Broken promises on clinical networks

This is NHS Check report no 5 originally published by Labour’s Shadow Health Team in  December 2012

Revealed:

• The government has broken its promise to protect funding for cancer networks and heart and stroke networks – vital groups of clinicians and other experts that drive improvements in patient care
• Cancer networks say their budgets have been cut by a quarter, and their staff by a fifth since 2009/10
• Heart and stroke networks say their budgets have been cut by 12% and their staff by 16%
• Funding for both types of networks has fallen year on year under the government, and is now 21% lower than when Labour left office
• These cuts mean vital work to improve patient care for cancer and cardiac disease – Britain’s biggest killers – is being scaled back or dropped altogether
• The government’s NHS reorganisation has caused huge uncertainty and confusion about the future of clinical networks, and risks losing vital local specialist expertise

KEY FINDINGS:

• A Freedom of Information survey by Labour reveals severe cuts to budgets and staff in cancer, stroke and heart disease networks, despite repeated reassurances from the Government that funding for clinical networks has been protected.

• Labour received responses from 86% of all Cancer Networks and 82% of Cardiac Networks in England

Cuts to budgets:

• Responses from Cancer Networks show that their funding has been cut by 26% between 2009/10 and 2012/13

• Stroke and Heart (Cardiac) Network budgets have been cut by 12% in the same period.

Cuts to staffing levels:

• Cancer Networks have lost at least 72 members of staff – 20% of their workforce – since 2009/10

• Cardiac Networks have lost at least 38 members of staff –16% of their workforce since 2009/10

 

Cuts, chaos and confusion

Funding cuts combined with the Government’s massive NHS reorganisation have caused huge uncertainty and confusion about the future of clinical networks.

Cancer and Heart and Stroke Networks were supported by regional Strategic Health Authorities (SHAs). They received funding from a number of sources including both core and specific project funding from the Department of Health, funding from SHAs and Primary Care Trusts (PCTs), and charities like Macmillan Cancer Support.

SHAs and PCTs were abolished under the Health and Social Care Act 2012. Networks will now be hosted centrally by the new NHS Commissioning Board. Cancer and Cardiac Networks are being merged to cover larger geographical areas and with networks for other medical conditions.

Networks say they are unclear both about their own future and how the new structures will work. This lack of clarity has had a considerable impact on their work:

• Uncertainty as to what will happen after March 2013 has resulted in Networks reducing the number of existing and future projects and initiatives.

• Many have not replaced leaving members of staff due to their unsure future.

• Networks are very concerned that they will have fewer staff to cover wider geographical areas, reducing the effectiveness of their work and risking the loss of vital local specialist expertise.

• At least one network was forced to decline additional grants from charities as this would have required them to make commitments into 2013/14, which they were not in a position to make

GOVERNMENT’S BROKEN PROMISES

‘The cancer networks funding is guaranteed during the course of 2011-12. There is not a gap, because from April 2012 onwards the NHS commissioning board will take up its responsibilities.’

Andrew Lansley, then Secretary of State for Health, Second Reading of the Health and Social Care Bill, 31^st January 2011[1]

‘Cancer networks are here to stay and their budget has been protected. They are extremely important’[2]

Jeremy Hunt, Secretary of State for Health, Health Questions, 27^th November 2012.

‘The budget through which the clinical networks are funded is increasing (… ) those clinical networks are extremely important and will continue.’[3]

Jeremy Hunt, Secretary of State for Health, debate on the NHS Commissioning Board Mandate, 13^th November 2012.

Labour has repeatedly warned about reductions to clinical networks and how such cuts might harm the crucial work that these networks do:

Liz Kendall: “Funding [for clinical networks] is crucial. In response to a parliamentary question on 21 May this year, the Minister stated that strategic health authorities will be given £18.5 million to fund cancer networks in 2012-13, just as in the previous two years. Page 6 of the recent document from the Department of Health, “Progress Update on the Design of the NHSCB” states:

“Around £10 million of the costs of supporting Networks and Senates are expected to count against running costs.”

(…) Will the Minister say whether the £10 million referred to in the document about the future functioning of the NHS Commissioning Board covers all networks, or cancer networks alone? That is a real concern for people who work in cancer networks and are already worried about the future.

Paul Burstow MP: “(…) On funding cancer networks, my right hon. Friend the Secretary of State has made the position clear. We have provided funding for the remaining year for which the Department is responsible. Indicative figures have been set out. A review is going on of clinical networks and how they are governed. That will ultimately determine precisely how much resource is allocated. There is no final figure at this stage.”

