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Progress in improving cancer services and outcomes in England

The Department of Health, its arms length bodies and the NHS have made progress in improving cancer services since 2010, according to the National Audit Office. However, significant variations in outcomes and access to services persist across England, indicating that there is considerable scope for further improvement.

Since the NAO last reported on cancer services, in 2010, overall outcomes for cancer patients have continued to improve. For example, the proportion of people surviving for one year and five years after diagnosis has increased to 69% (for those diagnosed in 2012) and 49% (for those diagnosed in 2008) respectively. However, data on 5-year survival rates published in 2013 (for those diagnosed between 2000 and 2007) showed that survival rates remained about 10% lower than the European average.

Good progress has been made in implementing the recommendations made by the Public Accounts Committee in 2011. As a result, although some data gaps remain, better information is becoming available to support improvements in cancer care. For example, the proportion of newly diagnosed cancers with ‘staging data’ (a record of how advanced a person’s cancer is at diagnosis) increased from 33% of cases in 2007 to 62% in 2012.

However, outcomes for cancer patients and access to services vary significantly across the country. They are generally poorer for older patients in particular. Cancer patients aged 55-64, for example, are 20% more likely to survive for at least one year after diagnosis than those aged 75-99. While survival rates for people in the latter age group are expected to be lower because, for example, they are frailer and less likely to cope with treatment, this is unlikely to explain fully this significant variation between age groups.

Those from more deprived socio-economic groups are also more likely to experience worse outcomes than those from less deprived groups. There would be nearly 20,000 fewer deaths from cancer each year if mortality rates for all socio-economic groups were the same as for the least deprived.

In addition, while cancer awareness campaigns have increased awareness of cancer signs and symptoms, one in five people are still diagnosed via an emergency presentation. Those diagnosed in this way are, on average, twice as likely to die within a year as those diagnosed through an urgent GP referral because their cancers are generally more advanced.

“Outcomes for cancer patients have improved since 2010. Of course, there will always be variations in cancer outcomes, but the significant variations across the country, and the poorer outcomes for older patients and those from more deprived backgrounds, show that there is potential for improvement. The gap in outcomes between England and the European average, shown in the latest data, also demonstrates this.”

Amyas Morse, head of the National Audit Office

Notes for Editors

£6.7bn

Estimated cost to the NHS of cancer services in 2012-13

280,000

People diagnosed with cancer in 2012

31%

Of people diagnosed with cancer in 2012 died within a year

3-in-5

New cancers are diagnosed in people aged 65 or over

1-in-5

Cancers were diagnosed via an emergency presentation at hospital between July and December 2012

62%       

Of newly diagnosed cancers in 2012 had a record of how far advanced the cancer was at diagnosis

51%

Increase in urgent GP referrals for suspected cancer between 2009-10 and 2013-14

64

NHS trusts and NHS foundation trusts failed to meet the standard that 85% of patients should start cancer treatment within 62 days of referral by a GP between July and September 2014

1. Press notices and reports are available from the date of publication on the NAO website, which is at www.nao.org.uk. Hard copies can be obtained by using the relevant links on our website.

2. The National Audit Office scrutinises public spending for Parliament and is independent of government. The Comptroller and Auditor General (C&AG), Amyas Morse, is an Officer of the House of Commons and leads the NAO, which employs some 820 employees. The C&AG certifies the accounts of all government departments and many other public sector bodies. He has statutory authority to examine and report to Parliament on whether departments and the bodies they fund have used their resources efficiently, effectively, and with economy. Our studies evaluate the value for money of public spending, nationally and locally. Our recommendations and reports on good practice help government improve public services, and our work led to audited savings of £1.1 billion in 2013.

PN: 04/15