Is the UK’s new all-in-one health condition strategy another policy misstep?

February 27, 2023
by John R. Fischer, Senior Reporter
In 2019, the U.K. passed an ambitious strategy bringing together providers and patients to voice their needs with the NHS and help formulate a nationwide strategy for addressing healthcare over the next decade. The Long Term Plan objectives included improving equal access to care, distributing funds more efficiently among different communities, expanding and better supporting the medical workforce, and diagnosing diseases like cancer earlier to increase survival.

In the years leading up to the Long Term Plan, international cancer benchmarks showed the U.K. had a lot of catching up to do. For example, five-year lung and colon cancer survival in England was 15% and 58.9%, respectively, from 2010 to 2014; the same place Australia was 10 years before. And Denmark, which had some of the poorest and lowest survival rate outcomes in 1995, along with Britain, had one of the highest rates for most cancers by 2014, due to a consistent cancer policy.

But four years into the Long Term Plan (and one global pandemic later), the NHS is under immense pressure. Staffers are going on strike, burned out from inadequate working conditions and undercompensated, while patients are waiting months, sometimes years, to receive care.

A controversial change of plans
So on January 24, 2023, Steve Barclay, the U.K.’s secretary of state for health and social care, announced that the Long Term Plan would be scrapped and replaced with a new plan called the Major Conditions Strategy. Described as a “generic chronic disease plan,” the proposal rolls the Long Term Plan into one strategy that addresses all major health conditions together, namely cancer, cardiovascular disease, chronic respiratory disease, dementia, mental health, and musculoskeletal disorders.

The new plan has been met with condemnation from providers and medical experts who argue that it risks deterring affordable, equal, and quality access to care, while failing to account for each condition’s unique complexities, which are already strained by declining funding and COVID-19.

In an op-ed published in the The BMJ, Richard Sullivan, professor of cancer and global health and director of the Institute for Cancer Policy at King’s College London, and Dr. Ajay Aggarwal, a consultant clinical oncologist and associate professor at the London School of Hygiene and Tropical Medicine, described the new plan as “catastrophic.”

“On one hand, you do need some sort of integrating strategy,” Sullivan told HCB News. “On the other hand, all high-income countries, most middle-income countries, and most scholars in this area have agreed for years that with cancer and other specific conditions you need to have a specific stand-alone plan that integrates with general health plans. The reason is the sheer complexity of the services and systems delivering better outcomes.”

Advocates of the Major Conditions Strategy argue that many conditions, including cancer, share common risk factors and challenges that may be better addressed together. Whereas the Long Term Plan addressed diseases in individual silos, the new strategy could facilitate care and research for associated comorbidities at the same time.

What went wrong?
The Long Term Plan was not meeting desired targets, and a large contributing factor was the pandemic, which pushed back an already severe backlog of waiting times for cancer treatment, and further diminished its declining healthcare workforce with one in ten NHS posts still vacant, as of September 2022.

As of November 2022, only 61% of patients in England started treatment within 62 days of an urgent suspected cancer referral, far below the 85% target the government set. And its goal of diagnosing 75% of cancers early by 2028 was deemed too ambitious by Cancer Research UK, the world’s largest charity and independent cancer research organization, which said it would have required around 100,000 extra patients by stage 1 or 2 each year in England.

The unsatisfactory performance of the Long Term Plan opened the door to alternative plans aimed toward addressing an increasingly dire, post-pandemic national healthcare climate.

“Our workforce model needs to adapt, reflecting that the NHS is caring for patients with increasingly complex needs and with multiple long-term conditions,” said Barclay. “We need greater emphasis on generalist medical skills to complement existing deep specialist expertise in the NHS, supporting clinical professionals to heal with whole person care.”

New plan stirs skepticism
Sullivan and Aggarwal maintain that an effective national healthcare strategy must address post-pandemic backlogs of sicker patients with more advanced cancers, brought on by delays in diagnostic screenings and high vacancy rates in cancer-specific workforce personnel.

“It’s not like diabetes or heart disease, which are really an emergent property of general health systems, said Sullivan. “The drugs and therapeutics we use are highly unique and specialized; the surgery is complex and highly specialized; radiotherapy is only used in cancer; and we now have multiple, complex regimens and treatment pathways for culling cancer, but of course it’s thousands of different diseases we’re essentially treating.”

One concern among cancer research and care workers is that bundling cancer with other conditions will take attention away from addressing care gaps. According to Cancer Research UK, a new plan must have measures for diagnosing cancer early, facilitating care quicker, and preventing cancer in the first place.

“The strategy will need to address the persistent failure to hit cancer targets — with clear metrics for progress and success, with clarity on who is accountable for delivery and performance, and ideally independent oversight of that performance,” wrote the organization’s chief executive, Michelle Mitchell in an op-ed.

Is a new plan the answer?
In addition to delaying diagnosis and yielding inferior patient outcomes, Sullivan worries the Major Conditions Strategy will cause Britain to clash with internationally accepted benchmarks followed by the rest of the world, as well as public opinion and common business sense for delivering affordable, better care.

“You need to have a really good handle on the tariffs or the economics of delivering your cancer care,” he said. “You can’t achieve that with a generic plan.”

Cancer diagnoses in the U.K. are expected to rise one-third by 2040, bringing the number of new cases annually to over half a million, according to Cancer Research UK. In their op-ed, Sullivan and Aggarwal argue that a generic chronic disease strategy sends the message that the government does not consider cancer a political priority and is not willing to address the complexity and escalating costs associated with it.

“There doesn’t seem to be a reasonable explanation from everyone, except to say that there seems to be this idea that they wanted the problems in cancer to go away, and to make them go away, what you do is hide them in a generic plan,” said Sullivan. “That’s the only explanation that we can come up with that seems to be heuristically accurate.”