A perfect storm appears on the horizon. Health systems around the world are exposed to the destabilizing force of macroeconomic headwinds. This volatility puts increasing pressure on healthcare systems to implement cost-cutting measures. However, these measures represent a short-term solution, which may not bring positive system or patient benefit in the long term.
The net result is a skeleton health service run by an exhausted and exhausted workforce. However, the unmet needs, preferences and expectations of patients continue to grow.
The challenge is that evidence-based improvements are often overshadowed by austerity measures. Providers may be forced to make trade-offs between providing seamless and efficient services that strive to improve the patient experience or offering essential services to balance the books.
Policy makers, governments and health systems of all shapes and sizes can see the challenge of delivering on the seemingly irreconcilable priorities of improving the patient experience, reducing costs and running more efficient services. However, this is not an impossible question to ask, if done right, seemingly opposing approaches can be mutually reinforcing.
All.Can is an international, non-profit, multi-stakeholder initiative focused on identifying inefficiencies in cancer treatment. All.Can recently relaunched in the UK and is currently funded by Bristol Myers Squibb (BMS). All.Can UK is a special chapter contributing to this global endeavor by focusing on connecting the dots between improved system efficiency, patient experience and health outcomes.
All.Can UK believes this is key. At a time when healthcare systems are facing significant budget cuts, there is a danger that systems may end up neglecting the patient experience in their quest to do more with less. Not only is this worse for patients, it’s a false economy. If the right support is not put in place early, as determined by patient preferences, there is an increased likelihood of clinical escalation with those patients returning to the system through an unplanned and more costly route later.
Ultimately, improving the patient experience, achieving improved clinical outcomes, and better system efficiency must be seen for what they are inherently interconnected and mutually reinforcing. Take one out of the equation and the rest will fall. Previous research commissioned by BMS has already highlighted this in the context of workforce capacity with evidence showing that when staff are stretched too far, outcomes, safety and patient experience will suffer.
Both globally and nationally, All.Can is working to pave the way forward for health systems facing these difficult dilemmas. With this in mind, All.Can UK began exploring the key role the third sector can play in supporting cancer patients and the system.
Early estimates from analysis commissioned by the group, highlighted in a report published today, suggest a conservative saving to the NHS of £40.7 million a year as a result of third sector support provided directly to patients. All services considered in the analysis were complementary to clinical interventions and helped to achieve better experience, outcomes and system efficiency in cancer care.
Of course, the caveat to this is that the third sector is under-resourced and therefore not a panacea for many of the challenges facing the healthcare system. There is therefore a need to start acting on the ambition of introducing integrated care systems by bringing together partner organizations under a broader definition of what constitutes a health system and recognizing charities as a key player in health care delivery. The UK has the chance to achieve truly integrated care with all organizations moving in the same direction for the benefit of patients. The All.Can UK report draws on evidence from the contribution of the third sector to show how improving the patient experience using holistic support can prevent further costs.* This in turn helps to make a positive contribution to reducing system inefficiencies and ultimately saves the NHS money.
The All.Can UK analysis is the first step towards establishing health economies with limited costs. In particular, it offers hope to those facing perceived trade-offs. This may include, for example, choosing between a skeleton service (which has been shown to lead to increased waiting lists and increased risk to patient safety) and the provision of holistic support interventions, which are often seen as non-essential but can help drive significant improvements and increase efficiency both for patients and for the system.
A similar project underway elsewhere in the cancer patient journey is a partnership between BMS, Macmillan Cancer Support and a range of NHS sites to develop and pilot a program of prehabilitation in non-surgical settings such as immunotherapy.
Prehabilitation is a process that helps prepare cancer patients for treatment, in effect acting as secondary prevention. This includes advice, support and intervention to improve diet and lifestyle, increase physical activity and provide psychological support for mental well-being. Typically, prehabilitation can help by reducing the length of hospital stay and the risk of emergency readmission.
With cancer services under increasing pressure, these pilots aim to demonstrate the capacity and service utilization benefits of large-scale adoption of prehabilitation. By freeing up staff time and capacity by reducing unplanned demand, more resources are made available to initiate the care process for new patients waiting to start treatment.
Prehabilitation could also help make better use of the waiting time between receiving a cancer diagnosis and starting treatment, supporting patients to wait well, while highlighting the point of patient interaction with professional support and care in the urgent and time-limited cancer pathways. Early trials are also exploring the delivery of prehabilitation via digital healthcare, which may further support the wider pathway optimization process.
If successful, the expansion of these pilots will be an opportunity to significantly improve patients’ ability to receive and benefit from innovative cancer treatments by preparing them for their treatment journey, while delivering significant savings to the NHS.
The examples highlighted above and in the new All.Can UKs report show that improving the experience of cancer patients and providing more effective care does not have to be an either/or scenario.
All.Can UK will now seek the views of health system and policy experts to help develop a clear way forward that will come full circle for health systems aiming to do the apparently impossible.
To read the new All.Can UKs report and find out more about the group, including how to get in touch, click here.*
Date of preparation: November 2023
Job number: ONC-GB-2300480
*Please note that clicking this link will take you to the All.Can website sponsored by BMS.
 NHS England (2017). Improving people’s own health and care: Statutory guidance for clinical commissioning groups and NHS England. Available at: https://vvv.england.nhs.uk/vp-content/uploads/2017/04/ppp-involving-people-health-care-guidance.pdf (accessed November 2023).
 Doyle C., et al. (2013). A systematic review of the evidence on the links between patient experience and clinical safety and efficacy. Available at: https://vvv.ncbi.nlm.nih.gov/pmc/articles/PMC3549241/ (accessed November 2023).
 BMS (2022). Transforming cancer outcomes in the UK: clearing the backlog, improving capacity and building services for tomorrow. Available at: https://www.bms.com/gb/about-us/transforming-cancer-outcomes-in-the-uk-clearing-the-backlog-improving-capacity-and-building-services-for-tomorrow .html (accessed November 2023).
 All.Can ordered data, available on file.
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