce and equipment as well as the organisation of services.

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Conclusion 18

Conclusion · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Concluded (the committee's words)
The Government’s new cancer plan should provide an update to the 2014 radiotherapy vision which should include a long-term rolling investment programme for outdated radiotherapy equipment as well as changes to the national radiotherapy tariff to incentivise the delivery of modern radiotherapy techniques and remove perverse incentives.

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Conclusion 19

Conclusion · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Concluded (the committee's words)
Major specialist cancer hospitals have better access to staff, expertise and technology, and patients referred to these sites are more likely to be offered potentially life- saving surgery. During the pandemic, these hospitals were the ones most likely to be able to continue treatment, perpetuating regional disparities. Creating more of these specialist hospitals would ensure that cancer surgery was more resilient in 44 Cancer services the event of future health emergencies and would better spread specialist cancer services across the country. However, disparities may continue with services outside of these sites.

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Recommendation 20

Recommendation · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Recommended (the committee's words)
As part of the Government’s new cancer plan, the Government and NHS England should review the organisation of cancer surgery with a specific focus on whether more specialist hospitals should be established to ensure that more cancer surgery is carried out on sites without an emergency department.

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Recommendation 21

Recommendation · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Recommended (the committee's words)
As part of the long-term plan for the cancer workforce, the Government and NHS England should develop specific proposals for improving the retention of experienced cancer staff, including targeting burnout and improving the day-to-day working conditions of staff.

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Conclusion 22

Conclusion · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Concluded (the committee's words)
Cancer Alliances have had a positive impact on transforming cancer services and sharing best practice, and enjoy strong support from the sector. However, it is clear that while they are having some success, there is still significant unwarranted variation across regions in England and that the ability of Cancer Alliances to address this is limited as a result of underlying factors such as workforce shortages. While Cancer Alliances have limited ability to address demographic factors such as deprivation which are also drivers of some variation, it is unacceptable if people receive inequitable care based on their ethnicity. It is welcome that the Government is developing and publishing more cancer data broken down by ethnicity as this will be essential to highlighting differences in care and outcomes.

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Conclusion 23

Conclusion · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Concluded (the committee's words)
To support Cancer Alliances to embed transformation into local cancer services, new Integrated Care Systems must be required to appoint cancer leads, with responsibility for working directly with Alliances to embed best practice into their own systems. Cancer performance should also be Ofsted-rated by Integrated Care Boards as a sub- domain to their main rating so there is clarity and transparency about where best practice is being followed and where support is needed.

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Recommendation 24

Recommendation · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Recommended (the committee's words)
Cancer Alliances must reflect on new data provided to them by NHS England and the Department of Health and Social Care about cancer outcomes by ethnicity in their areas. In particular they should review the care provided to people from Black, Asian and minority ethnic backgrounds to ensure that no one is receiving worse care on account of their race.

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Recommendation 25

Recommendation · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The new Office for Health Improvement and Disparities should review the drivers of disparities in cancer outcomes and develop a joint strategy with NHS England to address these disparities.

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Conclusion 26

Conclusion · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Concluded (the committee's words)
There are specific challenges facing people with rare and less common and less survivable cancers, including that they are often harder to diagnose and that issues with spreading best practice for treating less common cancers are more pronounced. Despite some positive changes such as Rapid Diagnostic Centres, it is not clear that sufficient focus is being given to rare and less common and less survivable cancers.

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Recommendation 27

Recommendation · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The Government must consider rare, less common and less survivable cancers specifically as part of its new cancer plan. NHS England should also produce an action plan for rare, less common and less survivable cancers, containing clear commitments to address key issues around the diagnosis and treatment of those cancers. It should cover raising awareness of these cancers among health professionals and the delivery of optimal treatments.

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Conclusion 28

Conclusion · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Concluded (the committee's words)
The impact of Covid-19 on cancer research was significant and it is concerning that trial recruitment has not yet reached pre-pandemic levels. However, the pandemic has provided a model for how cancer research can be conducted more efficiently, in more hospitals, to bring greater benefits to patients.

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Recommendation 29

Recommendation · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The Government should set out how it will build on the lessons learnt during the pandemic by making it easier for researchers to: a) access vital patient data; b) access staff needed for their studies, by providing more protected time for research in NHS contracts, and c) get studies open for recruitment swiftly, by streamlining ethics and other approval processes.

