What the long-term NHS plan says for people with pancreatic cancer

On Monday 7th January, NHS England finally released the new NHS long-term plan, which sets out the strategic priorities for the NHS over the next 10 years in England.

The plan is backed by a funding settlement over the next 5 years of £20.5bn which the Prime Minister’s announced in 2018, the 70th birthday of the NHS.

The plan covers a huge range of issues from clinical areas such as stroke to maternity care as well as infrastructure issues such as data and technology – but what will it mean for people affected by pancreatic cancer?

Cancer will remain as a key clinical priority for the NHS and features as a major focus in the long-term plan. This is great to see. Here at Pancreatic Cancer UK we worked tirelessly last year to ensure that NHS England were made aware of the improvements needed for people with pancreatic cancer, including increased research and other investments required to transform outcomes for the disease.

Whilst pancreatic cancer does not get a specific mention on the 6-7 pages dedicated to cancer, we are hopeful that there is a strong intent to deliver initiatives for all cancers, including less survivable cancers like pancreatic cancer, not just the most common cancers. This is something we will continue to monitor and push for in the months ahead. In the meantime, we are very pleased that the plan includes important commitments on key issues that we asked NHS England and Government to prioritise to ensure that everyone with pancreatic cancer receives the best care and treatment to live long and well.

What we called for, and how this compares with the NHS long-term plan:

A commitment to setting goals towards levelling up pancreatic cancer survival with other cancers

We are pleased to see focus in the long-term plan on early diagnosis to improve long-term survival. By 2028, the NHS has set an ambition to diagnose 75% of cancers at stage 1 or 2. This is particularly important for pancreatic cancer, which is often diagnosed late and as an emergency, but achieving it will be challenging. At the moment, less than 20% people with pancreatic cancer in England are diagnosed at an early stage and less than 10% people with pancreatic cancer have surgery – the only potentially curative treatment. This is why pancreatic cancer has the lowest five-year survival among all common cancers, standing at 6.9%, and this needs to change by improving early diagnosis. We have been asked to work with NHS England to ensure that we can set a stretching but realistic target for the earlier diagnosis of pancreatic cancer.

Faster treatment of pancreatic cancer across England with the ambition that people affected will be treated within 20 days from diagnosis

The long-term plan acknowledged that shortening intervals between referral to treatment can save lives especially for fast growing cancers. This is of particular importance for pancreatic cancer, which progresses quickly and is the deadliest common cancer. One in four people with pancreatic cancer will die within a month and three in four within a year. That is why we launched the Demand Faster Treatment campaign for pancreatic cancer at the end of October 2018, which has already received over 70,000 petition signatures. In our policy report, we explicitly demonstrate that pancreatic cancer needs to be treated faster and we have set key recommendations to achieve this. Although there is not a commitment in the NHS plan towards our ambition for treatment within 20 days for pancreatic cancer, we will continue to argue for and help to ensure that NHS England will prioritise developments that enable patients with pancreatic cancer to access treatment faster.

Rapid Diagnostics Centres across the country to diagnose pancreatic cancer faster

The long-term plan confirmed the nationwide roll-out of Rapid Diagnostic Centres (RDCs) and a new faster diagnosis standard from 2020 to ensure most patients receive a definitive diagnosis or a ruling out of cancer within 28 days of referral.  RDCs enable people with vague symptoms to have a range of tests in one place rather than repeatedly visiting their GP, and they have shown promising results for pancreatic cancer. That’s why we believe that this wider roll out could really improve earlier diagnosis and ensure that there is not a postcode lottery in the diagnosis of pancreatic cancer – something we have continuously called on the Government and the NHS England to address.

Treatment pathway pilots featuring one-stop clinics and patient navigators for pancreatic cancer with an ambition that everyone affected with the disease will be treated within 20 days

The long-term plan stated that timed diagnostic pathways will be developed for specific cancers. Optimal timed pathway pilots to provide faster diagnosis and provisional treatment plans have been rolled out by the NHS England and Cancer Alliances for prostate, colorectal and lung cancer and is a key ask for pancreatic cancer in our case for Demand Faster Treatment. Key elements of these pathways are one-stop clinics and additional workforce to act as patient navigators (who can help people navigate through what can sometimes feel a fairly complex health care system, particularly when tests and investigations are needed). Such a pathway for pancreatic cancer will ultimately accelerate treatment decisions and access to treatment. We have already discussed the need for optimising and standardising treatment for pancreatic cancer patients with NHS England, following the publication of the NICE guidelines last year. Pancreatic Cancer UK will continue to press the Government and NHS England to ensure that pancreatic cancer will be prioritised in the roll out of timed diagnostic pathways.

People diagnosed with pancreatic cancer to have a holistic needs assessment

The plan has stated that from 2021 all patients will have access to personalised care, including needs assessment, a care plan and health and wellbeing information and support, including a Clinical Nurse Specialist (CNS) or support worker. Holistic needs assessment and helping people maintain the best possible quality of life, including at the end of life, are crucial for pancreatic cancer as it is a disease with complex symptoms such as pain, malnutrition and psycho-social issues. For people with pancreatic cancer, a holistic approach and access to Clinical Nurse Specialists is needed straightaway.

NHS England to invest in more research and incentivise clinical trials for pancreatic cancer

The plan sets out some important changes to make it easier to carry out more research in the NHS and increase participation of patients in experimental treatments. Given the appalling survival of pancreatic cancer, and the fact that 7 in 10 of patients with pancreatic cancer do not receive any treatment, we have asked for more clinical trials to be rolled out for pancreatic cancer and also that everyone with the disease is encouraged to participate in clinical trials that might benefit them.

What happens next?

NHS England have said that between now and the summer of 2019 that staff, patients and the public will have the opportunity to help the NHS work out what the NHS long term plan means for their area of interest and for the place that they live in. The more people engaging in their local areas about improving outcomes for pancreatic cancer the better.

At Pancreatic Cancer UK we will be working with the cancer policy team at NHS England and the Government to ensure that delivery of the plan is relevant to people with pancreatic cancer and is also targeted at improving outcomes for those affected.

We want to see NHS England and the Government committing to specific targets on early diagnosis and survival for pancreatic cancer that local health services can work towards so that pancreatic cancer is not sidelined and seen as too difficult to tackle.  Ultimately, swift diagnosis and faster access to treatment is essential to improve long-term survival so we welcome this focus in the plan.

What about Scotland, Wales and Northern Ireland?

The 10-year plan is only for the health service in England, but the devolved governments in Scotland, Wales and Northern Ireland will receive a proportional increase in funding as well. The Scottish and Welsh governments, as well as a future Northern Ireland Executive, can then decide how this money will be spent.