Oncology Central

Cancer care in the UK: we need to be more ambitious

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Ciaran Devane speaks to Francesca Lake, Managing Commissioning Editor of Future Oncology & Emily Brown, Editor of Oncology Central. Ciarán Devane is the outgoing Chief Executive of Macmillan Cancer Support. Educated at University College Dublin (Ireland), he holds a degree in biochemical engineering. He also holds a Master’s degree in international policy from George Washington University (DC, USA). Ciarán is a trustee of the National Council for Voluntary Organisations and sits on the advisory council of the Cicely Saunders Institute, an institute for research into palliative care (London, UK). Since January 2012, he has also been a Non-Executive Director of the National Health Service England.

Can you tell us a little about your career, and what led you to where you are today?

I’m a chemical engineer, and joined what was Imperial Chemical Industries on Teesside (UK) back in 1984, 30 years ago! I spent a number of years there, which was great training, as it invested a lot in its people. After about 9 years I moved on to management consulting at Gemini Consulting in London (UK). This background formed a good combination – you have this very development-focused, multinational early career, and then time at Gemini, at the time one of the great management consulting practices doing work across a whole bunch of industries. You couldn’t help but learn.

The thing that switched me to Macmillan was that my wife died unexpectedly of cancer, and (for the wrong reason) I had the freedom to do what I wanted to do. I ended up going to Washington (DC, USA) and doing a Master’s in international policy. When I came back from that, a headhunter for Macmillan rang. If I’d been asked a couple of years before, I would have said I never wanted to hear the word cancer again, but because time had moved on, and it was Macmillan after all, 7 interviews and 2.5 hours with a psychologist later, they let me in the door.

Can you tell our international readers a little about Macmillan?

We’re just over 100 years old, set up by a 24-year-old civil servant who watched his father die of cancer; if you can imagine what that would have been like in 1911, it wasn’t a pretty thing. He was a classic kind of young entrepreneur-founder. There’s a lovely phrase about him that he was “often more strident than wise”. He was two things; he was a bit of a campaigner – early on he was saying that smoking and tobacco were causes of cancer – and he was also a bit of a ‘data geek’, as we’d call him today. He went to every death register in the UK and showed that there was more cancer than there used to be, incidence correlated with age, the older the population the more that you see, and that as you conquer infectious diseases, then you are going to see more of it again. For much of the history of Macmillan we have been campaigning and raising awareness; we’ve been involved in the hospice movement, helping set up 22 hospices as independent charities.

The main points of the charity are two things. The first is improving care within the National Health Service (NHS; UK) – that is where the famous Macmillan Nurse comes in, supporting people through diagnosis, treatment and, sadly for most cancer patients, through dying. The second is making sure that the patient gets the care and support they need, not just for their cancer but for the life that comes with that; that got us into things like providing good information so that people make good decisions, ensuring financial support is in place, and in place early on.

Ultimately, Macmillan is about innovation in cancer treatment, care and support, but also being on the side of the patient and what the patient says are the priorities for them. This isn’t necessarily the same as the clinical view. That’s part of our role – to make sure there is a focus on the priorities of the individual and not just the measurable clinical outcome.

Do you find there are many challenges to your work in that respect?

Yes! Like most western health systems we have a very medical model and we don’t balance the clinical, commissioning and the patient views the right way. People tend to have binary conversations; the patient organizations talk to the clinicians, the clinicians talk to the commissioners, and the commissioners talk to the patient organizations, but you don’t often get the three points of view in the room at the same time, having the debate. The commissioner will be trying to find out what is the most cost-effective treatment at the same time as the clinician is saying “what is the best possible from the professional point of view?” and the patient is saying “yes, that is all very well but at the same time I have this problem.”

This is something we tend not to do in developed-world health systems. We don’t balance the medical model with the social model of healthcare. Until we get to that mode of operating, with all three viewpoints in the room, we’re always likely to be either making decisions too focused on the money, or not enough focused on the medical or social, or not focused enough on the human being and their family. Really, it is about holding all three views in your head at the same time, which is a challenge!

You also act on the advisory council of the Cicely Saunders Institute. What does this role entail?

Cicely Saunders was the founder of the hospice movement, very much involved in using great palliative care and hospices, seen as part of our duty as a society, and a large part of the hospice movement in the UK and internationally. King’s Hospital (London, UK) has set up a palliative care research institute with Irene Higginson running it, which we at Macmillan helped set up. It’s really a place where good research into care can take place. What’s nice about the advisory council of the institute is it does try to take that view from around the whole person, the medical view and the commissioning view as well. It is really a world-leading center in research and it is something that we at Macmillan are very pleased to have made a major contribution to.

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