The upcoming national cancer plan – and lessons from Denmark – with Michelle Mitchell and Jesper Fisker

Cancer Research UK (2025). Cancer in the UK – Overview 2025. 

European Commission/OECD (2025). Country Cancer Profile – Denmark 2025. 

Cancer Research UK (2024). Leading on Cancer: the case for dedicated strategy and leadership across the UK. 

BBC (2025). What the NHS can learn from the European country that helped more people survive cancer. 

OUP (2022). Successful Public Policy in the Nordic Countries – Cancer Treatment Policy in Denmark.

Jennifer Dixon:

Cancer. Half of us will be given a diagnosis at some point and half of us will survive for 10 years or more. Cancer is still the biggest killer in the UK and in Denmark. 25 years ago, Denmark's record on cancer care was poor, as was ours. In both, survival rates were among the lowest compared to other rich countries. But since then, big improvements and Denmark's performance has raced ahead of ours despite them having the same GDP, more or less spent on health (although they spend a little bit more per head than we do). In the UK, we've made good progress too. But as we await this autumn's forthcoming NHS cancer plan, what should be in it and what can we learn from Denmark, and indeed our previous four cancer plans?

Well, with me to discuss all this, I'm very pleased to welcome Michelle Mitchell, who is the Chief Executive of Cancer Research UK. And Jesper Fisker, who is the Chief Executive of the Danish Cancer Society and who was key in shaping the reforms in Denmark. Welcome both. 

So tell us what's happening at the moment with cancer. What are the main trends and why is the incidence rising?

Michelle Mitchell:

We've seen in cancer survival or mortality huge progress. Cancer survival has doubled since the 1970s in the UK and cancer death rates have fallen by around 22%. And the improvement, Jennifer, down to prevention, diagnosis and treatment driven by research, government action and the role of the NHS and individuals. But worryingly in the UK, research shows that progress on cancer survival has slowed down in recent years and is at risk of stalling. Our data shows that survival across all cancer combined has increased nearly three times faster in the early 2000s compared to the early 2010s. So pressure on cancer services in the UK resulting in longer waits for diagnosis and treatment could be contributing to this slowdown in progress.

Jennifer Dixon:

Jesper, what about the situation in Denmark?

Jesper Fisker:

I think we've been improving heavily, starting out really poorly 25 years ago and the improvement in due to a lot of different efforts working together, national cancer plans, centralised standard services, huge investments, patients interest, research, lots of different initiatives consistently taking place. So the background for our improvement over the past 25 years has been all these different components knit closely together and being consistent with the shared political ambition between centrally placed things, politicians, for about 25 years. We lack exactly the same challenges nowadays. Our prevention is not good enough, too many smokers, especially early diagnosis, is also an area where we should improve. So we might have the same problem about the survival rate and we need to work more especially on prevention since we're heavily smoking in Denmark compared to most other countries.

Jennifer Dixon:

And how much of the trend is due to the ageing of the population and whether or not treatment is effective in older people?

Michelle Mitchell:

Really good point. I mean, when we look at cancer incidence, the number of people getting cancer is increasing and that's largely due to a growing and ageing population. Our projection suggests there'll be around 2.2 million new cancer cases diagnosed in the UK between 2024 and 2029. That's over 20% more cases in the previous 5 years. And this will result in increased demand on health services, which sadly we know are already struggling.

Jennifer Dixon:

And is that true also in Denmark?

Jesper Fisker:

Yeah, exactly the same. That we have an ageing population and since the incidence of cancer is rising by age, we have an increase in the cancer incidence. But I think it's fair to say that the reason why we are on the pressure is not the quality of the treatment. That's been improving over the years constantly and still is improving. We have a lot of demographics showing that the pressure will be increasing. That's why you have the entire health system trying to focus on primary health, especially health care provision out of the hospitals and close connection with the hospitals. Since we've been focusing too much on the hospital system for the past 25 years, one of the developments where we are trying to adjust our health care system to the future patients, which more in the future it will be elderly patients with more than one disease. And when you have cancer patients, they will be likely to have more than one additional disease on top of their cancer.

Jennifer Dixon:

Now you mentioned I think, Jesper, a 25 year coordinated plan for cancer, which we would love I think would we not, Michelle, I'll come to you in a minute. Why did policymakers really get more serious about this and chart a coordinated path for 25 years?