Westminster Hall debate on cancer treatments, 19^th June 2012

Liz Kendall: “Cancer networks have played a crucial role in improving patient care, including by earlier diagnosis. The former Health Secretary promised this House that their funding would be guaranteed in 2011, but the South East London Cancer Network now says its budget was cut by 40% between 2009 and 2011. This year, it has been slashed by a further 55% and its staff have been cut from 15 to eight. Will the Minister now admit that her Government have cut funding for vital front-line cancer experts and have broken their explicit promises on cancer care?

Anna Soubry: My information is that any 40% reduction is a result of cuts in administration—and that, if I may say so, seems the right way to go about things. This Government are determined to make sure that when we make cuts of that nature, they are not actually cuts.”

Health Questions, 23^rd October 2012

Liz Kendall: “The reality is that the Government are ripping away the foundations of better cancer care. The former Health Secretary made a clear promise from the Dispatch Box to protect cancer network funding, but the NHS South East London and greater midlands cancer networks both say that their budgets and staff have been slashed. The NHS medical director, Sir Bruce Keogh, says that cancer networks are an NHS success story, and Macmillan Cancer Support says it is nonsensical to cut their specialist expertise. Why do the Government not agree?”

Jeremy Hunt: Cancer networks are here to stay and their budget has been protected.”[4]

Health Questions, 27^th November 2012

NETWORKS REPORT – Impact of budget cuts

‘A network chemotherapy nurse post was not replaced due to the future uncertainty of the networks.’

Arden Cancer Network

‘We lost our stroke education and training lead and as a result have not run the enormous number of training sessions covering care homes, enablement, community and acute trust rehabilitation service that we have previously organised, supported and delivered.’

Bedfordshire and Hertfordshire Heart and Stroke Network

‘From April 2013 budgets and staffing will be cut further and this will mean that we will be able to achieve less than we have previously.’

Merseyside and Cheshire Heart and Stroke Network

‘There has been reduced clinical training in the Stroke work stream …. the lower funding has meant a reduction in the number of work streams that are priorities. In addition we were asked to cover two additional work streams – complex vascular surgery and interventional radiology’

North East London Cardiac and Stroke Network

‘In the new structures the network will be unable to provide the wide range of training and educational programmes we offered in previous years and our ability to continue to offer this support in terms of training/education and service improvement support will be greatly reduced in 2013/14.’

Greater Manchester Heart and Stroke Network

‘(…) we have had to decline the offer of £150,000 from Macmillan to support a Survivorship programme as this would have required commitments into 2013/14, which we were not in a position to make. Other support has stopped due to the transition of the NHS.’

Peninsula Cancer Network.

‘…. a reduction is anticipated in 2013/14 in the following functions: training and education; patient and public involvement; Information support; service improvement’ 

North of England Cardiovascular Network

‘….posts have been removed from the structure as a result of requirements to make savings.. The new structure does not have enough posts for current staff. We are all in a redeployment pool. We have been told that we should know by the 31st December as to whether or not we have a post from 31st March. With no presence in Essex from 1.4.13 for the network current skill set from current staff will be lost.’

Essex Cancer Network

‘Please also note that central project funding in previous years for stroke enabled us to support more projects than we are currently able to.’

 South London Heart and Stroke Network

‘This smaller team will also be expected to cover a much larger foot print to include Lancashire and South Cumbria.’

Greater Manchester Heart and Stroke Network

‘….we clearly have rather less capacity overall for all our areas of work.’

Coventry and Warwickshire Cancer Network

NETWORKS REPORT – Uncertainty about future

‘Uncertainty and transition has resulted in Network reducing the number of new projects and initiatives reducing the size in line with available support.’

South East London Cancer network

‘….a great many [staff] have left and I have not replaced them for financial reasons and also because of uncertainty.’

South West London Cancer Network

‘….some Network staff may ultimately be made redundant as a result of transition to new organisational structures. Details cannot be confirmed at this stage’

Central South Coast Cancer Network

‘No there will be no Essex Cardiac and Stroke Network. Networks will sit within a senate. There will be a very small support team for senates and networks under the East Anglia Local Area Team, covering the whole of the East of England and more areas. Numbers of staff are not yet clear…. Working locally with stakeholders has been key to the networks success. There is no clear direction on who will undertake the Networks work forward within Essex when it ceases at the end of March 2013.’

Essex Cardiac and Stroke Network

‘The exact operational format has not yet been released to us, but it will not be as it is now’

Surrey Heart and Stroke Network

‘The process for transferring the functions of the Network (including work responsibilities and staff) has yet to be determined.’

