Select Committee · Health and Social Care Committee

Cancer services

Status: Closed Opened: 6 Jul 2021 Closed: 1 Aug 2022 15 recommendations 15 conclusions 1 report

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 … Show more

Reports

1 report
Title HC No. Published Items Response
Twelfth Report - Cancer services HC 551 5 Apr 2022 30 Responded

Recommendations & Conclusions

30 items
1 Conclusion Twelfth Report - Cancer services Accepted

We welcome the development of Rapid Diagnostic Centres and Community Diagnostic Centres, particularly in giving...

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 … Read more

Government response AI summary
The government states there are already 84 pathways live transforming the way that people with symptoms not specific to one cancer are diagnosed or have cancer ruled out, and have set expectations in the NHS Operational Planning Guidance for 2022/23 to extend coverage.
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Department of Health and Social Care
2 Recommendation Twelfth Report - Cancer services Accepted in Part

NHS England has been focusing on encouraging people to come forward with cancer symptoms during...

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 … Read more

Government response AI summary
NHS England will extend coverage of non-specific symptom pathways to at least 75% population coverage by March 2023, ensuring at least 65% of urgent cancer referrals meet the Faster Diagnosis Standard and will trial new approaches to prostate cancer and expanding routes into the system …
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Department of Health and Social Care
3 Conclusion Twelfth Report - Cancer services Accepted

Cancer screening is a vital tool for early diagnosis, but even before the pandemic there...

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 … Read more

Government response AI summary
The government describes the existing cancer screening programmes, including the introduction of primary Human Papilloma Virus (HPV) screening in cervical screening in 2019, continued work to evaluate self-sampling for HPV, expansion of the home testing programme, and progress in tackling the backlog of invitations caused …
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Department of Health and Social Care
4 Recommendation Twelfth Report - Cancer services Accepted

The Government should implement the recommendations of Professor Sir Mike Richards’ review of cancer screening...

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.

Government response AI summary
The government states that through NHS screening programmes they are able to reduce mortality and morbidity and there have been important changes in screening programmes in recent years.
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Department of Health and Social Care
5 Conclusion Twelfth Report - Cancer services Acknowledged

We understand the rationale for simplifying the Cancer Waiting Times standards.

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 … Read more

Government response AI summary
The government acknowledged the importance of a quick cancer diagnosis, referring to the Delivery Plan for Tackling the COVID-19 Backlog of Elective Care and investment in Community Diagnostic Centres to increase diagnostic capacity and reduce waiting times.
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Department of Health and Social Care
6 Conclusion Twelfth Report - Cancer services Accepted

The Government’s recent announcement of a £2.3 billion investment in 100 new Community Diagnostic Centres...

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 … Read more

Government response AI summary
The government announced a £2.3 billion investment to increase the volume of diagnostic activity and to roll out up to 160 community diagnostic centres (CDCs) by March 2025 and outlined workforce planning measures including expanding training places, streamlining training routes, optimising the use of existing …
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Department of Health and Social Care
7 Recommendation Twelfth Report - Cancer services Acknowledged

The Government and NHS England must set out detailed plans for how the £2.3 billion...

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. Read more

Government response AI summary
The government acknowledges the recommendation by referencing the Delivery Plan for Tackling the COVID-19 Backlog of Elective Care and stating CDCs delivered over 880,000 diagnostic tests in 2021/22, projecting 17 million more tests over the next three years, increasing annual capacity by 9 million tests …
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Department of Health and Social Care
8 Recommendation Twelfth Report - Cancer services Acknowledged

The Government and NHS England must also develop a specific plan to address gaps in...

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. Read more

Government response AI summary
Health Education England invested £52 million in 2021/22 in the cancer and diagnostics workforce and the Government's forthcoming 10 Year Cancer Plan will set a new vision for cancer care, and the Department commissioned HEE to review long term strategic trends for the health workforce.
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Department of Health and Social Care
9 Conclusion Twelfth Report - Cancer services Acknowledged

There is huge potential in NHS cancer data, and a large amount of data from...

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 … Read more

Government response AI summary
The government welcomes the committee's recognition of work underway to diagnose 75% of cancers by 2028, highlighting six priorities to increase early diagnosis and stating it is premature to suggest progress is off track.
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Department of Health and Social Care
10 Conclusion Twelfth Report - Cancer services Accepted

Notwithstanding the lag on published data, on the basis of evidence supplied by the Government...