Jesper Fisker:

Going back 25 years, Danish society at that time, patients were dying on the waiting lists. All our statistics were really, really bad compared to our Scandinavian countries, which we used to compare ourselves with. We were by far those who were doing the worst. So we had a situation where it was just unacceptable for welfare state or welfare society as a Danish society to have a cancer area that was not living up to the standards that patients, politicians, clinicians, the press, the patient organisations, would ask for and be anticipating. So we had this moment of truth where something had to be done. This was just really, really unacceptable. And you had stories in the press almost every day on specific cancer patient histories where people were really treated badly. So we had this moment of truth, almost this burning platform or whatever you call it, that everybody agreed on the fact that we needed to do something.

And I think that point of departure was important because that built the alliance of another 25 years of commitment, which had in it five different national cancer plans. We just had the last one about half a year ago and we've had them since 20 years ago when the first one came. And we've had them successfully over the years tackling the most important issues for cancer. And I think coming from this really bad situation, the agreement between key actors that this is unacceptable and the commitment of doing something about it and this consistent commitment, massive investments as well, has been the background of our improvement.

Jennifer Dixon:

And how did you mobilise this alliance to maintain the political focus, including the investment, I'm presuming, over that long period of time? Was there something more than we would see here in the UK in terms of stable policymaking?

Jesper Fisker:

One of the reasons behind this was the poor point of departure, to be honest, that we started out really poorly. So someone needed to do something about it. And we had different politicians from different political parties agreeing on the fact that you needed to have this long-term view on the improvement of cancer. But I also think that the role played by the Cancer Society, and I wasn't in the Cancer Society at that time, they were constantly paying attention to do we move forward? How are the latest figures? How does that develop? Was the last plan implemented as it should be? What about the next plan? Are we on top of this? Are we looking for the next plan? So there's been a driving factor from the Cancer Society as well. And I think that driving factor has been conducted closely together with the clinicians, which I think has been key factor as well.

Jennifer Dixon:

Michelle, how does that compare to the last 25 years in your experience of cancer reform?

Michelle Mitchell:

We had the first national cancer plan in the early 2000s led by the Blair government and Professor Mike Richards, and I think that was an incredibly important moment, followed several years later by a refreshed cancer plan. And what we're able to take from that is significant improvements can be made when there's strong direction, clarity of policy focus, investment and reform and guiding coalition of the willing, who not only make change happen for patients, but ensure there's accountability, transparency on performance in the midterm.

So I think we should look back to our history, not to copy it entirely, but to say this is a challenge that shouldn't daunt us. This is a challenge where we have succeeded before in improving cancer survival significantly, and we will succeed again in the future learning from countries like Denmark. So I think it's a time of choice really, but a time of opportunity to push ahead with a really ambitious national cancer plan for England. And that's what we've been calling for. Providing the evidence, the research, the economic analysis and supporting government to think about exactly that at this moment. Because when we look at Denmark, I mean, research from the International Cancer Benchmarking Partnership really does show that over two decades ago, England and Denmark had similar cancer survival. Denmark has surged ahead and now owns many comparable countries. And we've heard from Jesper there, a direct and a dedicated plan, political will, financial backing, all can make a real difference to cancer outcomes.

Jennifer Dixon:

And just on one aspect of that, Denmark is a publicly largely funded system, which is largely organised locally. We are a pretty nationalised system, aren't we? Even though it's a bit of a federation. Both of you. What do you have to learn for the last 25 years on the extent to which National Grip is needed versus local autonomy? What's the right balance here?

Jesper Fisker:

Well, it's difficult to say what the right balance is, that we've been struggling with that almost forever. But I think we've been centralising our system over the past 25 years in health, especially when it comes to the specialised treatment. Heavily centralised wards taking responsibility, for instance, certain cancers, we've only got a third of those wards today as compared to 25 years ago. Even though we have a regional system, it's still heavily dependent on the national agreements between the regions and the national government every year. So it's highly centralised, it's a bit like the English system. And I think probably what we are looking into now is more focused on developing actually the primary health care system outside the hospital system and the cross-connection between the two because that's going to be our next challenge, especially looking at an elderly population with different characteristics on their diseases, more chronic diseases for instance.

Jennifer Dixon:

And Michelle, do you have any reflections now on the right balance?

