A new clinical consensus statement aims to tackle the postcode lottery in specialist cancer care by setting out the core services that cancer patients should be able to access locally and the specialist expertise that should be available through regional networks when they become acutely unwell.
Published today by the Royal College of Physicians (RCP) and Macmillan Cancer Support, the clinical consensus statement on acute and supportive oncology sets out what health systems should provide to reduce significant variation across the NHS and ensure patients can access timely specialist support wherever they live.
The consensus sets out a model in which core acute and supportive oncology services are available locally, backed by regional networks providing access to specialist and highly specialised expertise where it cannot reasonably be provided in every hospital.
Access to acute and supportive oncology currently varies across the country, including differences in opening hours, integration with urgent and emergency care, and access to specialist supportive services.
Evidence suggests people living with cancer are more than twice as likely to use primary care as those without cancer, almost 50% more likely to attend emergency departments and three times more likely to be admitted to hospital[1]. The latest figures from Macmillan show that one in five people with cancer in the UK (20%) have received care or treatment from an acute oncology nurse, rising to 23% of those with a disability and 24% of those with risk factors for suspected frailty, showing acute oncology plays a key role in many people’s cancer care[2].
However, access to acute and supportive oncology currently varies across the country, including differences in opening hours, integration with urgent and emergency care, and access to specialist supportive services. This variation can lead to fragmented care, delays in specialist input, avoidable emergency department attendance or hospital admission, and differences in patients’ experience of care depending on where they live. A 2022 UK audit found over 18% of acute cancer-related admissions were admitted to a unit without an Acute Oncology Service (AOS), highlighting the need for greater availability or improved signposting to existing services, where clinically appropriate and geographically feasible[3].
The clinical consensus statement recommends that:
- acute oncology provision should be available 24 hours a day, 7 days a week, with continuous specialist oversight and access to consultant expertise 7 days a week
- every acute hospital caring for people with cancer should have access to a core acute oncology service and a 24/7 advice line
- regional networks should provide specialist advice and services that cannot reasonably be delivered in every hospital, including expertise in complex treatment toxicities and cancer emergencies
- cancer, acute, primary, community and palliative care services should work more closely together to prevent avoidable deterioration and enable people to receive care closer to home where clinically appropriate
- acute oncology should be integrated with relevant NHS services, including NHS 111, primary care and unplanned care, so there is ‘no wrong front door’ for patients, and effective two-way flow between services.
- The statement comes as more people are living longer with and beyond cancer, while an ageing population and rising levels of frailty and multiple long-term health conditions mean many patients now require increasingly complex care across different parts of the health service.
- People living with cancer are more than twice as likely to use primary care as those without cancer, almost 50% more likely to attend emergency departments and three times more likely to be admitted to hospital.
Dr Hilary Williams, RCP clinical vice president and consultant medical oncologist, said:
‘Cancer patients should not be left with worse access to specialist support simply because of where they live or when they become unwell.
‘At the moment, provision is too inconsistent. This consensus sets out a clearer national approach – strong local services, backed by regional expertise and rapid access to specialist advice.
‘If we get that right, we can intervene earlier, prevent avoidable deterioration and keep more patients out of hospital when admission is not necessary.’
Dr Ashling Lillis, national clinical advisor at Macmillan Cancer Support and acute medicine consultant, said:
‘A cancer diagnosis is the biggest challenge many people will ever face, and for some it can be made even tougher often because of who they are or where they live. It shouldn’t be that way.
‘This consensus statement is a call to challenge the variation in access to cancer care. It sets out a shared ambition for acute and supportive cancer services to provide expertise across entire regions, ensuring that high-quality cancer care is available wherever a person accesses unplanned care.
‘We are calling for specialist cancer services to support an entire region, so that wherever a patient accesses unplanned care, whether through an emergency department, urgent care service or another healthcare setting, clinicians can quickly access the expert advice and support they need.
‘By connecting local and specialist services more effectively, we can provide more consistent, equitable care, improve patient outcomes and ensure people receive the right support whenever and wherever people turn in their time of need.’
The consensus statement responds to commitments in the National Cancer Plan for England to expand and improve acute and supportive oncology services.
It also supports the ambitions of the 10 Year Health Plan for England to provide more care in community settings, make greater use of prevention and provide more joined-up care.
The statement was developed by the Acute and Supportive Oncology Collaborative, jointly led by the RCP and Macmillan Cancer Support, with representation from organisations and clinicians working across cancer, acute medicine, emergency medicine, palliative care, geriatric medicine and other specialties.