The fifth Care Conversation event heard the views of world-renowned Karol Sikora – Medical Director of CancerPartnersUK and Professor of Cancer Medicine – on the future of cancer care
‘Healthcare is in a perfect storm, and it’s global’ Professor Sikora told delegates. ‘Whatever system you look at, it’s just not working.’
People were living longer and had much more access to health information, while society had, in many ways, become more selfish, he said. ‘People want and demand things, and one key issue is the distribution of cancer care.’ This could easily be delivered in an outpatient setting, he said, as hospitals were very often the wrong places – inconvenient or even inaccessible for many people. ‘But the biggest challenge is how we pay for it,’ he said. ‘Cancer is getting expensive.’
Approaching cancer as he would a patient, he said, the problem had begun to be noticed in the 1980s, with slow diagnostic pathways and huge variations in care. The 1995 Calman Hine report made good recommendations but no money followed, while 2000’s NHS Cancer Plan had led to a ‘highly bureaucratic way of doing things that lost huge amounts of money without trace.’ Although the budget for cancer had increased four-fold in the last decade, he said, problems with waiting times persisted, the IT situation remained ‘hopeless’ and there was significant under-capacity in diagnostics and radiotherapy.
By 2007, UK survival figures continued to lag behind the rest of Europe. ‘We’re spending the same amount on cancer as our European colleagues, but the care people are getting is of a lower quality,’ he said. Core problems were inefficiency, lack of initiative and innovation and too many stakeholders – GPs, consultants, PCTs, cancer networks and patient activist groups, among others – all ‘pulling in different directions.’ Levels of patient satisfaction remained low compared to other countries, and the chemotherapy situation was ‘scandalous’, he said. ‘The single payer, single provider model is not for the future.’
So if cancer was the patient, what was the treatment plan? ‘Firstly, diversify the providers,’ he said. What was needed was a system of well-regulated specialist providers dealing with radiotherapy and chemotherapy, rather than local hospital trusts trying to do it themselves. Secondly, the concept of ‘cancer hotels’ – every town with more than 100,000 people should have a cancer centre with high quality facilities and resources, inter-linked IT and no waiting times. Finally, it was necessary to create a system that could evolve, he stressed. ‘On the whole it’s stuck in the past, and the main problem is IT – you can’t integrate the data in any meaningful way.’ If supermarkets could do it, there was no reason why providers couldn’t, he told delegates.
In diversifying providers, some would inevitably fail while others would be very successful, he said, and insurance companies would need to come on board in a much more significant way. ‘The NHS can’t do everything for everybody. Top up payments for extra services is the way it has to go.’
Cancer care would always be a political priority, he said, as no politician could afford to ignore it. However, it would be a shame if the UK became the ‘poor man of Europe’. ‘We can do it,’ he stressed. ‘But it requires complete reform and rethinking of cancer care.’