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Recommendation 30

Recommendation · Twelfth Report - Cancer services · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The Government should also establish a ring-fenced fund for cancer research infrastructure targeted at NHS trusts which have historically low levels of research activity.

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Reports

1 report

Oral evidence sessions

5 sessions

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Date Session and witnesses Source
20 Jan 2022
Oral evidence session
Dame Cally Palmer · NHS England, Judith Neptial, cancer patient, Maria Caulfield · Department of Health and Social Care, Mark Foulkes · Royal Berkshire NHS Foundation Trust, Professor Peter Johnson · NHS England, William Vineall · Department of Health and Social Care
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9 Nov 2021
Oral evidence session
Anna Jewell · Less Survivable Cancers Taskforce, Ian Vousden · Kent and Medway Cancer Alliance, Jane Lyons · Cancer52, Katy Hall, Expert by experience, Professor David Baldwin · School of Medicine (University of Nottingham), Professor David Shackley · Greater Manchester Cancer, Sarah Stevens · National Disease Registration Service, NHS Digital
View ↗
26 Oct 2021
Oral evidence session
Baroness Delyth Morgan · Breast Cancer Now, David Watson · The Association of the British Pharmaceutical Industry (ABPI), Dr Philippa Hetherington, Expert by experience, Professor David Cunningham · Association of Cancer Physicians, Professor Mike Griffin · Royal College of Surgeons of Edinburgh, Professor Nick James · Institute of Cancer Research, Professor Pat Price · Action Radiotherapy
View ↗
14 Sep 2021
Oral evidence session
Andrea Brady, person with lived experience, Dr Andrew Millar · North Central London Cancer Alliance, Dr Jeanette Dickson · Council of the Academy of Medical Royal Colleges, Dr Richard Roope · Royal College of General Practitioners, Michelle Mitchell · Cancer Research UK, Professor Peter Sasieni · King's College London, Clinical Trials Unit, Sir Harpal Kumar · GRAIL Europe
View ↗
13 Jul 2021
Oral evidence session
Dame Cally Palmer · NHS England, John Butler · International Cancer Benchmarking Partnership, Prof Jon Emery · University of Melbourne, Prof Peter Johnson · NHS England, Prof Sir Mike Richards, Former National Cancer Director
View ↗

Written evidence

62 submissions recorded

Submission metadata is shown here; use the source links to read the evidence on Parliament’s website.

Showing the latest 50 of 62 recorded submissions. Written evidence in the activity timeline uses this same preview. Browse the inquiry on Parliament.

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ReferenceDateSubmitter
CSV0065 29 Mar 2022 Cancer Research UK
CSV0054 11 Feb 2022 Royal College of Surgeons of Edinburgh
CSV0064 8 Feb 2022 Judith Neptial
CSV0063 8 Feb 2022 Mark Foulkes, Royal Berkshire NHS Foundation Trust
CSV0062 30 Nov 2021 NHS Digital
CSV0061 30 Nov 2021 Less Survivable Cancers Taskforce
CSV0060 30 Nov 2021 Cancer52
CSV0059 19 Nov 2021 Royal College of Surgeons of Edinburgh
CSV0058 9 Nov 2021 Emma Metcalfe
CSV0056 9 Nov 2021 Cancer Research UK
CSV0055 9 Nov 2021 Professor Pat Price, #CatchUpWithCancer campaign, Action Radiotherapy
CSV0015 19 Oct 2021 Royal College of Radiologists
CSV0051 19 Oct 2021 The Association of the British Pharmaceutical Industry
CSV0014 21 Sep 2021 UK Lung Cancer Coalition
CSV0013 21 Sep 2021 Healthcare Safety Investigation Branch
CSV0012 21 Sep 2021 UK Clinical Expert Group for Lung Cancer and Mesothelioma
CSV0011 21 Sep 2021 Bristol Myers Squibb
CSV0010 21 Sep 2021 Pancreatic Cancer UK
CSV0009 21 Sep 2021 Institute of Physics and Engineering in Medicine
CSV0008 21 Sep 2021 Roche Products Ltd
CSV0007 21 Sep 2021 Dr Andrew Birnie, East Kent Hospitals University NHS Foundation Trust
CSV0006 21 Sep 2021 Dr S. Michael Crawford, Airedale NHS Foundation Trust, Skipton Road, Steeton, Keighley, West Yorkshire
CSV0005 21 Sep 2021 Prof William Hamilton, University of Exeter
CSV0004 21 Sep 2021 Professor Jane Hopkinson, Cardiff University
CSV0001 21 Sep 2021 Mr Bob Blizzard
CSV0030 21 Sep 2021 Less Survivable Cancers Taskforce
CSV0029 21 Sep 2021 British Society for Immunology
CSV0028 21 Sep 2021 Macmillan Survivorship Research Group< Health Sciences, University of Southampton
CSV0027 21 Sep 2021 Care Quality Commission
CSV0026 21 Sep 2021 Independent Healthcare Providers Network (IHPN)
CSV0025 21 Sep 2021 NICE (National Institute for Health and Care Excellence)
CSV0024 21 Sep 2021 Institute of Cancer Policy, Global Oncology Group, King's College London
CSV0023 21 Sep 2021 Outreach Research & Innovation Group
CSV0022 21 Sep 2021 Hologic
CSV0021 21 Sep 2021 Professor karol sikora, Rutherford Cancer Centres
CSV0020 21 Sep 2021 Blood Cancer Alliance
CSV0019 21 Sep 2021 AstraZeneca
CSV0018 21 Sep 2021 Pancreatic Cancer Action
CSV0017 21 Sep 2021 Dr Elizabeth Marsh, University of Derby
CSV0016 21 Sep 2021 University of Oxford
CSV0045 21 Sep 2021 Prostate Cancer UK
CSV0044 21 Sep 2021 #CatchUpWithCancer campaign
CSV0043 21 Sep 2021 Ovacome
CSV0042 21 Sep 2021 Philips UKI
CSV0041 21 Sep 2021 Teenage Cancer Trust
CSV0040 21 Sep 2021 Target Ovarian Cancer
CSV0039 21 Sep 2021 MSD
CSV0038 21 Sep 2021 Guardant Health
CSV0037 21 Sep 2021 Sarcoma UK
CSV0036 21 Sep 2021 Macmillan Cancer Support