Michelle Mitchell:

Well, I think getting the policy direction clear and sending a message from national leadership is absolutely critical. So focus on cutting waiting times, much more ambitious targets on earlier diagnosis, making sure prevention is at the heart of the plan. Having research and innovation funded with academic clinical trials being a critical part of the plan is all really important. And of course, access to treatment. So no matter where you live, you should have the best possible treatment outlying a national plan with money with the right kit and the right people. That's the direction. But the cancer alliances have also played a critical part in the delivery of cancer plans locally and I think it's essential that they continue to be funded, continue to have a significant role in the implementation of a new cancer plan, and we wouldn't want to see them diminished at all.

Jesper Fisker:

If I can just add something here, because I think the national driving force behind the positive development at Denmark has been absolutely crucial. The national cancer plans, they're all driven by ministers and parliament. All funds used by the hospital system comes from the national level on individual contracts every year between the regions and the national government. Introducing all the patient rights. Like for instance, the right to get treated within a certain number of days. That comes from the national level as well. Whenever a national cancer plan has been introduced, it's always been on the national initiative sites or the patient organisations. I think the regional practical responsibility for the health care system or the hospital system is important for the everyday functioning of the hospital system. But I think from the driving force behind the development in the cancer area has mainly been on a national level.

Michelle Mitchell:

We've talked about the need for clear direction and priorities, but what worked in the 2000s was also significant investment. I would argue that the government really doesn't have a big hope of meeting any future ambitions unless it's serious about sustained funding alongside really clear and specific targets. And that has been one of the messages from Denmark as well. I think the other is this sense of accountability, what we've seen in other countries around the world is it's important to hold leaders to account for delivering on cancer. It should be an opportunity to think differently about how we can build accountability and governance around any future cancer plans. So charitable sector, people with lived experience, leaders in the NHS, scientists, innovators, commercial sector, outlying A; the contribution they can have in building a movement for improving cancer outcomes. But also really focusing not just on the 10 years but the three years ahead of us, making sure we're clear on what's the progress on the plan, are we heading in the right direction? Are the priorities that are outlined really meeting the expectations of cancer patients.

And Jasper, that was important for you, wasn't it? That three-year cycle, building a coalition of the willing and focus on accountability.

Jesper Fisker:

Totally agree. And I think if we should be criticised in one area, I think our follow-up of the national cancer plans has not been solid enough. So I would recommend that you become even better at that. I mean, actually following up on the plan and the implementing of the plans, we've been a little bit too loose in that perspective I think. But the main thing is that if you have this coalition of the [foreign language 00:14:57], it is possible. I think 25 years ago and I was at the National Board of Health at that time, we were not really searching that this was possible because there was this atmosphere of we're really performing poorly, are we good enough to change that development? I think maybe the most important message is that if you really want it, if you're really able to build this quality, if you're really able to have this consistency over 25 years with the different components and the development, it is possible to change it dramatically.

Jennifer Dixon:

You've both mentioned the key aspects of reforms that are needed to improve. Michelle, you had a rollcall earlier. You had research and development investment, diagnostics, research and development, diagnostics and related kit, hospital care, drug treatment, primary care, are some of the ingredients. So those are the main ones.

Michelle Mitchell:

What has to be in this plan is a commitment by the government to meet cancer waiting time targets by the end of this parliament and provide the investment and reform needed to achieve this. Screening also makes a big difference. We talked about earlier diagnosis, reducing the number of lives lost to cancer. So a clear measurable target for diagnosing more cancers early will be vital. But here's a practical way, lung screening is a proven way of saving lives you could help to tackle, and really stark inequalities created by tobacco. We estimate that at 50% uptake around 1,500 lung cancer deaths could be avoided annually in England with a wider economic benefit of just under a billion per year.

So the plan must include a commitment to the full rollout of lung screening as well. And as I said, the importance of research innovation in clinical trials, all key components of an improving cancer survival, which is what we all want. We all want more precious time with our loved ones and we should look to Denmark and all around the world where countries are doing better than us and say, we will succeed in this area. We've got the plan, we've got the know-how, we've got the people, so let's come together and really make this a turning point for cancer in England and the UK.

