King’s College London: Senior King’s oncologists weigh in on government health initiative
Senior oncologists at King’s have published an article for the British Medical Journal that weighs in on the government’s My Planned Care initiative and offers alternative solutions to managing treatment backlogs.
My Planned Care, due to be formally introduced in December 2022, allows patients to choose which hospital they receive treatment at based on their waiting times. The scheme has been devised to help alleviate treatment backlogs that grew across all services over the Covid-19 pandemic.
Writing in the British Medical Journal, Professor Richard Sullivan, Professor of Cancer Policy and Global Health, and Dr Ajay Aggarwal, Consultant Clinical Oncologist, have provided an analysis of the current plan and pitched an alternative strategy that builds on opportunities provided by existing models of care.
Slowing and reversing the cancer crisis in the UK will require a radical departure from current strategies. The single most important medium- and long-term goal must be to deliver the required workforce, as well as structure and organise care more effectively. In the meantime, expanding paid hours for staff is the only immediate solution.”
– Professor Richard Sullivan, Professor of Cancer Policy and Global Health
In the paper, they write that NHS England needs to identify spare capacity, assure its quality, and then coordinate its best possible use based on the complexity of the needs of patients.
To do this would require developing a better understanding of the configuration of healthcare provision in each region as well as data patients flows between hospitals for tumour-specific treatment. The NHS already utilises specialist multidisciplinary cancer teams to organise individual cancer treatments within their regions. The role of these teams could be expanded to use the new information to recommend where patients should be treated according to the severity of the cancer and the complexity of the procedure.
The cancer backlog needs a strategic evidence-based plan which considers the complexities of delivering complex multidisciplinary cancer care and can match supply to demand in an equitable manner. The market-based mechanisms suggested are unlikely to be effective.”
– Dr Ajay Aggarwal, Consultant Clinical Oncologist
According to the paper, My Planned Care does not give full consideration some factors relating to cancer care. These include the complexity of patient choice, disparities in quality of care across England, and challenges in coordinating diagnosis and treatment.
The authors state that waiting times are just one of many factors influencing where patients choose to receive treatment. They write that “patients are attracted to hospitals that deliver better outcomes according to official ratings, perform a higher volume of procedures, offer more advanced technologies or have a better reputation according to local and national media”.
The scheme could also affect health inequalities. Patients choosing to travel to hospitals further away are typically younger, fitter and more affluent, resulting in some patient groups being left behind.
Geographical variation in the availability of services could also necessitate longer – or impossible – travel times for some patients. This issue could be exacerbated by patients who need to continue working or have caretaking responsibilities.