Macmillan Cancer Support will prioritise access to its welfare advice for gay, transgender and ethnic minority cancer patients, and those with existing health problems, The Sunday Telegraph can reveal.
Under a new model, the charity’s benefits advisers would target ongoing financial and wellbeing support at groups it would deem most vulnerable, including LGBTQ+ people, ethnic minorities and those already unwell before their cancer diagnosis.
Staff will also be asked to prioritise those with caring responsibilities.
The new approach is set to be rolled out across Macmillan’s welfare advice service on June 1.
‘Casework’ support
For nearly two decades, its advisers have helped newly diagnosed patients secure essential benefits when cancer leaves them unable to work. Specialist staff provide short interventions, usually under 30 minutes, as well as more in-depth “casework” support.
Delivered through 120 local organisations, including Citizens Advice branches, the service supported more than 100,000
cancer patients in 2024, the latest year on record. However, costs rose to more than £20 million, which the charity said was unaffordable, while demand outstripped provision.
Macmillan said it had been under financial strain for several years. Last year, it cut a quarter of its staff and scrapped its £17m annual hardship fund, which provided £200 grants to tens of thousands of low-income
cancer patients. It also considered withdrawing its welfare advice service entirely, prompting a public backlash.
Now, as part of a cost-efficiency drive, bosses have designed a new model backed by a £16.5m annual grant, guaranteed for three years to June 2029. The “local financial and wellbeing support” service aims to improve value by contracting with fewer partner organisations and focusing more costly casework on those deemed most in need.
‘Preferred not to say’
Macmillan has reviewed NHS cancer patient experience data to identify who to prioritise. The latest survey found that those “who preferred not to say if their gender identity is the same as the sex they were registered at birth” and those “who self-reported [their ethnicity] as Mixed, Asian, Black, or not given” reported lower than average overall care experiences.
Explaining this approach in a recent article, Kate Seymour, the charity’s head of advocacy, said NHS data suggested that “many people with cancer are reporting poorer experiences across several areas of care, particularly some people who face the highest risk of health inequalities, such as those with mixed or multiple ethnicities, and those from the LGBTQ+ community.”
She added that “people with cancer in England who are Black, LGBTQ+, autistic or have other long-term health conditions or a learning disability, are all significantly less likely to get the support they need with their health and wellbeing while receiving hospital treatment.”
From June 1, advisers will also be encouraged to proactively reach out to vulnerable groups, including LGBTQ+ patients, ethnic minorities and those with pre-existing conditions.
While these groups have been identified as national priorities, Macmillan accepts that in some areas, such as rural communities, prioritising ethnic minorities may not be appropriate where populations are overwhelmingly white. Their strategy involves working with local partners to tailor priorities to local demographics.
This could include targeting farmers in rural areas and fishermen in coastal communities, who face distinct barriers to care, such as long periods at sea.
The new strategy will not affect Macmillan’s free phone line, staffed by advisers and cancer nurse specialists, which runs seven days a week from 8am to 8pm, or its other well-known services, such as Macmillan nurses working in hospitals, hospices and the community.
‘Simply wrong’
The new welfare service would also continue to target patients in the greatest financial hardship. Macmillan hopes it will reach similar numbers, if not more, by triaging more robustly and directing some patients to less intensive support, such as the phone line.
It is understood that all cancer patients will still be able to access more intensive, ongoing financial help if deemed necessary, regardless of race or sexual orientation, though advisers may not be prompted to prioritise them.
The plan has raised concern among some benefits advisers, with one whistleblower describing the changes as “simply wrong.”
On Saturday [March 21], a Macmillan social security adviser, speaking anonymously, told The Telegraph: “There is considerable angst amongst staff about having to ask patients sensitive questions about their sexuality. Such questions just feel inappropriate.”
The social security adviser added: “Macmillan’s overarching policy seems to be addressing health inequalities. Whilst this is an admirable goal which I’m sure is being pursued with the best of intentions, favouring certain groups over others because of characteristics such as the colour of their skin is simply wrong.
“Thinking of my current caseload, I have struggled to identify a single patient for whom I would not deem casework necessary.”
There is strong evidence that people with pre-existing conditions and learning disabilities could have worse cancer outcomes.
However, for ethnicity, sexual orientation and gender identity, national data on cancer incidence and mortality do not consistently support the new model.
Office for National Statistics data, analysed by the King’s Fund, shows white British people are, on average, more likely to develop and die from cancer than Asian, Chinese and mixed-race groups.
White women have higher cancer incidence than black women, while rates among black and white men are broadly similar.
Patterns vary by cancer type and sex. Asian populations are deemed to have had higher rates of liver and oral cancers, Bangladeshi men had a higher lung cancer mortality than white men, and black men had a significantly higher prostate cancer incidence and mortality than their white counterparts.
Scientists attribute some disparities in cancer outcomes to the “healthy migrant effect”, whereby healthier individuals are more likely to migrate, as well as higher rates of obesity, smoking and alcohol use among white populations.
There is no evidence that being gay or transgender affects cancer outcomes in the UK, a finding previously recognised by both Cancer Research UK and Macmillan.
The charity would provide additional training to staff on discussing sexual orientation and gender identity sensitively.
Steven McIntosh, the charity’s chief partnerships officer, said that Macmillan’s new service would “offer local financial and wellbeing support to people living with cancer in every part of the UK.”
He added that the new service was “designed to keep up with rising demand” and ensure everyone would get the “support they need.”
Citizens Advice declined to comment.