Jesper Fisker:

This is the political decision. Do we want to have a better cancer treatment? It is possible, you have the strongest health care system in the world potentially. We've always looked up to the NHS in the entire world of health. I think it is possible. I think we need to do some new things as well. Tobacco is the main killer here as well. We need to get rid of tobacco and we can do whatever we can do to do that. That's good because it's, as I say, the main killer within cancer. But also, I mean, screening programmes, even though we've got better participation rates in screening programmes in Denmark than you have in England, I think we are falling down a little bit. So we need to work on screening, modern screening, risk-based screening. So that's another really important thing to work with. So we've got lots of challenges ahead, but in a Danish context, it's still conducted within this framework agreement and making the next move forward within cancer

Jennifer Dixon:

And given the stark inequalities of cancer incidents and survival actually, how far upstream are you going, Jesper, in terms of primary prevention? I mean, you mentioned smoking and obviously obesity is another big one, but are there other candidates that you think are carcinogenic given the increase in incidence of cancer that you've got your eyes on?

Jesper Fisker:

Strengthening the primary health care system is really important for us at the moment. Trying to sort of turn the entire health care system from being a hospitalised-based, almost a sickness system without not a health system to sort of change that into a more dynamic interacting between the primary health and secondary health system. And that includes focus on inequality to develop the role of the GPs in our health care sector. That's really important. We have a strong GP sector, but we've not made the best of it. Focus on inequality is really important as well. And then early diagnosis, as we were mentioning before. We are still detecting cancer too late. If we should, improve our improved survival rates even more.

Michelle Mitchell:

It's interesting, Jesper that you talk about smoking in Denmark as well. The prevalence of risk factors like smoking and alcohol still high in Danish population is here in the UK. I mean, one area that the UK government has really pressed ahead with and needs huge congratulations for is the Tobacco and Vapes Bill. Genuinely a world-leading piece of legislation.

Jesper Fisker:

Really impressive and envious, a little bit envious as well.

Michelle Mitchell:

My son who's 16 won't ever be able to legally buy tobacco products. Hugely important when that legislation is passed because it potentially sets a precedent for around the world. And it's important to remember, cancer death rates are nearly 50% higher in the most deprived areas compared to the least deprived areas in the UK. This equates from just under 30,000 extra cancer deaths per year, about 78 deaths every single day. And smoking remains the single biggest contributor. Rates are three times higher in the most deprived areas.

So when we talk about prevention, we still must keep her resolute focus on smoking and great to see the legislation coming through. We want to see properly funded smoking cessation services and of course action, a targeted focus in some of the most deprived communities where we're seeing the highest rates of cancer deaths and deprivation really matters in cancer. People often don't think of cancer being heavily influenced by deprivation, but it absolutely is. So we will see targeted action in those areas, in the country where cancer survival is lowest, diagnosis is often latest and people are diagnosed in A&E.

Jennifer Dixon:

So you're both very clear and have set out what should be in the plan and the investment to back it. That's for sure. I can imagine a whole lot of people in the health service and outside in the alliances that you mentioned, Jesper, saying, yes, yes, yes, we agree with all of this. And yet in the past, while there is progress, it may not be as fast as we would like. So Jesper, were at one point permanent section as I understand in the equivalent of the Ministry of Health or Department of Health we have here. What kind of blend of leavers or motivators did you craft around this plan to nudge people towards doing it? You mentioned targets already, you mentioned accountability, investment. What about the other things like regulation or indeed payment incentives or other consentives?

Jesper Fisker:

I think it's a weak point in Denmark. Traditionally and historically, we haven't been really good at structural initiatives, if you could call it that within prevention in general. But smoking in particular, we've been really reluctant raising prices. For instance, we've been late movers when it came to hiding through tobacco packages being dull and grey. We are lacking behind, as you were mentioning your passing regulations on the generation ban. France just put out some really heavy advance on the use of tobacco in public areas. Holland has been good at that. And distribution part of the issue as well, so we haven't traditionally been really good at those more national based initiatives within smoking and prevention in general. And we've been constantly working with the politicians. They're improving a little bit in this recent national cancer plan, Cancer Plan V. There really are some significant preventive issues as well, which is really, really good. So hopefully they're moving in the right direction. We can please say that when we put out polls and things like that, the Danish population is ready for decisions, main empowerment on banning tobacco and growing even further than other countries are.

Jennifer Dixon:

Now, Michelle, let's turn to the cancer plan itself. We've referred to it, it's forthcoming, imminent, we hope. What are the kind of pitfalls you think the UK government should avoid in the upcoming plan and what kind of tests are you using to assess whether the cancer plan is going to be a good one?