South London Heart and Stroke Network

“It is unclear at this point whether or not there will be an outpost in the Beds, Herts and MK region anywhere.‘

Bedfordshire and Hertfordshire Heart and Stroke Network

‘The exact format of these new structures is being developed at present, and the final architecture is due to be released in the coming weeks.’

Black Country Cardiovascular Network

‘Details of new structures and supporting arrangements have yet to be finalised.’

Coventry and Warwickshire Cardiovascular Network

‘Cardiac and stroke will be incorporated in the Cardiovascular Disease Strategic Clinical Network which will also incorporate diabetes and some renal. The design of the Strategic Clinical Network is still in development and it has yet to be established if there will be a local office base within the Peninsula.’

Peninsula Heart and Stroke Network

‘…. The final format is still to be confirmed for the area….’

Sussex Heart Network

‘The details of how this is to be organised and what arrangements will be put in place underneath this [The Clinical Network] specifically for West Yorkshire are currently under discussion’

West Yorkshire Cardiovascular Network

‘There are indications that there may be a support team based on the current LSCCN footprint which could continue some of the current cancer work streams – although there is a lack of clarity regarding what these might be.’

Lancashire and South Cumbria Cancer Network

‘Detailed arrangements for the future of the Yorkshire Cancer Network in the financial year 2013/14 remain unclear.’

Yorkshire Cancer Network

CLINICAL NETWORKS

• Clinical Networks are teams of experts who help GPs and hospitals to deliver the best outcomes for cancer, heart disease and stroke patients.

• The previous Labour Government established Cancer Networks in the 2000 Cancer Plan and Cardiac Networks in the 2007 National Stroke Strategy to drive up the quality of clinical services delivered to cancer and stroke patients and improve patients’ experience of care.

• Clinical Networks employ both clinical specialists (doctors and nurses) and project managers to put in place a range of programmes to improve cancer and cardiac care.

• Networks have played a vital role in reducing waiting times, such as the crucial maximum 2-week wait between a referral and first appointment at hospital for suspected cancer. For example one cancer network worked to reduce chest x-ray waiting times from an average of 15 to just 3 days[5].

• Networks help avoid unnecessary emergency admissions, reduce the length of time patients need to stay in hospitals, and speed up patients’ recovery for example by informing the patient of the correct dietary requirements or giving them information and exercises to perform after leaving hospital.

• Networks provide information and support to patients on how to deal with their disease during and after their treatment, for example through organising cancer survivor networks. They also work with NHS staff to deliver specialist training and educational programmes, for example on increasing awareness of symptoms to improve dearly diagnosis, on the best new drugs and treatments, and on how to manage the side effects of cancer treatment and support patients’ recovery.

• Networks also do important work on prevention, for example Cancer Networks have worked to increase breast cancer screening uptake, whilst heart and stroke networks have worked to identify those at high risk of heart disease in local communities.

ACHIEVEMENTS

Cancer, heart disease and strokes are Britain’s biggest killers, accounting for over 300,000 deaths each year – 6 in 10 of all deaths in the UK.[6]

Under the last Labour Government significant improvements were made in the treatment of heart, stroke and cancer patients. Mortality as a result of stroke and heart disease fell by over 50%, and cancer by 16%, during the 13 years Labour was in government[7]. Five year survival rates for nearly all types of cancer improved.[8] The incidence of stroke fell by 29% between 1999 and 2008 [9] and survivors’ chances of recovering without having a major disability increased[10].

Local clinical leadership, including from Cancer and Heart and Stroke Networks, has played a vital role in making these improvements. Their work is crucial to making further progress patients need in the years ahead.

‘Clinical networks, both formal and informal, are an NHS success story… For more than 10 years’ we have seen improvements brought about by networks. Combining the experience of clinicians, the input of patients and the organisational vision of NHS staff, they have supported and improved the way we deliver care in distinct areas by enhancing integration across primary, secondary and often tertiary care.’

Sir Bruce Keogh, the NHS Medical Director, 9^th Aug 2012[11]

“I value very highly the important work currently being done by cancer and cardiovascular networks which enable doctors and nurses to share insight and advice for patient treatment”

Prof Mike Richards, the government’s former cancer tsar who is now the NHS Commissioning Board’s director for reducing premature mortality, 16^th Oct 2012[12]

“Heart and stroke networks do very important work. They have made a huge contribution to the NHS. (…)  I’m very concerned about the current plans. It would be a tragedy if we started losing things we have already gained.”

            Prof Tony Rudd, the NHS’s stroke director for London, 4^th Oct 2012[13]

“Cancer networks provide a valuable service to patients. Their expertise provides support where necessary. This allows clinicians to spend more of their time on what is most important – their patient. It is essential that this expertise is retained within the NHS, yet we risk losing it.”

