Select Committee on Public Accounts Second Report

Conclusions and recommendations

1.  The Department should publicise some simple guidelines to help people recognise and act on appropriate symptoms for major cancers. UK survival rates from cancer are still well below the best in the world. A key factor is the tendency of patients in England to be diagnosed at a later stage of the disease.

2.  Research indicates that cancer is likely to be more advanced by the time it is diagnosed in poorer areas. Cancer Networks should identify areas where cancer is diagnosed at a more advanced stage, with reference to measures of deprivation, so as to determine and tackle the underlying reasons for late presentation.

3.  Action is needed to help GPs improve their ability to identify symptomatic patients. Helpful measures would include better guidance; closer monitoring of GP referrals; and the development of GPs specialising in cancer as champions to spread good practice among the profession.

4.  A significant number of patients referred non-urgently, and who eventually are diagnosed with cancer, wait much longer than they should to be treated. The Department needs to develop a mechanism to record the time taken to assess and diagnose all patients who are routinely referred and then diagnosed with cancer. Delays in the patient pathway should be identified and reduced by redesign of services drawing on good practice such as that identified in the C&AG's Report.

5.  Better information is needed on how far cancer has advanced at the point of diagnosis, so that quality of treatment can be benchmarked properly for the first time. The Department should press ahead with its work to develop a database of waiting times for cancer diagnosis and treatment in order to set priorities for improvement and deal with blockages.

6.  Patients and the public should have the information to help them press for improvements in cancer services in their locality. Information about the level of cancer service provision, whether surgery is being carried out by specialists, and the performance of service providers should be disseminated locally.

7.  A deadline should be set for ending the current wide variations in prescribing of anti-cancer drugs such as Herceptin. The recommendations by the National Cancer Director regarding resources, clinical practices and enhancements in NICE guidance should be implemented speedily, with a clear timetable for monitoring their impact and reviews of progress.

8.  Some areas benefit more than others from the current distribution of pathologists, diagnostic radiographers and scanner provision. Lack of skilled staff is a major problem, not just in diagnostics but also in specialist surgery. The results of the exercises should then be used to work towards greater equity of provision over an explicit timescale.

9.  Waiting times for radiotherapy treatment are too long and getting longer. Besides continuing efforts to recruit more staff, there is a clear need for identification and dissemination of good practice and re-design of services. The National Cancer Director should lead and co-ordinate this activity, following from his recent "stocktake" sessions with relevant stakeholders.

10.  Primary Care Trusts in their role as commissioners of cancer services should promote the concentration of cancer surgery in the hospitals which carry out higher volumes of such operations, in line with best practice. The National Cancer Director should report progress made in this respect.

11.  The Department should commission research into the long term effectiveness of its Stop Smoking services. Currently it is not clear why more than two thirds of people who initially quit using the service are likely to be smoking again within the year.

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Prepared 25 January 2005