Support for cancer in England

Cancer is the cause of just over a quarter of all deaths in England in a typical year. The most common cancers are breast, lung, prostate and bowel cancer.

In 2021, 134,802 people died from cancer in England. The number of deaths has increased by 6% since 2001. But after accounting for the fact that England’s population is both growing and ageing, the rate of cancer deaths has fallen by 23% among men and 16% among women.

The Library briefing Cancer statistics for England (updated February 2023) provides an overview of cancer statistics for England. It covers detailed information on cancer diagnoses up to 2020 and deaths up to 2021, as well as statistics on NHS screening and treatment.

The NHS Long Term Plan (January 2019) includes cancer care as one of its clinical priorities, and aims to boost cancer survival rates by focussing on early diagnosis. The Long Term Plan set a new target that by 2028, the proportion of cancers diagnosed at stages 1 and 2 will rise from around half now to three-quarters of cancer patients. It also set an ambition that where appropriate, every person diagnosed with cancer would have access to personalised care.

The Government is working jointly with NHS England on implementing the delivery plan for tackling the COVID-19 backlogs in elective care (published February 2022) and plans to spend more than £8 billion from 2022/23 to 2024/25 to help drive up and protect elective activity, including cancer diagnosis and treatment activity.

The NHS Cancer Programme has developed a Faster Diagnosis Framework, which brings together the objectives and key requirements for cancer alliances under a single programme of work. The Framework combines several elements including the Faster Diagnosis Standard, that patients will be diagnosed or have cancer ruled out within 28 days of having an urgent GP referral for suspected cancer. It also includes the non-specific symptoms pathway, which was introduced in 2019, and is a route for patients with “red flag” symptoms that may indicate cancer but whose symptoms do not align with one tumour type and thus cannot be referred to a single specific suspected cancer pathway. The Framework also includes best practice timed pathways, that aim to shorten cancer diagnosis pathways by identifying specific clinical events and tests for patients referred with certain symptoms, with the ambition that these are available across all cancer pathways by the end of 2023/24.

On 24 January 2023 the Secretary of State for Health and Social Care announced there would be a new strategy covering major conditions, including cancer. The strategy signals a shift to integrated, whole person care for the increasing numbers of people in England with complex and multiple long-term conditions. This strategy also draws on previous work on cancer, including over 5,000 submissions provided to the Department of Health and Social Care as part of a call for evidence to develop the 10 Year Cancer Plan, held in 2022.

In August 2023, the Government published the Major Conditions Strategy: case for change and our strategic framework. This outlines current priorities in cancer care, such as sustained investment in the cancer workforce, increasing diagnostic and treatment capacity and investment in research. It also notes that NHS England will implement the recommendations of the clinically led review of cancer service standards (March 2022).

In August 2023, NHS England and the Department of Health and Social Care announced changes to current set of cancer waiting times standards which had become they said had “increasingly becoming unwieldy for trusts to manage and confusing for patients”. From 1 October 2023, the current set of ten standards will be streamlined to three key performance standards:

• A 28-day Faster Diagnosis Standard (patients are diagnosed or have cancer ruled out within 28 days of an urgent GP referral for suspected cancer)
• A 62-day referral to treatment standard
• A 31-day decision to treat to treatment standard.

The NHS currently offers bowel, cervical and breast screening. Coverage, which refers to the proportion of the eligible population who have been screened within the recommended time-period, has been falling for cervical and breast screening, but rising for bowel screening.

In February 2024, the Government announced a new Children and Young People Cancer Taskforce to improve treatment, detection and research for cancer in children. The Taskforce is chaired by Caroline Dinenage MP and brings together clinicians, cancer charities and the government.

Efforts to identify, treat and prevent cancer are underpinned by a broad range of research. Some of this may be focused specifically on developing new medications to treat cancers. Alongside this, biological, immunological and genetic research seeks to understand more about ‘cancer biology’, the mechanisms by which cancers develop and grow.

Funding for medical research in the UK is provided by both the public and private sectors, as well as charities and non-governmental organisations. For example, the UK Clinical Research Collaboration – a partnership of the main stakeholders who fund and direct clinical research across the business, public and charitable sectors in the UK – noted that, in 2018, charities provided “the majority of funding for Cancer and neoplasms (73%, £353m)” research and that almost half of that funding (45%) was from Cancer Research UK.

Government funding for medical research is typically channelled through the National Institute for Health and Care Research (NIHR - which is funded by the Department of Health and Social Care) and through UK Research and Innovation (UKRI – whose funding comes mainly via the science budget of the Department for Science, Innovation and Technology). In January 2022, the Government stated that the NIHR’s cancer research expenditure had “risen from £101 million in 2010/11 to £138 million in 2019/20” and that it was “supporting over 800 cancer studies through its Clinical Research Network”. UKRI’s total expenditure on cancer research similarly increased, from £98.1 million in 2015/16 to £125.5 million in 2020/21.

Translating laboratory research into new treatments and improved patient care is often referred to as ‘translational research’, or from bench (laboratory) to bedside (patients). The stages involved include preclinical development and clinical trials, through to regulatory approval, appraisal, and price negotiations. Not all drug candidates will make it through every stage; it is estimated that about 90% of drug candidates (for all diseases, not just cancer) that begin Phase I clinical trials will fail and never make it through to be approved / licenced as medicines. For those new drugs that are licenced, their research and development journey will have taken, on average, “12 years and cost around £1.15bn”.

After being approved and obtaining a ‘licence’ (formally known as a ‘marketing authorisation’), the next stage is for a medicine to go through an assessment – a type of cost/benefit analysis – to establish whether it should be made available via the NHS. In England, the National Institute for Health and Care Excellence (NICE) is responsible for making recommendations on the use of new and existing medicines and treatments within the NHS. NICE does this through undertaking ‘technology appraisals’. In the case of cancer drugs, NICE can recommend a drug for use within the Cancer Drugs Fund