What is it about your job that you feel would surprise the public?
Most people don’t realise that Macmillan is almost entirely (98%) funded by the British public, and as a charity we invest significantly in the NHS and social care. In fact, 44 per cent of the specialist cancer nurse workforce in England has ‘Macmillan’ in their job title. Starting our fundraising from zero each year means it’s essential we keep the voices of all those professionals and people living with cancer at the centre of our work.
What’s been the biggest change you’ve seen since you started working in the NHS and social care?
Without a doubt the biggest changes I have seen in my career are in the technical and digital space. Technological advancements have allowed health care professionals to communicate more easily, have improved diagnostics, treatments and offered significant efficiencies, but they haven’t realised their full potential. Patients are embracing technology in their daily lives, so it’s essential we keep them at the heart of future developments if the NHS is to truly succeed in its digital transformation.
If you could make one change to the NHS and social care over the next 10 years, what would it be?
We have been talking for years about integration, and there’s a consensus and strong evidence that integrated care is good for the patient and good for the health care system. But we need to stop talking about it and really make it happen. We need an honest and open discussion about the role social care plays in a truly joined-up service offer, as successive governments have failed to tackle the issue.
Change from the top
If you could give Matt Hancock one piece of advice, what would it be?
If he wants to leave a legacy, he needs to address the workforce crisis. The laudable aims of the NHS Long Term Plan, which included earlier diagnosis and better chances of survival for people living with cancer, will only be remotely realistic with a costed plan to grow and sustain the health and care workforce. A fully funded, ambitious NHS People Plan could be the opportunity to futureproof the NHS for the growing numbers and different needs of people who use it.
What do you wish people at the top of the NHS understood?
I am sure people do understand, but it gets forgotten in the noise that people with health conditions also have lives. Growing numbers of people now live with cancer as a long-term condition, and we need to take into account the ways this impacts on them not just physically, but also emotionally, practically and financially. We must find a way for the NHS to look at the whole person, not just the cancer patient.
Policy in practice
What policy have you seen successfully implemented, and why did it work?
Ten years ago, through a combination of strong evidence and an effective lobbying and communications strategy, Macmillan successfully campaigned for all people with cancer to receive prescriptions free of charge. At the time it was a much-needed and radical change: it’s no exaggeration to say that the financial impact of a cancer diagnosis can be crippling. We’ve built on this success by working with banks and financial institutions to support people to manage their money following a diagnosis.
What policy have you seen fail, or not be as successful as first intended?
Policies fail when incentives are not, or cannot be, aligned to action. An example would be the 62-day wait time from diagnosis of cancer to starting treatment. Despite the best efforts of hard-working health care professionals, this target has now been breached for 40 months in a row. Measuring the target through individual trusts isn’t addressing the significant gaps in the diagnostic and cancer workforce at a system level, which are contributing to the problem.
What policy and/or change in behaviour are you currently trying to implement, and how’s it going?
We have a clear model of what personalised care means if you’re a person living with cancer. Now, building on the promises made in the Long Term Plan, we want to see this become a reality. We’re currently working with the NHS England cancer and personalised care teams to build on the important progress so far, and ensure that all people are offered a holistic needs assessment at the point of diagnosis – and after as needed – so they get the care that meets their individual needs.
The NHS is under pressure because...
The NHS is a national treasure, but as a result it can be a victim of its own success. People expect everything from it, despite its increasingly constrained resources. The pressure is unrelenting and staff stretch themselves as far as possible to meet demand, but the NHS still doesn’t have all the basics in place to do its job. It needs sufficient funding, enough staff (including specialised doctors and nurses), good professional development opportunities and digital capabilities to make it fit for the future.
Dr Fran Woodard is the Executive Director of Policy and Impact at Macmillan Cancer Support.