Michelle Mitchell:

I suppose the pitfalls will be the opposite of what international evidence tells you works. So I think it would be a mistake to not set clear direction and priorities. It would be a mistake to think you can transform cancer outcomes in a generation without any new investment. I think it would be a mistake if you have weak accountability and fail to build a coalition of the willing who put a generational effort into changing and improving lives. We'll be using some tests really built on strong research and evidence, the ambition around early diagnosis, whether the government commit to long screening and get a full rollout by 2030. Whether they've made a commitment to meeting cancer waiting times by the end of this parliament and whether there's a real focus on research and innovation to ensure that not only is there more support for clinical trials, but that staff get protected time to carry out important research in their daily responsibilities.

So my advice would be, this is an opportunity for a turning point for cancer. We've been successful before, we can be successful again. And the key components are well evidenced internationally. And there's a whole community of people, charities like Cancer Research UK, leaders in the NHS, top research and innovators, the public at large and cancer patients who want to work with government to ensure that England, at least in this instance, is world leading not world lagging. And we shouldn't be fearful about our ambition or ability to deliver. I feel very confident we can. When the Secretary of State is considering the detail of the cancer proposals, he listens to a range of people and organisations and looks at evidence from around the world of what works.

Jennifer Dixon:

And my last question then is what kinds of things really excite you, perhaps looking forward to 2040 even? What are you looking forwards to seeing and hopeful for?

Jesper Fisker:

Digital development is going to change our health care system dramatically. Not just the 2040 or '50 perspective, but just in a relatively few years I think our health care system will be changed because we can do new things that goes to treatment, but even more on our own as patients. We can monitor our health in a totally different way. We can actually produce treatment in people's homes like home treatment on cancer for instance, which is already developing. So I think AI, the digital development is probably going to change the health care system more than we can ever imagine. And I think looking back, just going maybe five or 10 years ahead, I think we will be looking back and say, wow, we didn't see that coming. You need to take into account that that poses some really positive possibilities in development. Personalised medicine is just one area of cancer treatment in the future. Prevention would be more personalised.

So this personalization, digitalization role of AI and other digital developments I think is going to extremely important. We're at the beginning of this. I think what's so crucial about this development is that you actually, you take it on, you see that this is necessary to be a lot better in that area than we are today. In Denmark, we have really a shortage of personnel and that is going to develop to be a huge problem in the future, 10, 15, 20 years, and digital development, AI is a part of that solution. So I think it's fair to say that this area would probably be crucial for the development of the health care system.

Michelle Mitchell:

I believe within that timeframe, we will be able to spend more time with our loved ones. And that's because today, thanks to decades worth of very generous support and research, we are in the golden age of cancer research. And that's going to be propelled by advances in technology, data, and science, which will create not just a much deeper understanding of cancer, how we prevent, diagnose and treat it, but I'm convinced it's going to transform cancer care as well already.

When we look at personalised and combination treatments, we know there won't be one single approach that will work for every cancer type or every individual, but we're going to be researching ways to combine different treatments together for the very, very best effects and quality of life. We're also seeing huge advances in whole area of cancer research, exciting developments in immunotherapy. Also, recently you would've read the headlines about the possibilities, potential of the cancer vaccines, both to prevent and possibly treat cancer. Training our immune system to seek out the earliest signs of cancer. Developing and stopping it in its tracks could make a huge difference for some of those really difficult to treat cancers a great time of opportunity. And I would say on the policy and legislative front, the fact that the UK government has committed to enacting the Tobacco and Vapes Bill will be vital to preventing more cancers caused by smoking. Yes, we want more smoking cessation services, targeted media campaigns, but that bold step on legislation will help create a smoke-free generation for the future.

Jennifer Dixon:

So I hear you got some insights. For me, I heard you need a very clear plan. The key elements that they outlined, strong national direction and accountability investment, of course, stability of purpose over time, not just a two-year plan, but hopefully a 15-year one at least. Strong alliances in the cancer community, which can also keep policy makers honest and on track. And also I thought there was significant hope there, not just for the future, but also in recognising the progress we've made undoubtedly in the past, and also the bravery of the government to go ahead with the Tobacco and Vapes Bill.

Thank you very much again to Michelle and Jesper for their insights today. Join us next month when we will be turning to making progress and health with artificial intelligence and we'll be interviewing two distinguished American guests on what's going on over there and what we can learn from it. Meantime, many thanks to Leo and Sean at the Health Foundation, to Paddy and his team at Malt Productions. And it's goodbye from me, Jennifer Dixon.