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 … Read more

Government response AI summary
The Government welcomes the Committee's recognition of the work that is already under way to deliver on the ambition to diagnose 75% of cancers by 2028 and describes programmes already underway.
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Department of Health and Social Care
11 Recommendation Twelfth Report - Cancer services Acknowledged

The static trajectory in early diagnosis demands that the Government’s new plan for cancer services...

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. (Paragraph 72) Access to treatments Read more

Government response AI summary
The government welcomes the recognition of its work to diagnose 75% of cancers by 2028 and lists existing priorities, but doesn't commit to any new or radical action to achieve the target.
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Department of Health and Social Care
12 Conclusion Twelfth Report - Cancer services Accepted

We recognise that the disruption to cancer services during the pandemic was primarily driven by...

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 … Read more

Government response AI summary
Cancer diagnosis and treatment has remained a top priority and there were over 4.9 million urgent referrals and over 600,000 people started cancer treatment between March 2020 and March 2022 and describes existing NHS Long Term Plan ambitions on early cancer diagnosis and actions local …
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Department of Health and Social Care
13 Recommendation Twelfth Report - Cancer services Accepted

The Department of Health and Social Care and NHS England must publish a detailed analysis...

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 … Read more

Government response AI summary
The government stated cancer diagnosis and treatment has remained a top priority throughout the pandemic with substantial funding and targets being set for local systems to reduce cancer diagnosis times and to reduce the shortfall in the number of first treatments.
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Department of Health and Social Care
14 Recommendation Twelfth Report - Cancer services Acknowledged

Based on these estimates the Department of Health and Social Care and NHS England should...

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 … Read more

Government response AI summary
Cancer diagnosis and treatment has remained a top priority and there were over 4.9 million urgent referrals and over 600,000 people started cancer treatment between March 2020 and March 2022 and describes existing NHS Long Term Plan ambitions on early cancer diagnosis and actions local …
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Department of Health and Social Care
15 Conclusion Twelfth Report - Cancer services Acknowledged

For patients with limited treatment options the approval of a new drug or therapy can...

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 … Read more

Government response AI summary
The government acknowledges that the drug approval process is too slow but states that NICE is committed to publishing guidance around the time of licensing and has consistently delivered on this commitment in the majority of cases.
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Department of Health and Social Care
16 Recommendation Twelfth Report - Cancer services Accepted

As part of its new cancer plan, the Government should include a plan for how...

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 … Read more

Government response AI summary
The government states that NICE is committed to publishing guidance around the time of licensing and has consistently delivered on this commitment in the majority of cases, with measures in place for funding ahead of NICE guidance and collaboration between MHRA, NICE, and NHSE&I.
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Department of Health and Social Care
17 Conclusion Twelfth Report - Cancer services Accepted

The Government and the NHS have recognised some of the issues with radiotherapy delivery in...

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 … Read more

Government response AI summary
The government claims to be already addressing concerns about radiotherapy services by investing in new equipment and supporting optimal machine utilisation, staff training, and technology.
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Department of Health and Social Care
18 Conclusion Twelfth Report - Cancer services Accepted

The Government’s new cancer plan should provide an update to the 2014 radiotherapy vision which...

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. Read more

Government response AI summary
The government stated that until the 2021 Spending Review, replacing equipment resided with NHS Trusts, but since 2016 NHS England has taken steps to ensure every NHS Trust has access to modern equipment and has invested £162m to replace or upgrade over 100 radiotherapy treatment …
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Department of Health and Social Care
19 Conclusion Twelfth Report - Cancer services Deferred

Major specialist cancer hospitals have better access to staff, expertise and technology, and patients referred...

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 … Read more

Government response AI summary
The government's response states the Cancer Call for Evidence has closed, and the responses are being analysed alongside wider evidence for a new vision for cancer care in their 10-Year Cancer Plan.
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Department of Health and Social Care
20 Recommendation Twelfth Report - Cancer services Deferred

As part of the Government’s new cancer plan, the Government and NHS England should review...

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. Read more

Government response AI summary
The government deferred action, stating that the Cancer Call for Evidence is being analysed and the 10-Year Cancer Plan will address the organisation of cancer surgery.
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Department of Health and Social Care
21 Recommendation Twelfth Report - Cancer services Accepted

As part of the long-term plan for the cancer workforce, the Government and NHS England...

