In the following article, Jason Pawluk, Managing Director of West Yorkshire and Harrogate Cancer Alliance, examines the National Cancer Plan.
The National Cancer Plan has been broadly welcomed as creating a positive vision where cancer outcomes do not continue to lag international comparators. A bold, but necessary, statement of intent.
Meaningful commitments on prevention, tackling rarer cancers, promoting expanded access to research and development, and creating parity of focus between adult and children and young people’s cancers were all key steps forward. These were not fully seen before in earlier national cancer plans.
England’s 19 Cancer Alliances[1], being mature collaborative bodies which draw partners together to transform outcomes, are rightly being championed for wider functions to support delivery.
Our system in West Yorkshire and Harrogate, covers 2.6 million people, and continues to proudly stand as quality-led, clinically directed, and locally informed, in our response to this plan[2].
Our values of being honest, courageous, and kind, help us to galvanise partners into an end-to-end effort across the pathway. We deliver transformation in partnership not just because policy says that they must, but also because our partners see the point of coming together to do so.
At our conference on June 2, Innovation through Collaboration[3], we will explore further what this means in practice, sharing award winning ventures in the fields of cancer workforce, living with and beyond cancer, and tackling health inequalities which impact on access.
At macro-level, Alliances must accept that they operate in a challenging fiscal and social policy context where cancer is now the leading cause of death in England[4].
Alliances must continue to drive home the point for strategic commissioners that cancer will become their most pressing population health challenge, both in acute terms, but also increasingly as a condition for chronic management. Faced with inexorable and unavoidable growth in cost and demand, the ability of commissioners and regional teams to use the expertise of Alliances and the wider cancer community to redesign care and avoid cancer becoming siloed will be pivotal to success.
In terms of meeting the challenge and delivering the vision, the experience of Denmark is often cited, sometimes without elaboration or nuance. Whilst the remainder of this article does not claim to include any references to buildings made from Lego, it does attempt to bridge some of this gap!
First, the consistent influence delivered by the Danish Cancer Society[5] is a clarion call for English Cancer Alliances and policy leaders in meeting the cancer challenge. Bi-partisan political focus drawn to the issues of cancer incidence, treatment, survival, and necessary commissioning and leadership functions over the past 25 years have been central to progress[6]. Here, the learnings of strategic patience, stepping in to the space, and staying the course, all feel real and clear to England.
Second, in Denmark, the average general practitioner (GP) to patient ratio is approximately one GP for every 1,600 patients[7]. In England the figure is closer to one to every 2,200-2,300[8]. Higher list sizes predominate in more deprived communities[9]. Investment in cancer beds[10] and administrative spend is also lower,[11] as is the ratio of employed nursing staff per capita. “Left shift” must translate into sustained and targeted investment, including in the primary care cancer workforce and funding model.
Third, Danish cancer patients broadly concur with local experience surveys[12] that expedited referral, diagnosis, and treatment, and short waiting time for all investigations, including the very first ones often prescribed by the GP, are all key to patient experience[13]. Primary care referral, including for gut feeling or non-site-specific cases, remain the central entry route on to cancer pathways.
Delayed access, review, and onward referral arrangements both diminish confidence and act as a barrier – perceived or otherwise – to timely management of symptomatic patients[14]. Therefore, future policy focusses on referral quality, advice and guidance, effective safety netting, and protocolised management, must account both for under and over referral being a concurrent challenge in a parallel context.
Fourth, Denmark’s Cancer Patient Pathways (CPPs) draw comparison with England’s best practice timed pathways and planned initiatives[15] to oversee delivery such as cancer manuals. Seasoned cancer health professionals may hear feint calls of older initiatives such as cancer peer review[16] and the Map of Medicine[17]. Eight in 10 cancer patients in Denmark are included in CCPs and greater patient choice exists. Approximately eight in 10 in scope cases are seen within the target (and quicker) timeframes[18]. Whilst better than our current performance on access[19], this is not radically different in all cases. In response, the access challenge must remain a key, but crucially also balanced, driver of policy. We must also be prepared to have the difficult conversation around how we are measuring access and not overcomplicate access arrangements themselves in attempts to deliver the key target for patients.
