In a perfect reality, this shouldn’t be a question that needs to be asked. Sadly, in a world filled with growing apathy, we find ourselves in a situation where people are being failed by decision–makers and are left wondering, who actually cares about cancer?
With significant pressure growing across our public services and as the strain on NI’s budget intensifies, decision–makers are at significant risk of failing an ever–growing number of people with cancer. However, cancer doesn’t wait for bureaucracy to be addressed.
The Forgotten ‘C’
In October 2020 Macmillan released the Forgotten C report in response to the impact of the Covid19 pandemic on cancer across the UK. Still, in 2024 we never envisaged that cancer care in Northern Ireland would be in such a critical condition, currently facing a myriad of challenges that severely impact outcomes and overall healthcare quality. Among the most pressing issues are cancer waiting times, treatment delays, increasing incidence rates, and inequity across the system.
How did we get here?
These issues didn’t just happen overnight, there has been a steady decline with many red flags along the way. I can think of four major reviews into health since 2001 including the much–lauded Systems Not Structures, more commonly known as the Bengoa Report. We must ask, why haven’t these reforms been implemented? Quite simply, that takes courage, investment and a steadfast view by decision–makers that the health of people in NI is more important than the results on a ballot paper come election time.
Cancer Waiting Times
Cancer waiting times in NI have been a significant concern for years. Ministerial targets for timely cancer diagnosis and treatment are continuously missed. The term ‘worst on record’ is becoming a more frequent theme with many people experiencing prolonged waits for initial consultations and subsequent treatments. The latest statistics covering January to March 2024, newly published on 9 July, show only 29.8% of people began their first treatment within the 62–day target from an urgent GP referral. The target is 95%.These continuing delays in diagnosis and initiation of treatment can drastically affect the prognosis and survival rates of people with cancer.
The underlying causes of these delays include a shortage of specialised medical staff, outdated infrastructure, and inefficiencies in patient referral pathways. Radiology and pathology services, critical for diagnosing cancer, are particularly strained, resulting in bottlenecks that delay the entire treatment process leaving people in a prolonged state of uncertainty and anxiety.
Treatment Delays
Treatment delays occur at multiple stages of the cancer care pathway, for example, after a diagnosis, people often wait several weeks to start chemotherapy, radiotherapy, or surgery. This wait can lead to cancer progression, reducing the efficacy of treatments and potentially leading to worse outcomes. It is a relentless reality facing many.
Increase in Incidence Rates
NI has seen a noticeable increase in cancer incidence rates, partly due to an ageing population and lifestyle factors such as smoking, poor diet, and lack of physical activity.
The rising incidence rates place additional pressure on an already strained healthcare system. This increase also highlights the need for enhanced public health initiatives focused on prevention and early detection. Despite efforts to promote healthier lifestyles and regular screenings, the rising incidence rates suggest that these initiatives need to be more robust and far–reaching.
Inequity in Cancer
Many cancers are more treatable when detected early. Still, delays in the system mean that patients often present with more advanced stages of cancer where treatment options are less effective. The Routes to Diagnosis 2018 – 2020 report by the NI Cancer Registry shows vast disparity in cancer types diagnosed in emergency departments with an average of 23.8% diagnosed in an ED setting. Socioeconomic factors play a significant role, with individuals from lower–income backgrounds experiencing higher mortality rates due to later stage diagnoses and fewer treatment options. Addressing these disparities requires a comprehensive and cross–departmental approach that includes improving access to healthcare services, ensuring equitable distribution of resources, and targeted interventions for high–risk populations.
Systemic Challenges and the Way Forward
The challenges facing cancer care in Northern Ireland are deeply rooted in systemic issues within the healthcare system. Addressing these challenges requires a multi–faceted approach:
- Investing in Healthcare Infrastructure
- Enhancing Workforce Capacity
- Streamlining Referral Pathways
- Strengthening Public Health Initiatives
- Addressing Health Inequities
Across the world cancer care is changing for the better but the current challenges facing cancer in NI must be addressed as a priority. Macmillan’s Future Cancer Pathway report shows the 12 factors shaping the evolution of cancer care. Fundamentally, the same access to innovation, not only for people diagnosed with cancer but also for our hard–working, dedicated workforce who deserve to be able to grow their skills in the same way as their peers globally.
The 12 factors shaping the evolution of cancer care
Conclusion
Cancer care in NI is at a critical juncture, facing significant challenges that impact outcomes. Prolonged waiting times, treatment delays, rising incidence rates, and inequity highlight the urgent need for systemic improvements. Addressing these issues requires comprehensive oversight that includes infrastructure investments, workforce enhancements, streamlined referral pathways, robust public health initiatives, and a focus on health equity. Only through such a multifaceted approach can NI hope to improve cancer care and outcomes for its population.
Our MLAs and decision–makers need to be brave and make strategic decisions – a divide and conquer approach is bad for our health. We need a firm commitment from all parties that they care about cancer and for them to reinforce that commitment with tangible actions, not just from the Minister of Health but every Minister around the Executive table.
Sarah Christie is Policy and Public Affairs Manager in Northern Ireland for Macmillan Cancer Support.
Sarah has worked in the cancer charity sector since 2019 and across the community and voluntary sector for over ten years. Sarah has a passion for addressing health inequities, welfare inequalities and improving the lives of people with cancer. Outside of work, Sarah is a trustee for Integrated AlumNI.
