Agenda item

For the Committee to consider the development of a Cancer Prevention Plan for NCL.

Ali Malik, Managing Director, and Fanta Bojang, Programme Manager, at NHS North Central London Cancer Alliance, introduced the report on the North Central Prevention, Awareness and Screening strategy and action plan.

Ali Malik said that work had recently been carried out to examine the overarching cancer pathway and the core aims and objectives for the cancer system. At the heart of this was the early diagnosis programme, which supported the national target in the NHS Long Term Plan for 75% of people with cancer to be diagnosed at stage 1 or 2 by 2028.

Fanta Bojang explained that the strategy had initially been drafted in 2019/20 but had been delayed by the Covid-19 pandemic and redrafted in the context of the implementation of Integrated Care Boards, aligning with the cancer system aims and objectives, the Population Health and Integrated Care Strategy and the Core20PLUS5 framework on health inequalities. The focus on prevention, awareness and screening included supporting and encouraging people to present to primary care early and to take up their screening invites, a targeted lung health checks programme which was still at an early stage, and identifying people with a high risk of developing cancer through genetic testing. Prevention was part of the strategy but this was a shared priority across the health system. There was an action plan associated with the strategy and this was only a two-year plan as the future availability of resources beyond this was not known.

Ali Malik and Fanta Bojang then responded to questions from the Committee:

• Referring to the case study on page 62 of the agenda pack, Cllr White commented that this example did not necessarily reflect some of the higher risk factors such as deprivation.
• Cllr White commented that prevention was preferable to treatment, both in terms of health outcomes and cost to the NHS, and suggested that support networks to help people reduce their tobacco and alcohol consumption and better manage their weight could help. Fanta Bojang said that the prevention budget sat elsewhere, but that there were active programmes in areas such as smoking cessation across the system and that the Royal Free were piloting a Healthy Living hub initiative. Ali Malik agreed with the focus on prevention and added that managing cancer as a long-term condition through support networks could also be beneficial.
• Cllr Clarke asked about methods of early detection such as through bowel cancer testing kits or dentists advising patients about mouth cancer for example. Fanta Bojang responded that the action plan highlighted the issue of drawing upon healthcare professionals across the whole system. Ali Malik added that a Primary Care Cancer Strategy had also been developed which addressed education and awareness across primary care staff, picking up on possible signs of cancer.
• Cllr James expressed concerns about low rates of cervical cancer screening. Fanta Bojang agreed that there was a long-standing challenge with a national decline in screening rates, though there were sometimes upticks in rates when there were national campaigns or publicity on these issues. There had also been several extended access programmes locally, offering appointments outside of core GP practice hours which could improve participation rates in some groups. A research study had been carried out on allowing people to collect their own samples to increase rates with people who found the testing in a clinic to be too invasive - the results of this study were being awaited.
• Asked by Cllr James about HPV immunisation, Fanta Bojang confirmed that this was included as an objective in the strategy as there were varying participation rates across NCL. The need for two doses was believed to be a factor in this and so this was being changed to one dose from September to improve uptake. Awareness was also a factor as some parents were not aware that immunisation was being offered and could be accessed via primary care. Cllr Connor suggested that an initiative aimed at university students could help to improve uptake and Fanta Bojang agreed to consider this as part of the action plan. (ACTION) Chris Caldwell added that there was some ongoing local work about school-age vaccination and so the suggestion could combined into this work, particularly in terms of the communications.
• Cllr Milne requested further explanation about the graph on page 64 of the agenda pack relating to the two week wait referrals for suspected cancer in each of the NCL boroughs, noting that Islington had the lowest rate of referrals and higher mortality outcomes. Ali Malik confirmed that those with the higher rates of referrals on the graph would be expected to lead to better outcomes but that there were also other factors to consider in each borough, such as population age. Richard Dale, Director of Performance and Transformation at NCL ICB added that simply increasing the number of two-week referrals would not necessarily improve quality of care and that it would add to pressure on the system, so it was necessary to find the balance between referring as many people as possible appropriately and getting those people seen as soon as possible.
• Cllr Cohen (who was not present at the meeting) had submitted a written question asking why the two-week referral rates were higher in Enfield and Barnet compared to the other NCL boroughs. Ali Malik responded that the age profile of the boroughs would explain the majority of the variation. He noted that some GP practices referred for certain types of cancer more than others and so they wanted to better understand the data on this and the reasons for this. He added that the downside of a high rate of referrals was the impact on operational performance, noting that NCL performed comparatively poorly on the 62-day cancer standard, mainly because of the high volume of referrals received by hospitals. Cllr Connor requested that the data of variation in GP referrals be provided to the Committee. Ali Malik explained that a visual tool was in the process of being developed that would display detection and referral rates as a heat map which could be shared with the Committee when it was available. (ACTION)
• Asked by Cllr Connor about the progress towards the target for 75% of people with cancer to be diagnosed at stage 1 or 2 by 2028, Fanta Bojang said that the current rate was around 20% below the target.
• Cllr Connor queried what action would be taken to engage with the difficult to reach parts of the population on prevention and awareness. Fanta Bojang said that work with the voluntary sector and community/faith groups could be effective as they were engaging with people at community level. Resources and training was provided to the sector to help spread messaging on cancer screening. She added that they were open to suggestions about how else this approach could be improved. Ali Malik added that there was data about which demographic groups tended to respond least to traditional methods of approach and could therefore benefit from a more targeted approach. Chris Caldwell commented that a lot had been learned through the Covid vaccination programme in terms of what to do and not to do in reaching certain groups and this could be applied to other public health interventions such as this, though there were finite resources which had be carefully targeted to maximise value. Cllr Connor suggested that it would be useful for the Committee to understand whether these interventions had succeeded in changing outcomes. (ACTION)
• Cllr Clarke asked about the backlog in cancer referrals caused by the Covid-19 pandemic. Ali Malik explained that the backlog was measured by the number of patients waiting for longer than 62 days for their treatment to start following a GP referral. The proportion of referrals waiting longer than this had reduced from around 20% to under 10% so this was trending in the right direction with more still to do. Richard Dale added that overall referral rates from GPs had now returned to pre-pandemic levels.