Appendix 4 – Improving cancer mortality rates in Rutland
Introduction
Cancer causes around a quarter of all deaths in Rutland. Reducing premature deaths from cancer
will increase life expectancy and help to reduce health inequalities.
The term ‘cancer mortality rate’ refers to the annual numbers of deaths from cancer relative to the
size of the population. This is often expressed as the number of deaths from cancer per 100,000
population.
These mortality rates (and indeed survival rates) are dependant upon many factors including:
(1) the numbers of people who develop cancer
(2) How many new cases of cancer are detected and how quickly they are detected
(3) How effective treatment is for cancer patients
The HWBB will be interested in what the local health and social care colleagues can do in partnership
with local people and communities to reduce the burden of cancer in Rutland.
We have access to a number of sources of data that tell us how well or otherwise we are doing in
Rutland compared to national and ‘peer’ averages. Rutland is a relatively affluent place. In general
terms we should aspire to have better than average outcomes- cancer outcomes are generally worse
in areas of socio-economic deprivation due to greater levels of risk factors for cancer and later
presentation of people with cancer.
Improvements over the years mean more people are surviving cancer but cancer survival in the UK is
still some way off the best in Europe, and rates vary even across the UK. Poorer survival in the UK is
felt to be largely due to later diagnosis as a result of lower levels of awareness of cancer symptoms
and signs amongst the public and also to certain barriers to presentation and onward referral of
newly presenting cancer patients.
By diagnosing cancer at an earlier stage, and ensuring access to optimum treatment, it is hoped that
significant improvements in survival can be made
We also recognise that although cancer services have improved for everyone nationally and in
Rutland, the progress made in achieving better cancer outcomes has been uneven. We know that
inequalities between different groups of people persist: in terms of lifestyle and social risk factors,
incidence, access to services and treatment, patient experience and outcomes. This suggests there
is a need to target resources towards our most vulnerable populations to address these factors.
Please note: where data is not available for the area of Rutland, the figures for Leicestershire County
and Rutland PCT have been used instead.
Summary
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Around 200 people in Rutland are diagnosed with cancer each year and about 90 die of the
disease, accounting for almost a quarter of all deaths in the area.
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The coverage of both the cervical and breast screening programmes in the Leicestershire
County and Rutland area are significantly higher than the national average; breast screening
coverage rates are the highest in the country.
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Adults in Rutland are among the most active in the East Midlands, with a significantly higher
percentage of adults taking up physical activity than nationally.
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Overall, cancer incidence is similar to the national average. Rates are significantly lower for
lung cancer due to the lower prevalence of smoking.
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However, the female incidence rate of colorectal cancer is significantly higher than the
national average.
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Overall, mortality rates are significantly lower than the national average, particularly for
females; leading to a lower number of years of life lost due to cancer than nationally. Male
lung cancer mortality is significantly lower than the national average.
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The inequality gap in mortality rates is smaller than the national average. However, for lung
cancer mortality, rates are 60% higher in the most deprived fifth of areas than in the least
deprived fifth of areas in Rutland.
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Overall, female one and five-year relative survival rates are significantly higher than the
national average.
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Males diagnosed with prostate cancer are less likely to survive for one year after diagnosis
than they are nationally. However, interpretation of survival rates for prostate cancer is
difficult due to widespread differences in PSA testing.
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Over a third of cancer patients die at home in the Rutland area, significantly higher than the
national average.
Commissioning of cancer services
The Health and Social Care act has resulted in significant changes that will potentially impact on the
cancer pathway from prevention through to specialist treatment and end of life care from April
2013:
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Commissioning of primary preventative services i.e. related to lifestyle and socio-economic
risk factors remains to some extent a collective responsibility across health and social care
partners. However local authorities and specifically public health departments will have a
pivotal role
Commissioning of basic secondary care cancer services will become the responsibility of
Clinical Commissioning Groups
More specialist (tertiary) treatments will be commissioned by the National Commissioning
Board (NCB)
Cancer screening programmes will be commissioned and co-ordinated by the NCB with
support from Public Health England (PHE) and an ‘oversight’ role for the Director of Public
Health
Public Health England will host the National Cancer Intelligence Network whose role will be
to collect and collate data across the cancer journey, providing a common national
repository for cancer datasets and producing expert analyses to monitor patterns of cancer
care to drive improvements in cancer care and clinical outcomes
The East Midlands cancer network currently plays a pivotal role in guiding the strategic
development of cancer services across the East Midlands. Its future role is unclear
The Health and Wellbeing board will oversee the commissioning of local cancer services
(including prevention) and bring key local stakeholders together to collectively tackle cancer
in its broadest sense
There are concerns about how the strategic planning and operational delivery of cancer services will
function post April, 2013 given these shifting organisational roles and responsibilities.
Recommendations:
The HWBB is asked to:
(1) Monitor and influence cancer outcomes by retaining a clear focus across the entire pathway
from primary prevention to end of life care. In doing so the HWBB must also be assured that
co-ordination of cancer services and care both locally and regionally remains robust despite
the significant organisational changes across the system post April, 2013
(2) Facilitate and encourage partnership working across the health and social care systems to
maximise collective efforts across the whole cancer pathway
(3) Ensure that commissioners and partners target resources proportionally across the entire
pathway, from primary prevention all the way through to specialist treatment and end of life
care
(4) Ensure that resources are targeted towards our most vulnerable populations to address the
multiple factors that influence cancer mortality: from lifestyle through to access to services
and service provision
(5) Facilitate, promote and increase cancer symptom awareness amongst the public- including
ensuring that commissioners work with patients and primary care providers particularly to
improve early awareness and diagnosis of cancer
(6) Influence providers, commissioners and wider partners to ensure prompt and full access to
screening programmes
(7) Influence providers, commissioners and wider partners to ensure timely and appropriate
referral for people identified as potentially having cancer.
(8) Ensure that commissioners and providers and other partners utilise accurate and timely
cancer data as part of collective efforts to understand which cancers are killing local people
disproportionately, how well people with cancer are being treated and whether the local
situation is different from that in similar areas