In response to the Black Lives Matter protests and observation of the impact of Covid-19 on different groups of people, the Transforming Cancer Services Team (TCST) has started to look with fresh eyes at the avoidable differences in health across London.
Cancer Inequalities Toolkit
Back in 2019, the Transforming Cancer Services Team (TCST) produced a toolkit to support the reduction of inequalities in cancer care and outcomes in London and West Essex. The toolkit covers clinical, psycho-social and patient experience dimensions and provides recommendations for all organisations planning, commissioning and delivering cancer care for Londoners.
The toolkit recommendations were based on a comprehensive needs and assets assessment which included analysis of published data, evidence of effective interventions (including relevant NICE guidance), consultation with a range of stakeholders, the views of people affected by cancer and insights drawn from these sources.
Whilst the toolkit continues to have utility going forward, TCST is starting to widen its approach and strengthen its focus on inequalities; examples are outlined below and include the approach being taken by the London Patient Advisory Group, action being taken for Personalised Cancer Care and detail of further data analysis that has been carried out.
London Patient Advisory Group
The London Patient Advisory Group (PAG) is currently working to improve the diversity of its membership so that it more readily reflects local population demographics. The Group also plans to create a statement of principles on how we conduct patient involvement.
A key change to the schedule of the Cancer Transformation and Improvement Board for London is the inclusion of a patient story at the opening of each of its board meetings and a reflection from the Chair of the London Patient Advisory Group.
TCST is also planning to review how we can support greater patient involvement in the pan-London Clinical Working Groups.
The TCST Earlier Diagnosis Programme is planning to undertake a full review of the two week wait urgent suspected referral forms in the summer of 2021. The review will include an opportunity to consider how to improve referrals rates in those population groups who experience poorer cancer outcomes due to late diagnosis.
The two week wait referral toolkit currently includes patient information to support referral. All patient information is translated into the top 12 languages used in London including those materials developed during the pandemic.
Personalised Cancer Care
Following the murder of George Floyd and Black Lives Matter protests during Summer 2020 and the increasing awareness of how COVID-19 impacted people from ethnic backgrounds, TCST’s Personalised Cancer Care (PCC) Team facilitated two workshops to review areas of concern on the personalised cancer care pathway. As a result a common aim and set of objectives were co-produced for London.
Aim – by using local data and wider research, we aim to understand a) who does and does not receive PCC interventions and b) inequities within the cancer workforce.
This is so that we know:
- What the specific issues are for patients, families and the workforce locally
- Where to prioritise changes so that nobody is disadvantaged or excluded
- Whether changes inadvertently widen inequalities.
This work will be collaborative and iterative, led through a pan London PCC & Inequalities steering group – so that we can demonstrate our progress and reprioritise as required.
The Transforming Cancer Services Team have undertaken a number of analyses on what variation there is in London across a number of protected characteristics. We’ve looked at:
- Variation in cancer incidence by ethnicity across London Variation
- How cancer referrals and treatment have recovered during the pandemic in London. Summary for referrals is available to download (powerpoint presentation) . Full dataset available at CADEAS ncin.org.uk
- Prevalence of cancer, how this varies with age, gender, ethnicity and socio-economic status (link to prevalence dashboard)
- Patient experience of cancer services and how this varies with ethnicity – National Cancer Patient Experience Inequalities Analysis 2018-2019