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. (Paragraph 115) Variation Read more

Government response AI summary
The government states that the forthcoming 10 Year Cancer Plan, NHS People Plan and 22/23 NHS priorities address workforce wellbeing, including staff mental health hubs and a retention programme.
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Department of Health and Social Care
22 Conclusion Twelfth Report - Cancer services Accepted

Cancer Alliances have had a positive impact on transforming cancer services and sharing best practice,...

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 … Read more

Government response AI summary
The government states that Cancer Alliances already lead the planning and delivery of cancer services and their improvement across their local systems.
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Department of Health and Social Care
23 Conclusion Twelfth Report - Cancer services Accepted

To support Cancer Alliances to embed transformation into local cancer services, new Integrated Care Systems...

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- … Read more

Government response AI summary
The government states that Cancer Alliances already lead the planning and delivery of cancer services, and the ICS Design Framework has made clear that Integrated Care Boards (ICBs) will look to the Cancer Alliances to continue to undertake these roles from July 2022.
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Department of Health and Social Care
24 Recommendation Twelfth Report - Cancer services Accepted

Cancer Alliances must reflect on new data provided to them by NHS England and the...

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 … Read more

Government response AI summary
The government states that tackling inequalities is a key focus of the NHS Long-Term Plan and 22/23 Planning Guidance, with actions in place to increase accessibility of surveys, target lung health checks, and target messaging in campaigns to minority audiences.
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Department of Health and Social Care
25 Recommendation Twelfth Report - Cancer services Acknowledged

The new Office for Health Improvement and Disparities should review the drivers of disparities in...

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.

Government response AI summary
The government states they remain committed to levelling up outcomes across the UK and are planning on publishing the Health Disparities White Paper later this year to break the link between people’s backgrounds and their prospects for a healthy life.
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Department of Health and Social Care
26 Conclusion Twelfth Report - Cancer services Deferred

There are specific challenges facing people with rare and less common and less survivable cancers,...

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 … Read more

Government response AI summary
The government is analysing responses to the Cancer Call for Evidence to develop the 10 Year Cancer Plan, which will address all cancer types, including rare and less survivable cancers.
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Department of Health and Social Care
27 Recommendation Twelfth Report - Cancer services Deferred

The Government must consider rare, less common and less survivable cancers specifically as part of...

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. … Read more

Government response AI summary
The government deferred action, stating that it is analysing responses to the Cancer Call for Evidence and that the 10 Year Cancer Plan will address all cancer types, including rare and less survivable cancers.
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Department of Health and Social Care
28 Conclusion Twelfth Report - Cancer services Accepted

The impact of Covid-19 on cancer research was significant and it is concerning that trial...

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. Read more

Government response AI summary
The government describes the multi-year Vision for the Future of UK Clinical Research Delivery, how it will build on the lessons learnt during the pandemic, and sets out the ambition to create a patient-centred, pro-innovation and digitally enabled clinical research environment.
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Department of Health and Social Care
29 Recommendation Twelfth Report - Cancer services Accepted

The Government should set out how it will build on the lessons learnt during the...

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 … Read more

Government response AI summary
The government outlines actions to improve data access, staff access for studies and streamlining of approval processes, referencing the Vision for the Future of UK Clinical Research Delivery, investment in Trusted Research Environments, a single front door for study approvals, and the Innovative Licensing and …
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Department of Health and Social Care
30 Recommendation Twelfth Report - Cancer services Accepted

The Government should also establish a ring-fenced fund for cancer research infrastructure targeted at NHS...

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. (Paragraph 149) 46 Cancer services

Government response AI summary
The Department provides sustained investment in research expertise, specialist facilities, a research delivery workforce and support services through the NIHR Infrastructure including Experimental Cancer Medicine Centres (ECMCs) and NIHR Biomedical Research Centre at the Royal Marsden BRC.
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Department of Health and Social Care

Oral evidence sessions

5 sessions
Date Witnesses
20 Jan 2022 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 View ↗
9 Nov 2021 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 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 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 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 ↗

Who gave evidence

31 witnesses
WitnessOrganisationSessions
Dame Cally Palmer · National Cancer Director NHS England 2
Andrea Brady, person with lived experience 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 Commer… 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 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 1
Katy Hall, Expert by experience 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 1
Professor David Baldwin · Consultant Respiratory Physician and Honorary Pro… 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
DateDirectionTitle
29 Mar 2022 Corresondence from the National Cancer Director on the Cancer services inquiry
25 Jan 2022 To cttee Letter from the National Cancer Director and National Clinical Director on Canc…
19 Oct 2021 To cttee Letter from Jeanette Dickson providing further information requested by the Com…