John Baron is MP for Basildon and Billericay and Chairman of the All-Party Parliamentary Group on Cancer
Despite the fashionable doom and gloom, Britain’s economic fundamentals remain strong. However, for our standard of living to better reflect this, the tax take has to fall.
Greater efficiencies are required within our public services to allow more headroom for tax cuts to help individuals and encourage enterprise. In the long run, there is no substitute to economic growth.
Reforming the NHS, which looms large over our society and economy, is a prime example. Clause Five of the Health & Care Act 2022 provides a blueprint.
According to the King’s Fund, health spending in England has risen from £124.1 billion in 2009/10 to £173.8 billion in 2022/23. However, analysis from the IFS showed the NHS is moving fewer people off waiting lists than in 2019 despite spending being 12 per cent higher in real terms, and there being 13 per cent more doctors, 11 per cent more nurses and 10 per cent more clinical support staff when compared to 2019. The NHS urgently needs to up its game and translate these substantially increased resources into greater activity.
Yet the bureaucracy within the NHS – around half of the workforce is not clinically trained – is impeding progress. With cancer, the Government has a golden opportunity which, if seized correctly, could be an example for wider NHS reform.
The Government once estimated that 10,000 extra lives could be saved if we matched the best survival rates in Europe. Despite the massive increases in health spending in recent decades, there is little sign we are closing the gap.
As Chairman of the All-Party Parliamentary Group on Cancer (APPGC) for nearly 10 years, a former shadow Health minister and a constituency MP, I have seen how the NHS falls short for patients and families. One of our major APPGC enquiries showed the key reason the NHS lags behind on survival rates is because it diagnoses cancers later than its counterparts in many other countries. Late diagnosis invariably leads to poorer survival rates, as catching cancers early maximises the chances of successful treatment.
In 2013, the OECD confirmed that our survival rates rank near the bottom when compared to other major economies. Boosting early diagnosis is therefore the ‘magic key’ which unlocks better survival rates, and this became the major focus of the APPGC’s work. Though we scored a fair number of little victories, the shifting sands of a health service undergoing constant reform made it very difficult to bed these down.
One recurrent problem is that the NHS is bound to ‘process targets’, which measure activity rather than achievement. The House of Commons Library identified nine process targets applying to cancer alone – these include the ‘two-week wait’ to see a specialist after a referral and the ’62-day wait’ from referral to first definitive treatment (which hasn’t been met for many years). Such targets spawn unnecessary bureaucracy.
These targets are only part of the story when it comes to cancer care, but the NHS keeps to them because they are invariably the key to unlocking funds. The advantage of outcome measures – which measure the success of the outcomes of treatment – is that improved outcomes (such as one-year survival rates) can only be achieved by improved processes, whilst measuring what really matters to patients and their families – namely whether they survive and how quickly they recover from their cancers.
During the recent passage of the Health & Care Act, I tabled a simple amendment to ensure that outcome measures are put above process targets by the NHS, encouraging it to focus on earlier diagnosis. This was supported by 80 cross-party MPs, many peers (including the former Chief Executive of NHS England) and the founding Chief Executive of Cancer Research UK, Sir Alex Markham. After a little persuasion the Government duly accepted it, and it now forms Clause Five of the Act.
Specifically, Clause Five affects the objectives set out in the Mandate for NHS England. In the period after the legislation received Royal Assent I have remained in touch with Health Ministers to ensure that this amendment is respected in both letter and spirit. Accordingly, at the end of last year I wrote to the Government and received a letter in response to say that it was consulting with cancer charities, among others, as regards the latest iteration of the NHS England Mandate.
Over my two decades in Parliament, I am fully aware of the excellent work undertaken by the cancer charities and have often worked closely with them. However, it was disappointing that many of them were unwelcoming of our amendment as it was making its passage through Parliament. This was perhaps understandable, given process targets allow for the easy generation of campaigning points. We were never going to eliminate all of the targets but ensure that outcome measures took priority.
I have accordingly written to the Secretary of State for Health to enquire how Clause Five is being implemented. I am determined that the intentions behind the amendment are not watered down to ‘patient experience’ surveys and the like, which have their worth, but only up to a point. Many patients will not be aware, for example, how far we lag behind the performance of comparable healthcare systems abroad.
More broadly, given there is a consensus that merely increasing spending is not enough, there is space for radical thinking. We should be humble enough to learn from other countries’ systems. The Dutch put through major reforms to their health service in 2006, and now have some of the best health outcomes in Europe, and indeed the world – whilst providing a safety net for those who need it.
Given our doctors and nurses are apparently voting with their feet, it is also worth investigating why they find the Australian health system so attractive and which aspects of it we might be able to replicate here. We should not let dogma get in the way of greater efficiencies and better outcomes for patients and their families. Clause Five reflects this wish; let us hope Health ministers fully capitalise on its potential for good.
