CIVITAS REPORT: NHS Cancer Plan largely ineffective?
Improvements have been registered in avoidable mortality from cancer and circulatory disease, the biggest ‘killers’ in England & Wales, but real cause for concern remains:
- The decline in avoidable deaths from cancer has been less steep since 1999, at odds with trends since 1979. The effectiveness of NHS Cancer Plan must be questioned.
- Avoidable mortality rates from circulatory disease remain far above most European countries of comparable development.
The improvements
The report, ‘Just how well are we?’ released today by the independent think-tank Civitas, uses the concept of avoidable mortality* as a proxy for health system performance. It shows real progress has been registered in England & Wales:
- Between 1999 and 2005 in England & Wales, avoidable mortality from cancer has fallen by 15.0% (p.9) and avoidable mortality from circulatory disease has fallen by 34.0% (p.10).
- The performance also compares quite favourably with other European countries. Avoidable mortality from cancer decreased by 13.5% between 1999 and 2004 in England & Wales**, compared with an eleven-country average decrease of 9.9%; and avoidable mortality from circulatory disease decreased by 29.4%, compared with an average decrease of 26.2% (p.17).
But two particular areas of concern spring out and warrant urgent attention:
Falling rates of improvement in cancer
- The rate at which avoidable deaths from cancer have been falling has slowed year-on-year from 1999-2005 (p.9):
Table 2 (adapted). CANCER CONSIDERED AMENABLE TO HEALTH CARE:
Age-standardised mortality rates in England & Wales (per 100,000 population, 0-74 years, unless stated)
- Crucially, this bucks the long-term trend. The five-year period 1999-2004 is the only period since 1979 in which the rate of decrease in avoidable cancer mortality has been less than in the previous one (p.16):
Table 9 (adapted). CANCER CONSIDERED AMENABLE TO HEALTH CARE:
Age-standardised mortality rates in England & Wales (per 100,000 population, 0-74 years, unless stated)
- Such trends can be ill-afforded, not least because the cancer mortality rate in England and Wales is still higher – at 25.5 per 100,000 population in 2004 – than countries at a similar level of economic development, e.g. France (24.5), Austria (24.6), Sweden (22.0) and Finland (18.9) (p.17).
Table 10. CANCER CONSIDERED AMENABLE TO HEALTH CARE:
Age-standardised mortality rates 0-74 years (per 100,000 population)
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The trend is particularly alarming given the intense focus cancer care has received since the introduction of the NHS Cancer Plan in 2000, which provided for some £2.0 billion in extra funding for cancer services and promised the fastest improvement in cancer care anywhere in Europe. Its impact has apparently been negligible at best.
Mortality rates from circulatory disease remain very high
- Despite improvements, avoidable mortality rates from circulatory disease remain much higher in England and Wales than in other countries. In 2004, the mortality rate in England and Wales was 72.58 deaths per 100,000 in the population, compared with the Germany (63.81), Netherlands (47.41) and France (31.69)(p.17):
Table 11. CIRCULATORY DISEASE AMENABLE TO HEALTHCARE:
Age-standardised mortality rates 0-74 years (per 100,000 population)
- This is a huge problem. A part of this statistic is surely explained by higher rates of incidence in England & Wales(p.19), but to put the end result in context: in 2004, around 18,400 more people died in England & Wales from circulatory disease, where death is considered avoidable, than in France (the best performer) despite the population being some 10 million less (p.18).
- Assuming France – the best performing country – made no improvements in the coming years, and the NHS continued to improve at the same rate as between 1999-2004, it would still take until about 2019 for us to catch up(p.21).
The report’s author, James Gubb, said:
- “While it’s true that the NHS should be given a degree of extra leeway for having to deal with higher incidence of circulatory disease, it’s also true we’re still a long way behind. The flat-lining of improvement in preventable deaths from cancer is also a serious concern.
- “Crucially, this study isolates conditions where it’s reasonable to expect death to be averted even after the onset of disease. With top quality health care for all in England & Wales, there’s no intrinsic reason why mortality rates shouldn’t fall to the levels of the best international performers.
- “One can always wonder, for a start, what could have been achieved if the increase in expenditure hadn’t been front-loaded, and the NHS had been able to use the extra cash anywhere near efficiently. Would avoidable mortality then have fallen even further?”
The report, ‘Just how well are we?’, can be found below.
*Avoidable mortality is based on the concept that deaths from certain conditions should not occur in the presence of timely and effective health care. Generally speaking, causes of death are included in this measure if they are either amenable to treatment and medical care and/or amenable to secondary prevention through early detection. For all, with the best health care, it is reasonable to expect death to be averted even after the condition has developed.
Separating amenable conditions from others – where death might not be averted even with the best medical care – helps to isolate the effectiveness of a health system from other factors out of its control, such as diet and lifestyle, which may lead to the natural end of someone’s life.
**The year 2004 is the latest year for which international data is available.
For more information ring:
James Gubb, Director, Civitas Health Unit: 020 7799 6677 (w), 07930 243570 (m)
Just how well are we?