Cancer Outcomes in the UK

Earl Howe Excerpts

Tuesday 21st April 2026 Grand Committee

[Earl Howe (Con)]

My Lords, I declare my interest as an honorary fellow of the Royal College of Physicians. If I have learned one thing during my time in the House of Lords, it is that any pronouncement emanating from the lips of the noble Lord, Lord Patel, should be listened to with the utmost care and attention. I therefore say at the outset that his analysis of where we stand as a country in our ability to diagnose and treat cancer in all its forms can surely not be bettered. We have since heard some excellent speeches from around the Room, which have usefully developed the messages that the noble Lord, Lord Patel, so capably articulated.

Our starting point, as all others have said, must be the Government’s recently published national cancer plan, which I for one found an inspiring read. I very much welcome the ambitions set out in it, particularly because they are not only outcome-based but based on outcomes that are in many cases pretty challenging to achieve. That has to be the right approach, but every challenging target carries with it an implicit invitation to the wider world to hold the system to account for its delivery. With the cancer plan, that is not entirely a straightforward matter.

The ambitions in the plan are, quite rightly, many. They cover not only the desired ends but the means. We can measure success, or the lack of it, in the traditional way, by reference to the waiting time standards, and those are extremely important, but when we look at some of the other boxes that the plan sets out to tick—for example, quality of life improvements; reducing regional inequalities, which the noble Lord, Lord Patel, emphasised; reducing inequalities for children and young people; as well as such things as fostering a whole-society approach to prevention—we begin to see how many areas there are to be monitored and for which credible metrics will need to be devised.

I was glad to see that the Government have thought about this in the area of diagnostics, which will of course be crucial to the success of the plan. The four new key metrics that have been designed to track improvements in early-stage cancer diagnosis are excellent but, as the plan sets out, there is a whole set of measures on which such improvements will themselves depend: for instance, the expansion and wider take-up of screening; the enhancing of the NHS app and getting people to use it; and the general speeding up of the patient pathway.

As the plan concedes, quite refreshingly, a lot will also depend on basic improvements in administrative efficiency across the NHS, which, I am afraid, has been a depressingly difficult nut to crack in a number of areas. Let us not forget that put together, these ambitions, if they are to be met to their fullest degree, will require a focus on that rather elusive concept, championed so effectively by the noble Lord, Lord Darzi, in the last Labour Government, of quality—quality of process, quality of care and quality of outcomes. So it is good news that the National Quality Board will be taking it as part of its remit to adopt what the plan calls a

“more rigorous and evidence-based approach to quality improvement”.

Much will also depend, though, on local commissioners and providers monitoring their own performance and being swift to pounce on system weaknesses where these appear. For that, they will need the tools to do the job, chief among which are data and modern IT to deliver it. There are NHS trusts that are still dependent on slow and outdated software which, from a manager’s point of view, makes life extremely frustrating. The chief executive of the King’s Fund, Sarah Woolnough, was right to point out that many hospitals still cannot share imaging or pathology results in a timely way for that very reason. I hope the Government have this problem within their sights: it is important.

After all the consultation that took place on the cancer plan, which was considerable, it was not surprising to see that criticism of the plan from around the health community has been almost entirely of a constructive nature. The questions that have been posed have largely centred on the obvious challenges around delivery.

The King’s Fund, Cancer Research UK, the Royal College of Physicians and the London School of Hygiene & Tropical Medicine, to take just four examples, have expressed very similar anxieties, many but not all of which can be placed under the broad heading of “resources”.

The main anxiety, which I share, and which is shared by other noble Lords today, is that of human resources. There is a section of the cancer plan which addresses workforce issues, but it frankly put me off by being overly political, which was not at all necessary. The Government seem determined to rubbish the long-term workforce plan published by the previous Government, but I remind the Minister that it was a plan that, like the cancer plan, was widely consulted upon and widely welcomed when it came out. It most certainly did not focus simply on expanding workforce numbers but went into detail on where in the system more staff were needed, along with their skills and training, including continuing professional development. It also talked about clinical leadership, which I did not see much referred to in the cancer plan.

The elephant in the room is the demand curve. Doing better on prevention and early diagnosis will take cost out of the system, but with the best will in the world, the effects will not be felt for a number of years. Meanwhile, the demand for cancer services will continue to rise, as it has done inexorably over recent years. As noble Lords have said, our cancer outcomes as a country are nothing like as good as they should be. Nevertheless, and contrary to what you might think reading the cancer plan, the Government of which I was a member made considerable progress in cancer care and treatment. Mortality in many of the major cancers fell significantly, despite rising incidence.

However, as we know, the NHS struggled to meet its targets because of constraints around capacity. I very much welcome the sections of the plan that address capacity in diagnostics, one of the main areas in which the NHS has struggled, but at the same time, we are asked to accept that training and better equipment will in due course reduce the need to recruit staff. I am willing to believe that, but only up to a point. The efficiencies that the Government rightly want to see cannot and will not be delivered overnight or in short order.

Further down the patient pathway, we will need more clinical and medical oncologists, and we will need to train them. The Government have already pledged to create several thousand more specialty training places, but following the recent breakdown of negotiations with the BMA, we now learn that these places will not be on offer until next year at the earliest, which is not a very encouraging start to the cancer plan’s workforce ambitions.

Therefore, delivery at pace is a concern. That applies to another area: research and innovation. We have made progress in the setting up time for clinical trials, as others have said, and I welcome the Government’s plan for a clinical trials accelerator. The expansion of genomic science and facilities such as the UK Biobank have enabled major advances over the past 15 years, but again, it is about people. Our homegrown pipeline of research graduates is simply not going to be sufficient for our national needs. For the UK to remain competitive, we have to keep attracting international talent into our laboratories, and the costs associated with this are far higher than in other developed countries.

Of course, that is only part of the challenge. To have an effect on cancer outcomes—which is in the end what matters—the fruits of research need to be accessed by NHS patients. The National Healthtech Access Programme is a welcome concept, but to achieve success, it must spread proven new technologies beyond the bounds of our major teaching hospitals and somehow overcome the ingrained resistance towards innovation on the part of the wider NHS. How will it do that?

The National Cancer Plan for England is an excellent document, but because of that, it is a complex jigsaw with many pieces. For the Government’s ambitions around cancer to be achieved, all those jigsaw pieces must be put in the right places and seamlessly joined up. For that to happen, the system as a whole must contain the right accountability mechanisms to ensure delivery over a period of years. I look forward to seeing how those delivery and accountability mechanisms take shape over the course of the coming months.