John Baron is MP for Basildon and Billericay and Chairman of the All-Party Parliamentary Group on Cancer
Despite the fashionable doom and gloom, Britain’s economic fundamentals remain strong. However, for our standard of living to better reflect this, the tax take has to fall.
Greater efficiencies are required within our public services to allow more headroom for tax cuts to help individuals and encourage enterprise. In the long run, there is no substitute to economic growth.
Reforming the NHS, which looms large over our society and economy, is a prime example. Clause Five of the Health & Care Act 2022 provides a blueprint.
According to the King’s Fund, health spending in England has risen from £124.1 billion in 2009/10 to £173.8 billion in 2022/23. However, analysis from the IFS showed the NHS is moving fewer people off waiting lists than in 2019 despite spending being 12 per cent higher in real terms, and there being 13 per cent more doctors, 11 per cent more nurses and 10 per cent more clinical support staff when compared to 2019. The NHS urgently needs to up its game and translate these substantially increased resources into greater activity.
Yet the bureaucracy within the NHS – around half of the workforce is not clinically trained – is impeding progress. With cancer, the Government has a golden opportunity which, if seized correctly, could be an example for wider NHS reform.
The Government once estimated that 10,000 extra lives could be saved if we matched the best survival rates in Europe. Despite the massive increases in health spending in recent decades, there is little sign we are closing the gap.
As Chairman of the All-Party Parliamentary Group on Cancer (APPGC) for nearly 10 years, a former shadow Health minister and a constituency MP, I have seen how the NHS falls short for patients and families. One of our major APPGC enquiries showed the key reason the NHS lags behind on survival rates is because it diagnoses cancers later than its counterparts in many other countries. Late diagnosis invariably leads to poorer survival rates, as catching cancers early maximises the chances of successful treatment.
In 2013, the OECD confirmed that our survival rates rank near the bottom when compared to other major economies. Boosting early diagnosis is therefore the ‘magic key’ which unlocks better survival rates, and this became the major focus of the APPGC’s work. Though we scored a fair number of little victories, the shifting sands of a health service undergoing constant reform made it very difficult to bed these down.
One recurrent problem is that the NHS is bound to ‘process targets’, which measure activity rather than achievement. The House of Commons Library identified nine process targets applying to cancer alone – these include the ‘two-week wait’ to see a specialist after a referral and the ’62-day wait’ from referral to first definitive treatment (which hasn’t been met for many years). Such targets spawn unnecessary bureaucracy.
These targets are only part of the story when it comes to cancer care, but the NHS keeps to them because they are invariably the key to unlocking funds. The advantage of outcome measures – which measure the success of the outcomes of treatment – is that improved outcomes (such as one-year survival rates) can only be achieved by improved processes, whilst measuring what really matters to patients and their families – namely whether they survive and how quickly they recover from their cancers.
During the recent passage of the Health & Care Act, I tabled a simple amendment to ensure that outcome measures are put above process targets by the NHS, encouraging it to focus on earlier diagnosis. This was supported by 80 cross-party MPs, many peers (including the former Chief Executive of NHS England) and the founding Chief Executive of Cancer Research UK, Sir Alex Markham. After a little persuasion the Government duly accepted it, and it now forms Clause Five of the Act.
Specifically, Clause Five affects the objectives set out in the Mandate for NHS England. In the period after the legislation received Royal Assent I have remained in touch with Health Ministers to ensure that this amendment is respected in both letter and spirit. Accordingly, at the end of last year I wrote to the Government and received a letter in response to say that it was consulting with cancer charities, among others, as regards the latest iteration of the NHS England Mandate.
Over my two decades in Parliament, I am fully aware of the excellent work undertaken by the cancer charities and have often worked closely with them. However, it was disappointing that many of them were unwelcoming of our amendment as it was making its passage through Parliament. This was perhaps understandable, given process targets allow for the easy generation of campaigning points. We were never going to eliminate all of the targets but ensure that outcome measures took priority.
I have accordingly written to the Secretary of State for Health to enquire how Clause Five is being implemented. I am determined that the intentions behind the amendment are not watered down to ‘patient experience’ surveys and the like, which have their worth, but only up to a point. Many patients will not be aware, for example, how far we lag behind the performance of comparable healthcare systems abroad.
More broadly, given there is a consensus that merely increasing spending is not enough, there is space for radical thinking. We should be humble enough to learn from other countries’ systems. The Dutch put through major reforms to their health service in 2006, and now have some of the best health outcomes in Europe, and indeed the world – whilst providing a safety net for those who need it.
Given our doctors and nurses are apparently voting with their feet, it is also worth investigating why they find the Australian health system so attractive and which aspects of it we might be able to replicate here. We should not let dogma get in the way of greater efficiencies and better outcomes for patients and their families. Clause Five reflects this wish; let us hope Health ministers fully capitalise on its potential for good.