John Baron MP, chair of the All-Party Parliamentary Group on Cancer, 4^th Oct 2012[14]

‘Cancer networks have played a central role in driving up the quality of cancer services and ensuring that patients get the care that they deserve’

Mike Hobday, Director of Policy and Research at Macmillan Cancer Support, 26^th Jul 2012[15]

‘The opportunity to improve outcomes for cancer patients is clear, and cancer networks, established as strategic clinical networks, can and should play a significant role in helping to achieve the Government’s ambition of saving 5,000 lives every year. However, there is a danger that the progress that has been made in improving cancer outcomes and mortality in recent years could be threatened by the uncertainty in the structures of the new NHS.’

Cancer Campaigning Group, “Developing excellence in cancer networks”, February 2012[16] 

APPENDIX 1

Clinical Networks budgets for each of the last 4 financial years:

Network	2009/10	2010/11	2011/12	2012/13
Anglia Cancer Network	2435000	2006000	1986000	1833000
Arden Cancer Network	1230000	809000	686000	596900
Avon, Somerset and Wiltshire Cancer Services Network	522205	522205	511761	511761
Central South Coast Cancer Network	not provided
Dorset Cancer Network	622800	572800	567505	478505
East Midlands Cancer Network	not provided
Essex Cancer Network	data not comparable
Greater Manchester and Cheshire Cancer Network	not provided
Greater Midlands Cancer Network	not provided
Humber and Yorkshire Coast Cancer Network	data not comparable
Kent and Medway Cancer Network	543000	543000	543000	543000
Lancashire and South Cumbria Cancer Network	1947000	1612277	1327895	1104478
Merseyside and Cheshire Cancer Network	1470000	1370000	1210000	1210000
Mount Vernon Cancer Network	779467	786533	772631	771162
North Central London and West Essex Cancer Network	1163000	1163000	647000	647000
North East London Cancer Network	1199905	1212000	942000	970000
North of England Cancer Network	not provided
North Trent Cancer Network	1294000	1340000	1422000	1793000
North West London Cancer Network	1744869	1302400	964000	481718[17]
Pan Birmingham Cancer Network	1870000	1785000	1635000	1450000
Peninsula Cancer Network	2369555	2102358	2313632	1790103
South East London Cancer Network	1620000	1215838	969710	430000[18]
South West London Cancer Network	772000	1140000	977000	620000
Surrey, West Sussex and Hampshire Cancer Network	not provided
Sussex Cancer Network	1039000	1064000	1064000	1182000
Thames Valley Cancer Network	1269004	1880000	1298634.5	1428751
Three Counties Cancer Network	953210	873700	839700	795020
Yorkshire Cancer Network	1354918	1304118	824000	842000
Anglia Stroke and Heart Network	677000	645000	556000	556000
Avon, Gloucestershire, Wiltshire and Somerset Cardiac and Stroke Network	711000	711000	711000	711000
Bedfordshire, Hertfordshire and Milton Keynes Heart and Stroke Network	832797	832797	481797	481797
Birmingham, Sandwell and Solihull Cardiac and Stroke Network	not provided
Black Country Cardiovascular Network	468000	468000	378000	378000
Caridac and Stroke Networks in Lancashire and Cumbria	593957	795326	796500	873000
Coventry and Warwickshire Cardiovascular Network	379820	379820	379820	379820
Dorset Cardiac and Stroke Network	data not comparable
East Midlands Cardiovascular Disease Network	907000	877000	685000	1015000
Essex Cardiac and Stroke Network	573636	573636	483636	483636
Greater Manchester and Cheshire Cardiac and Stroke Network	690000	690000	600000	600000
Herefordshire and Worcestershire Cardiac and Stroke Network	not provided
Kent Cardiovascular Network	719134	719134	544134	544134
Mereyside and Cheshire Clinical Networks	535000	535000	535000	535000
North East Yorkshire and Humber Clinical Alliance	not provided
North Central London Cardiovascular and Stroke Network	not provided
North East London Cardiac and Stroke Network	635603	558299	468299	468299
North of England Cardiovascular Network	1115000	1115000	935000	935000
North Trent Cardiac Network	574000	874000	541000	541000
North West London Cardiovascular and Stroke Network	not provided
Peninsula Heart and Stroke Network	545746	568746	478746	478746
Shropshire and Staffordshire Heart and Stroke Network	709000	813000	468000	468000
South Central Cardiovascular Network	1319610	1252610	1046342	1046342
South East London Cardiac and Stroke Network[19]	1221877	1491877	907877	907877
South West London Cardiac and Stroke Network[20]
Surrey Heart and Stroke Network	732000	732000	732000	732000
Sussex Heart Network	505000	505000	475000	441000
West Yorkshire Cardiovascular Network	600000	600000	600000	600000
TOTAL	41244113	40341471	34304620	32654049
				-8590064
				-20.8%
CANCER TOTAL	26198933	24604226	21501469	19478398
				-6720535
				-26%
HEART AND STROKE TOTAL	15045180	15737245	12803151	13175651
				-1869529
				-12%

APPENDIX 2

How many members of staff did the network employ in each of the last 4 financial years?