Fifth, upon referral, Denmark has 6.6 PET-CT scanners per million people, leading other wealthy countries in the Organisation for Economic Co-operation and Development (OECD). The UK trails behind with 0.8 per million[20]. Radiation investment per capita is also the second highest.[21] England also retains significant challenges in terms of standardising local access models and delivering a sustainable workforce, even with the welcome advent of community diagnostic centres[22] which mirrors parts of the Danish approach. A whole-system approach is key, also recognising the growing roles of genomics and wider pathology testing in cancer patient management.
Sixth, diagnostic access and times to first treatment are key contributors to the quality of patient experience and outcome. However, amongst its population of six million, some 400,000 people are living with a cancer diagnosis, where rehabilitation, counselling, and late effects initiatives are funded significantly[23]. A demographic time bomb still ticks. In England, the figure is currently close to half of the Danish population[24]. Or in sporting analogy, the same as every Premier League football ground in the country being filled more than three times over[25]. To turn the match around in the second half, the triennial review of this Plan needs to translate commitment into a consistent commissioning model for the wider cancer journey, reflecting need both before and after treatment is complete.
Finally, cancer related deaths are higher in Denmark than in England, even though cancer care costs per capita are around 30% higher, with accelerated access to emergent targeted therapeutics[26]. In both systems, screening functions remain comprehensive and expansive, if somewhat conservative. Here, useful learnings are being taken from England around the benefits of lung cancer screening[27] which has been a centrepiece of the heartening improvement in early diagnosis rates in the last eight years. The impact of tobacco control legislative policy as smoking related mortality is a key area relating to difference and will likely magnify impact in time.
This means that the case is not just for investment, but also for integrated social policy decision making and governmental action across the spectrum described in the plan. The vision must consistently guide policy action and priority setting.
This is perhaps the most important learning point of all.
References
[1] https://www.england.nhs.uk/cancer/cancer-alliances-improving-care-locally/
[2] https://canceralliance.wyhpartnership.co.uk/
[3] https://canceralliance.wyhpartnership.co.uk/latest-news/innovation-through-collaboration-cancer-alliance-conference-and-awards-announced
[4] Technical Annex, National Cancer Plan, Figure 7 – https://www.gov.uk/government/publications/national-cancer-plan-technical-annex
[5] https://www.uicc.org/membership/danish-cancer-society
[6] Jesper Fisher, discussion with Michelle Mitchell, Cancer Research UK, 2025
[7] OECD, Denmark Country profile, accessed April 2026
[8] British Medical Association and UK Office of National Statistics
[9] ibid
[10] OECD Health Statistics 2021, op cit, King’s Fund
[11] OECD Health Statistics 2022, op cit, Administrative Spend is lower in the UK health system, King’s Fund
[13] A differentiated approach to referrals from general practice to support early cancer diagnosis – the Danish three-legged strategy Br J Cancer 2015 Mar 31;112 Suppl 1:S65-9. doi: 10.1038/bjc.2015.44, citing Booji et al 2013.
[14] ibid
[15] What Denmark (and Lego) can teach us about improving cancer survival – Cancer Research UK – Cancer News
[16] https://data.parliament.uk/DepositedPapers/Files/DEP2008-1205/DEP2008-1205.pdf
[17] https://cegedimrx.co.uk/blog/what-can-replace-map-of-medicine
[18] What Denmark (and Lego) can teach us about improving cancer survival – Cancer Research UK – Cancer News
[19] https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/
[20] The secrets of the country that helped more people survive cancer – BBC News
[21] Ibid
[22] https://www.england.nhs.uk/long-read/community-diagnostic-centres/
[23] The secrets of the country that helped more people survive cancer – BBC News
[24] Technical Annex, National Cancer Plan, Cancer Registrations per year and survival
[25] https://en.wikipedia.org/wiki/List_of_Premier_League_stadiums
[26] Comparison of Cancer-Related Spending and Mortality Rates in the US vs 21 High-Income Countries – PMC, Table 1 – Characteristics
[27] https://www.nhs.uk/tests-and-treatments/lung-cancer-screening/
