Our evaluation of the ‘Answer Cancer’ initiative increased cancer awareness in underserved communities and demonstrated good value for money. Our findings will inform future commissioning to improve cancer screening and healthcare equity in Greater Manchester.

Background

NHSE Greater Manchester Public Health Commissioning Directorate commissioned NHS Midlands and Lancashire’s (NHS ML) Improvement Unit to conduct an independent service evaluation of the ‘Answer Cancer’ service. This evaluation aimed to understand the service’s impact within the community setting. 

Answer Cancer is the programme name for the cancer screening engagement initiative, which seeks to raise cancer awareness and increase screening uptake for bowel, breast, and cervical cancers across Greater Manchester. 

The evaluation focused on the following key areas:​

• The overall impact of the service on improving cancer awareness.

• The overall impact of the service on increasing cancer screening uptake.

• Equity of service provision.

• Whether the service provides value for money.

A separate review was conducted to identify any duplication of activities with other similar service provisions.

Action

Our Improvement Unit employed a comprehensive approach to complete this independent service evaluation, which included both quantitative and qualitative analysis:

Quantitative Analysis:

• Desktop review of evidence against the programme’s key performance indicators (KPIs).

Qualitative Analysis:

• 18 semi-structured interviews with a wide range of stakeholders.

• 6 grant recipient site visits.

• Attendance at 2 external engagement/celebration events.

Impact

Answer Cancer was widely recognised amongst other similar service provisions across Greater Manchester as being highly valuable at engaging with the most difficult to reach communities. The independent service evaluation identified the following:

Answer Cancer independent service evaluation outcomes:

– Positive impact on cancer awareness: The service demonstrated a positive impact of on improving cancer awareness ​in the community.

– Challenges in measuring screening uptake: The overall impact of the service on increasing cancer screening uptake was difficult to ascertain due to limited access to quantifiable data. Some examples of increased uptake were noted from engagement work in Primary Care Networks (PCNs). 

– Equity of service provision: Equity of service provision was not substantiated as the service lacked

real-time data to inform their target areas and community groups.

– Value for money: The service was deemed to provide good value for money, with wide reach into deprived communities and the underserved population. 

Reporting and KPI’s

– Answer Cancer’s quarterly reporting to commissioners was unstructured and did not clearly demonstrate that it was meeting all the KPIs. The programme’s KPIs require revision to ensure that they best represent the intended outcomes of the service and are measurable for the service provider. 

Duplication of activities:

– Some evidence of duplication of activities with other similar service provisions was noted, although minimal. Answer Cancer is the only service provision with established links into the heart of the most deprived and underserved communities across Greater Manchester. Increased collaboration between the services was recommended. 

The independent evaluation findings will inform future commissioning decisions.

The work conducted through this evaluation has several direct and indirect benefits for patients. By improving cancer awareness within the community, patients are more likely to recognise symptoms early and seek medical advice, leading to earlier diagnoses and better treatment outcomes. Although measuring the direct impact on screening uptake was challenging, engagement efforts in specific areas showed promise, with increased screening leading to early detection of cancers, significantly improving survival rates and treatment success.

Evaluating and improving the equity of service provision ensures that underserved and deprived communities receive appropriate attention, helping to reduce health disparities. Ensuring the service provides value for money means that resources are used efficiently, maximising the benefits for the community and potentially allowing for expanded services or additional support initiatives. Recommendations for increased collaboration with other services help streamline efforts, reduce duplication, and ensure patients receive cohesive and comprehensive care.

Feedback

Excellent engagement from Kim and Andrew.  Both were very professional and supportive and keen to ensure the evaluation met our requirements. 

Lesley Elmes | Public Health Programme Manager | NHS England Greater Manchester

For more information

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