This week the NHS released a new “long term plan” to explain how the healthcare service will develop over the next ten years.
The plan has many areas of focus across all areas of health with extra money being given to mental health services, disease prevention and community services.
The plan is very ambitious and has the potential to save and improve the lives of thousands of people if it can be put into place.
What does this mean for pancreatic cancer?
Cancer is mentioned as one of the focus areas of the long-term plan. However, there is a lack of focus on cancers like pancreatic cancer which currently cannot be screened for and are less survivable. The prime minister has set a target for early diagnosis of cancer to raise stage one and two diagnosis from 50% to 75%.
The majority of pancreatic cancer cases are diagnosed at a late stage and therefore this is a target that is not very achievable for pancreatic cancer. However, there is good news for diagnosis;
- The threshold for GP’s to refer those suspected of cancer to a specialist will be lowered, meaning there could be more testing and diagnosis of many cancers at an earlier stage, pancreatic cancer included.
- Rapid diagnostic centres will be created to allow faster diagnosis of cancers such as pancreatic cancer, with vague or nonspecific symptoms. This will allow patients to have diagnostic tests such as blood tests and CT scans and a result on the same day. These patients can then have further tests, be referred to a specialist or go home without a stressful waiting period for diagnosis.
- Personalised care is to increase, therefore people with a family history of pancreatic cancer may be tested and monitored to manage their personal risk and, genomic testing will help personalise treatment plans in the future.
- Follow up pathways for cancer survivors including rapid access to support if someone is worried their cancer has returned.
Pancreatic Cancer Action welcomes these changes and any measures to increase early diagnosis and improve the chances of surgery and survival for patients.
Rapid diagnostic centres could be a promising route to diagnosing the disease which has no screening test and a variety of vague symptoms, but only if pancreatic cancer and a diagnostic pathway for the disease is a priority. The effectiveness of rapid diagnostic centres has been questioned and there will be challenges in creating these changes.
Acquiring enough scanners for testing and the staff to use them and read the results will be difficult as the NHS faces a shortage of these workers and machines already.
The NHS in England has invested £130m in radiotherapy and £200m in rapid diagnosis and assessment. Health Education England has already invested in increasing Clinical Radiology training programmes and created a fast-track training pathway for Clinical Endoscopists.
In 2016 there were 2,805 clinical radiologists in post. However, according to Health Education England, If no further action is taken and their forecasts of joiners and leavers are broadly correct, then in 2021 we would expect to see approximately 3,181 staff in post, an increase of 376 FTE (13 per cent). However, currently of all the available posts, 10% remain vacant.
NHS England needs to create a clear plan to address lack of diagnostic capacity caused by workforce shortages and prior lack of investment.
The lack of detail in this plan for pancreatic cancer is a concern. The disease has the lowest survival rate of 18 common cancers and has become the fifth biggest cancer killer in the UK (set to become the 4th). Survival rates have not improved much in decades and we would like to see more of a focus on early diagnosis of pancreatic cancer so that more patients survive for longer.
Another major announcement in the long-term plan is the focus on improving community services and providing care outside of hospital. Integrated care systems are a way of all health care providers working together to make sure patients get the right care at the right time and in the right place. This has promise for pancreatic cancer patients. Every patient with cancer should, by 2021, have a personalised assessment of what their needs are, a care plan to meet those needs and suitable support to make sure that what is in the care plan can be carried out. This will be in digital form and will allow the professionals involved to review a patient’s history, tests, appointments and notes. Having this information to hand could speed up diagnosis for patients who have multiple appointments before investigations for pancreatic cancer.
Pancreatic Cancer Action supports the move towards more joined up care and healthcare professionals working together to move care into the community. We work with GP practises and pharmacies to raise awareness of pancreatic cancer in these areas, promoting early diagnosis. We also support the move towards community led care such as clinical assessment teams to avoid hospital admissions for people with pancreatic cancer needing more support.
However, integrated care systems face their own challenges, including a mass update of technology and the recruitment of community staff who can deliver care. Being able to use and view your own records will be very useful for some people but not for those who are unable to access the internet or who are not confident using it. The system has the potential to leave some people behind.
What we can conclude
Overall, the long-term plan offers some interesting developments in the early diagnosis and treatment of cancers. However, over the past 20 years there have been at least 26 of these plans with no marked change in the outcomes for pancreatic cancer. The outlook for pancreatic cancer under this plan is uncertain.
Alongside increased diagnostic capacity and rapid diagnostic centres, we need to improve GP referrals and ensure that NICE referral Guidelines are actually utilised (the PC ones were published in 2015) and ensure greater training and awareness of symptoms for diagnosing clinicians is improved.
Giving GPs greater access to diagnostic tools such as CT scans should also be a priority.
The key focus of PCA’s work is on improving early diagnosis of pancreatic cancer with initiatives such as e-learning for GPs and pharmacists, GP symptom aware campaigns and award-winning public symptoms campaigns.
Pancreatic Cancer Action will continue to raise awareness among health care professionals, the public and policy makers and campaign for early diagnosis.