Network	2009/10	2010/11	2011/12	2012/13
Anglia Cancer Network	23	23	24	28
Arden Cancer Network	11	11.95	11.3	12[21]
Avon, Somerset and Wiltshire Cancer Services Network	11	9	11	9
Central South Coast Cancer Network	11.87	15	22.44	21.24
Dorset Cancer Network	18	20	12	10
East Midlands Cancer Network	Not provided
Essex Cancer Network	8.33	8.33	6.13	4.94
Greater Manchester and Cheshire Cancer Network	not provided
Greater Midlands Cancer Network	data not comparable
Humber and Yorkshire Coast Cancer Network	data not comparable
Kent and Medway Cancer Network	30.4	23	16	12.3
Lancashire and South Cumbria Cancer Network	data not comparable
Merseyside and Cheshire Cancer Network	20	18	16	14
Mount Vernon Cancer Network	12	15	15	16
North Central London and West Essex Cancer Network	20.2	20.2	13.9	9.5
North East London Cancer Network	21.1	21.1	14.1	8.3
North of England Cancer Network	not provided
North Trent Cancer Network	10	10	10	10
North West London Cancer Network	17.7	22.1	12.2	11.2
Pan Birmingham Cancer Network	26.33	25.66	26.53	25.13
Peninsula Cancer Network	23.15	21.05	19.85	17.15
South East London Cancer Network	14.9	14.9	14.9	8.2
South West London Cancer Network	19	16	16	5
Surrey, West Sussex and Hampshire Cancer Network	not provided
Sussex Cancer Network	23	23	22	22
Thames Valley Cancer Network	11	14.6	12.2	16.4
Three Counties Cancer Network	11	11	10	9
Yorkshire Cancer Network	20.6	17.5	18.32	22.07
Anglia Stroke and Heart Network	7.2	not provided		5.1
Avon, Gloucestershire, Wiltshire and Somerset Cardiac and Stroke Network	11	11	10	8
Bedfordshire, Hertfordshire and Milton Keynes Heart and Stroke Network	5.6	5.6	4.2	3.6
Birmingham, Sandwell and Solihull Cardiac and Stroke Network	not provided
Black Country Cardiovascular Network	8	7	7	7
Caridac and Stroke Networks in Lancashire and Cumbria	13.5	14	10.3	10.4
Coventry and Warwickshire Cardiovascular Network	6	7	7	4.8
Dorset Cardiac and Stroke Network	5.23	5.32	4.43	3.03
East Midlands Cardiovascular Disease Network	12	8	6	7
Essex Cardiac and Stroke Network	9	11	8	7
Greater Manchester and Cheshire Cardiac and Stroke Network	20	20	20	20
Herefordshire and Worcestershire Cardiac and Stroke Network	Not provided
Kent Cardiovascular Network	9.8	9.8	6.8	7
Mereyside and Cheshire Clinical Networks	12.3	10.3	9.5	7.5
North East Yorkshire and Humber Clinical Alliance	not provided
North Central London Cardiovascular and Stroke Network	not provided
North East London Cardiac and Stroke Network	7.09	7.2	5.7	5.4
North of England Cardiovascular Network	13.3	18.1	16.06	17.04
North Trent Cardiac Network	17	18	18	18
North West London Cardiovascular and Stroke Network	not provided
Peninsula Heart and Stroke Network	7	7	4	4
Shropshire and Staffordshire Heart and Stroke Network	8	11	11	9
South Central Cardiovascular Network	7.9	11.1	10.1	11.1
South London Cardiac and Stroke Network	32	30	28	19
Surrey Heart and Stroke Network	10	10	10	10
Sussex Heart Network	10	10	10	10
West Yorkshire Cardiovascular Network	7	7	7	7
TOTAL	602.5	598.81	536.96	492.4
				-110.1
				-18.3%
CANCER TOTAL	363.58	360.39	323.87	291.43
				-72.15
				-20%
HEART AND STROKE TOTAL	238.92	238.42	213.09	200.97
				-37.95
				-16%