On 20 May 1999, in a statement to the House of Commons, Tony Blair, then Prime Minister, announced that he was hosting a high-level seminar on cancer later that day at Number 10 Downing Street. The seminar would bring together experts on cancer, from prevention to screening and treatment, including senior clinicians and researchers from the NHS, leaders from the voluntary sector and a patient representative. The statement went on:

All people, wherever they live, should have access to high-quality cancer services. This was the aim of the Calman–Hine report A policy framework for commissioning cancer services. However, when the Calman–Hine principles were adopted in 1995, no machinery to monitor progress was established. We are now rectifying that omission.

Described by Tony Blair in the Daily Mail as a crusade to ‘save 60,000 lives’, the press release following the meeting announced a number of proposals, including a new National Cancer Action Team, more challenging targets, new guidelines and the first-ever national survey of cancer patient experience. A large amount of machinery was put in place in the months following the seminar, which culminated in The NHS Cancer Plan, published in September 2000.

The NHS Cancer Plan aimed to be the first large-scale, centrally driven effort to improve services and outcomes for a specific disease in the NHS in England. At its zenith, a team of civil servants in the Department of Health was complemented by the outward-facing National Cancer Action Team, comprising NHS managers and clinicians, both led by a full-time National Cancer Director. More than 70 people worked to assemble evidence, commission research, develop and distribute data, support networks of local clinicians and managers, and monitor progress across the NHS.

Three national cancer strategies have followed, the most recent published in 2015. Cancer remains a national priority, one of only two clinical areas singled out in the Five year forward view in 2014, and there are indications that it will be prioritised in the forthcoming 10-year plan. But much of the centralised improvement infrastructure set up after 2000 was either scaled back or broken up and moved into different bodies in the wake of the 2012 Health and Social Care Act. National cancer waiting time targets remain and are still the object of political and media scrutiny, but the continuing effort expended on improving outcomes and quality of care is much less visible.

The ambitions behind the first cancer plan were bold: to raise the level of cancer services to be the ‘best in Europe’, and to build for the future ‘so that the NHS never falls behind in cancer care again.’ These ambitions have fallen short. In 2018, the CONCORD-3 study of international cancer survival published its most recent data, for 2000 to 2014. Although survival rates have improved for almost all cancers, the UK has still not caught up with other European countries – with the exception of breast cancer, where the gap has narrowed.

This report does not attempt to provide a comprehensive evaluation of the NHS Cancer Plan and its subsequent strategies between 2000 and 2015. Instead, drawing on documents, official data and oral evidence from almost 70 people involved in its creation and implementation, the report aims to provide an account of what these national strategies were designed to do and how they worked in practice. A full list of those we interviewed is available as an appendix. We have also analysed data on the progress in treatment and outcomes of cancer services in the same period, and we consider what factors might have contributed to success and failure in how cancer services developed.

Our aim is to draw out learning for the future, not least for the policymakers currently pondering how to invest (and account for) the additional resources that have been promised by the government. There are striking parallels between today and the year 2000: extra resources announced after a period of underfunding, coupled with high expectations on the part of politicians under pressure to demonstrate tangible results to patients and the voting public. In 2000, there was also an urgent sense that improvement hinged on the engagement and mobilisation of the clinical workforce, a workforce described by the NHS Cancer Plan as ‘overworked, run off their feet, and exhausted’.

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