Who gave evidence

31 witnesses

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WitnessOrganisationSessions
Dame Cally Palmer · National Cancer Director NHS England 2
Andrea Brady, person with lived experience Not recorded 1
Anna Jewell · Chair Less Survivable Cancers Taskforce 1
Baroness Delyth Morgan · Chief Executive Breast Cancer Now 1
David Watson · Executive Director of Economic, Health and Commercial Policy The Association of the British Pharmaceutical Industry (ABPI) 1
Dr Andrew Millar · Rapid Diagnostic Centre Lead North Central London Cancer Alliance 1
Dr Jeanette Dickson · Chair Council of the Academy of Medical Royal Colleges 1
Dr Philippa Hetherington, Expert by experience Not recorded 1
Dr Richard Roope · Clinical Adviser for Cancer Royal College of General Practitioners 1
Ian Vousden · Programme Director Kent and Medway Cancer Alliance 1
Jane Lyons · Chief Executive Officer Cancer52 1
John Butler · Clinical Lead International Cancer Benchmarking Partnership 1
Judith Neptial, cancer patient Not recorded 1
Katy Hall, Expert by experience Not recorded 1
Maria Caulfield · Parliamentary Under-Secretary of State Department of Health and Social Care 1
Mark Foulkes · Macmillan Lead Cancer Nurse Royal Berkshire NHS Foundation Trust 1
Michelle Mitchell · Chief Executive Officer Cancer Research UK 1
Prof Jon Emery · Chair of Primary Care Cancer Research University of Melbourne 1
Prof Peter Johnson · National Clinical Director for Cancer NHS England 1
Prof Sir Mike Richards, Former National Cancer Director Not recorded 1
Professor David Baldwin · Consultant Respiratory Physician and Honorary Professor of Medicine School of Medicine (University of Nottingham) 1
Professor David Cunningham · Chair Association of Cancer Physicians 1
Professor David Shackley · Director Greater Manchester Cancer 1
Professor Mike Griffin · President Royal College of Surgeons of Edinburgh 1
Professor Nick James · Prostate and Bladder Cancer Team Leader Institute of Cancer Research 1
Professor Pat Price · Consultant Clinical Oncologist and Chair Action Radiotherapy 1
Professor Peter Johnson · National Clinical Director for Cancer NHS England 1
Professor Peter Sasieni · Academic Director King's College London, Clinical Trials Unit 1
Sarah Stevens · Deputy Director National Disease Registration Service, NHS Digital 1
Sir Harpal Kumar · President GRAIL Europe 1
William Vineall · Director of NHS Quality, Safety and Investigations Department of Health and Social Care 1

Correspondence

3 letters

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